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Root canal without rubber dam?

60 replies

Hetty241 · 18/12/2013 23:23

I have to have a root filling done on back upper molar. Asked my new dentist if she would be using a rubber dam and she said no. I thought a rubber dam should always be used for RCT to reduce chance of infection. Can anyone advise?

OP posts:
Mrsmorton · 21/12/2013 12:10

So you mean you don't use rubber dam or in fact do you mean you have no practical or even sound theoretical knowledge of it? Smile

flow4 · 22/12/2013 11:00

Wow, do you mean to be so rude, Mrsm?

Mrsmorton · 22/12/2013 13:13

Ah the excellent MN response to perceived rudeness. I meant what I said to come across the way it did. You're still not answering the questions I've asked you.

flow4 · 22/12/2013 17:04

Well, ok, since you insist; though the reason I didn't bother was because your questions are still very obviously rhetorical, and based on a false dichotomy. My interest in this is clearly explained in my first post, which also answers the questions you keep asking, so I assume you haven't read it...

I am a patient not a dentist. Of course if you are the sort of person who thinks that only 'expert opinion' is worth anything, then you will want to dismiss mine. But my background is in patient and public experience, so am used to the idea that clinicians are not always right, or the only people worth listening to. I'm not very familiar with the commissioning framework for dentistry, but I'd guess that as in the rest of the NHS, patient experience - and specifically patient reported outcomes - are becoming increasingly important. In hospitals round the country, clinicians are discovering that if they dismiss patients' views, their 'PROM' scores will be low, and their payments will be correspondingly lower, and contracts will be lost. If this reality hasn't hit dentistry yet, it will so soon. So if patients tell you they don't like dental dams, and you ignore them, you will be foolish.

In this case, it's not just patients who don't like dental dams, but also the majority of dental practitioners. To repeat figures you are keen to ignore, 80% of British dentists do not use dams, and 60% have never used them.

See, that's why I didn't answer you, twice: it really is pretty boring for most people, and doesn't answer the OP's original concerns. Sorry Hetty. :)

For what it's worth Hetty, I think you should ask for whatever you prefer. If you want your dentist to use a dam, ask. If you don't, that's fine. The dentists here who say they are 'essential' are in a minority, and most UK dentists don't use them. But you should ask for whatever feels right for you.

Good luck tomorrow! :)

Mrsmorton · 22/12/2013 17:12

Remember your dentist is perfectly within their rights to refuse to do this procedure without one. As per the conclusion in the link shared by flow

For me patient experience is hugely important, I tell my patients who don't want me to use dam that I will give them every assistance in finding a less scrupulous dentist who will treat them without one and to let me know if they would like a copy of their records. Can you just double check that you read the conclusion in your link because it's a little counterintuitive that you are so against the use of dam but post a well researched, peer reviewed article that strongly disagrees with your standpoint.

I do a spot of medico legal work (just at the work experience stage at present while I finish my LLM) and the expert and lay opinion in the GDC is absolutely in favour of the use of dam...

atthestrokeoftwelve · 07/01/2014 14:13

I have just had root canal treatment today- a rubber dam was used- I can see why though- it helps isolate the working area keeping it clean and dry. Each canal was irrigated 4 or 5 times with hypochlorite between excavations- it smelled pretty strong- I would have hated any of that dripping in the back of my throat. The dam wasn't too uncomfortable, soft and pliable and i was able still to partially close my mouth wearing it to give my jaw a rest.

BTW the whole procedure was painless, a bit time consuming- but I felt my dentist did a very professional job, I would opt for the dam if I need similar work in the future.

Mrsmorton · 07/01/2014 14:54

Good post.

atthestrokeoftwelve · 07/01/2014 14:58

Thanks- my anaesthetic has now worn off and my tooth feels great.

atthestrokeoftwelve · 07/01/2014 15:14

In fact I am glad I didn't read this thread before I went for my RTC treatment this morning.

There seems to be a lot of scaremongering going on here.

I don't get why the rubber dam is such a big thing- it the great scheme of things it's a little piece of harmless soft rubber- a bit like a bib.
I was still able to swallow, move my jaw, breathe.
It didn't even cover my whole mouth or nose.

Although the treatment was painless, the dam was secondary to the rasping of the files, the hypochlorite, the injection, the x rays mid treatment, and even keeping my jaw open for such a long time.

Am I missing something here?

4nomore · 07/01/2014 16:21

All I can say is that I've had a root canal performed with a dental dam and two without and I preferred the experience without. I imagine that the location of the tooth being worked on and the dexterity and preferences of the dentist may also make a difference to just how things play out. The most recent RC was on a top front tooth so I don't even know why or how you'd need a dental dam (maybe that's why he didn't use one) and obviously there's not a bunch of roots/nerves there to be cleaned out and the tooth was so dead I didn't even have anaesthetic - have to say that one was a breeze and probably about as untypical as it could be

atthestrokeoftwelve · 07/01/2014 16:59

Perhaps it does depend on the complexity of the job. My molar today had 4 canals, each one needing drilled/manually probed/bleach treated 6 or seven times each. Took an hour and a half.
I can understand why the dam was helpful to do the work- it was certainly helpful for me so I didn't get a throatful of bleach!!

