Dental-Dam for Infection Control and Patient Safety during Clinical Endodontic Treatment: Preferences of Dental Patients.

BACKGROUND: A number of factors (first experience, treating clinician and time to place dental-dam) may influence patients' preferences regarding dental-dams. In general, patients accept placing it and that it must be used for teeth isolation during endodontic procures for the sake of patient safety and infection control. OBJECTIVES: The aim of this study is to investigate preferences and experiences of patients using dental-dam (DD) isolation during root canal treatment (RCT) and to explore influencing factors among the residents of Madinah Munnawara, Saudi Arabia. METHODS: Following an ethical approval and a pilot study, a self-administrated questionnaire was distributed to 305 patients attending endodontic clinics at the Taibah University College of Dentistry (TUCOD) over six months. Patients voluntarily participated in the study after understanding the methodologies and signing a consent form. They were asked to fill out a questionnaire on their experiences and preferences in placing the DD during RCT. Data were analyzed using the Chi-square test at p = 0.05. RESULTS: The response rate was 91%. There was no significant correlation between patients' preferences and their race, age and gender (p > 0.05). The majority of participants (74.3%) would prefer to use a DD in their next session (p < 0.001). This preference negatively correlated with the time required to place a DD and the duration of the current visit (p < 0.001). While most of those who would prefer to use a DD in their next visit were pleased with how it was placed in the current session (76.6%), most of those who would not do so (66.7%) were uncomfortable. Overall, the highest proportion of participants (40.2%) reported that prevention of instrument swallowing was the most important advantage of DD isolation (p < 0.001). CONCLUSIONS: Overall, DD isolation for RCT is generally well accepted by patients regardless of their country of origin, gender, education and awareness of its advantages. Patients' safety was the most attractive advantage for patients to the application of the DD. The time required to place the dental dam and first visit experience in placing the DD affect patients' future preference.

Factors associated with patients' satisfaction of rubber dam use during root canal treatment.

BACKGROUND: The use of rubber dam (RD) has been recommended in dental procedures including root canal treatment. The aim of the study was to identify factors that were associated with patients' satisfaction and acceptance of RD. SETTING AND DESIGN:: This was a cross-sectional study, conducted from January 2015 to December 2016 at Kuwait University School of Dentistry. MATERIALS AND METHODS: A pretested questionnaire was used by a face-to-face interview of patients after taking informed consent. The study was approved by the Institutional Ethics Review Board. The providers/operators who applied RD were grouped into three categories: undergraduate final year (7th year) dental students; general dentists and postgraduate students; and specialists. RESULTS: Mean age of the patients (n = 175) was 31.6 ± 13.0 years. About 55% had past experience, and 52% expressed a better experience during the current procedure compared with the previous one. A positive experience during the current procedure correlated significantly with the future intention of RD use (r = 0.244, P = 0.001). Time needed for RD application was short (4 min), irrespective of the operators. The duration of RD use during the procedure was significantly shorter among dental specialists compared with the other groups. Time for RD application was the only significant predictor for patient satisfaction, after controlling for other independent variables. CONCLUSION: Based on the positive influence of current RD use on the future intention, dentists should spend time needed to explain the importance, safety and effectiveness of RD use with their patients.

Levels of Stress among General Practitioners, Students and Specialists In Pediatric Dentistry during Dental Treatment.

OBJECTIVE: To assess self-reported stress during the performance of different procedures in pediatric dentistry, according to the professional experience of the dentists. STUDY DESIGN: During the years 2010 to 2011, an anonymous survey was administered by means of an internet link, and by distribution at professional meetings of dentists . RESULTS: No statistically significant differences in stress were reported for maxilla and mandibular procedures. Placement of a rubber dam was rated as the most stressful procedure among dental students. For general practitioners and specialists, injection of local anesthesia to an anxious child was the most stressful procedure, regardless of age, sex, or years of professional experience. A negative correlation was found between years of experience and level of stress for all the procedures surveyed, but not for the use of nitrous oxide. No differences were found between male and female dentists in stress scores for any of the procedures. CONCLUSION: Higher rates of stress during operative procedures were reported among dental students than among experienced dentists. Anxiety of the pediatric patients, but not the location of the procedure: maxillary or mandibular, affected the dentists' reported level of stress.

Comparison of the effects of cognitive behavioural therapy and inhalation sedation on child dental anxiety.

