Except for economic reasons in poor countries, I can't understand why the use of rubber dam is not widespread in general practitioners' clinical activity. From my point of view, there is no reliable explanation to justify not using rubber dam, especially in endodontics.
Good topic, but... indeed rubber-dam's history is over 50 years now. I have no idea why it is still rarely used in dental practices. I think the main factor is the lack of education on universities and on post-graduate courses. Why dentists do not use it? They are lazy ;-) Maybe they think that it is horrifying to the patients. Dentists' doubts and anxiety concerned with the use of rubber-dam is visible to the patients. Then patients don't agree and we have circulus vitiosus. I admit, that i don't use rubber dam in every case of restoration, because smoetimes it doesn't help. In endodontic treatment rubber dam is a must-have. According to ESE rubber dam is one of a standard features of RCT. I always teach practicing dentists during post-graguate courses, that without rubber dam they have no contamination control during endo (saliva is everywhere). Argument about a possibility of patient's choking with the endodontic instrument is very good also.
In my opinion, the reason is:
"Failures due to reinfection of the canals via microorganisms of the oral cavity is not usually a rapid consequence of not using a rubber dam."
Medico-legal involvement is the most reasonable way to reduce the occasion of this habit. Indeed, there are clinical situations where the use of the rubber dam is not indicated; but still they are few.
From my point of view the practionner should not wonder if the rubber dam is indicated or not in endodontics. The crucial question is how to put it ? I think there is always a possibility to facilitate the rubber dam use. For exemple, it is imperative to make a restoration before the RCT when you have lost some dentin wallls in the coronal part. When it is impossible to find a way to put the rubber dam, the tooth should be extracted. Endodontics without rubber dam should not exist
It's unfortunate that too many dental practitioners do not regard the patient's health, safety and welfare as paramount. Patients place their trust in doctors, so when a dentist knowingly skips over the use of a rubber dam, this is a breach of trust.. Every dentist knows (or should know) that the rubber dam (RD) is essential for endodontic therapy. Failing to use the RD is likely due to ignorance, laziness or greed..
Time, perceived value for money, and performance I would say are the main reasons, with laziness topping those 3. There are some procedures where saliva is required to contact inner surfaces of teeth prior to filling so its not appropriate in all dental procedures.
My way of thinking is: no rubber dam=no RCT as simple as that. And I prefer to use it for almost all of my restorative work. I do not know about you but I get tired of all this pulling of cheeks, tongue, etc...
It is simple and fast to put rubber dam on any tooth but, and it is a big but, clinicians have to do it regularly and not rarely. The reality is that most of GP try to work fast and and rubber dam slowes them down and force them to explian how to manage with it (no spittttt- how can one manage without spiting- easy. it is just a set of mind!). They want the patient to remember them as fast, comfortableand unpainfull and rubber dam, in their mind, slows the treatment and makes it uncomfortable.
Rubber dam is beneficial for both parties: the patient and the dentist
Benefits for the patient are:
- " It feels as if the tooth you have treated was outisde my mouth"! This is an often heard statement by the patients.
- "It gave me the ease to move my tongue around and swalow".
- "I felt very comfortable and safe!"
Benefits for the dentists:
- Prevention of leackage (BTW: never came across any procedure where salive was required!).
- Isolation of the view and creation of a clear view - ease to focus.
- Isolation from gum penetration.
The benefits for the treatment were already discussed above.
Problem for the dentists are:
-the additional treatmnet step,
-learning curve,
-need of instruments and materials.Very few of the GDP s outside are willing to learn, to realy improve (to much hassle...), to keep up with evidence ( to much to read...),
-need to teaching the team, etc.
It is very sad to realise that 97% of the profession stick to what they have been instructed last time at dental school....
Sorry for the negative statement ....but there is no reason on this world not to use rubber dam....
Liviu Steier
Maybe they don't care if the pacient come back with tooth problems after a while.
