Does using a rubber dam to isolate teeth from the rest of the mouth during a dental procedure improve the success of tooth repairs?

When dental practitioners need to repair a tooth, they often isolate it from the rest of the mouth to:

‐ keep away saliva to prevent it from impairing the bonding of materials;
‐ reduce aerosols produced during the dental procedure to a certain extent;
‐ stop materials, liquids or instruments used for the repair from being swallowed or damaging the mouth.

A common method for isolating teeth from the rest of the mouth is to use cotton rolls and a straw‐like tube that sucks up saliva. This technique uses simple, inexpensive equipment, but requires frequent replacement of sodden cotton rolls.

An alternative option is to use a thin sheet of rubber (rubber dam). First, the dental practitioner makes a small hole in the sheet. They then place it over the tooth to be treated, creating a barrier around it. The sheet can be held in place with several methods, such as clasps placed over the tooth or a small piece of rubber wedged between teeth.

What was the research?

A systematic review to find out if rubber dams improve the success of tooth repairs when compared against other methods for isolating teeth. We also wanted to know if they are associated with unwanted (adverse) effects.

Who conducted the research?

The research was conducted by a team led by Cheng Miao of the West China Hospital of Stomatology, Sichuan University, China on behalf of Cochrane Oral Health. Xiaoyu Yang, May CM Wong, Jing Zou, Xuedong Zhou, Chunjie Li and Yan Wang were also on the team.

What evidence was included in the review?

We found six randomised controlled trials that involved 1,342 people in total (mostly children). Teeth needed repairing for a range of reasons, including caries (holes in teeth created by bacteria) and loss of hard tissue at the base of teeth. The studies compared rubber dams against:

‐ cotton rolls (five studies); and
‐ the Isolite system (a new method that combines plastic blocks, a shield for the tongue and cheek, and a tube that sucks up saliva and other mouth contents) (one study).

What did the evidence say?

Rubber dam compared against cotton rolls

The evidence suggests that when a rubber dam is used rather than cotton rolls, tooth repairs may be more likely to remain in place and be in good condition after six months (2 studies). There is not enough robust evidence for us to determine if this is the case beyond six months.

Rubber dam compared against the Isolite system

The evidence is not robust enough for us to determine if using a rubber dam improves the success of tooth repairs when compared against the Isolite system.

Side effects

No study investigated side effects.

How good was the evidence?

The evidence is based on a small number of studies conducted in ways that may have introduced errors into their results.

What are the implications for dentists and the general public?

When a rubber dam is used to isolate teeth instead of cotton rolls, tooth repairs may be more likely to remain in place and be in good condition after six months.

What should researchers look at in the future?

We need to conduct more studies in this area, to strengthen the evidence. These studies need to use robust methods, follow people beyond six months, and investigate adverse (unwanted) effects and costs.

Link

Miao  C, Yang  X, Wong  MCM, Zou  J, Zhou  X, Li  C, Wang  Y. Rubber dam isolation for restorative treatment in dental patients. Cochrane Database of Systematic Reviews 2021, Issue 5. Art. No.: CD009858. DOI: 10.1002/14651858.CD009858.pub3.

This post is an extended version of the review’s plain language summary, compiled by Anne Littlewood at the Cochrane Oral Health Editorial Base.