The Report Proforma: Re-evaluation and reflection of work in the light of

published evidence
Registration number:

Date report submitted:

Tooth treated: LR5, LR6

Photograph 1

Procedure: Placement of rubber dam

and winged clamp
Photograph 2

Description of photograph 1

Description of photograph 2

Photo of all equipment used for rubber Photo of rubber dam on tooth with floss
dam
and clamp
Introduction - description of the procedure undertaken, including a summary
of techniques and materials employed and any difficulties encountered. Focus
on the chosen aspect of the task.
I carried out a class II restoration on the distal aspect of the LR5 and decided to use
a rubber dam to isolate the tooth; reducing the risk of any harmful materials being
inhaled and reducing iatrogenic damage. It also keeps the tongue out of the way and
prevents saliva contaminating the cavity.
I punched two holes where the teeth would be and stretched the dam over the frame.
I chose a winged clamp and threaded floss through the holes in the clamp for safety
precautions (if the clamp was to break it would not be inhaled as the clamp will still
be intact).
Lubrication was used around both sides of the holes in the dam to ensure a smooth
placement and this was stretched over the clamp leaving the wings outside. I used
the forceps to carefully place the clamp/dam over the LR5 and pushed it right down
to the cervical margin and tucked the wings in the dam using a carver. I pulled the
second hole over the adjacent tooth.
I had difficulty keeping the dam on the LR6 so I used a widget to secure it in place.
Otherwise it was a smooth process without any real problems.

Summary of the evidence underpinning the technique used

There has been a lot of debate on the research about the how rubber dam should be
implemented in dental schools and in clinical practice.
Rubbers dams have been available for over 140 years however a systematic review
suggested that dentists have a negative view of rubber dam due to costs, time taken
for application, difficulty in use and worries that the patient may not accept it (Ahmad,
IA., 2009). However, more recent studies show this is not the case. Another
systematic review (Kapitan et al., 2013) contrarily found that the majority of patients
receiving treatment using a rubber dam felt safer and more comfortable and would
prefer using it again. The same review also estimated a mean placement time of 4
minutes and established it does not take a long time and so the benefits outweigh
the disadvantages.
It is important that the patient feels safe, especially being within a dental school
where iatrogenic damage is more likely to occur. The patients are also at less risk of
inhaling any dangerous substances, instruments, sharp objects and overall it makes
the procedures easier because the tongue and saliva cannot get in the way. Another
systematic review supporting the use of rubber dam concluded Restorations that
were placed with a rubber-dam showed significantly fewer material fractures that
needed replacement, and this also had a significant effect on the overall longevity
(Heintze S, et al.,2012).
A systematic review from Cardiff stated rubber dam was never used by 75% of
respondents when placing posterior amalgam restorations, and by 21% of
respondents when placing anterior composite restorations. (Mala, et al., 2009). The
dental students also admitted they will use them even less once in clinical practice.
This evidence suggests greater emphasis should be in place in the importance and
advantages of using a rubber dam in dental schools as well as in future clinical
practice.
Reflection
When I first attempted at placing a rubber dam in the clinical skills lab, I found it very
frustrating and immediately disliked it. I encountered many problems such as the
dam ripping, the clamps popping off the teeth and the dam placed too high and
covering the nose. Some of these problems were easily resolved with practice as I
learnt to estimate where the teeth would be by drawing a guide onto the dam,
meaning they would not have to be over stretched and therefore not ripping. I had to
push the clamp as far down to the gingival margin as possible in order for it not to be
displaced from the tooth. I also found I could easily trim the dam with scissors if it
was too far up allowing the patient to breathe and not covering the nose.
It took me several attempts each time I placed the dam, and this worked out quite
costly. So I can understand why some of the dentists feel it is expensive and time
consuming, this is probably because of lack of training or practice. It became easier
with practice and guidance from the tutors and I now feel I can competently and
efficiently place a rubber dam and would be happy to do so in practice when carrying
out restorations on patients.

Conclusion final comments and thoughts

Overall, rubber dam is a useful technique to aid with moisture control and can help
make procedures and restorations easier. It can be time consuming and costly but
with the right training it can be placed efficiently. Patients also prefer a rubber dam
and in my own opinion they should be mandatory.

References (include no more than 4 references to support your report):

Ahmad, IA. (2009). Rubber dam usage for endodontic treatment: a review. International
endodontic journal. 42 (11), 963-72.
Kapitan, M.; Hodacova, L.; Jagelska, J.; Ivancakova, R.; Sustova, Z. (2013). The
attitude of Czech dental patients to the use of rubber dam. Health Expectations: an
international journal of public participation in health care and health policy. 24 (10),
1111.
Heintze, SD.; Rousson, V.. (2012). Clinical effectiveness of direct class II restorations
a meta-analysis..The journal of adhesive dentistry. 14 (5), 47-31.
Mala, S.; lynch, CD.; Burke FM.; Dummer, PM. (2009). Attitudes of final year dental
students to the use of rubber dam. International endodontic journal. 42 (7), 632-8.