A bad filling or a mised root treatment are just ocasions for another treatment and some more money. Acording to the legal treatment requirements in many countries (as long as I know) you don't have to use rubber dam in all situations (if any).
Around us are a lot of examples that greed is good, isn't it?
Have been asked by practioners to quote scientific evidence in favour of rubber dam.
Sadly none available....but how would one design a study in vivo at all? This is the question....common sense ? Difficult to perform....any further suggestions?
Dr. Liviu Steier, may I suggest that anyone who raises this question with you should be told that their question is equivalent to asking if there is scientific proof if air is really necessary for breathing. One of the functions of the RD is also to prevent small instruments from falling back into the patient's throat. So you are quite right, i.e., common sense should prevail.
Thank you dr cohen, could not agree more.
Even so we really have to come up with a miraculous study....the sooner the better i am afraid!
Liviu, as you were involved in some of the dental ozone esearch, you should remember the best source of minerals to start the remineralisation process after ozone treatment is the patients own saliva. If you want to use r/dam, then just get the dental nurse to lick it
In many countries just like Italy the lack of Government Clinical Guidelines specifically citing that RCT must be performed by using rubber dam gives to general practitioners the perception it is not required, thus they do not use it. They usually apply low fees for endodontic procedures in order to charge more prosthetics, therefore quality standards of GP's endodontics are still low. Recently the Italian Endodontic Society together with the Italian Academy of Conservative Dentistry, after a long lasting cultural battle, are recently involved in the "Rubber Dam Project" , approved by National Ministry of Health which will bring to a dense program of meetings, conferences, communication campaigns all over the country. This will culminate with the issuing of the New Clinical practice guidelines in dentistry where the use of rubber dam is finally required.
Thanks for all your comments. It is very astonishing to see that all our students are convinced about the advantages of the rubber dam and meanwhile just after their graduation, they seem have forgotten the guidelines to treat their patient. It's a vicious circle because their knowledge is "contaminated" by certain bad general practionners habits. Finally, they loose the pleasure when they work and they are disgusted by endodontics.
Julian, afraid i clearly have to contradict.
There is not one application of saliva in restorative dentistry neither in endodontic at least not evidence based! Sorry to agree that we massive disagree on the topic.
Dr pasqualini,
great news from italy. Thank you for sharing the informations with us.
Good luck and please do makes sure accurate guidlines will be set and hopefully
followed soon by the rest of the european community.
Here attached is the AAE Position Paper on Dental Dams, with few references, most of them focused on complications and legal litigations due to non use.
Thank you Liviu for your reply. Honestly "I believe it when I see it", when they will be approved and officially published. To many times in these last few years I have seen similar projects fail, sometimes even due to the tough opposition of the GP's Associations. Have a nice day
The only reason I can think of GP in Italy do not use it is they do ot read, and they do not care about their work. I work in Mexico, a not developed country yet and at the 74 dental schools we teach students they must use the R.D. all the time . Specially for endodontists, I am a Pediatric Dentist and always use it.
Dear Marisela I do not think italian dentists do not read or do not care about their work as well as the use of rubber dam is tought and mandatory in all Dental Schools. However I do not think that all graduated students, in Italy like in Mexico, use rubber dam just out from University in their private practice. In general the quality standards of italian dentistry are mean to high, since dentistry is almost entirely provided by private practitioners. Many italian endodontists are well known all around the world and are constantly involved in sensibilization campaigns all over the country. As I said it is just a question of bad culture and lack of official guidelines, both to be converted into a clinically correct and more ethical approach.
Yes, correct there is a difference between education and habits..! Bad culture and lack of guidlines.....trust me they do not care!
Yes except people like arnaldo, giuseppe, gianlucca, etc....
Yes, italian dentistry can be inspiring if demonstrated and practiced by experts!
