Lupine Publishers | Journal of Pediatric Dentistry
Letter to Editor
The concept of dental dam or rubber dam was first developed by Barnum
in 1864. He reported struggling with saliva contamination during
treatment for a long time. On one occasion, while he was treating a
mandibular molar and saliva was flowing all over the oral cavity, he
came up with a new idea, making a hole in his protective napkin and
putting it around the tooth. This idea resulted in developing rubber
dam, the main problem of which was not being fixed around the tooth. To
address this problem, rubber dam punches, a set of metal clamps, and
other equipment of rubber dam were introduced in the following years
[1]. Rubber dam is a thin, 15 cm square disposable rubber sheet, which
is of two types: latex and non-latex (nitrile). In dentistry, rubber dam
is used for the isolation of the operative site from the oral cavity in
order to increase the safety and quality of dental procedures. Rubber
dam prevents the patient from aspiration or swallowing dental
instruments as well as cross infection and contaminated aerosols [2].
This brief letter focused on the role of rubber dam against transmission
of contaminated aerosols, particularly COVID-19.
Dental aerosol or splatter is produced from dental instruments, such as
ultrasonic scalers or dental handpieces. Aerosol is a particle less than
50 μm in diameter and has the potential to stay airborne for a long
period before it settles on surrounding surfaces or gets into the
respiratory tract. Aerosol droplets which are >0.5-10 μm have an
improved ability to transmit severe acute respiratory syndrome.
Particles larger than 50 μm are defined as splatter and are airborne
only for a short period. With that being said, almost 99% of airborne
particles can be eliminated through the use of a high-volume evacuator
during treatment [3].
According to the World Health Organization (WHO), viral epidemics are a
serious threat to public health. Severe acute respiratory syndrome
coronavirus 2 (SARS-CoV-2) first appeared
in the city of Wuhan, in December 2019. On February 11, 2020,
WHO named the virus, coronavirus diseases 2019 (COVID-19). COVID-19
leads to severe respiratory problems and in some cases even death. It is
transmitted through contaminated aerosol droplets >5-10 μm from
coughing or sneezing. Thus, close contact (within 1 m) with an infected
person causes the mucosa, oral or nasal cavity, and conjunctiva to be
exposed to respiratory droplets containing coronavirus infection [4].
Since dental health care providers are constantly in close proximity to
patients, they are at risk of microbial or viral infection that can be
transmitted through atmospheric aerosols.
In a study conducted by Samaranayake et al. [5] the effectiveness of the
rubber dam in preventing contaminated aerosols during therapy was
examined. The result demonstrated that the rubber dam significantly
reduces the contaminated aerosol particles from the operational site up
to 3-foot distance (91,44 cm) by 70%. Moreover, the use of rubber dam
decreases the production of saliva and blood contamination during dental
treatment as well as the potential airborne particles between the
clinician and patient [3]. In addition, in the case in which the
gingival is exposed, the split-dam method is useful. According to the
evidence provided, it is possible that the use of rubber dam contributes
to the prevention of COVID-19. However, conducting more clinical or
laboratory studies investigating the role of rubber dam against
respiratory diseases, particularly COVID-19 is recommended in order to
obtain more accurate and valid data.\
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