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RUBBER DAM USE BY GENERAL DENTAL PRACTITIONERS - PREVALENCE AND OBSTACLES TO ITS USE.

Byline: AFSHEEN ALI, AYESHA ASLAM, BUSHRA REHMAN and ANUM TARIQ

Abstract

Optimal dental practice requires the use of isolation techniques. One such well-established method is the use of a rubber dam. It was first introduced in 1860s by S.C. Barnum and has since been used in dental practices. The use of rubber dam has a number of advantages. It provides the clinician with a dry operative field, enhances visibility, minimizes patient conversation, thereby increasing the overall efficacy of the treatment. Despite its well-known advantages, rubber dam is not commonly used during routine dental practice. Use of rubber dam is one of the most widely advocated techniques and yet equally ignored by dental practitioners. The aim of this study is to evaluate the attitudes of local general dentists towards rubber dam usage, its prevalence and to highlight any obstacles to the routine use of rubber dam. A self-administered close-ended questionnaire was used as the data collection tool.

The questionnaire was distributed to 150 dentists involved in general dental practice in Rawalpindi/ Islamabad, with a response rate of 93%. The data was analyzed using SPSS version 21. Descriptive statistics were calculated. Approximately 92% of the general dentists claimed that they knew the use of rubber dam but 77% stated that it was not available at their practice. Question pertaining to the frequency of rubber dam usage revealed that 52.1% "never" use it while another 20% used it "hardly ever", and only around 28% dentists used it to a varying extent. High patient load (49%) was considered the biggest obstacle to the use of rubber dam followed by time required to place it (16%) and cost (15%).

Key Words: Rubber Dam, Survey, Isolation.

INTRODUCTION

Optimal dental practice requires the use of isolation techniques.1 Exposure to patient's saliva and/or blood makes the dentist vulnerable to occupational biohazards.2 These potential threats of cross infection between dental professional and patient can be reduced by employing isolation techniques.3 One such well-established method is the use of a rubber dam. It was first introduced in 1860s by S.C. Barnum and has since been used in dental practices.4

A few contra-indications are associated with this isolation modality. Allergy to latex present in rubber dam sheets have been reported, although now latex-free rubber dams are also available.4 Some patients may experience a claustrophobic feeling with the rubber dam in place as well as difficulty in communicating with the dentist.5 However, this minimized communication may actually result in improved quality of treatment. The use of rubber dam is associated with a number of other advantages too. It provides the clinician with a dry operative field, enhances visibility, minimizes patient conversation, thereby increasing the overall efficacy of the treatment.6

It also offers significant patient protection by preventing aspiration of instruments, medications, debris as well as by excluding the risk of injury caused by high-speed rotary instruments.7

Research studies have proved that using a rubber dam significantly reduces the microbial content of aerosols produced during routine dental procedures.8 All these advantages make rubber dam the best method of cross-infection control during dental treatment.

Despite its well-known benefits, rubber dam is not commonly used during routine dental practice. Gilbert et al9 reported a significantly lower use of rubber dam for the procedures of operative dentistry. A survey of the civilized UK society revealed that up to 44.5% of dental practitioners did not use rubber dam for isolation.10

Similar findings have been reported by a number of different studies from other countries.11-13 The reasons put forward by practitioners vary to a large extent, ranging from lack of expertise to a complete lack of interest in employing this technique.

Use of rubber dam is one of the most widely advocated techniques and yet equally ignored by dental practitioners.8 A need exists to educate the general and specialist dental practitioners regarding the importance of rubber dam usage and the benefits it offers. The aim of this study was to evaluate the attitudes of local general dentists towards rubber dam usage, its prevalence and to highlight any obstacles to the routine use of rubber dam.

METHODOLOGY

A self-administered close-ended questionnaire was used as the data collection tool. The questionnaire was first pilot - tested to ensure its validity, reliability and relevance. The questions were designed to assess the prevalence of routine use of rubber dam, the attitude of the dentist towards its use and the barriers felt by the dentists that hinder its routine usage. The questionnaire was then distributed to 150 dentists involved in general dental practice in Rawalpindi/Islamabad. Data was analyzed using SPSS version 21. Descriptive statistics were calculated.

RESULTS

Out of the 150 distributed questionnaires, 140 were completely filled and returned resulting in a response rate of 93%. Of these respondents, 28 were females and 112 were males (Fig 1).

TABLE 1: KNOWLEDGE AND ATTITUDE OF GENERAL DENTISTS TOWARDS THE USE OF RUBBER DAM

###Question/Statement###Yes (%)###No (%)

1.###Do you know the use of rubber dam?###92###8

2.###Do you think rubber dam is beneficial in routine practice?###97.1###2.9

3.###Is it available at your practice / workplace?###23###77

4.###Do you think rubber dam usage should be compulsory before endodontic/###82###18

###operative/prosthodontic procedures?

