A Randomized Clinical Trial Evaluating Rubber Dam Clamp Pain Reduction from a New Topical Liposomal Anesthetic Gel.

PURPOSE: Discomfort during rubber dam clamp often occurs in pediatric dentistry. The purpose of this randomized, triple-blind, clinical trial was to evaluate the effect of pain reduction using a new topical liposomal thermo-sensitive gel (TLTG) or a placebo gel during rubber dam clamp isolation for sealants in children. METHODS: Eighty-one children (eight to 12 years old) had LTSG or the placebo gel with random assignment placed around the gingival tissue of their permanent mandibular first molars. A clamp was placed after two minutes on the teeth, and intensity of pain was registered using a Wong-Baker FACES scale and an 11-point numerical scale. The data were evaluated using McNemar's test and Wilcoxon signed rank test. RESULTS: The odds ratio for pain (OR equals 0.7; 95 percent confidence interval equals 0.3 to 1.8) was not statistically significant (P=0.52). However, there was a small difference in the pain intensity between liposomal and placebo groups for both scales (P<0.05). CONCLUSION: The liposomal thermo-sensitive anesthetic gel may reduce, to a small extent, the pain intensity in children submitted to rubber dam isolation before resin sealant placement.

Does operatory field isolation influence the performance of direct adhesive restorations?

PURPOSE: To evaluate the influence of different adhesive strategies (etch-and-rinse and self-etching adhesives) and type of field isolation (absolute or relative) on the clinical performance of restorations of noncervical carious lesions (NCCLs). MATERIALS AND METHODS: One hundred forty NCCLs were selected from 38 patients, according to previously established inclusion/exclusion criteria, and assigned to one of four groups (n = 35): etch-and-rinse/rubber-dam (ERR), etch-and-rinse/cotton roll (ERC), self-etching/rubber-dam (SER) and self-etching/cotton roll (SEC). The adhesive systems used were: Adper Single Bond 2 (3M ESPE) and Adper SE Plus (3M ESPE), with restorations made using a composite resin (Z350, 3M ESPE). Using the USPHS modified criteria, 140 restorations were evaluated by two calibrated examiners at 5 different times: immediately after placement, at 7 days, and 2, 6, and 12 months. In order to evaluate the presence of gingival recession after the use of the #212 rubber-dam clamp, the clinical crowns of the teeth from groups ERR and SER were measured at six different periods (baseline, immediately, and at 7 days, 2, 6, and 12 months). Data were subjected to McNemar's, chi-square, and Student's t-tests. RESULTS: Both adhesive strategies reduced tooth sensitivity beyond the second period of evaluation (7 days); tooth sensitivity disappeared after the third period of evaluation (2 months). There were no statistically significant differences between the adhesive techniques or isolation techniques, except for a Bravo score for marginal discoloration in group SEC at 6 months, which was significantly different from the other groups. The rubber-dam isolation technique was more uncomfortable for the patient and resulted in short-term gingival recession. CONCLUSION: No significant differences were found between the types of isolation or adhesive strategy in this clinical evaluation, with the exception of 2 restorations in group SEC that showed marginal discoloration, possibly due to inadequate enamel etching by the self-etching adhesive. Class V restorations perform equally well placed with or without rubber-dam.

Influence of rubber dam on objective and subjective parameters of stress during dental treatment of children and adolescents - a randomized controlled clinical pilot study.

BACKGROUND: Rubber dam is recommended for isolating the working field during adhesive dentistry procedures; however, dentists often omit rubber dam, particularly in paediatric dentistry, supposing that it would stress the patient. AIM: The aim of this study was to evaluate stress parameters during a standardized dental treatment procedure performed with or without rubber dam. The treatment time was measured as a secondary outcome variable. DESIGN: This study was designed as a randomized, controlled, clinical study with 72 patients (6-16 years; mean age, 11.1). During standardized fissure sealing procedures, objective parameters of stress (e.g., skin resistance, breath rate) were recorded. The operator's stress level was measured by pulse rate. Subjective pain (patients) and stress perception (operator) were evaluated by an interview. RESULTS: The breath rate was significantly (P<0.05) lower and the skin resistance level was significantly higher during treatment with rubber dam compared to the control group. Subjective pain perception was significantly lower for the test group. The treatment time needed for the fissure sealing procedure was 12.4% less in the test group. CONCLUSION: Isolation with rubber dam caused less stress in children and adolescents compared to relative isolation with cotton rolls if applied by an experienced dentist.

Effects of open mouth and rubber dam on upper airway patency and breathing.

