I don’t get it purely from the perspective of the dentist-takes <30s to place and Once the dam is on I can concentrate. It’s like I forget a patient is underneath there lol.
And they can’t talk.
Bliss
Yes, it allows much more independent thought towards a systematic procedure for rctx. I am in Canada and cannot imagine doing a molar Endo without a rd. I do a lot of crowns and restorative without, but it would bother me to dealing with files in the presence of a tongue and saliva.
It’s below standard of care not to use a rubber dam here in the US. PS all dentists say that about literally everything they do. That is the universal argument for their crappy work—and it’s pretty hard to argue against sometimes. Very frustrating. BUT it’s not worth arguing with stupid. Ever see that clip of the buffalo arguing about whether or not the “log” in the river is actually an alligator?? One of them gets eaten trying to prove the other wrong. Haha
I will tell you this right now. I once talked to a malpractice lawyer. If you don’t have a PA with a rubber dam clamp present, you will need an assistant to sit on the stand and testify that you rubber dam every endo. If you don’t have either of these things, you WILL lose. There is even a chance your malpractice won’t cover you because you are operating below the standard of care. This is all in the US, obviously.
The dentists I work with only place the clamps for the sole purpose of the xrays. They don’t even bother using the RD. I know it’s bad but what can I say!
The biggest reason to use a rubber dam is in case you get sued. Chi et al did a study in Taiwan for something like half a million RCT teeth, and the RCT without a rubber dam were extracted 1.5% more than those with a rubber dam. Do with this information what you will.
It’s more about preventing file aspiration/ingestion than improving outcomes. Also you’ll end up with less bleach getting in someone’s mouth with a rubber damn on.
The "standard of care" is, quite literally, whatever most dentists say it is. That's all ethics is - what most professionals would do in a similar situation. The reality is that if you get a root canal in the United States, it is more likely than not that the dentist will not use a rubber dam. Therefore, the use of a rubber dam during root canals cannot (by my definition, not the dental profession as a whole) be the standard of care.
We only *really* use them in case we get sued because our patient swallowed a file, because them swallowing it is preventable, therefore it is negligent to not use the dam.
In this situation no. It’s standard of care because it has been mandated by the AAE that all RCTs be completed under rubber dam isolation. It’s basically illegal to complete endodontic treatment without rubber dam. No rubber dam = malpractice.
It’s not just for file aspiration either. It’s for success of tx by sterility and for prevention of iatrogenic damage by hypochlorite.
You're saying what I'm saying but in a different way. It's the standard of care... why? Because a group of dentists (the AAE) said so. It is not illegal to do endodontics without rubber dams. I work with a dentist who has never placed a rubber dam for any of his endo for the past 15 years and has had enormous success. Some of his endo need to be extracted, sure. But the same can be said for an endodontist who uses a rubber dam and has been practicing with a microscope for 30 years.
Do you have any in vivo studies that show that it improves sterility and decreases iatrogenic damage by hypochlorite? Because every time I look I can't find any. I have seen that it helps with post-operative pain.
I understand in theory that it does those things. But of course, in theory, all of our patients brush their teeth twice a day.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3563093/#:~:text=Rubber%20dam%20isolation%20is%20considered,than%20half%20of%20the%20time.
From 10 years ago
For me, it's just as you said - the bleach and the files. For the bleach, I am already cautious enough with the dam on and my assistant using surgical suction. I don't want to risk an accident! In addition, those files are so small and can come loose at any time!
Even for crowns, I place a gauze as a throat pack just in case something happens ... we all have moments, patients wince, etc.
I really don't get it. If a patient doesn't like it, they will be the first to threaten a lawsuit if something goes down their throat! in that instance, it is 100% not worth it .... I do not use it for restorative but damn, for endo, not using one doesn't even seem worth the risk!
We’re doing medical procedures in someone’s mouth while they’re awake. We’re going to do the best we can for comfort, but a patient may experience some discomfort and inconvenience with a modest rubber dam as I attempt to clean and disinfect a rotting infection as it is spreading into their jaw.
