|Year : 2012 | Volume
| Issue : 2 | Page : 75-79
The attitudes of dental interns to the use of the rubber dam at Riyadh dental colleges
Bander Mohammed Al-Abdulwahhab1, Huda Al-Thabit2, Alhanoof Al-Harthi2, Rawan Shamina2, Ashwaq Al-Ashgai2, Fayhaa Al-Qabbani2, Sharefa Al-Ghamdi2, Roaa Al-Taher2
1 Royal Clinics Department of Dental Services, Part time faculty at Riyadh Colleges Dentistry and Pharmacy, Riyadh, Saudi Arabia
2 Riyadh Colleges Dentistry and Pharmacy, College of Dentistry, Riyadh, Saudi Arabia
|Date of Web Publication||6-Mar-2013|
Bander Mohammed Al-Abdulwahhab
Royal Clinics Department of Dental Services, Part Time Faculty at Riyadh Colleges Dentistry and Pharmacy Riyadh 11685, P.O. Box 102799
Source of Support: None, Conflict of Interest: None
Background : The rubber dam is one of the best tools for tooth isolation and infection control in the dental field. Our aim is to evaluate the attitudes toward the use of rubber dams by dental interns in Riyadh Dental Colleges (RCsDP) and determine the barriers to their use. Materials and Methods: A self-administered questionnaire was designed and used for data collection. 150 questionnaires were distributed by hand to the dental interns of RCsDP over a period of two weeks. Information sought included the attitudes toward and difficulties for the use of the rubber dam, the time needed to apply the rubber dam, and the patients' allergic history of the rubber dam. Respondents were asked to state their preference on a five point Likert type scale ranging from "strongly dislike" to "strongly like". The information and data of the completed questionnaires were statistically analyzed using Mann-Whitney U test and Friedman test. Results: Of 150 questionnaires distributed, 150 were completed and returned (response rate = 100%). Of those, 46.7% were males and 53.3% were females. In general; (43.3%), interns strongly liked the use of the rubber dam and the rest (46.7%) liked the use of the rubber dam. The majority of respondents liked to use rubber dam in direct restorations more than in indirect restorations and 46.7% strongly liked to use it in posterior teeth for composite restoration. Most dental interns felt that they would strongly like to use a rubber dam for endodontic treatment whether in posterior teeth (73.3%) or anterior teeth (68.7%). 66.7% of interns asked their patients if they had an allergy to latex prior to the use of the rubber dam. Child behavior (mean rank about seven) is the most important reason for not using rubber dam. The time is taken to apply the rubber dam was less than five minutes in most cases. Conclusion: Most dental interns prefer to use rubber dams in the general dental field and are enthusiastic to use it in future.
Keywords: Attitudes, dental interns, Riyadh dental colleges, rubber dam usage
|How to cite this article:|
Al-Abdulwahhab BM, Al-Thabit H, Al-Harthi A, Shamina R, Al-Ashgai A, Al-Qabbani F, Al-Ghamdi S, Al-Taher R. The attitudes of dental interns to the use of the rubber dam at Riyadh dental colleges. Saudi Endod J 2012;2:75-9
|How to cite this URL:|
Al-Abdulwahhab BM, Al-Thabit H, Al-Harthi A, Shamina R, Al-Ashgai A, Al-Qabbani F, Al-Ghamdi S, Al-Taher R. The attitudes of dental interns to the use of the rubber dam at Riyadh dental colleges. Saudi Endod J [serial online] 2012 [cited 2020 Aug 9];2:75-9. Available from: http://www.saudiendodj.com/text.asp?2012/2/2/75/108153
| Introduction|| |
Isolation of teeth is an important factor for multiple procedures in dentistry. The value of isolation relates to reducing potential risk of cross infection between dental staff and patient.  The rubber dam is the most widely used and considered to be the best method of infection control, in particular during root canal treatment. It has been used in dentistry for over 150 years and S.C. Barnum was the first author to introduce it in the 1860s. , The use of the rubber dam enhances patient comfort and protection from aspiration or swallowing dental instruments, irrigating solution, medication, or debris during dental procedures. In addition, it improves treatment efficiency during root canal treatment. ,, Studies have shown that the use of rubber dam greatly reduces the microbiological content of aerosols produced during dental procedures. ,
Many societies worldwide recommends the use of the rubber dam in many dental procedures, including the European Society of Endodontology  and British Society of Paediatric Dentistry. 