OBJECTIVES: Rubber dams increase the quality and safety of dental treatment. However, the condition of a rubber dam over an open mouth may also obstruct the route for respiration. We tested whether an open mouth with or without a rubber dam would affect upper airway patency and breathing pattern. MATERIALS AND METHODS: Twenty young healthy volunteers were imaged with a magnetic resonance (MR) system under three conditions: mouth closed, mouth open, and rubber dam with mouth open. Respiration was concurrently monitored with plethysmography. MRI slices of the upper airway were obtained at 5-mm thicknesses, and the size of the cross-sectional area of the upper airway was measured by image analysis software. Respiratory cycle duration and tidal volume were also measured with digital signal analysis software. RESULTS: The volume of the upper airway became significantly decreased with the mouth open. Analysis of each cross-sectional area of the upper airway revealed that while the oropharyngeal area was significantly narrower with an open mouth, the retropalatal and hypopharyngeal areas were not affected. Placing a rubber dam had no additional influence on upper airway patency but was seen to significantly shorten mean respiratory duration and decrease tidal volume. CONCLUSIONS: Open mouth position plays the largest role in decreased upper airway patency, and open mouth position with a rubber dam may further disrupt breathing pattern. CLINICAL RELEVANCE: Breathing pattern may become deteriorated by airway obstruction during dental treatments requiring a rubber dam.

Prevalence of allergy to latex gloves among dental professionals in Udaipur, Rajasthan, India.

PURPOSE: Nowadays, gloves are worn routinely by most general dental practitioners while treating patients, with latex being the most commonly used glove material worldwide. The aim of the present study was to determine the prevalence of allergy to latex gloves among dental professionals of Udaipur, Rajasthan, India. MATERIALS AND METHODS: In this cross-sectional study, a total of 163 dental professionals (73% males and 27% females) were surveyed using a pre-tested self-administered questionnaire. The questionnaire was comprised of a total of 12 items and gave information about the participants and their glove use, namely demographic profile, working habits and glove use, signs and symptoms related to glove use, any other type of allergy, as well as precautions taken to minimise it. The statistical analysis was performed using chi-square and Fisher's exact tests to compare frequency and percentage. The level of significance was set at P u 0.05. RESULTS: A total of 26 (16%) dental professionals reported allergy to latex gloves, of which females (27.3%) reported significantly greater allergy than males (11.8%) (P = 0.016). The number of years of glove use was significantly associated with allergy to latex gloves (P = 0.000). The prevalence of allergy to latex gloves was significantly greater for those who had allergy to pollen grains, foodstuffs and rubber dam, those who had asthma or history of eczema and those with family history of allergy. However, allergy to latex gloves was independent of age, type of gloves used, hours of use per day as well as number of patients seen per day. CONCLUSIONS: The present study showed a high rate of allergy to latex gloves among dental professionals in Udaipur, Rajasthan, India.

[Medico-legal autopsy case of an infant suffering anaphylactic shock during dental treatment. Potential hazards in the use of a rubber-dam-sheet for infants].

We report a medico-legal autopsy of a 4-year-old girl without any history of allergies, who died following anaphylactic shock due to local anesthesia with lidocaine during dental treatment. The shock symptoms were overlooked due to a rubber-dam-sheet covering her face. The autopsy revealed laryngeal edema, secretory fluid filling the trachea, severe pulmonary congestion and edema. An immunohistochemical investigation showed numerous mast cells releasing histamine in lungs, and the fluids in the pulmonary alveoli and veins also showed positive staining. In addition, the plasma concentration of histamine in the heart blood showed a high value. From these findings, the cause of death was determined to be respiratory failure due to anaphylactic shock induced by lidocaine. In this case, her death was considered to be due to medical malpractice; adequate life support had not been performed, because anaphylactic shock was overlooked until the rubber-dam-sheet removed. In addition, due to two previous autopsy case reports that described infantile fatalities involved with the misusage of a rubber-dam-sheet for the patients under local anesthesia, we therefore recommend immediate improvements in rubber-dam-sheets and/or better applications of them in pediatric dentistry.

The effect of rubber dam placement on the arterial oxygen saturation in dental patients.

This study assessed the effect of rubber dam placement on arterial blood oxygen saturation in dental patients; it also determined whether the effects are technique sensitive. The study group consisted of 28 ASA Class I patients who were randomly allocated to one of two groups: Group A--rubber dam isolation of the maxilla (from tooth #14 to #6) and Group B-rubber dam isolation of the mandible (from tooth #19 to #27). A pulse oximeter was used to detect arterial blood oxygen saturation in both groups. Each patient's oxygen saturation (Sp02) was recorded every 30 seconds for two minutes to establish a baseline. Group A subjects received local infiltration in the vestibule above tooth #14, while Group B subjects received an inferior alveolar nerve block using 1.8 ml of 2% Lidocaine with 1:100,000 epiphrine, respectively. During the subsequent five minutes, the patient's Sp02 was recorded every 30 seconds. A rubber dam was then placed, which extended to the anterior septal angle (which completely covers the nose). This rubber dam remained in place for 20 minutes, with the patient's Sp02 being recorded every 30 seconds. The rubber dam was then altered (cut) to expose the nasal passages, creating what is known as proper rubber dam isolation, and the Sp02 was recorded every 30 seconds for 20 minutes. In both groups, there was no significant change in arterial oxygen saturation before or after rubber dam isolation was performed. Also, there was no significant difference in Sp02 when comparing the rubber dam isolation technique. Although rubber dam placement has no effect on blood oxygen levels in healthy patients, its effects on unhealthy patients are unknown.

