2Objectives List the advantages and indications for use of rubber dam. Use the appropriate rubber dam instrumentationand application for the child patient.
3The objective of isolation is to provide A dry, clean operatingfield.Access and visibilityImproved propertiesof dental materialsProtection of thepatient and operatorImproved operatingefficiently.
4Different methods of isolation: Rubber damHigh volume evacuatorAbsorbentsRetraction cord
5Mouth propCotton rolls and holders+ saliva ejector
6RUBBER DAMIt is used to define the operating field by isolating one or more teeth from the oral environment. The dam eliminates saliva from the operating site and retracts the soft tissue.
7Advantages of Rubber dam Clean, dry operating field. Clear access and visibility. Improves properties of dental materials. Protection of the patient and operator. Improves operating efficiency. Prevents aspiration of fluids used. Prevents accidental ingestion of files/reamers. Prevents injury to soft tissue such as tongue, cheek, gingival. Reduced patients conversation.
8Disadvantages of Rubber dam - Time consumption- Patient objectionCertain conditions may preclude the use of rubber dam:- Incompletely erupted teeth.-Third molar isolation-Extremely mal-positioned teeth.-People suffering from asthma, mouth breathers.
9Precautions to be taken with using Rubber Dam: Patient must not be a mouth breather.Clamps used must be tightlysecured in place and a flossthread must be tied to retrievethe clamp if ingested or aspirated.The dam should be checked not to cover the nostril.Lips should be lubricated to provide drying.The clamp must not impinge on the gingival nor traumatize the adjacent teeth.
10Armamentarium Rubber dam sheet clamps Rubber dam forceps Rubber dam punchRubber dam templateRubber dam holder frameScissor
11made of latex material : Size – 5 x 5 inches (Pediatric purpose) Rubber dam materialmade of latex material :Size – 5 x 5 inches (Pediatric purpose)6 x 6 inches (Adult size)Thickness – Thin (0.006”)Medium (0.008”)Heavy (0.010”)Extra-heavy (0.012”)Special heavy (0.014”)Color – green, blue, black, brown.It has a dull and bright surface ??The dull surface should face the occlusal aspect as it reflects less light.Thicker material resists tearThe thinner ones pass through the tight proximal contact easily.
12Clamps: used to anchor the damto the posterior tooth tobe isolated.Different sizes are available for different teeth.
15Placement of rubber dam Steps involved are:Obtaining anesthesia.Mark the punch holes – usingthe template.Make punch holes using rubber dam punch.Selection of the correct clamp.Rubber dam placement (one of the 3 methods):- Clamp is placed first on the tooth followed by the sheet- The sheet is placed first followed by the clamp- Both the clamp and the sheet are placed simultaneously;this is possible when winged clamp is being used.