Rubber dams are used mainly in endodontic and operative dentistry. Unfortunately, the majority of dentists do not always use a rubber dam during endodontic procedures. ,, Undergraduate dental students indicate that they are highly likely to place a rubber dam during root canal treatments. , In other instances, the use of a rubber dam for operative dentistry procedures is much lower. ,, A survey of the United Kingdom (UK) was carried out by a group of general dental practitioners reported that 44.5% never used rubber dam. 
A literature review identified the major barriers of using rubber dame as: Challenging technique, occasionally time consuming, some patient does not like it, and cost of equipment and materials. ,,,, A survey carried out in the UK noted frequent rubber dam users were significantly less likely to see barriers than non-users. 
The dental interns are recent graduate students who must finish a one-year internship program. The program included a clinical training where they performed a complete comprehensive dental treatment to patients including root canal therapy and operative dentistry. Their daily clinical practice is usually based on what they have been learned during their undergraduate study. So, at this stage of training, it was interesting to know their idea about their current and future attitudes toward rubber dam usage. Therefore, the aim of this study was to evaluate the attitudes of using rubber dam by the dental interns in college of Dentistry of Riyadh Dental Colleges (RCsDP).
| Materials and Methods|| |
A self-administered questionnaire was designed and used for data collection. The questionnaire was developed after extensive literature review and expert discussion and opinion. In addition, a pilot study was conducted on twenty interns to examine the validity and reliability of the questionnaire. A total of 150 questionnaires was distributed to the dental interns of RCsDP which include questions about the attitudes toward the use of rubber dam during their dental practice. The difficulties of using the rubber dam such as the time needed to apply it, type of performing dental treatment, patient's behavior, patients' allergic history of the rubber dam were included in the questionnaire form. The survey was estimated to take less than two minutes. Permission from the Department of Research and Development at RCsDP was obtained prior to conducting this study. All the interns were given the opportunity to decline participating in the study.
The respondents were asked to rate their preferences over a five point Likert type scale with 0 indicating that they strongly disliked using a rubber dam in a given procedure and 5 indicating that they strongly liked using a rubber dam in a given procedure. The information and data of the completed questionnaires were entered into an electronic database (SPSS® for windows ® V.20.0). The Mann-Whitney U test was used to determine differences between gender regarding specific barriers to the application of the rubber dam. The Friedman test for multiple related responses was used to rank the difficulties reported by the interns from the most important (highest rank) to the least important (lowest rank).
| Results|| |
Results are summarized in [Table 1] and [Table 2] and [Figure 1] and [Figure 2].
|Table 1: Attitudes toward rubber dam use in the general dental field, adult and child patients, and in the future|
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All the 150 questionnaires distributed were completed and returned (response rate = 100%). The male participants were 46.7% and the females were 53.3%.
The attitude of dental interns to use rubber dam
In general, most dental interns (90%) liked to use rubber dam. There was no significant difference between males and females (P = 0.432). Most interns (87.3%) were more likely to use a rubber dam on adults. About 22.6% disliked using rubber dam on children. In addition, 86% stated they would prefer to use a rubber dam in the future after finishing the internship program [Table 1].
The majority of respondents liked to use a rubber dam in direct restoration more than indirect restoration and 46.7% strongly liked to use it in composite restoration of posterior teeth [Table 2].
Most of the dental interns were strongly like to use the rubber dam during endodontic treatment whether in posterior teeth (73.3%) or anterior teeth (68.7%) [Figure 1].
66.7% of interns asked their patients if they had an allergy to latex prior to the use of the rubber dam.
The difficulties of using the rubber dam
The main problem of using rubber dam for both males (Mean rank 6.54) and females (Mean rank 7.02) was child behavior (P = 0.789). However, the last obstacle was rubber dam cost (P = 0.090). There were no significant differences in in the difficulties of using rubber dam between males and females.
Time for placement the rubber dam
The time is taken to apply the rubber dam was mostly less than five minutes for both male and female interns. However, male interns (48.5%) could apply the rubber dam more quickly than female interns (42.5%). There was no statistical significant difference (P = 0.191) between males and females at the time of placement of the rubber dam [Figure 2].
| Discussion|| |
Currently, dental institutions worldwide teaches the use of the rubber dam as an important method of tooth isolation for most dental procedures in both adult and child patients.  In RCsDP, the use of rubber dams is a standard of care in both endodontic and restorative procedures. The college of Dentistry of RCsDP was the first private dental college in the Kingdom of Saudi Arabia. It was established in 2004 and graduated its first patch in 2009. This survey was conducted among the 4 th graduate who currently serving their internship as general practitioners. The idea behind selecting this group was to obtain information that could help to improve the student's attitude toward the importance of using rubber dam in a daily dental practice as well as to help the teaching institution to teach the students how to overcome difficulties. The selection of a convenient time of the intern, simplification of the questions, and time needed to answer the questions were the key to get a 100% response.
