2. Why use a rubber dam?  Improves access and visibility of teeth  Prevents contamination of teeth and dental materials by saliva  Retracts soft tissues  Prevents water, debris, or dropped instruments from entering patient’s throat  Infection control—barrier reduces microbial contamination to staff by 70-95%

3. Contraindications to rubber dam use  Patient is claustrophobic  Asthma (relative contraindication)  Latex allergies (use non-latex dam material)

4. Armamentarium Retainers come in a variety of sizes and shapes. Winged or wingless Anterior, bicuspid or molar

5. Retainers

6. Parts of retainer

7. Retainer selection  All four jaw points should contact the teeth— 2 on the facial and 2 on the lingual  Jaws should not extend beyond the mesial or distal line angles—may interfere with matrix and wedge placement  When retaining a tooth near the jawbone, winged clamps may not be possible  In front of patients, use the word “retainer” instead of “clamp”

8. Armamentarium  Rubber dam forceps

9. Armamentarium  Rubber dam material

10. Armamentarium  Rubber dam punch

11. Sizes of hole punch

12. Punch patterns

13. Punching the rubber dam  Keyhole is largest hole, and is for retained tooth. Select one tooth distal from tooth being worked on. Punch to the midline  Larger holes for molars, holes get smaller as you move anteriorly in the mouth.  Holes approximately 3.5-4.5 mm apart. Look in the mouth for size of arch, missing teeth, malpositioned teeth, bridges, etc.  If holes are too close, the dam will stretch causing leakage  If holes are too far apart there will be too much material between the teeth

14. Armamentarium Rubber dam frame

15. Placement of Rubber Dam ALWAYS LIGATE THE RETAINER!!!

16. Placement of Rubber Dam  Select appropriate retainer for tooth to be retained. Jaw points should contact facial and lingual surfaces evenly  Ligate the retainer  Ensure that retainer is stable and not impinging on gingival tissue  Make sure you and your patient wear safety glasses in case the retainer goes flying!

17. Placement of Rubber dam  Attach dam to frame at the dam’s four corners, allowing the material to sag in the middle  Stretch the keyhole over the retainer  Stretch the other tooth holes over the teeth. Use floss down the sides of the teeth to ease material interproximally. Do not floss directly down on dam or it may tear  Ligate the most anterior tooth  Invert the dam with an instrument and air  Check for leakage

18. Evaluate your rubber dam  Moisture is controlled (no leakage)  Enough teeth are exposed to allow for good visibility of the field and for fulcrums  Retainer is stable and secure  No tissue trauma  Retainer is ligated  Dam material is inverted

19. Removing the Rubber Dam  Use scissor to snip ligature and between all septums. Place your finger under the dam to protect the lip from being cut  Remove the retainer, dam and frame together  Lay the dam flat and check that no pieces of dam material are missing. If there is, floss between the appropriate teeth to remove material  Rinse patient and wipe dry the lips and face

20. Other tidbits  Using a water soluble lubricant such as shaving cream can make the dam slip over the teeth easier  A rubber dam napkin or 2x2 gauze squares placed between the dam and the patient’s face can enhance patient comfort while wearing a rubber dam