5.###Are you interested in gaining knowledge about rubber dam usage through###96.4###3.6

###CDE programs?

TABLE 2: FREQUENCY OF RUBBER DAM USAGE

###Frequency###Percentage

Q. How often do you use rubber dam for routine dental procedures?###1. Always###2.9

###2. Quite often###7

###3. Some times###18

###4. Hardly ever###20

###5. Never###52.1

Approximately 92% of the general dentists claimed that they knew the use of rubber dam. While majority (97.1%) of the respondents agreed to the benefits of its use, 77% stated that it was not available at their practice (Table 1). Question pertaining to the frequency of rubber dam usage revealed that 52.1% "never" used it while another 20% used it "hardly ever" (Table 2). Fig 2 highlights the obstacles felt by general dentists to the use of rubber dam, with the greatest percentage for high patient load.

DISCUSSION

In the present survey, majority of the respondents were male general dentists. This is consonant with the results of Udoye and Jafarzadeh12 as well as Ravanshad et al.14

The knowledge about rubber dam was high (92%) among the local general dentists. 97% dentists agreed that using rubber dam is beneficial while 82% of the respondents agreed that rubber dam should be used in routine dental procedures. However, the use of rubber dam for routine dental procedures was quite low. About 52.1% of the dentists never used rubber dam in their routine practice. Similar findings were reported by a number of different studies including Whitworth et al.15 (58.1%), Stewardson16 (63.2%) and Wilson et al.17 (61%). In the present study, about 28% used it for routine procedures to a varying extent. This finding is in accordance with the results of Gupta and Rai18 who reported 27% usage by dentists in India. However, other studies have reported a significantly higher prevalence of rubber dam usage, especially in the developed countries.4,19

When asked about the obstacles to the routine use of rubber dam, majority of the dentists (49%) reflected a higher patient load as the greatest hindrance. About 16% considered it a 'time-taking" procedure while 15% thought cost as the major impediment to its use. Similar results were reported by Madarati20 where about 16.7% of general dentists found it time-taking. Contrary to the present results, Csinszka et al4 reported time and patient discomfort as the biggest obstacles to its use. A higher patient load on local dentists indicates a lack of practicing dental practitioners for the local population, resulting in over-burdening of the dentists and a compromised quality of dental practice. Patient discomfort was reported as the least prevalent impediment to the use of rubber dam. This finding is endorsed by the results of Tanwir et al21 and Stewardson.16

Approximately 96.4% of the respondents showed an interest in improving their knowledge about rubber dam through continuing dental education programs, similar to the findings of Tanwir et al.21 This shows an overall positive attitude of the local dentists towards the use of rubber dam. However, the use of rubber dam needs to be increased to provide quality dental care to the patients. Greater emphasis must be placed on rubber dam usage during undergraduate and postgraduate dental education.

CONCLUSION

Within the limitations of this study, the following conclusions can be drawn:

The prevalence of rubber dam use by local general dental practitioners was quite low (28%).

High patient load was found to be the biggest impediment to the routine use of rubber dam.

Despite their shortcomings, local general dentists showed an over-all positive attitude towards rubber dam use and were interested in enhancing their knowledge through well-structured CDE programs.

REFERENCES

1 Al-Abdul Wahhab B, Al-Thabit H, Al-Harthi A, Shamina R, Al-Taher R, Al-Ashgai A, et al. The attitudes of dental interns to the use of the rubber dam and obstacles to its use. Indian Journal of Dentistry. 2013; 4(4): 179-83.

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9 Gilbert GH, Litaker MS, Pihlstrom DJ, Amundson CW, Gordan VV. Rubber Dam Use During Routine Operative Dentistry Procedures: Findings From The Dental PBRN. Operative dentistry. 2010; 35(5): 491-99.

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13 Al-Omari MA, Al-Dwairi ZN. Compliance with infection control programs in private dental clinics in Jordan. Journal of Dental education. 2005; 69(6): 693-98.

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16 Stewardson DA. Endodontics and new graduates: Part I, Practice vs training. Eur J Prosthodont Restor Dent. 2002; 10(3): 131-17.

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19 Mala S, Lynch CD, Burke FM, Dummer PM. Attitudes of final year dental students to the use of rubber dam. Int Endod J. 2009; 42(7): 632-38.

20 Madarati AA. Why dentists don't use rubber dam during endodontics and how to promote its usage? BMC Oral Health. 2016; 16(1): 1-10.

21 Tanwir A, Amin M, Choudhry Z, Naz F. Knowledge, attitude and perception of dental fraternity towards practice of rubber dam. Pak Oral Dent J. 2015; 35(4): 691-94.
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Publication:Pakistan Oral and Dental Journal
Geographic Code:9PAKI
Date:Sep 30, 2016
Words:2261
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