Rubber dam application in endodontic practice: an update on critical educational and ethical dilemmas

Abstract

Proper isolation is an essential prerequisite for successful endodontic treatment. This article aims to provide an update on the prevalence of rubber dam (RD) use, and the role of education along with attitudes of general dental practitioners (GDPs) and patients towards the application of RD in endodontics. Critical ethical issues are also highlighted. Using certain keywords, an electronic search was conducted spanning the period from January 1983 to April 2013 to identify the available related investigations, and the pooled data were then analysed. The results show that although RD is the Standard of Care in endodontic practice, there is a clear discrepancy in what GDPs are taught in dental school and what they practice after graduation. There is little scientific evidence to support the application of RD; however, patient safety and clinical practice guidelines indicate that it is unnecessary and unethical to consider a cohort study to prove what is already universally agreed upon. A few clinical situations may require special management which should be highlighted in the current guidelines. This would pave the way for clear and straightforward universal guidelines.

[Retracted] Application of Quality Control Circle in Promoting the Use of Rubber Dams in the Root Canal Treatment of Primary Teeth

“…Based on the fact that the clinical pathway of hospital information management has been included in the treatment of chronic pulpitis of deciduous teeth, the theme of QCC activity is to increase the usage of rubber dam in root canal treatment of chronic pulpitis of deciduous teeth. Rubber dam in root canal treatment has been recognized as a standard treatment procedure internationally [10]. In developed countries, rubber dams have been widely used in children's oral treatment.…”

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

“…A recent literature review concluded that rubber dam use is also the international standard. 12 Technically, the standard of care in the USA is decided by the legal system on a case-by-case basis. 13–15 However, courts usually rely on a professional consensus about what a reasonable dentist would do in a similar circumstance.…”

Endodontic Management of a Three Rooted Mandibular Third Molar with a Dilacerated Distal Root and Close Approximation to the Inferior Alveolar Canal: A Case Report

“…The use of apex locator in this case was beneficial to minimize additional radiographic exposures, and potential gagging reflexes (1,14). In addition, determining the exact location of the minor diameter of the apical foramen was of prime importance to prevent potential mechanical irritation of the periapical area since the inferior alveolar canal lies between the mesial roots apices.…”

“…Despite the fact that the rubber dam is generally tolerated by patients, clinicians may face some difficulties while placing the rubber dam assembly on a mandibular third molar (1,14) That's why caution should be given to keep the rubber dam away from gagging reflex trigger areas (1,14). The use of apex locator in this case was beneficial to minimize additional radiographic exposures, and potential gagging reflexes (1,14).…”