Rubber Dam

Question 1

What is Type 1 latex allergy? Symptoms and treatment?

Answer 1

• Type 1: anaphylaxis
• Symptoms: swelling, light-headedness, dizziness oedema, erythema, itching, difficulty breathing.
• Treatment: call ambulance, 0.5mL (1:1000) epinephrine IM - repeat after 5 mins if needed. 100% oxygen - 10 liters/min.

Question 2

What are wedjet cords and when are they used (2)?

Answer 2

• Small elastic cords.

Uses:
- When placing rubber dam as an EMERGENCY and are not placing a clamp
- When placing a clamp on one side of the arch and want to stabilize the other.

Question 3

What two chemicals can be used to disinfect teeth when placing rubber dam?

Answer 3

• 1% hydrogen peroxide.
• 0.2% iodopovidone.

Question 4

By what % does rubber dam reduce the spread of microorganisms into the atmosphere?

Answer 4

90%

Question 5

What is the treatment for anaphylaxis?

Answer 5

• call ambulance
• 0.5mL (1:1000) epinephrine IM - repeat after 5 mins if needed
• 100% oxygen - 10 liters/min.

Question 6

What type of clamp would you use in a partially erupted tooth?

Answer 6

Active clamp

Question 7

What are the steps to placing rubber dam (ignore clamp and frame).

Answer 7

1. Mouthwash for 30 seconds with 1% hydrogen peroxide or 0.2% iodopovidone, spit into disposable cup.
2. Disinfect rubber dam before use.
3. Place rubber dam.
4. ensure adequate seal around the tooth.
5. disinfect tooth with hydrogen peroxide on cotton wool.

Question 8

How many species of microbes exist in the mouth? How many bacterial cells?

Answer 8

• 700 oral species.
• 10 billion bacterial cells.

Question 9

would you use rubber dam for an emergency access?

Answer 9

YES

Question 10

What are 7 uses of rubber dam?

Answer 10

• Protection from ingestion/ aspiration (ex. of small files used in endodontics).
• Retract/ protection of soft tissues.
• Better visibility.
• Reduction of delays during treatment (patient cannot get up to spit and rinse etc).
• Patient and dentists more relaxed.
• Dentists and nurses are protected against infections which can be transmitted by patient’s saliva.
  o Reduces the spread/ atmospheric contamination by microorganisms by more than 90%.
• Prevents the root canal system from being contaminated with the patient’s saliva.

Question 11

What restorative procedures is rubber dam used for?

Answer 11

• composite fillings (especially in molars).
• bonded restorations (crowns, cores, veneers, posts)

Question 12

What are the 4 types of rubber dam clamps?

Answer 12

• Winged/ wingless.
• Passive/ active.

Question 13

Describe a method of clamping anterior teeth without the use of an anterior clasp.

Answer 13

• Punch 8 holes
• Place topical around tooth being clamped.
• Seat clamp on premolar tooth.
• Place dam over premolar- premolar, ensure fluid tight seal using floss ligatures.

Question 14

what does the choice of clamp depend on? (size, active/passive, winged/ wingless).

Answer 14

• Size: tooth size/type.
• Active/passive: tooth structure.
• Winged/ wingless: technique.

Question 15

What MUST be done when placing a clamp on a tooth?

Answer 15

MUST floss clamp to allow retrieval if it breaks.

Question 16

When can a rubber dam be removed during endodontic treatment?

Answer 16

When the temporary dressing is placed.

Question 17

How is a wingless clamp applied to a tooth?

Answer 17

placed on tooth before applying the rubber dam

Question 18

When is an active clamp best suited (3)? When should it not be used? What is a “drawback”

Answer 18

• good for badly broken down teeth, partially erupted or no undercut.
• do not use on a ceramic crown
• may traumatize gingival tissues, give LA.

Question 19

How is a liquid dam used?

Answer 19

Place around tooth and cure with light.

Question 20

What type of clamp would you use in a tooth with a ceramic crown?

