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RUBBER DAM USE BY GENERAL DENTAL

PRACTITIONERS – PREVALENCE AND OBSTACLES
TO ITS USE

Article · October 2016

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 Original Article

RUBBER DAM USE BY GENERAL DENTAL PRACTITIONERS –

PREVALENCE AND OBSTACLES TO ITS USE
AFSHEEN ALI
1

2
AYESHA ASLAM
3
BUSHRA REHMAN
4
ANUM TARIQ
ABSTRACT
Optimal dental practice requires the use of isolation techniques. One such well-established method
is the use of a rubber dam. It was first introduced in 1860s by S.C. Barnum and has since been used
in dental practices. The use of rubber dam has a number of advantages. It provides the clinician with
a dry operative field, enhances visibility, minimizes patient conversation, thereby increasing the over-
all efficacy of the treatment. Despite its well-known advantages, rubber dam is not commonly used
during routine dental practice. Use of rubber dam is one of the most widely advocated techniques and
yet equally ignored by dental practitioners. The aim of this study is to evaluate the attitudes of local
general dentists towards rubber dam usage, its prevalence and to highlight any obstacles to the routine
use of rubber dam. A self-administered close-ended questionnaire was used as the data collection tool.
The questionnaire was distributed to 150 dentists involved in general dental practice in Rawalpindi/
Islamabad, with a response rate of 93%. The data was analyzed using SPSS version 21. Descriptive
statistics were calculated. Approximately 92% of the general dentists claimed that they knew the use
of rubber dam but 77% stated that it was not available at their practice. Question pertaining to the
frequency of rubber dam usage revealed that 52.1% “never” use it while another 20% used it “hardly
ever”, and only around 28% dentists used it to a varying extent. High patient load (49%) was considered
the biggest obstacle to the use of rubber dam followed by time required to place it (16%) and cost (15%).
Key Words: Rubber Dam, Survey, Isolation.

INTRODUCTION rubber dams are also available.4 Some patients may

experience a claustrophobic feeling with the rubber dam
Optimal dental practice requires the use of isola-
in place as well as difficulty in communicating with the
tion techniques.1 Exposure to patient’s saliva and/or
dentist.5 However, this minimized communication may
blood makes the dentist vulnerable to occupational
actually result in improved quality of treatment. The
biohazards.2 These potential threats of cross infec-
use of rubber dam is associated with a number of other
tion between dental professional and patient can be
advantages too. It provides the clinician with a dry
reduced by employing isolation techniques.3 One such
operative field, enhances visibility, minimizes patient
well-established method is the use of a rubber dam. It
conversation, thereby increasing the overall efficacy
was first introduced in 1860s by S.C. Barnum and has
of the treatment.6 It also offers significant patient
since been used in dental practices.4
protection by preventing aspiration of instruments,
A few contra-indications are associated with this medications, debris as well as by excluding the risk
isolation modality. Allergy to latex present in rubber of injury caused by high-speed rotary instruments.7
dam sheets have been reported, although now latex-free Research studies have proved that using a rubber dam
significantly reduces the microbial content of aerosols
1
Afsheen Ali, Demonstrator, Department of Operative Dentistry,
AFID, Rawalpindi. produced during routine dental procedures.8 All these
2
Ayesha Aslam, PG Resident, Department of Prosthodontics, advantages make rubber dam the best method of
AFID, Rawalpindi. cross-infection control during dental treatment.
3
Bushra Rehman, Demonstrator, Department of Prosthodontics,
AFID, Rawalpindi. Despite its well-known benefits, rubber dam is not
4
Anum Tariq, PG Resident, Department of Orthodontics, AFID,
Rawalpindi. Corresponding Author: Dr Ayesha Aslam, 926-A, commonly used during routine dental practice. Gilbert
Street 44, Phase 7, Bahria Town, Rawalpindi. Cell: 0321-5978935 et al9 reported a significantly lower use of rubber dam
Email: dr.ayesha.aslam@hotmail.com for the procedures of operative dentistry. A survey of the
Received for Publication: May 12, 2016 civilized UK society revealed that up to 44.5% of dental
Revised: July 26, 2016
Accepted: July 31, 2016 practitioners did not use rubber dam for isolation.10

Pakistan Oral & Dental Journal Vol 36, No. 3 (July-September 2016) 468
 Rubber dam use by general dental practitioners

Similar findings have been reported by a number of

different studies from other countries.11-13 The reasons
put forward by practitioners vary to a large extent,
ranging from lack of expertise to a complete lack of
interest in employing this technique.
Use of rubber dam is one of the most widely ad-
vocated techniques and yet equally ignored by dental
practitioners.8 A need exists to educate the general and
specialist dental practitioners regarding the impor-
tance of rubber dam usage and the benefits it offers.
The aim of this study was to evaluate the attitudes of
local general dentists towards rubber dam usage, its
prevalence and to highlight any obstacles to the routine
use of rubber dam.

