When in Dental School, we are taught the ‘proper’ gold standard way of performing certain procedures. After all, in an academic setting, it is important to do things by the book, otherwise one risks getting a failing grade. The hope is that by teaching us the right way of doing things, then we will through the rest of our career, practice correctly and properly.
Then, there is the rubber dam.
When in dental school, dentists are taught that this square piece of rubber (though these days there are latex free versions), is used in situations where it is essential to keep the tooth dry while treating a patient. As you may have guessed, there are lots of situations where having a dry tooth is crucial to ensuring long term success of procedures. Root canals, sealants, and white composite fillings are a few examples of where a rubber dam helps ensure your tooth stays dry.
Furthermore, pediatric dental residency programs teach placement of a rubber dam to keep our patients safe. It keeps lips, tongues and cheeks out of the way; it prevents aspiration or swallowing of things (ie. fillings, crowns); and it provides a clear visual area where one can focus on the tooth/teeth you are treating. It also helps calm a patient down who may be afraid of gagging on all the water that is sprayed from our handpieces. If using nitrous oxide, the rubber dam also serves to ensure that the patient is breathing all of the nitrous instead of exhaling any excess into the surrounding environment.
But if you poll dentists, I would bet that less than 3 out of 10 dentists use it on a regular basis (pediatric dentists tend to use the rubber dam at a much higher rate). I know this because when I ask patients of ours who are referred in from other dentists if they have ever seen a rubber dam, they usually say no. Also, at meetings when I ask dentists who have adult/family practices if they use the rubber dam, most admit that they don’t on a regular basis. They argue that patients don’t like them, and/or they have a difficult time placing them. If pressed, they would admit that they should be placing them but that they have found workarounds that eliminate the need to use them. Truth be told, our patients are so comfortable with the rubber dam (we call them ‘raincoats’), that a lot of them take naps during our procedures, not worrying at all about swallowing, being asked to move their tongue, or feel like they are drowning in all the water that we spray.
Well, at the risk of sounding like an outlier, our practice has always used rubber dams and will continue to do so until evidence, dental schools, and experts say otherwise. The rubber dam is the gold standard of treatment, and if we fail to use it when indicated, we are providing less than exceptional care for our patients.
Just “Dam” it!
“Beware of bargains in parachutes, fire extinguishers, life preservers, brain surgery, and dental care” – author unknown
It’s important to remember that one gets what one pays for. When searching for a dentist for yourself or your child, choose carefully. Professional expertise, word of mouth recommendations, sterilization procedures, technical expertise, professional credentials, friendliness of the staff, office decor and atmosphere, ability to explain insurance, out of pocket expenses, rapport with your child and trust, are all elements that must be taken under consideration when choosing a dental home. One should never choose a dentist on price alone.
Trust is a key part of any relationship. Dentistry is a vocation where unfortunately at some level, the only people who are in a good position to judge the quality of the treatment performed are other dentists. As a dentist, I can look at a filling or a crown and know immediately if the person who placed the restorations is technically excellent, average or poor. For a patient, as long as it doesn’t hurt or isn’t causing any problems, one is satisfied.
This is where trust comes into play. You need to trust that your dentist treats your child with as much compassion, empathy and kindness as they would their own child. You need to trust that the workmanship is technically superior. And you need to trust that treatment recommendations are made with your child’s best interests in mind.
Feeling good that you got a ‘bargain’ filling should never feel better than knowing without any doubt that your child got the best possible care available anywhere,
Now that’s a bargain.