AIM: To compare the effectiveness of inhalation sedation with nitrous oxide/oxygen (N2O/O2) and cognitive behavioural therapy (CBT) in reducing dental anxiety in preschool children. STUDY DESIGN: Randomised controlled clinical trial. METHODS: This study was conducted on 45 preschoolers with moderate to severe dental anxiety (determined by the Children's Fear Survey Schedule Dental Subscale), who required pulp treatment of at least one primary mandibular molar. Baseline anxiety and cooperation levels were determined using Venham Clinical Anxiety and Cooperation Scales (VCAS and VCCS) and Venham Picture Test (VPT) at the first dental visit (dental prophylaxis and fluoride treatment). Before the second dental visit (pulp treatment), the children were randomly assigned to one of three groups--1: control, 2: N(2)O/O(2) and 3: CBT. In group 1, the usual behaviour management techniques were used, in group 2, nitrous oxide/oxygen gas was used and in group 3, unrelated play, Benson's breathing and positive self-talk and modelling were used. Anxiety and cooperation levels were determined at three periods: injection, rubber dam placement and the application of a high-speed handpiece with VCAS and VCCS and VPT. Finally, anxiety and cooperation differences between the two dental visits were compared within the three groups. STATISTICS: Chi square, ANOVA and Kruskal-Wallis and Mann-Whitney U tests were used. RESULTS: N(2)O/O(2) and CBT significantly resulted in lower anxiety and higher cooperation in the second visit (at all three periods) compared to the control, although there was no significant difference between these two treatment methods. CONCLUSION: Both test methods were effective in reducing dental anxiety in preschoolers. Considering the adverse effects and necessity of equipment and trained personnel when using nitrous oxide and oxygen inhalation sedation, cognitive behavioural therapy is preferable because of its better applicability.

Evaluation of senior dental students' general attitude towards the use of rubber dam: a survey among two dental schools.

The purpose of this study was to evaluate the general attitude of senior dental students towards rubber dam use, specifically focusing on endodontic practices prior to starting to serve community. Questionnaires were distributed to senior year students of a private school and a state school in Istanbul. Questions were asked about areas where the students used rubber dam, its advantages and difficulties, and whether they agreed or disagreed with some aspects of the rubber dam. The private school students rated isolation whereas those of the state school selected prevention of aspiration which the top advantage rubber dam provides. Students of the state school agreed with the opinion that isolation cannot be achieved without rubber dam and it extended the procedure with a significantly higher ratio compared to the private school. Within the limitations of the present study, it can be concluded that the perceptions of dental students on rubber dam needs to be improved and strategies should be developed so that this valuable adjunct will comprise one of the indispensable elements of dental care.

Attitude of general dental practitioners toward root canal treatment procedures in India.

OBJECTIVE: The percentage of general dental practitioners is very common in India, so the purpose of this study was to assess attitude of general dental practitioners toward root canal treatment (RCT) procedures. MATERIALS AND METHODS: In a cross-sectional study, 178 dentists (96 males and 82 females) were surveyed using a selfadministered, structured questionnaire pretested through a pilot survey. The questionnaire collected information regarding RCT procedures among participants. Data were analyzed using SPSS version 15. Frequency and percentage distributions were calculated. RESULTS: In the present study most of the participants, i.e. 86.4% reported that they perform (RCT) procedures in posterior teeth. Isolation is mainly done with cotton rolls only (74.6%) and very few are using rubber dam in their practice (3.2%). Radiographs were not taken after every step in most of the cases. Rotary instruments were used in less number of cases and K-files were the most popular instruments (66.2%). Also single sitting RCT was not commonly seen. CLINICAL SIGNIFICANCE: This study indicates that most of the general dental practitioners' do not comply with quality standards guidelines such as use of rubber dam as isolation. So dentist should update their knowledge and practices with current techniques and materials through CDE programs.

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.

A comparison of conventional and new rubber dam systems in dental practice.