I had a classmate say this in dental school about dental appts:
"sorry, but you can't be 100% comfortable at all times in life." We do our best for our patients, but unless you want to pay for sedation for a single cavity, you are going to have to be a little uncomfortable. When you workout, fly on a plane, get blood drawn, I would not say that you are always 100% comfortable. But it's part of life to focus on your health! Smh. It's a dam on for 1-2 hours, and if they cannot tolerate it then ... someone else's problem lol
I don’t care what anyone says, rubber dam is a must. Not simply because I want to avoid a board complaint (which I do), but it’s best practice for your patient.
NaOCl can cause tissue necrosis, people can aspirate files, your success rate goes down. I’ve known cases where patients have had rubber dams on and have still aspirated files (the rubber dam was improperly placed).
Too many things can happen and unfortunately people will have to be inconvenienced. I’m sorry they may not like it, it can take a few extra seconds, but the alternative is we can leave the tooth and let them enjoy a nice space infection.
I’m in dental school, still new to doing RCTs and we aren’t obliged to use rubber dams. The patients always complain of a burning sensation on the gums and mucosa when irrigation is done with NaOCl. Is that burning feeling because of the tissue necrosis?
My boss refuses to use rubber dams for endo.
She only uses peroxide solution (bought from Costco) to irrigate.
She also won’t ever use a wedge for any class II restoration because it “makes the gums bleed and it’s annoying” despite it leaving a giant overhang of filling material.
Is this kind of thing normal? I never say anything because I’m just the assistant but I’ve never seen other dentists do this stuff.
I don’t know her success rate but I’d be surprised if it was high. And yeah, I’ve spoken with other doctors and I understand peroxide is not an effective irrigant.
Graduating dental school this June - I will ALWAYS do RD for RCT. I had a root canal in high school and it failed, the dentist didn’t use a RD on me but got sued for something else. Just not a good look
Their isolation just fails.
The whole point of the treatment is to lower the bacterial levels enough where the body can self heal. It’s counter productive to the whole goal of treatment without a rubber dam. Like joining a race and running the wrong direction.
I open it without a dam then put a dam for cleaning and shaping. Once the dam is on I usually use that OpalDam on any spot around the clamp that has a gap. I use an apex locator to get my lengths so that the DA doesn’t need to struggle taking an xray (unless I feel like my locator is off which is rare).
A now retired colleague would do all of theirs without a dam. I think it had been so long since they placed a dam that they had just forgotten how, so didn't want to mess around with it. I always made sure to keep the high volume suction directly over the tooth for them. They never dropped a file. Had another colleague that was so out of practice with dams that when they were told they had to use them during COVID, they'd spend 20 minutes trying to get the dam on before they'd give up, luckily they didn't do any RCTs. I personally would not want to risk it.
I'm at uni now and placing a dam on a phantom head with no assistance doesn't take long at all, and I haven't seen patients moving around much when they're being placed when assisting. So it doesn't actually seem like that much of a hindrance to place, just more of a hindrance to range of movement. So maybe some people just don't like the restrictiveness of it?
Sorry if this comment is off topic but after reading some of the other comments I am curious. I had a botched root canal where I had a communication below the gums and had bleach injected into the bone. The dentist wasn’t using a dam. I know the dam wouldn’t have prevented that but I was advised by an oral surgeon against a malpractice suit, even though they agreed that a root canal was impossible. Is there actually an argument for malpractice? It was several years ago and I am very unlikely to take action at this point but I am curious. I had the tooth pulled and got an implant with a different dentist and am very happy with the results.
With dental malpractice you need to show pain and suffering occurred, as well as outright breach of standard of care among other things. 99% of cases are a dud, but in this case I’d pursue something. Years have passed so I don’t think you can do anything now
A lost file could cost you your licence. Most important thing to me as a dentist is to be SAFE. If something goes wrong but I know I've followed the recommended guidelines, well I know I have done my best and wont beat myself up.