Influence of the rubber dam on proximal contact strengths.

PURPOSE: The study tested the hypothesis that the application of a rubber dam influences the reconstruction of proximal contact strengths, while the corresponding contra-lateral teeth are not affected. METHODS: Seventy-four systemically and periodontally healthy subjects in need of a direct posterior composite restoration were treated with the use of a rubber dam. The proximal contact strengths (PCS) were electronically evaluated by measuring frictional forces during removal of a 50.0 +/- 5.0 microm-thick straight metal band. RESULTS: Proximal contact strengths significantly increased from 2.26 +/- 1.45N before to 3.83 +/- 2.34N after application of the rubber dam; whereas, the variation of PCS at the corresponding contacts in the contra-lateral quadrant remained within the intra-examiner variance of +/- 0.2N. Upon removal of the rubber dam, there was a statistically significantly drop in PCS from 3.54 +/- 1.87N to 2.31 +/- 1.35N. Again, there was only minimal change in the contra-lateral quadrant. It was concluded that application of the rubber dam affects proximal contact strengths.

Delayed type allergic reaction following the use of nonlatex rubber dam during endodontic treatment.

AIM: To describe the development of a delayed type allergic reaction 24 h following the use of nonlatex rubber dam during endodontic treatment. The symptoms were alleviated with adequate medication; however, the patient rejected any further analysis. SUMMARY: In recent years, allergic reactions because of latex rubber dam and gloves have received more attention. Nonlatex products are advocated in clinical use in cases where the patient presents an allergic background. Although rare, adverse reactions may be encountered even with these products. In this article, a very rare case is presented in which a patient developed signs of allergy 24 h after the utilization of nonlatex rubber dam and gloves during endodontic treatment. Signs including visible redness on the mucosa, submucosal oedema and desquamation in the vestibular mucosa were observed. With proper medication, the signs and symptoms were alleviated. Although the patient was referred to an allergy specialist for patch testing, she did not accept any further analysis. KEY LEARNING POINTS: This case emphasizes the necessity of precautions during the management of latex-allergic patients in clinical practice. The unusual response encountered in this patient does not undermine the usefulness of nonlatex rubber dam and gloves in sensitive individuals.

Latex allergy in dentistry. Review and report of case presenting as a serious reaction to latex dental dam.

Latex allergy may have severe consequences including development of anaphylaxis. This report describes a patient who underwent a reaction to latex dental dam manifesting as erythema, facial swelling and mild airway compromise. Restorative procedures under latex dental dam were performed under local anaesthesia on two occasions resulting in reactions of increasing severity. Following the first event the cause of the reaction was undetermined, but attributed to a possible allergy to local anaesthetic, and managed with corticosteroids and antihistamines. On a subsequent occasion the swelling was more severe, associated with difficulty in swallowing and mild airway compromise, and was managed as previously with adrenaline also being required. Latex allergy was subsequently confirmed.

Endodontic treatment in cases of allergic reaction to rubber dam.

The prevalence and severity of latex allergies have rapidly increased recently. This article presents two cases of patients with rubber latex allergy. The patient in case A was unaware of her sensitivity to latex and presented symptoms of contact dermatitis-stomatitis during endodontic treatment. The patient in case B reported latex allergy before the initiation of the treatment and a different approach was followed. Certain aspects of latex allergy related to the endodontic treatment are discussed. Moreover, a protocol is proposed for treatment of patients with latex hypersensitivity with safety.

In vivo measurement of colour changes in natural teeth.

It has been observed that teeth become lighter when they are dried. The present study was designed to quantify these changes and the time taken for tooth colour to return to normal. The colour of an upper central incisor in each of seven subjects was measured using a reflectance spectrophotometer before and after application of a rubber dam and, in another seven subjects before and after taking a polyvinylsiloxane impression. There were statistically significant changes in the L*, a* and b* values following rubber dam application and in the L* value following impression taking. The results demonstrate that teeth become brighter and less colour saturated after rubber dam application and brighter after impression taking. The original values were regained after 30 min.

Allergic reaction after rubber dam placement.

In the last few years allergic reactions to natural rubber latex (NRL) have increased in dental practice affecting both the dental team and patients. Some case reports discuss the potential risks of hypersensitivity to NRL products. An adverse patient reaction after dental rubber dam placement is reported. About 1 min after the isolation of the tooth with a rubber dam the patient presented signs and symptoms of hypersensitivity. Oxygen and intravenous hydrocortisone were administered and the patient kept under observation. After 2 h she had stable vital signs and no more allergics symptoms. It is unclear whether components of the NRL dam or the cornstarch powder incorporated with the rubber dam was responsible for the allergic reaction. Dentists must be aware of the health problem and be prepared for an adequate management in dental practice.

Management of the latex hypersensitive patient in the endodontic office.

This case report documents the treatment of an endodontic patient who experienced a type 1 hypersensitivity reaction to latex. The dental, medical, and environmental aspects of treating latex allergic patients are reviewed. Because gutta-percha and latex rubber are similar compounds, the possible cross-reactivity of these materials is discussed.