Who cares about dental dams? You should care. Your patients should care. Our dental licensing bodies definitely do care. And (let me whisper this) so do lawyers! So why is this a topic of discussion?
A recent study conducted by the National Dental Practice-Based Research Network stated that about half the dentists in America do not use rubber dam isolation when performing every one of their root canal treatments. Half. It’s absolutely mind-boggling that in 2015, this is a subject of conversation.
Now, please ask yourself the following: should you always use rubber dam isolation in root canals? What if your patient is claustrophobic? Or the tooth is broken down and difficult to clamp? Or you have a difficult time taking mid-treatment radiographs with the rubber dam clamp? Or your patient simply doesn’t like it? Or…?
The answer is very sweet and simple: yes. You should always use rubber dam isolation. No ifs, ands, or buts!
Endodontics is not mathematics, and 2+2 does not always equal 4 when dealing with human beings and the many nuances and scenarios we see. So I don’t like to say “always” or “never” when it comes to clinical protocol, except for only one thing in endodontics: rubber dam isolation.
Why, then, should you use rubber dams? It’s simple. By isolating the tooth, you eliminate the chance of files or intracanal medicaments from being aspirated. No one wants to have to take a chest X-ray to look for an aspirated file or have to explain to patients why they swallowed bleach.
Also, by isolating the tooth, you eliminate the chance of using good ol’ saliva, full of bacteria, for a canal lubricant. That would defeat the purpose of root canal treatment and intracanal disinfection. All it takes is just one drop of saliva and its bacteria to enter the canal and infect the root canal system. This would be especially unfortunate in cases that are not infected to begin with, such as irreversible pulpitis.
Cotton roll isolation just doesn’t cut it! In fact, I’ll go so far as to say that it will never hold up in a court of law. I’m certainly not a lawyer, but this I know. In other words, it could be considered malpractice not to use rubber dam isolation. And, anyone not using rubber dam isolation will have absolutely no excuse that will be accepted in a court of law or by a licensing body or any ADA approved university. Period.
If at any time in the endodontic procedure, no rubber dam clamp is seen radiographically, then you’ll be in trouble and the prognosis for the procedure will be compromised. (Remember those bugs in saliva and poor patients possibly aspirating what they shouldn’t!)
Personally, I don’t care why you decide to use rubber dam isolation. Whether it be to please your licensing body, yourself, or your patients, or to perform root canals at the minimal standard of care, or to keep lawyers off your back, please, just use it!
Dr. Manor Haas is a Certified Specialist in Endodontics in Toronto, Canada, and is extensively involved in continuing education to dentists with emphasis on advanced instrumentation, obturation, and the benefits of 3-D imaging in endodontics. He is a Fellow of the Royal College of Dentists of Canada and is on staff at the University of Toronto Faculty of Dentistry and the Hospital for Sick Children. He maintains a full-time private practice limited to endodontics and microsurgery in Toronto. He may be reached at manor@HaasEndoEducation.com.