Rubber dam was introduced byBarnum, a New York dentist in 1863

Advantages of using a rubber dam

• It is raincoat for the teeth
• It helps in improving accessibility and visibility of the working area
• It gives a clean and dry aseptic field while working
• It protects the lips, cheeks and tongue by keeping them out of the way
• It helps to avoid unnecessary contamination through infection control
• It protects the patient from inhalation or ingestion of instruments and medicaments
• It helps in keeping teeth saliva free while performing a root canal so that tooth does not get decontaminated by bacteria present in saliva
• It improves the efficiency of the treatment
• It limits bacterial laden splash and splatter of saliva and blood

• It potentially improves the properties of dental material.
• It provides protection of patient and dentist.

Disadvantages of using a rubber dam

• Takes time to apply 
• Communication with patient can be difficult 
• Incorrect use may damage porcelain crowns/crown margins/ traumatize gingival tissues 
• Insecure clamps can be swallowed or aspirated.Contraindications of use of rubber dam

• Asthmatic patients
• Allergy to latex
• Mouth breathers
• Extremely malpositioned tooth • Third molar (in some cases).

Rubber dam equipment

• Rubber dam sheet• Rubber dam clamp • Rubber dam forceps• Rubber dam frameRubber dam accessories•Lubricant/petroleum jelly• Dental floss• Rubber dam napkin.

Rubber Dam Sheet

• The rubber dam sheet is normally available in size 5 × 5 or 6 × 6 squares in green or black color
• It is available in three thicknesses, i.e. light, medium and heavy

• The middle grade is usually preferred as thin is more prone to tearing and heavier one is more difficult to apply
• Latex-free dam is necessary as number of patients are increasing with latex allergy
• Flexi dam is latex-free dam of standard thickness with no rubber smell.

Rubber Dam Clamps

• Rubber dam clamps, to hold the rubber dam onto the tooth are available in different shapes and sizes.
• Clamps mainly serve two functions:
  1. They anchor the rubber dam to the tooth.
  2. Help in retracting the gingiva.

Rubber Dam Forceps

• Rubber dam forceps are used to carry the clamp to the tooth.
• They are designed to spread the two working ends of the forceps apart when the handles are squeezed together.
• The working ends have small projections that fit into two corresponding holes on the rubber dam clamps.
• The area between the working end and the handle has a sliding lock device which locks the handles in positions while the clinician moves the clamp around the tooth.
• It should be taken care that forceps do not have deep grooves at their tips or they become very difficult to remove once the clamp is in place.

Rubber Dam Frame

Rubber dam frame supports the edges of rubber dam .Frames have been improved dramatically since their old style with the huge ‘butterflies’.Modern frames have sharp pins which easily grip the dam. These are mainly designed with the pins that slope backwards.

• Rubber dam frames are available in either metal or plastic. 

• Plastic frames have advantage of being radiolucent.
• When taut, rubber dam sheet exerts too much pull on the rubber dam clamps, causing them to come loose,especially clamps attached to molars.
• To overcome this problem, a new easy-to-use rubber dam frame (Safe-T-Frame) has been developed that offers a secure fit without stretching the rubber dam sheet. Instead, its “snap-shut” design takes advantage of the clamping effect on the sheet, which is caused when its two mated frame members are firmly pressed together. In this way, the sheet is securely attached, but without being stretched. Held in this manner, the dam sheet is under less tension, and hence, exerts less tugging on clamps—especially on those attached to molars.

Rubber Dam Punch

• Rubber dam punch is used to make the holes in the rubber sheet through which the teeth can be isolated.
• The working end is designed with a plunger on one side and a wheel on the other side.
• This wheel has different sized holes on the flat surface facing the plunger.
• The punch must produce a clean cut hole every time.
• Two types of holes are made, single and multihole.
• Single holes are used in endodontics mainly.
• If rubber dam punch is not cutting cleanly and leavingbehind a tag of rubber, the dam will often split as it is stretched out.

0. Rubber Dam Template
   • It is an inked rubber stamp which helps in marking the dots on the sheet according to position of the tooth.
   • Holes should be punched according to arch and missing teeth.

0. Rubber Dam Accessories
1. Lubricant or Petroleum Jelly
2. It is usually applied on the undersurface of the dam.
3. It is helpful when the rubber sheet is being applied to theteeth.
5. dental floss
6. It is used as flossing agent for rubber dam in tight contact areas.
7. It is usually required for testing interdental contacts.

Rubber Dam Napkin

• This is a sheet of absorbent materials usually placed between the rubber sheet and soft tissues.
• It is generally not recommended for isolation of single tooth.

REFERENCE – NISHA GARG TEXTBOOK OF ENDODONTICS AND GROSSMAN’S TEXTBOOK OF ENDODONTICS