METHODOLOGY
Fig 1: Distribution of male and female respondents
A self-administered close-ended questionnaire was
used as the data collection tool. The questionnaire was
first pilot – tested to ensure its validity, reliability and
relevance. The questions were designed to assess the
prevalence of routine use of rubber dam, the attitude
of the dentist towards its use and the barriers felt by
the dentists that hinder its routine usage. The ques-
tionnaire was then distributed to 150 dentists involved
in general dental practice in Rawalpindi/Islamabad.
Data was analyzed using SPSS version 21. Descriptive
statistics were calculated.

RESULTS Fig 2: Obstacles felt by general dentists to the use of

Out of the 150 distributed questionnaires, 140 were rubber dam
completely filled and returned resulting in a response Approximately 92% of the general dentists claimed
rate of 93%. Of these respondents, 28 were females and that they knew the use of rubber dam. While majority
112 were males (Fig 1). (97.1%) of the respondents agreed to the benefits of

TABLE 1: KNOWLEDGE AND ATTITUDE OF GENERAL DENTISTS TOWARDS THE USE OF RUBBER DAM

Question/ Statement Yes (%) No (%)

1. Do you know the use of rubber dam? 92 8
2. Do you think rubber dam is beneficial in routine practice? 97.1 2.9
3. Is it available at your practice / workplace? 23 77
4. Do you think rubber dam usage should be compulsory before endodontic/ 82 18
operative/prosthodontic procedures?
5. Are you interested in gaining knowledge about rubber dam usage through 96.4 3.6
CDE programs?
TABLE 2: FREQUENCY OF RUBBER DAM USAGE

Frequency Percentage
Q. How often do you use rubber dam for routine dental procedures? 1. Always 2.9
2. Quite often 7
3. Some times 18
4. Hardly ever 20
5. Never 52.1

Pakistan Oral & Dental Journal Vol 36, No. 3 (July-September 2016) 469

its use, 77% stated that it was not available at their
practice (Table 1). Question pertaining to the frequency
of rubber dam usage revealed that 52.1% “never” used
it while another 20% used it “hardly ever” (Table 2).
Fig 2 highlights the obstacles felt by general dentists
to the use of rubber dam, with the greatest percentage
for high patient load.
DISCUSSION
In the present survey, majority of the respondents
were male general dentists. This is consonant with the
results of Udoye and Jafarzadeh12 as well as Ravanshad
et al.14
The knowledge about rubber dam was high (92%)
among the local general dentists. 97% dentists agreed
that using rubber dam is beneficial while 82% of the
respondents agreed that rubber dam should be used
in routine dental procedures. However, the use of
rubber dam for routine dental procedures was quite
low. About 52.1% of the dentists never used rubber
dam in their routine practice. Similar findings were
reported by a number of different studies including
Whitworth et al.15 (58.1%), Stewardson16 (63.2%) and
Wilson et al.17 (61%). In the present study, about 28%
used it for routine procedures to a varying extent. This
finding is in accordance with the results of Gupta and
Rai18 who reported 27% usage by dentists in India.
However, other studies have reported a significantly
higher prevalence of rubber dam usage, especially in
the developed countries.4,19
When asked about the obstacles to the routine use
of rubber dam, majority of the dentists (49%) reflected
a higher patient load as the greatest hindrance. About
16% considered it a ‘time-taking” procedure while 15%
thought cost as the major impediment to its use. Similar
results were reported by Madarati20 where about 16.7%
of general dentists found it time-taking. Contrary to
the present results, Csinszka et al4 reported time and
patient discomfort as the biggest obstacles to its use. A
higher patient load on local dentists indicates a lack of
practicing dental practitioners for the local population,
resulting in over-burdening of the dentists and a com-
promised quality of dental practice. Patient discomfort
was reported as the least prevalent impediment to
the use of rubber dam. This finding is endorsed by the
results of Tanwir et al21 and Stewardson.16
Approximately 96.4% of the respondents showed an
interest in improving their knowledge about rubber dam
through continuing dental education programs, similar
to the findings of Tanwir et al.21 This shows an overall
positive attitude of the local dentists towards the use
of rubber dam. However, the use of rubber dam needs
to be increased to provide quality dental care to the
patients. Greater emphasis must be placed on rubber
Pakistan Oral & Dental Journal Vol 36, No. 3 (July-September 2016)
Rubber dam use by general dental practitioners
dam usage during undergraduate and postgraduate
dental education.
CONCLUSION
Within the limitations of this study, the following
conclusions can be drawn:
The prevalence of rubber dam use by local general
dental practitioners was quite low (28%).
High patient load was found to be the biggest im-
pediment to the routine use of rubber dam.
Despite their shortcomings, local general dentists
showed an over-all positive attitude towards rubber
dam use and were interested in enhancing their
knowledge through well-structured CDE programs.
REFERENCES
1 Al-Abdul Wahhab B, Al-Thabit H, Al-Harthi A, Shamina R,
Al-Taher R, Al-Ashgai A, et al. The attitudes of dental interns
to the use of the rubber dam and obstacles to its use. Indian
Journal of Dentistry. 2013; 4(4): 179-83.
2 Khan R, Prabhakar C. Infection control in endodontic clinic.
Pak Oral Dent J. 2015; 35(1): 140-44.
3 Viragi PS, Ankola AV, Hebbal M. Occupational hazards in den-
tistry–Knowledge attitudes and practices of dental practitioners
in Belgaum city. Journal of Pierre Fauchard Academy (India
Section). 2013; 27(3): 90-94.
4 Csinszka K, Ivácson A, Monica M, Mihai P, Aurita A-S, Angela
B. Prevalence of Rubber Dam Usage Among Dental Practitioners
and Final Year Students in Tirgu Mures: A Questionnaire
Survey. Acta Medica Marisiensis. 2015; 61(3): 188-91.
5 Koshy S, Chandler NP. Use of rubber dam and its association
with other endodontic procedures. New Zealand Dental Journal.
2002; 98: 12-16.
6 Lin H-C, Pai S-F, Hsu Y-Y, Chen C-S, Kuo M-L, Yang S-F. Use
of rubber dams during root canal treatment in Taiwan. Journal
of the Formosan Medical Association. 2011; 110(6): 397-400.
7 Ahmad I. Rubber dam usage for endodontic treatment: a review.
International endodontic journal. 2009; 42(11): 963-72.
8 Shashirekha G, Jena A, Maity AB, Panda PK. Prevalence of
Rubber Dam Usage during Endodontic Procedure: A Question-
naire Survey. Journal of clinical and diagnostic research: JCDR.
2014; 8(6): ZC01.
9 Gilbert GH, Litaker MS, Pihlstrom DJ, Amundson CW, Gordan
VV. Rubber Dam Use During Routine Operative Dentistry Pro-
cedures: Findings From The Dental PBRN. Operative dentistry.
2010; 35(5): 491-99.
10 Jenkins S, Hayes S, Dummer P. A study of endodontic treatment
carried out in dental practice within the UK. International
endodontic journal. 2001; 34(1): 16-22.
11 Tanalp J, Kayataş M, Başer Can ED, Kayahan MB, Timur T.
Evaluation of Senior Dental Students’ General Attitude towards
the Use of Rubber Dam: A Survey among Two Dental Schools.
The Scientific World Journal. 2014; 2014.
12 Udoye CI, Jafarzadeh H. Rubber dam use among a subpopula-
tion of Nigerian dentists. Journal of oral science. 2010; 52(2):
245-49.
13 Al-Omari MA, Al-Dwairi ZN. Compliance with infection control
programs in private dental clinics in Jordan. Journal of Dental
education. 2005; 69(6): 693-98.
470
 Rubber dam use by general dental practitioners