Mrsmorton · 07/01/2014 17:16

I will say it again, if your dentist isn't using rubber dam then they are cutting corners. What other corners are they cutting that you can't see?

It is taught as compulsory in all UK undergraduate teaching and we all SHOULD be using it, when the GDC say SHOULD, they mean you must do it or we will strike your sorry ass off the register when something goes wrong (chemical burns, instrument aspiration, laceration of soft tissues etc) and a patient complains.
Apologies if this is snippy Hmm

atthestrokeoftwelve · 07/01/2014 17:35

Not snippy MrsM- a little direct perhaps.
I am ignorant of the whole process- although as I have said I could understand - even as a patient- the necessity of a dam.
If you are suggesting that all root canal work needs a dam then I fully accept that.
My mother has had several RC done without a dam, so this is new territory for me.
Any simple yet effective device that improves patient care and outcome must be a good idea.

I have been researching dental dams and it does seem conclusive that they are a very good idea.
However a google search for dental dams does come up with some very dodgy S& M rubberwear sites.
Hope my OH doesn't check my browing history- he'll be running scared!!

Mrsmorton · 07/01/2014 17:44

Hahahaaaa at S&M!! You DH might get some ideas and surprise you one night...

I am direct, I can't help it I'm afraid. You hit the nail on the head here Any simple yet effective device that improves patient care and outcome must be a good idea

atthestrokeoftwelve · 07/01/2014 17:56

No problem MrsM- I like direct people!!

Let's hope my OH doesn't get any ideas- It'll be me running!!

ukatlast · 07/01/2014 18:02

This explains the benefits of rubber dam for root canal.

NHS dentists are just cutting corners/doing substandard care if they don't use one:
www.dentalfearcentral.org/faq/rubber-dam/

ukatlast · 07/01/2014 18:04

I am pleased Mrs Morton agrees with me. I saw a documentary about dental students at Cardiff I think it was back in 1980s and it showed a dental dam being used for root canal even then.

Mrsmorton · 07/01/2014 18:16

ukatlast Dentistry is not synonymous with the NHS, dentists are cutting corners if they don't use dam no matter under what scheme they claim their remuneration.

NinaandtheNeurotics · 07/01/2014 20:47

I recently had a RCT done on a upper molar right at the back of my mouth (well obviously it would be in my mouth!). After reading this thread I asked my dentist why she didn't use a dam and she said, as there was only 1 wall of the tooth left, there wasn't anything to clamp the tooth to.

Also she didn't crown the tooth but used a CEREC inlay (or would it have been an onlay?) and I don't understand why. Would a conventional crown have been better if there was so little tooth left?

She's a private dentist and spends a lot of time discussing procedure, answering questions - do you think she's cutting corners in not using a dam?

Mrsmorton · 07/01/2014 20:50

Yes

Mignonette · 07/01/2014 20:54

I have not had one of these applied thank goodness. I am having a lot of dental treatment at the moment and had never even heard of this as a possibility for me.

I gag easily and am phobic (controlled through autohypnosis) and they are contraindicated for those.

Mrsmorton · 07/01/2014 21:02

No they aren't. Dam helps to reduce gag reflex but I'm not going to get into this discussion again. Not using dam for root canal treatment is at best idle, and and worse negligent. That is the opinion of the GDC who have the power to take dentist's careers away, that is also the peer reviewed opinion of any number of authors of dental literature.

atthestrokeoftwelve · 07/01/2014 21:04

I could imagine that dams could actually help people with a strong gag reflex. It stops the tongue and back of the throat coming into contact with materials and instruments.
I found it really good not to have a throatful of debris and bits of filling falling into my mouth.
Usually I am picking bits out for a couple of hours afterwards.

I don't get why people are so anti these things- is it a controversial topic?
It was mildly intrusive at worst- no big deal.

atthestrokeoftwelve · 07/01/2014 21:06

Sorry mrsm- x posted- I think we are in agreement here- I am happy that I have a dentist who understands the importance of these devices.

Mignonette · 07/01/2014 21:07

You would recognise the dental practice I used the other day mrsM

It is very very posh and very respected. Super high tech and cutting edge.

They (in consultation with my hypnotherapist who is also a HCP) decided to not use one. They didn't just casually decide this.

I am going to email them this thread to see what they say out of interest and hopefully they will respond (especially as I am having ongoing treatment). I was previously with an NHS dentist and have NEVER had a dental dam in 47 years of treatment, mixed private and NHS. Neither has my DH who lived in Australia for some time. Neither did the hospital orthodontist/dentist who treated me last year. Neither did the Flagstaff who treated my ex (have just asked him too).

That's a lot of incompetent should be struck off dentists!