Background
Current guidance recommends reducing patient and healthcare worker exposure to products containing latex as much as possible 1 yet suitable alternatives to established latex-containing materials are not always readily available. Dentists have used rubber dams (RDs) to isolate teeth from the oral environment for nearly 150 years. 2 Benefits include moisture control, reduced microbial aerosol and airway protection. A square (150mm x 150mm) of latex rubber is used or proprietary variations thereof. DryDam (Directa, Upplands Väsby, Sweden) is one such variation, used primarily to isolate the anterior dentition. It is held in place by elastic loops stretched behind the patient’s ears, frequently avoiding the need for the discomfort of RD clamps or local analgesia. Unable to source a latex-free equivalent, we present a simple chairside adaptation of a non-latex RD (Roeko Flexi Dam®, Coltène, Altstätten, Switzerland).
Technique
Take a single sheet of non-latex RD. Use the largest diameter on an Ainsworth rubber dam punch (Marrickville, NSW, Australia) to place a hole in each corner of the RD, approximately 20mm from the upper and lower edges and 10mm from the sides. Using a scalpel or scissors, cut from top to bottom between the punched holes to create ear loops (Fig 1). Apply to the teeth as normal (Fig 2). Preparation and application is straightforward and the modified RD is tolerated well by patients.
Figure 1. Proprietary paper framed rubber dam (left) and our latex-free adaptation (right).
Figure 2. Adapted latex-free rubber dam in use during root canal treatment.
Discussion
This method aids compliance with recent guidance on managing latex allergy within healthcare 1,3,4 without compromising on operative technique or patient safety. An added benefit is a cost saving of 46% (unit cost £0.76 vs £1.40, based on 25 units of DryDam at £34.90 and 30 units of Flexi Dam® at £22.81).
References
- 1.Faculty of General Dental Practitioners (UK). Guidance for the Management of Natural Rubber Latex Allergy in Dental Patients and Dental Healthcare Workers. London: FGDP(UK); 2004. [Google Scholar]
- 2.Abrams RA, Drake CW, Segal H. Dr Sanford C Barnum and the invention of the rubber dam. Gen Dent 1982; 30: 320–322. [PubMed] [Google Scholar]
- 3.Medical Devices Agency. Latex Sensitisation in the Health Care Setting (Use of Latex Gloves). London: MDA; 1996. [Google Scholar]
- 4.National Patient Safety Agency. Protecting People with Allergy Associated with Latex. London: NPSA; 2005. [Google Scholar]