14 Ravanshad S, Sahraei S, Khayat A. Survey of endodontic practice
amongst Iranian dentists participating restorative dentistry
congress in Shiraz, November 2007. Iranian endodontic journal.
2008; 2(4): 135-42.
15 Whitworth JM, Seccombe GV, Shoker K, Steele JG. Use of rubber
dam and irrigant selection in UK general dental practice. Int
Endod J. 2000; 33(5): 435-41.
16 Stewardson DA. Endodontics and new graduates: Part I, Practice
vs training. Eur J Prosthodont Restor Dent. 2002; 10(3): 131-17.
17 Wilson NHF, Christensen GJ, Cheung SW, Burke FJT, Brunton
PA. Contemporary dental practice in the UK: aspects of direct
restorations, endodontics and bleaching. Br Dent J. 2004;
197(12): 753-56.
18 Gupta R, Rai R. The Adoption of New Endodontic Technology by
Indian Dental Practitioners: A Questionnaire Survey. Journal of
Clinical and Diagnostic Research: JCDR. 2013; 7(11): 2610-14.
19 Mala S, Lynch CD, Burke FM, Dummer PM. Attitudes of final
year dental students to the use of rubber dam. Int Endod J.
2009; 42(7): 632-38.
20 Madarati AA. Why dentists don’t use rubber dam during end-
odontics and how to promote its usage? BMC Oral Health. 2016;
16(1): 1-10.
21 Tanwir A, Amin M, Choudhry Z, Naz F. Knowledge, attitude
and perception of dental fraternity towards practice of rubber
dam. Pak Oral Dent J. 2015; 35(4): 691-94.

CONTRIBUTIONS BY AUTHORS
1 Ayesha Aslam, Afsheen Ali: Study conception and design.
2 Bushra Rehman, Afsheen Ali: Collection of data.
3 Ayesha Aslam: Analysis and interpretation of data.
4 Bushra Rehman, Ayesha Aslam: Drafting of manuscript.
5 Anum Taruq: Critical revision.

Pakistan Oral & Dental Journal Vol 36, No. 3 (July-September 2016) 471

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