Rubber dam isolation for restorative treatment in dental patients

Cheng Miao, Xiaoyu Yang, May CM Wong, Jing Zou, Xuedong Zhou, Chunjie Li, Yan Wang

Key messages

‐ 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.
‐ 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.

Why do we isolate teeth when they are being repaired?

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.

What do dental practitioners use to isolate teeth?

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 did we want to find out?

We wanted 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.

What did we do?

We searched for studies that compared using a rubber dam against another method for isolating teeth. We compared and summarized the results of these studies and rated our confidence in the evidence, based on factors such as study methods and sizes.

What did we find?

We found six studies that involved 1342 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).

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.

What are the limitations of the evidence?

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

How up to date is this evidence?

The evidence is up to date to January 2021.

Read the full review.

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.