Dear Liviu. I am a peruvian dentist It is true that in all dental schools taught students the importance of using the rubber barrier (Quality clinical procedure and biosafety). However, in daily work a large number of dentists do not use it. Each country has a different reality. In Peru, it is not an economic problem. Dentists get into bad habits when working for other health care private / public who mostly do not have the system to work with rubber dam. The same applies to the use of semi adjustable articulators. I pose the question why most dentists do not use semi adjustable articulator to rehabilitate a patient?
Dear luis,
we are in full agreement.
There is no way to perform a prosthetic restoration without mounting the modells in an at least semi adjustable articulator using face bow and an adequate bite registration (either centric or fgp). In prosthodontics physics will explain the consequences of not using the articulator while in endodontics only research may demonstrate the difference between using or not using the rubber dam.
The suggested research will never receive ethical approval as you can imagine...as a consequence common sense will replace scientifc prove!
Use of the RD is mandatory and when a practitioner departs from the Endodontic Standard of Care, ther's always a lean, hungry plaintiff's (was once the patient) counsel waiting to pounce on a negligent dentist if anything does not turn put well. SC
Hi Dr. Stephen,
Indeed, RD is mandatory in endodontics, and it is recommended for certain clinical situations in operative dentistry and pedodontics as well. But the important question is: What is the scientific evidence that the use RD increase the rate of clinical success?. Unfortunately, the scientific evidence is scarce, and even some studies showed that the application of RD does not affect the clinical outcomes of direct pulp capping via calcium hydroxide!! (Accorinte et al. 2006).
In my clinical practice, I almost use the rubber dam in every case even in third molars (Ahmed 2012), but I believe that the presence of a scientific evidence would increase its adoption among other clinicians; This has been the same situation with the role of magnification in endodontics, which have been investigated in many studies.
The other issue that many surveys showed that the prevalence of using the RD among GP/specialists is quite low, which I believe it is not a big problem to determine the prevalence as much as to know how dentists are placing the RD!. Placing a RD in the wrong way (leaky due insufficient proximal wall/caulking materials are not used when indicated) would bring saliva more than if it is not placed!!
Hello, Dr. Ahmed,
In the USA, these are 2 separate issues. Your issue is about the scientific evidence to support the need for the RD--a valid question which actually can be answered if you go to the AAE website or even Pubmed.gov. The other issue is from the Civil legal system in the USA wherein the Standard of Endodontic Care is our benchmark. Any dentist who fails to use established clinical practice guidelines will be subject to Civil penalties if an avoidable accident or mishap should occur. SC
Many thanks Dr. Stephen for your reply. Indeed, the application of RD/legal issues have been addressed in some countries. But my question is: "Is there any clinical study has been performed to compare the success rate of RCT with and without using the RD, so we can have a scientific evidence?." To my knowledge, the answer is no, and the reason is that such a study would require RCT without RD as a test group which is not applicable, even if the patient is going to sign for a consent with this regard. Probably, the application of animal models would provide this scientific validation, in my opinion.
By your inference about the inappropriateness of a cohort human study on this subject I think you've answered your own question. SC
Despite the inappropriateness of such clinical study, hopefully, this issue can be validated by other means, in vivo. I believe this is the best way to convince others fan of numbers/percentages and statistics!!
Thank you for all your comments. When i give a lecture, among all the available reasons to convince mostly practionners to use rubber dam, the most efficient is to avoid instruments inhalation-ingestion. In general, they freak out after seeing lungs or trachea radiographs with endodontic instruments.
I agree with you Frederic. This is another important approach for convincing DP regarding the application of the RD, besides its role in minimizing the transmission of diseases via droplet infection.
Dear Shahram Hamedani,
unfortunately, not to my knowledge. Having said that, how could we follow this kind of study if we are fully convinced about the rubber dam utility ?
From my point of view, even if we could think that rubber dam doesn't influence the prognosis, it would not be a sufficient argument not to employ it.
Indeed, we should take into account all its advantages in order to easy root canal therapy procedures. Endodontics is always a challenging activity and we must use all means in order to facilitate it.
