Though it is considered the standard of care, only 47% of dentists always use a dental dam during root canal treatment, with another 17% using it from 90% to 99% of the time, according to a study conducted by the National Dental Practice-Based Research Network.
Standard textbooks and the American Association of Endodontists both recommend using a dental dam during all root canal treatment. Dental dams stop bacteria in saliva from splashing onto the tooth and enhance patient safety while optimizing the odds of successful treatment.
The study queried 1,490 general dentists representing diverse characteristics, practice types, and patient populations about their dental dam use and their attitudes toward it. The researchers found substantial variations in dental dam use and attitudes.
“Beliefs that dental dam use is inconvenient, time-consuming, not effective, not easy to place, or affected by patient factors were independently and significantly associated with lower use of a dental dam,” said Gregg Gilbert, DDS, MBA, professor and chair of the department of clinical and community sciences at the University of Alabama at Birmingham School of Dentistry and an author of the study.
Clinicians reported that they have not had any problems as a result of not using a dental dam. They also noted their difficulty in placing dental dams and that patients didn’t want them. Some dentists said they use other safe and effective means to isolate the tooth such as cotton rolls, or Isolite from Isolite Systems.
Additionally, some dentists questioned whether the scientific evidence that dental dam use is the only way to increase the odds of successful treatment is strong enough. Yet others still said that a dental dam should be used in every case, and they encourage patients to ask for one during root canal treatment.
“These attitudes explain why there is substantial discordance between presumed standards of care and actual practice,” said Gilbert. The authors, then, question whether there really is a standard of care in root canals since most general dentists are not following standard procedures.
The study, “Discordance Between Presumed Standard of Care and Actual Clinical Practice: The Example of Rubber Dam Use During Root Canal Treatment in the National Dental Practice-Based Research Network,” was published by BMJ Open.