Applications, Benefits and Techniques
Although used in dentistry for over 150 years, dental dams have become significantly more popular since the COVID-19 pandemic. It is now seen as essential for all endodontic and restorative procedures.
Traditionally made from natural latex, dental dam sheets are now more commonly manufactured from a synthetic material such as polyisoprene which can be used on all patients, including those with a latex allergy. Despite this, dental dams are still often colloquially referred to as rubber dams by dental professionals.
The benefits of dental dams are numerous, both for the patient and for the entire dental team. By using dental dams routinely, procedures are not only more efficient with better results for the user, but the patient experience is vastly enhanced, providing a calmer, safer and more relaxing environment for both the dental team and patient alike.
How COVID-19 accelerated dental dam usage
There has been a significant increase in the use of dental dams in recent times. During the COVID-19 pandemic, the use of dental dam grew significantly. Dental professionals were obligated to use dental dams for all Aerosol Generating Procedures (AGPs) once practices were able to restart their regular primary and secondary care. This is because dental dams are highly effective at reducing exposure to aerosol including saliva and blood.
Post-pandemic, a large percentage of dental professionals have continued the practice of using dental dams regularly as they have seen the positives both for themselves, their colleagues and their patients. Whilst not only continuing to provide greater infection control and reducing Aerosol Generating Exposures (AGE), the clinical benefits of dental dams are huge.
Use of dental dam in crown removal and selective root canal retreatment by Dr Sean Botha, April 2024
Helps the dentist maintain focus
By using dental dams regularly, the results of restorative and endodontic procedures in particular can be greatly enhanced. Dr Adnil Kock of Smith & van Lierop Dentistry in Cape Town, South Africa says that dam sheets helps dentists ‘work in an isolated area and helps maintain focus, eliminating distractions such as wrestling with the tongue and the cheeks.’
Dr Mark Bowes of Enamel Clinic in Cape Town, South Africa believes that using dental dam in procedures ‘allows dentists to work in a much more effective way and decreases the stress because the user has an environment which there is complete control.’
One of the great benefits for users is time. Dr Kaveer Ratan from Ratan and Singh Advanced Dentistry in Cape Town, South Africa notes that dental dams give him ‘time to refit veneers or test the fit of an onlay without contamination from blood or saliva’. Echoing this, Dr Jean van Lierop of Smith & van Lierop Dentistry states the dental dam gives him ‘the opportunity to take time and really focus on the procedure throughout the whole process.’
By controlling the amount of saliva, reducing distractions and clearly isolating the working area, the user has total control of their environment. Dr Sean Botha of Harmonia Dentistry in Claremont, South Africa sums it up by saying ‘it keeps him calm when working as there is nothing else to focus on but the tooth’, adding that he believes this is why ‘every dentist needs to be using dental dams’.
Patient experience is on another level
Whilst being of assistance for the user, there is no doubt that using dental dam greatly enhances the patient experience too. Dr Ratan notes that whilst there can be some patient frustration initially during the dental dam placement, the feedback from patients having treatment with a dental dam for the first time is hugely positive because ‘they love the fact there’s no water going down their throat’. Previously a big concern for dentists not using dental dam sheets would be ensuring that the patient does not swallow items such as endodontic files. Dr Ratan continues by saying that dental dam sheets provide ‘additional comfort’ as the user knows ‘the patient is not going to swallow those small items’.
Dr Bowes believes that ‘from a patient experience point of view’ the use of dental dam sheets ‘really is on another level’. Dr van Lierop echoes this, saying that the ‘greatest thing is the patient can relax, they don’t have the stress of the dentist’s fingers or suction units, creating a calm and relaxing environment’.
Choosing the right clamps
An essential supplementary tool for dental dam usage is Dental Dam Clamps. Four point contact must be established with the tooth’s proximal surface, so it is essential a suitable clamp is selected. Available in a wide range of patterns, dental dam clamps are shaped to ensure the optimum fit of the dental dam sheet to the teeth. Often floss is tied around the clamp to ensure safe retrieval.
Medium or Heavy Gauge?
Most brands of dental dam will be available in either a Medium or Heavy gauge thickness, though some also offer a Thin gauge too. Dr Bill Gergis of Brickworks Dental in Adelaide, Australia compares the options, noting that ‘Medium is easy to pass through tight contact points, whilst Heavy provides greater gingival retraction’.
A Medium Gauge dam sheet can be seen as a great all-rounder, as it will be easier to place than a Heavy one, especially through tight contacts. Many dental professionals prefer using a Heavy gauge, particularly in endodontic procedures as it is less prone to displacement.
Selecting the right clamp for the task ensures ideal fit to the tooth
Using Quality Materials and Sharp Instruments
Dr van Lierop comments that ‘one of the biggest issues dentists face with dental dams is because of the material’. By using a high quality dam sheet, the user can avoid the frustration of tearing and breakage. Dr Gergis adds that by using ‘a high quality dam sheet, punch hole size isn’t as critical because you can stretch the dam without tearing.’
Dental dam equipment should be kept in good condition, especially the dental dam punch. A blunt punch can lead to imperfect hole punching which can potentially lead to sheet breakage. It is therefore recommended to ensure the punch is sharp before use. Storing dental dam sheets in a cool and dry environment is essential as incorrect storage can make the sheets more prone to tearing and breakage.
Dental dam is modern dentistry
In a post COVID-19 landscape, dental dams are an increasingly vital tool for the discerning dentist. Offering an improved patient experience and excellent clinical results, it has become a necessity for every dental practice. Perhaps Dr van Lierop encapsulates it best, stating that ‘dental dam is modern dentistry’.