Dear Frederic
You're absolutely true. I was thinking of it in the " researching lobe"! of my brain, since the clinical lobe is quite sure about the huge necessity of RD !....thank you for answering.
Dear Hamedani and Frederic,
Since more than 50 years, RD always is an argument between endodontists and GP. Many dentists strongly believe that the effort and cost of RD application is not corresponded with a detectable enhancement of the ttt outcomes, especially if they did not experience an accidental file ingestion or TB disease from a droplet infection.
I agree with you Hamedani; it is better to have an evidence to end up this argument scientifically, but this would require a good sample size of a relevant animal model and long term follow up. I am not sure what place can do such experiment. For me, if I have extra money and animals, I will gonna use them for another project!!. but it would be nice if any college could carry out this investigation.
Very true. That would inevitably end any controversies and confirms legal issues and laws which impose
GPs in using RD in all RCTs.
Apart from legal issues...... using rubber dam is Time Consuming, and expensive.
Knowing what you know, would you want root canal treatment without a rubber dam? Think long and hard before you reply. SC
Dear Rama Krisna Alla,
I can't figure out you comment. Please provide us all the detaiils to explain that. Time consuming...How long ...? Expensive...How much ? your arguments seem to be very weak.
With experience, it only takes seconds to apply. Could you answer my question? SC
Indeed Dr. Stephen, the application of RD would take from you few seconds, because you are an expert in the field, and this is quite similar to other endodontists, but for GP or freshly graduated dentists, this would take some minutes, or even more. For sure as we mentioned earlier, the application of RD is essential for endo ttt, despite all arguments/presence or lack of scientific evidence. But I hope that we consider that not all countries are the same regarding the cost. As we know, a RD is not only a sheet. There are clamps/frame/puncher/clamp holder (and you should have multiple sets if you are an endodontist). In developing countries, this could be considered as an "overhead" for a dentist/endodontist who is working in a quite poor area. I believe that the economic status also may play a role in such minor facilities!!
we once made a survey among our patients (alas, we only got it published in the belgian Dental Journal ([The rubber dam, a problem for the dentist or the patient?]., Slaus G, Minoodt I, Bottenberg P. Rev Belge Med Dent (1984). 2005;60(4):301-9. French (or Dutch, if you prefer). There it appeared that acceptance among patients was more than 80% positive, even after three-hours endo session with a jumnior student. On the other hand, dentists seem to be more reluctant, as another survey of our team suggests (A survey of endodontic practice amongst Flemish dentists. Slaus G, Bottenberg P. Int Endod J. 2002 Sep;35(9):759-67). I use rubber dam as often as possible an till now, most new patients ask "is this new?", I say: "yes, since 1860!". However, most patients accep0t or even prefer rubber dam: no dry mouth, no noisy suction device, no contamination by bad-tasting chemicals... DO IT!
Rubber dam is probably the best innovation Dentistry has had ...it is new since 1860!
It safeguards the patien during the treatmnet and raises treatment acceptance.
It eases dentist s work.
It embelish clinical dentistry.
It raise treatment outcame predicatbility.
It is cheap.
You are right do not use it if you do not want to benefit from the above advantages!
Dear Stephen
Could we exchange on different topic on private mail please?
My private mail is [email protected].
Kind regards
Liviu
Thanks Dr. Peter Bottenberg for sharing these valuable surveys. Indeed, these results should encourage more clinicians towards the application of RD.
I think the main reason GPs rarely used rubber dam is lack of confidence that they can put it in their first shot. Being not trained to choose the right clamp for every case make them hesitant to use it. If they use it frequently, they will end up using only 3 or 4 sizes for almost all cases. Actually, using the rubber dam save time as procedures generally go smoother than without it.
Well said Elsalhy, It is the practice which gives confidence and willingness to use RD in clinical practice just like other dental materials. I think whatever we study in our dental graduation is retained and followed longer. There should be incorporation of the usage of RD as a dental material in conservative dentistry and endodontics from the graduate level of education in every patient so that by the time the individual comes for practice he/she is much used to it and considers it to be a part n parcel of the instrument kit.