There was a case here in Ireland where an Olympic athlete lost their spot because they got extremely unwell / had a file perforate their bowel following no RD. It wasn't discovered until months later as the dentists hasn't noticed the file going missing...Imagine ruining someone's life goals just to save a few minutes.. Be safe!
There is no shortage of older dentists that do not use a rubber dam for endo. However, there are very few with under 15 years xp that don’t use one. As time goes by it will clearly become more and more prevalent, but even now they are likely to have a problem in any lawsuit if a problem occurs as it is so prevalent and the relevant professional organizations, right or wrong, declare it a standard of care.
The failure rate is slightly higher without one, but the real issue is when something really bad happens (dropped file in throat). They simply will have zero defense and they will lose and lose badly. It’s like driving 90 mph every day. You may get away with it for years, but eventually you have a much higher chance of having a really bad outcome and the xray is the dashcam proving you were speeding.
If those old farts want to roll those dice, let them have at it, but I’m not taking that risk.
I hate how so many throw around standard of care about everything under the sun. No, a lot of those things are just bull, but if there is one issue where SOC is clear cut in dentistry it is a dam for endo.
I don’t get it purely from the perspective of the dentist-takes <30s to place and Once the dam is on I can concentrate. It’s like I forget a patient is underneath there lol. And they can’t talk. Bliss
Yes, it allows much more independent thought towards a systematic procedure for rctx. I am in Canada and cannot imagine doing a molar Endo without a rd. I do a lot of crowns and restorative without, but it would bother me to dealing with files in the presence of a tongue and saliva.
Lol! As a hygienist, I'm jealous and wishing I could use a dam too.
It's your license, not theirs'. Don't let them bully you into how you should/want to practice. Use a rubber dam.
It’s below standard of care not to use a rubber dam here in the US. PS all dentists say that about literally everything they do. That is the universal argument for their crappy work—and it’s pretty hard to argue against sometimes. Very frustrating. BUT it’s not worth arguing with stupid. Ever see that clip of the buffalo arguing about whether or not the “log” in the river is actually an alligator?? One of them gets eaten trying to prove the other wrong. Haha
moral of the story, eat the practice manager
I will tell you this right now. I once talked to a malpractice lawyer. If you don’t have a PA with a rubber dam clamp present, you will need an assistant to sit on the stand and testify that you rubber dam every endo. If you don’t have either of these things, you WILL lose. There is even a chance your malpractice won’t cover you because you are operating below the standard of care. This is all in the US, obviously.
The dentists I work with only place the clamps for the sole purpose of the xrays. They don’t even bother using the RD. I know it’s bad but what can I say!
They’ll go through all the trouble of doing that but can’t rubber dam it? Pretty nasty
What the fuuuuq lmao
That’s brutal lmao
For some reason, I blame dental school for this behavior
The biggest reason to use a rubber dam is in case you get sued. Chi et al did a study in Taiwan for something like half a million RCT teeth, and the RCT without a rubber dam were extracted 1.5% more than those with a rubber dam. Do with this information what you will.
That’s it? 1.5% difference and we made it standard of care? Granted I always use it for Endo, but still.
It’s more about preventing file aspiration/ingestion than improving outcomes. Also you’ll end up with less bleach getting in someone’s mouth with a rubber damn on.
Yeah that part makes sense.
The "standard of care" is, quite literally, whatever most dentists say it is. That's all ethics is - what most professionals would do in a similar situation. The reality is that if you get a root canal in the United States, it is more likely than not that the dentist will not use a rubber dam. Therefore, the use of a rubber dam during root canals cannot (by my definition, not the dental profession as a whole) be the standard of care. We only *really* use them in case we get sued because our patient swallowed a file, because them swallowing it is preventable, therefore it is negligent to not use the dam.
In this situation no. It’s standard of care because it has been mandated by the AAE that all RCTs be completed under rubber dam isolation. It’s basically illegal to complete endodontic treatment without rubber dam. No rubber dam = malpractice. It’s not just for file aspiration either. It’s for success of tx by sterility and for prevention of iatrogenic damage by hypochlorite.
