Sir, I thank Raymond Shamash1 for his interest and comments in my recent opinion piece2 but perhaps he would be better served by enrolling in one of the 'Dam it – it's easy' seminars.

Saliva control is a simple and straightforward procedure, sedation or no sedation. The patient will either have a passive swallow or not. Although the operating team have an overall, as well as individual, duty of care for the patient being treated, this responsibility is fairly and squarely assigned to the close support nurse involved in the session, who will be able to easily peek at any possible saliva build-up by quickly lifting up the dam, looking into the mouth and then evacuating if needed.

We use a rigid plastic curved frame (Hygenic Master 6”) with the rubber stretched over the convex side which facilitates this. If there is a likely build up (seal of dorsum of tongue against superior and posterior of oropharynx) then this is quickly and gently aspirated, and the process replicated appropriately throughout the treatment session. Treated as described, we find that patients (unsedated) undergoing quadrant dentistry under dam will be totally relaxed and regularly fall asleep!

Placing a thin low volume aspiration tube behind the dam is the preference of some operators but I find that patients are more likely to be uncomfortable if their oral mucosa becomes over-dried and they will unsuccessfully try to re-lubricate with a dry tongue and hardly ever relax.

Considering emergency access to the airway being needed, in a career involving literally thousands of rubber dam applications for conservation/restorative treatment with a proportion of these patients sedated and/or anaesthetised (when this was allowable!) this has been considered necessary only twice. It is quickly solved if instant and complete removal is judged necessary by grabbing the rigid frame and pulling it off. This will usually, but not always, bring the clamps with it as the rubber is gingival to the jaws of the clamps.

In regard to the suggestion that for endodontic procedures in preference to rubber dam that 'it would be better to control against misplaced files with floss ties' and thereby have colleagues forgo the isolation, access benefits and protection delivered by rubber dam against instruments and irrigants, I can only in reply quote a certain J. McEnroe in his 1981 outcry in frustration to Wimbledon umpire (and incidentally, dentist, Edward James): 'You cannot be serious?'