It is naive not to use a rubber dam. It is essential to microscopy. Greatly reduces the physical energy required for practice by negating the need for cheek retraction. It diminishes aerosolization of oral pathogens. It closes the oropharynx to prevent aspiration and limits the encroachment of the tongue into the operating area. Once again, perhaps the best innovation dentistry has ever known.
The value of the RD remains undebatable. The prime reason why it's not used by many remains the question. In India, despite the use of modern technology in other aspects of dentistry, the dam has been neglected primarily citing a much heavier daily clinical load compared to other countries: averaging 15-30 patients a day. While i personally agree (and use the RD) that a habituated practitioner will take not more than 3 minutes to apply it, the inhibition arises from lack of experience and the heavy load of patients becomes the devils advocate, so to say. Those who use it do reap the benefits. Though personally,i also would add here, the innovation in the field of isolation deserves to come of age from 1860 to the next big thing.... Easier, faster...and most importantly...universally acceptable... no matter what the reasons given to not use the current ones.
The obvious reason that explain the controversial explanations regarding the use (not use ?) of RD is the educational process specially dealing with clinical asepsis. General speaking, as compared as the early primary school time of the students, an excellent education background lead toward attitudes and skills that all trainees will never change during life and what ever the professional environment in the future. Weak asepsis education lead also to bad attitudes even dealing wth the restoratives procedures. Surprisingly, asepsis is used for all surgical interventions including in endodontic speciality for which the dentist will never discuss the use of the RD
Students should be in contact with the patient since the first year (2nd semester). During the preclincal asepsis should be the main concern of the educational process and what ever the task should be strictly assessed supported by scientific critical thinking. The role of the staff is to help the students specially give pleasure to proceed easily the asepsis using RD within different situation from the restoratve clinical tasks (since 3rd semester) through endodontics for which the process is conceptuall easier than during restorative treatments.
Regarding my personnal experience I was extremely well educated and consequently I would never use the moral sense or my belief to stimulate the students. Giving continuing course (rotary shaping instruments) I noticed that the most of practitioner trainees were not skilled to use the RD and had no motivation to improve the aseptic conditions (to old to learn at this stage the said, very bad reason)
Great points raised gerard!
There is lack of understanding for the biologic side of our speciality including biofilm management. The goal of education should be refocused from a mechanic approach to a biologic one. This will as well help tremendous change the currently still misrepresented picture of dentistry within the public.
Of course major question is: do we own the resources, educators, facilities to shift the paradigm?
Liviu, I completely agree with you. Those dentists who practice strictly on the mechanical side are merely technicians. Dentists who practice with a biologic understanding of the living tissue they are treating--these dentists are rightfully called doctor. SC
One of the reasons could be a lack of awareness among the GPs about the proper technique of usage of dam and ignorance towards learning the same....
Basically, i think that the RB issue is probably the perfect reflect of both difficulties we have in terms of teaching.
We are in the vicious circle because even if our students are able to understand the advantages and have the skills to use RB easily, unfortunately, they are contaminated by the bad habits of most of practionners depending on the kind of dental office they will work after have been graduated.
w2onderful discussion.
and Liviu has put it very succinctly...."Of course major question is: do we own the resources, educators, facilities to shift the paradigm?"
in india, nobody uses the rubber dam at undergraduate level..endodontists use it the most.
money is a constraint and also lack of training.
The dentist are not trained for that and they underastand that with the ruber dam they get a fast treatment withou contamination
...and you are worried about practioners not using rubber dam....
Gave today a lecture at the british dental association - title: "to save or to extract - solving the treatment decision dilemma"...was told by the delegates that i released the genie out of the bottle .... Sadly the level of knowledge, expertise and professional skills today is substandard.... The audience got worried when looking back on their professional achievments....