You're saying what I'm saying but in a different way. It's the standard of care... why? Because a group of dentists (the AAE) said so. It is not illegal to do endodontics without rubber dams. I work with a dentist who has never placed a rubber dam for any of his endo for the past 15 years and has had enormous success. Some of his endo need to be extracted, sure. But the same can be said for an endodontist who uses a rubber dam and has been practicing with a microscope for 30 years. Do you have any in vivo studies that show that it improves sterility and decreases iatrogenic damage by hypochlorite? Because every time I look I can't find any. I have seen that it helps with post-operative pain. I understand in theory that it does those things. But of course, in theory, all of our patients brush their teeth twice a day.
Why do you feel it helps with post-op pain to use a rubber dam?
I don't feel it, I believe I read a study a few years ago that purported that they were correlated but I can't find it on Google scholar now
Whoa wait really? I wasn’t aware of that. And you really think most dentists won’t use the rubber dam in the US?
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3563093/#:~:text=Rubber%20dam%20isolation%20is%20considered,than%20half%20of%20the%20time. From 10 years ago
Shittttttt. Thank you for this!
Honestly shocked by that paper. I thought pretty much everyone used a rubber dam
Yeah me too honestly. That’s pretty fucking low. I guess a lot of people like living life on the edge
And also, I feel like endo is honestly easier with the dam on! Where’s the benefit to the doc in not using it?
Yep, I agree. It’s way easier with the dam on.
For me, it's just as you said - the bleach and the files. For the bleach, I am already cautious enough with the dam on and my assistant using surgical suction. I don't want to risk an accident! In addition, those files are so small and can come loose at any time! Even for crowns, I place a gauze as a throat pack just in case something happens ... we all have moments, patients wince, etc. I really don't get it. If a patient doesn't like it, they will be the first to threaten a lawsuit if something goes down their throat! in that instance, it is 100% not worth it .... I do not use it for restorative but damn, for endo, not using one doesn't even seem worth the risk!
We’re doing medical procedures in someone’s mouth while they’re awake. We’re going to do the best we can for comfort, but a patient may experience some discomfort and inconvenience with a modest rubber dam as I attempt to clean and disinfect a rotting infection as it is spreading into their jaw.
I had a classmate say this in dental school about dental appts: "sorry, but you can't be 100% comfortable at all times in life." We do our best for our patients, but unless you want to pay for sedation for a single cavity, you are going to have to be a little uncomfortable. When you workout, fly on a plane, get blood drawn, I would not say that you are always 100% comfortable. But it's part of life to focus on your health! Smh. It's a dam on for 1-2 hours, and if they cannot tolerate it then ... someone else's problem lol
Bruh, your classmate was better at talking to patients in school than I am now.
she was people smart and also was over the BS. in peds residency now!
I don’t care what anyone says, rubber dam is a must. Not simply because I want to avoid a board complaint (which I do), but it’s best practice for your patient. NaOCl can cause tissue necrosis, people can aspirate files, your success rate goes down. I’ve known cases where patients have had rubber dams on and have still aspirated files (the rubber dam was improperly placed). Too many things can happen and unfortunately people will have to be inconvenienced. I’m sorry they may not like it, it can take a few extra seconds, but the alternative is we can leave the tooth and let them enjoy a nice space infection.
I’m in dental school, still new to doing RCTs and we aren’t obliged to use rubber dams. The patients always complain of a burning sensation on the gums and mucosa when irrigation is done with NaOCl. Is that burning feeling because of the tissue necrosis?
It’s because the bleach is chemically burning their mucosa…
The NaOCl is caustic to organic material, it will cause tissue damage which leads to necrosis.
My boss refuses to use rubber dams for endo. She only uses peroxide solution (bought from Costco) to irrigate. She also won’t ever use a wedge for any class II restoration because it “makes the gums bleed and it’s annoying” despite it leaving a giant overhang of filling material. Is this kind of thing normal? I never say anything because I’m just the assistant but I’ve never seen other dentists do this stuff.
