Sir, the evidence in favour of the use of rubber dam in contemporary endodontics is strong. It's recommended in textbooks and articles,1,2 by the European Society of Endodontology3 and the American Association of Endodontists.4
However, it seems that it is still not being universally applied in general practice. The most recent study examining the use of rubber dam and reported in the British Medical Journal5 showed that less than half of the sample of 1,490 American dentists were routinely using a rubber dam every time.
Now, a widely reported6 accident in the UK, in which a file fell into a patient's airway and pierced the patient's stomach, highlights well the important role of the rubber dam in protecting the airway. Publicity of this kind is not what the profession needs.
Some years ago the Chief Dental Officer mandated single patient use of endodontic instruments to support cross infection control. Perhaps the procedural use of rubber dam should now be mandated to prevent further calamitous consequences?
In an era when forums provide resources and the opportunity for the sharing of information, it should not be argued that rubber dams are not tolerated. Well-informed patients can see the logic of isolating a tooth for both clinical and safety reasons.7
There is no better way of demonstrating that we put patients' interests first than by only operating according to best practice. The message should be no rubber dam, no root canal treatment.
Carrotte P . Endodontics: Part 6 Rubber dam and access cavities. Br Dent J 2004; 197: 527–534.
Webber J . Risk management in clinical practice. Part 4. Endodontics. Br Dent J 2010; 209: 161–170.
European Society of Endodontology. Quality guidelines for endodontic treatment: consensus report of the European Society of Endodontology. Int Endod J 2006; 39: 921–930.
American Association of Endodontists. AAE Position Statement. 2010. Available at: http://www.aae.org/uploadedfiles/publications_and_research/guidelines_and_position_statements/dentaldamstatement.pdf (accessed January 2017).
Gilbert G H, Riley J L, Eleazer P D et al. Discordance between presumed standard of care and actual clinical practice: the example of rubber dam use during root canal treatment in the National Dental Practice-Based Research Network. BMJ Open 2015; 5: e009779. 10.1136/bmjopen-2015-009779.
Frodsham I . Scared of the dentists? Turn the page now! Patient, 29, traumatised after dentist drops inch-long spike down her throat during root canal surgery. Daily Mail 19 November 2016. Available at: http://www.dailymail.co.uk/news/article-3949174/Woman-suffers-punctured-stomach-dentist-drops-inch-long-dental-file-throat-underwent-root-canal-surgery.html?ITO=1490 (accessed January 2017).
Dental Fear Central. What is a rubber dam and why would your dentist want to use one? Available at: http://www.dentalfearcentral.org/faq/rubber-dam/ (accessed January 2017).
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Webber, J. Endodontics: No rubber dam, no root canal. Br Dent J 222, 142 (2017). https://doi.org/10.1038/sj.bdj.2017.101