....and the conclusion is: we are living in pecuniar driven times...ethics are the past!
How sad is this?
Hello Liviu, we are in full agreement...as usual. When i speak about this topic i have exactly the same feeling. The decision making process is almost focussed on dentist business. It's gonna more and more tricky to exchange and share with this kind of practionners because i think finally we don't do the same work. I will send you a pdf of my presentation to observe if we have the same approach but it is probably the case
Dear frederik
thank you. Looking forward to that.
My e-mail address is
Kind regards
I agree with you Liviu. The application of RD is undermined in many places around the world because of all reasons mentioned in this interesting discussion. We only have such presentations/publications to encourage our colleges towards the application of RD, and it would be nice if we also investigate the effect of such presentations/education programs on the adoption of RD among dentists in the form of clinical surveys, which can be compared among different places in a given country or among different countries.
I agree 100%. When my wife and I opened our practice 30+ years ago we agreed that wherever possible we would use rubber dam. It is the best way to do dentistry.
What a raft of academic flap-doodle. Where is the mention of the patient connected to that rubber dam? They are universally hated by patients and clinical dentists alike. People who can't do fast, perfectly beautiful dentistry in a dry field without the RD sell funnel cakes at Yankee baseball games and let dentists practice on humans.
There is a Bell Curve for the quality of endodontic care, and some dentists are on the Left side of the Curve. Sad, Very sad. SC
Stephen well said and politically correct phrased.
Sadly lack of knowledge does not disculp...but there is
only one problem... Spreading of that should be forbidden!
Liviu, I completely agree with you. In a more perfect world it would be forbidden to do RCT without a RD, but all we can do teach the next generation how to serve the patients best of all and hope the knowledge is applied in clinical practice. SC
Hi Dr. Liviu and Dr. Stephen,
I think there is one question could be asked to those in the left side of the curve :"Would you ask for RD isolation for your own tooth if it is scheduled for RCT?". If the answer is NO, then we are facing a big problem that requires a great effort!!
Dear Hany, Stephen and Liviu,
I'm in full agreement. The way is long, long...in order to manage this kind of issue but we must not give up even if it is sometimes discouraging.
We have to struggle not only against the lack of kwowledge but also against intellectual dishonesty, and unfortunately, it is the most serious issue.
Hello dr
based on this issue we had a survey on the usage of rd in practice. The result and not using the rd was the same. To over come this we have implemented the use rd in ug level and its mandatory......
Frédéric , I am encouraged that Shashirekha and her clinic are upgrading to RD usage as mandatory. Yes, it's a l-o-n-g, slow slog, but we must keep pressing the message that the RD must be used everywhere when endodontic therapy is performed. SC
Basically, i think this issue is more difficult to manage with old practionners because they are conditionned by their habits and sometimes are afraid of the changes and the patient feeling front of their difficulties to put the RD.
Yes, Frederic.. "Learning in youth is like engraving in stone, while learning in the elderly is like engraving in water". Indeed, few exceptions do exist!!
The answer is very simple: it needs to learn about using the rubber dam. It is very difficult to put in discussion your own knowledge when your reality is every day the same little office with no possibility of confrontations.
Rubber dam fails to protect from saliva --assistants get lazy on suctioning and leakage sneaks up on you without a warning. The patients also do not like it and TMJ /occlusal muscular pain patients cannot withstand its use. My practice is full of these patients that have come to me after other dentists have iatrogenically locked their joints.
Dear Pedro and Robert,
I'm sorry not to agree with you. If in any case, the RD is not mandatory in restorative dentistry procedures (it's not my point of view) especially if you use an other way to bond in good conditions, i think the problem is totally different in endodontics.
In fact, even if i think it is almost impossible to avoid salivia contamination without RD, the goals of the RD are not only in relation with this point.
For instance, irrigants and instruments ingestion or inhalation must be prevent by using the RD. It is ESSENTIAL...
Moreover, technologies such as ultrasonic, microscope...can only be well used with RD.