OBJECTIVE: Rubber dam is an important tool in dentistry-in the past as well as today. As a result of a lack of acceptance of the conventional system, introduced by Barnum in 1869, new systems were developed (eg, OptraDam® by Ivoclar Vivadent AG, Schaan, Liechtenstein). This system was advertised as being very comfortable and easy to use, without distracting clamps. The aim of this study was to investigate if a new rubber dam system would be better accepted by patients and dentists than the conventional one. MATERIALS AND METHODS: Two hundred patients from the Department of Conservative Dentistry and Periodontology received at least one treatment with the conventional rubber dam (Dental Dam, Coltène Whaledent, Langenau, Germany) and one with the new rubber dam (OptraDam®, Ivoclar Vivadent). Staff/students and patients were asked to complete questionnaires with regard to the advantages and disadvantages of the particular system after every treatment. RESULTS: Among patients, students, and dentists in the dental school environment there is a high degree of acceptance of rubber dam in general. During the study there were only very few situations in which neither of the systems could be used. The conventional rubber dam was preferred by all patients, students, and dentists (p<0.0001). CONCLUSION: Our study confirms that there is a high degree of acceptance of the rubber dam when it is compulsory to use. The reasons for the refusal during the daily workload of a practice remain unclear, but appear to be independent of the material or design available. A new design does not necessarily imply better acceptance.

The impact of emotional intelligence and intelligence quotient (IQ) on child anxiety and behavior in the dental setting.

OBJECTIVE: The aim of this study was to evaluate the impact of IQ and EQ on child's anxiety and behavior in the dental setting. MATERIALS AND METHODS: One hundred and seven children (age range 7-12 years) were selected. BarOn Emotional Quotient Inventory: Youth Version (Baron EQ-I: YV) and the Raven's Colored Progressive Matrices (RCPM) tests were administered on the first examination session. Children's anxiety and behavior were evaluated using the modified child dental anxiety scale (MCDAS) and the sound, eye and motor (SEM) scales, respectively, during the second session. RESULTS: The mean (SD) age of subjects was 8.48 (1.41) years old. The result revealed a significant negative correlation between children's behavior and total EQ score (p < 0.01) but there was no relationship found between children's behavior and IQ score. A significant positive correlation was found between anxiety scores on MCDAS and SEM (p < 0.01), but no relationship was found between EQ and MCDAS scores. Both anxiety (p < 0.01) and EQ score (p < 0.01) were effective variables in predicting the child's SEM score. CONCLUSION: The major finding of this research suggested that a high EQ may be more effective than a low EQ in moderating the level of cooperation during dental treatment of children. IQ scores, on the other hand, were related to the child's EQ score (r = 0.20) and age (r = - 0.29).

The attitudes of undergraduate dental students to the use of the rubber dam.

UNLABELLED: The majority of dental schools teach that use of the rubber dam is mandatory for certain procedures, e.g., endodontic therapy and adhesive dentistry. Despite this, many dentists perceive use of the rubber dam as a hindrance to dental treatment in adults and children. PURPOSE: This study sought to evaluate the attitude of undergraduate students towards the use of the rubber dam and elucidate if the negativity towards its use is evident in undergraduate clinics. METHODS: A structured questionnaire was developed, which sought to establish current perceptions of the use of the rubber dam in adults and children, and circulated to the current fourth and final year clinical undergraduate class in the Dublin Dental Hospital. RESULTS: Isolation was identified as the main advantage of using a rubber dam and difficulty to place the main disadvantage. Some 98.5% of students believed they had received adequate training in rubber dam use for adults. While 72% of students were confident in placing a rubber dam for children, 38% felt that more training was necessary. The most commonly cited difficulty in placing a rubber dam was tight contacts. Most students are confident regarding which clamps to use. The majority of students (61%) believe that patients, especially children, prefer treatment without rubber dam isolation and that adequate isolation can be achieved without using a rubber dam. The average time spent placing the rubber dam was eight minutes for children and five minutes for adults. The students are more predisposed to using the rubber dam on adults than children for the same procedure. CONCLUSIONS: Undergraduate students are not convinced that the use of a rubber dam is effective and efficient except for endodontic therapy. Students already believe that patients, both adults and children, would prefer their treatment to be conducted without a rubber dam. Teaching efficient methods of placing the rubber dam may improve students' confidence and reduce placement time so that the students will be more likely to use the rubber dam after graduation.

[The rubber dam, a problem for the dentist or the patient?]. / La digue, problème pour le dentiste ou pour le patient?

Although the advantages of rubber dam use are obvious and rubber dam use is established standard of care in many disciplines, its application in general dental practice is low. To assess whether a negative attitude of patients might be the case, 304 patients were asked by means of a questionnaire comments on their treatment under rubber dam. The majority of the patients experienced no hinder, excepted for rubber dam restricting the communication with the dental practitioner. Women experienced more often than men anxiety, whereas smokers more frequently experienced discomfort.