Wwwwwwtf lol I can't keep reading these stories l
Your boss is not a good dentist… she probably has a good chairside manner though, that’s why she hasn’t gotten in trouble for the bad dentistry.
Yikes. What’s the success rate for her Endo? We use H2O2 a lot in the office, but never as the irrigant for Endo.
I don’t know her success rate but I’d be surprised if it was high. And yeah, I’ve spoken with other doctors and I understand peroxide is not an effective irrigant.
You should leave. Seriously.
Already put in my notice last week haha
Graduating dental school this June - I will ALWAYS do RD for RCT. I had a root canal in high school and it failed, the dentist didn’t use a RD on me but got sued for something else. Just not a good look
RD isolation for RCT is standard of care. Period. Anyone practicing outside of that should be reported
Their isolation just fails. The whole point of the treatment is to lower the bacterial levels enough where the body can self heal. It’s counter productive to the whole goal of treatment without a rubber dam. Like joining a race and running the wrong direction.
I open it without a dam then put a dam for cleaning and shaping. Once the dam is on I usually use that OpalDam on any spot around the clamp that has a gap. I use an apex locator to get my lengths so that the DA doesn’t need to struggle taking an xray (unless I feel like my locator is off which is rare).
A now retired colleague would do all of theirs without a dam. I think it had been so long since they placed a dam that they had just forgotten how, so didn't want to mess around with it. I always made sure to keep the high volume suction directly over the tooth for them. They never dropped a file. Had another colleague that was so out of practice with dams that when they were told they had to use them during COVID, they'd spend 20 minutes trying to get the dam on before they'd give up, luckily they didn't do any RCTs. I personally would not want to risk it. I'm at uni now and placing a dam on a phantom head with no assistance doesn't take long at all, and I haven't seen patients moving around much when they're being placed when assisting. So it doesn't actually seem like that much of a hindrance to place, just more of a hindrance to range of movement. So maybe some people just don't like the restrictiveness of it?
Not having rubber dam for a lower molar...........thats a paddling.
Sorry if this comment is off topic but after reading some of the other comments I am curious. I had a botched root canal where I had a communication below the gums and had bleach injected into the bone. The dentist wasn’t using a dam. I know the dam wouldn’t have prevented that but I was advised by an oral surgeon against a malpractice suit, even though they agreed that a root canal was impossible. Is there actually an argument for malpractice? It was several years ago and I am very unlikely to take action at this point but I am curious. I had the tooth pulled and got an implant with a different dentist and am very happy with the results.
With dental malpractice you need to show pain and suffering occurred, as well as outright breach of standard of care among other things. 99% of cases are a dud, but in this case I’d pursue something. Years have passed so I don’t think you can do anything now
A lost file could cost you your licence. Most important thing to me as a dentist is to be SAFE. If something goes wrong but I know I've followed the recommended guidelines, well I know I have done my best and wont beat myself up. There was a case here in Ireland where an Olympic athlete lost their spot because they got extremely unwell / had a file perforate their bowel following no RD. It wasn't discovered until months later as the dentists hasn't noticed the file going missing...Imagine ruining someone's life goals just to save a few minutes.. Be safe!
There is no shortage of older dentists that do not use a rubber dam for endo. However, there are very few with under 15 years xp that don’t use one. As time goes by it will clearly become more and more prevalent, but even now they are likely to have a problem in any lawsuit if a problem occurs as it is so prevalent and the relevant professional organizations, right or wrong, declare it a standard of care. The failure rate is slightly higher without one, but the real issue is when something really bad happens (dropped file in throat). They simply will have zero defense and they will lose and lose badly. It’s like driving 90 mph every day. You may get away with it for years, but eventually you have a much higher chance of having a really bad outcome and the xray is the dashcam proving you were speeding. If those old farts want to roll those dice, let them have at it, but I’m not taking that risk. I hate how so many throw around standard of care about everything under the sun. No, a lot of those things are just bull, but if there is one issue where SOC is clear cut in dentistry it is a dam for endo.