To summarize, from my point of view, even if the RD was not in relation with prognosis enhancement, the RD should be systematically used owing to its great convenience and its obvious role to easy RCT.
Having said that, the occlusal argument advocated by Robert is not reliable because we can avoid this kind of issue by using a posterior jig to avoid muscular or articular pain during RCT. After more fifteen years of endodontics practice with RD, i've had only one patient who had his joint temporary locked for two minutes after RD removing. What a pity for him...
Frederic is exactly right. Some dentists are willing to settle for "good enough" or "close enough"---these are probably the same dentists who were satisfied to receive a "C" in dental school. I submit this question as a hypothetical: If you were the patient receiving Endodontic therapy for a 2nd molar, would you want your dentist to use a rubber dam? Go inside yourself and examine your conscience and you will arrive at the better answer. SC
Totally wrong...
Wide majority of patients like RD if the practionner has well educated them by explaining all the advantages. Having said that it depends on the way you used to present the RD to your patient and also your ability to use it. I think the main problem with the RD is that practionner frequently lock his brain by convincing himself with inacurate arguments. The Human nature...
The majority is not always right...From my point of view, the problem is the same around the world like RCT quality...The social culture may has a strong impact but can't all explain. I continue to think that it is a question of willpower. RD is not a "nice to have" but a "must have". Having said that, all the comments regarding this topic allow us to understand why the rubber dam is rarely used by general practitioners but...most of arguments to justify it is likely irrelevant.
I think we are at the end of the corridor...Let me know if you want to participate to this new topic:
https://www.researchgate.net/post/Would_you_accept_to_be_treated_for_a_root_canal_therapy_without_rubber_dam
Just as saliva leaks into the rubber dam area, irrigants leak underneath the rubber dam. We use bite blocks as well, and roughly 50% of the time the patient asks to have it removed. Conceptually rubber dams are perfection. Clinically they create more problems than they solve. Thankfully, there are multiple options for controlling saliva and protecting patients against ingestion of medicaments.
You have to check out the absence of leakage before starting your root canal preparation. If a leakage exists, you can easily stop it by using differents means such as Opal Dam or other products. I will not manage to convince Robert. I give up.
Yes, Frederic. Your Question on the application of RD confirms that we are facing a big issue that is beyond the capabilities of our limited efforts.
"A multidisciplinary approach is a MUST"
maybe we waste time with this kind of topic. We are not the first and the last to attempt to convince GP about the RD. The discrepancy is incredible because you have many meticulous practionners in one or several fields of dentistry and the same are totally careless in other fields.
I do not agree with you this time Frederic. If we get only one, out of the over 1000 viewers of this topic, is convinced with the application of RD, this should be a great success!!. We should never give up because we have a number of portals, such as publications/books/lectures/websites and others, to convey knowledge and experience. I believe your question, at least, showed us the size of problem we have!!.
Frédéric, dentists have all been taught to use the RD when they were in dental school. If a dentist chooses to "cut corners" or has a loose moral compass enabling him to do second-rate dentistry, there is nothing that can be done about that. Indeed this is a betrayal of trust the patient places in the dentist's hands if the dentist knowingly avoids applying a RD for endodontic therapy.When ethical values are discarded, substandard dentistry will be the outcome. SC
As educator we ought to ignore which factors explain in what extend the use of rubber dam is versatile. Early contact of the student with patients, assessment of aseptic attitude since the first second of the educational process (including the lab learning) and simultaneous development of critical thinking are really stimulating for the students and consequently lead to graduate genuine doctors as quoted S Cohen
Let's discuss "substandard". For RCT do you use both sodium hypochlorite and chlohexidine? And then finish sterilization with laser?
Dear Robert
Regarding the use of LASER, find as attached file a recent metaanalysis showing weak evidence of the outcomes. Regarding the simultaneous use of NaOCl and chlorexidine, read Textbook of endodontology edited by Bergenohltz and al.
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