by Mary Govoni, CDA, RDA, RDH, MBA
There is no question that dental handpieces produce a substantial amount of aerosol during use. This can contaminate environmental surfaces and expose the dental team to the contaminants.
One way to significantly reduce the aerosol produced during treatment is by using a dental dam, often referred to as a rubber dam. Some practices use dental dams only for endodontic procedures to avoid potential injury from accidentally dropping a file into a patient’s mouth. But dams are not just for endo.
Dental dams can also be used for many restorative procedures, such as sealants and fillings. In addition to decreasing aerosol contamination, the dam serves to keep the field clear and dry and keeps the patient’s tongue out of the way of doctor and assistant. This is critical for success with sealants that require etching prior to placement.
Some possible roadblocks to implementing the use of dental dams include patient discomfort, difficulty of application, the need for additional armamentarium, and time constraints. Many of these roadblocks can be eliminated through the use of some newer products. In many states, the dental assistant is allowed to place and remove a dental dam.
The Insti-Dam from Zirc, Flexi Dam from Hygenic, HandiDam from Aseptico, and the OptiDam from Kerr are examples of preframed dams that increase efficiency in placing the dam.
These products come in latex and nonlatex. The possible concern about patient discomfort from the dam clamp can be addressed in several ways.
Practicon has the Cushee Rubber Dam Clamp Cushions, which can be placed on the wings of the clamps. Insti-Clamps from Zirc are single-use clamps that can be removed by cutting the clamp, and no forceps are required for removal. Soft Clamps from Kerr are made of medical-grade polymer, which increases comfort and eliminates slipping.
Another issue in using dental dams is stabilization of the dam. This is easily achieved with a great product from Hygenic called Wedjets. This stabilization cord is an elastic material, much like floss. In some cases, it can be used in place of clamps to stabilize the dam.
All these improvements in dental dam materials and technology can enhance the efficiency of isolating with a dam. The benefit to the practice in reducing aerosol contamination is an important factor in infection prevention.
If the dental assistant is allowed to place and remove the dam, the efficiency can be even greater since the dam can be placed by the assistant while the doctor is waiting for anesthesia to take effect. To find out if this is a legally delegable function in your state, contact the state dental board, state dental association, or the Dental Assisting National Board (DANB). DANB has compiled a list of functions allowable for dental assistants by state in its State Fact Booklet. This information is available on DANB’s website at www.danb.org.
Take a new look at an old technology. Perhaps isolation with a dental dam makes sense for your practice. All procedures that can enhance infection prevention and patient safety are worth investigating.
A product called Isolite delivers quick, easy, reliable isolation with uninterrupted retraction and continuous evacuation of fluids and oral debris. It’s the convergence of retraction, protection, suction, and illumination that translates to quick, easy, and reliable isolation, moisture control, and elimination of aerosol.
By inserting the soft Isolite mouthpiece, immediate tongue protection, cheek retraction, and throat protection are accomplished while the built-in bite block allows the patient to comfortably rest his or her jaw and keep the mouth open at all times.
By lighting the patient’s oral cavity from within the mouth, Isolite provides a unique shadowless illumination solution that cannot be blocked by practitioners’ heads or hands. Clear, bright illumination reduces eyestrain for the practitioner and diminishes light shining in the patient’s eyes.
The pairing of bite block with continuous suction and light gives the dental professional uninterrupted access to an entire quadrant. If the professional is using a headlight for illumination, I suggest buying the Isodry. This is the “no light” Isolite.
All of the systems mentioned will reduce or eliminate the aerosol contamination of the office treatment room.
Mary Govoni, CDA, RDA, RDH, MBA, is the owner of Clinical Dynamics, a consulting company based in Michigan. She is a member of the Organization for Safety, Asepsis and Prevention. She can be contacted at [email protected].
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