Answer 20

PASSIVE clamp, active clamp could damage crown

Question 21

What is rubber dam?

Answer 21

A means of isolating teeth during restorative and ALL endodontic procedures.

Question 22

What clamp would you use for the placement of a cervical composite on tooth 22?

Answer 22

Anterior clamp.

Question 23

What two materials can rubber dams be made of?

Answer 23

nitrile or latex

Question 24

What is a passive clamp? What are they best suited for?

Answer 24

• 4 points of contact have a flat approach to the crown of the tooth.
• Not agressive.
• Suit most molars/ premolars with an intact crown.

Question 25

How is a winged clamp applied to a tooth?

Answer 25

placed with rubber attached to clamp.

Question 26

What is a rubber dam technique that can be used to isolate broken down teeth/ bridgework?

Answer 26

- Split-dam technique: 1. clamps placed on teeth mesial/ distal to broken tooth. 2. 3 holes made in dam and joined using scissors. 3. dam is stretched over the 3 teeth. 4. use of salivary ejectors, cotton wool rolls in sulcus (+ liquid dam) to prevent salivary contamination.

Question 27

What % surface area do teeth make up in the oral cavity?

Answer 27

20%

Question 28

What are 4 methods to achieve a fluid tight seal when placing rubber dam?

Answer 28

1. caulking material. 2. liquid dam. 3. invert dam with flat plastic or 3 in 1. 4. floss ligatures

Question 29

How is a wingless clamp prepared for placement in a lower tooth?

Answer 29

- Lower tooth: place the clamp on the dam with the bow pointing UP. 1. Place clamp in the punched hole in the rubber dam. 2. Bring the holders (forceps) towards the clamp with the tips of the holders pointing DOWN. 3. Stretch the tips of the holders to engage the clamp holes. 4. Slide up the metal bar on the forceps, locking them in place.

Question 30

What is a word used to describe oral pathogens?

Answer 30

opportunistic

Question 31

What must the dam cover and what must it not cover?

Answer 31

Must cover the oropharynx, must NOT cover the nose.

Question 32

What is an ora-shield?

Answer 32

- Rubber dam napkin, used between the patient's skin and the dam for comfort.

Question 33

What endodontic procedures require rubber dam?

Answer 33

- Indirect AND direct pulp capping. - Emergency treatment that involves opening into the pulp chamber. - Pulpotomy - ALL root canal treatment procedures (including emergency access/ pulp extirpation).

Question 34

What are 2 uses of anterior clamps?

Answer 34

- very agressive. - teeth with minimal coronal tooth structure. - retraction of gingival tissues for placement of composite/ GI CERVICALLY.

Question 35

Why may a clamp break?

Answer 35

- Due to the effect of sodium hypochlorite or the autoclave.

Question 36

What are pre-framed rubber dams useful for?

Answer 36

emergencies and children's dentistry

Question 37

What percent of healthcare workers and the general public have a latex allergy?

Answer 37

- Healthcare: 8-12% - General public: 1-6%.

Question 38

How is a wingless clamp prepared for placement in an upper tooth?

Answer 38

- Upper tooth: place the clamp on the dam with the bow pointing DOWN. 1. Place clamp in the punched hole in the rubber dam. 2. Bring the holders (forceps) towards the clamp with the tips of the holders pointing UP. 3. Stretch the tips of the holders to engage the clamp holes. 4. Slide up the metal bar on the forceps, locking them in place.

Question 40

You want additional soft tissue retraction. Would you use a winged or wingless clamp?

Answer 40

Winged clamp.

Question 41

What is done to the rubber dam when working length and trial point radiographs are taken?

Answer 41

- MUST use endodontic film holder. - Rubber dam DOES NOT COME OFF.

Question 42

would you use rubber dam for an emergency pulp extirpation?

Answer 42

yes

Question 43

Is use of rubber dam for endodontic procedures a medico-legal requirement?

Answer 43

YES - use of rubber dam is the LEGAL STANDARD OF CARE. Instrument inhalation/ aspiration is considered NEGLIGENT.