Sir, we read with interest the correspondence by C. Emery and R. Chate (BDJ 2020; 229: 4-5) advocating the use of rubber dam as an infection control precaution. In response to the COVID-19 pandemic, we undertook a rapid literature review on the effectiveness of rubber dam in reducing the risk of transmission of microbial pathogens during dental aerosol-generating procedures (AGPs).
Six studies1,2,3,4,5,6 produced a broad consensus that the use of rubber dam during dental AGPs is effective at reducing the spread of spatter by 33%, as well as reducing surface contamination with bacteria by 80-99% at a distance of up to one metre. One exception7 suggested that rubber dam could deflect spatter onto the dentist's head; however, this is unlikely to be of clinical significance provided the dentist wears appropriate personal protective equipment.
Unfortunately, no studies investigated the effectiveness of rubber dam in preventing transmission of viral pathogens. While it might be reasonable for practical purposes to infer that rubber dam would reduce viral contamination as well, this is clearly a topic that deserves investigation. Using viral transport media for subsequent amplification by polymerase chain reaction, then reporting viral load data, would enable quantification of the impact of rubber dam on viral transmission.
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Scott, D., Hogan, T. & John, J. Rubber dam evidence. Br Dent J 229, 150 (2020). https://doi.org/10.1038/s41415-020-2011-y
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DOI: https://doi.org/10.1038/s41415-020-2011-y