Likert type scale (five points) was used in this study. It is a psychometric scale that is commonly involved in the questionnaire survey type of research. It was developed by Likert  where he measured the attitudes by asking people to respond to a series of statements about a topic, in terms of the extent to which an individual agree or disagree with a particular statement.
The majority of dental interns stated that they liked to use rubber dams in the general dental field (90%). This was not a surprising answer because of good training and strike close observation during their undergraduate studies. According to Whitworth et al.,  a qualifying dental schools have a significant impact on the use of rubber dam. We think that an inadequate training was less likely to be seen as an important reason for not using rubber dam even in private schools.
In this survey 87.3% of the interns liked to use a rubber dam on adults. Similar findings were reported Mala et al. They did a survey among a final-year dental students in Wales and Ireland. They reported a 99% of respondents used rubber dams in adult patients.
The major challenge to the interns when using rubber dam was child behavior, which is in contrast to other studies. , Our survey reported a 68.7% of the interns like to use it on children. Mala et al.  reported less number of students (32%) using rubber dam on child patients compared to our findings.
In other hand, the second most common difficulty of using rubber dam was that patients did not like the rubber dam, which is similar to the findings of Mala et al. and in contrast to Gergely  and Stewardson and McHugh.  These difficulties (child behavior and patient dislike) came from the patients' natures, which might have an impact on the interns' positive attitude toward rubber dam use.
The present study found that over 80% of dental interns would use rubber dam isolation in direct restorations and more extended to posterior composites than amalgam restoration. In a study of general dentists in the US 39% reported that they did not use rubber dams for posterior direct restorations, 45% did not use it for anterior direct restorations, and 53% did not use it for amalgams.  Most of the interns disliked a rubber dam for indirect restorations, which supports the results of Ryan and O'Connell.  This might be due to their belief that they can achieve better isolation without using a rubber dam, that other methods of moisture control are sufficient, and lack of experience in these cases.
The majority of interns strongly liked to use rubber dams in root canal treatment. This finding was similar to the results of other reports. ,, This tendency was higher than has been found among general practitioner ,, who attributed that to the patient as they do not like it. According to Christensen,  the general practitioners do not use a rubber dam during root canal therapy because of time loss, patient pain, extra cost, frustration and irritation. In a survey conducted by Al-Fouzan,  only 3% of general practitioners use a rubber dam during endodontic therapy. The use of rubber dam during root canal therapy is not only important for control microbial contamination of the root canal space but for the treatment outcome. , In addition, patient safety should be considered when practicing endodontics without adequate oropharyngeal protection. , Furthermore, it will improve the visibility of the operating field as well as helping to protect the patient's soft tissue from endodontic medicaments and sharp instruments.
It is of interest, however, to note that a high percentage of respondents reported they will continue to use the rubber dams in future practice. This finding is similar to the results of Whitworth et al.,  who noted that the rubber dam use was greater by newly graduated practitioners.
The time required to obtain isolation through the rubber dam technique in this study was less than five minutes. This is agreeing with the results of Stewardson and McHugh.  The time used seems reasonable when compared to the benefits gained from its use.
Knowledge of the materials used in rubber dam construction was demonstrated by the majority of the interns during their answers. This was indicated by their tendency to ask if patients had allergies to latex. These results are similar to the findings of Mala et al.
Our findings may reflect how private dental schools teach the usage of rubber dams. Further studies are needed for government-run dental schools.
| Conclusion|| |
The majority of dental interns (both males and females) in this study believed in rubber dam use in general. They liked to use it and they were enthusiastic to use it in future.
Academic institutions should place a greater effort to stress more on infection control by using rubber dams during dental practice, which will increase the success of dental work.
| Acknowledgments|| |
The authors extend their thanks to RCsDP for giving us this opportunity, and to Professor Mosadomi for his support. Also, we offer our great thanks to Dr. Sharat Pani, who analyzed the data.
| References|| |
|1.||Forrest WR, Perez RS. The rubber dam as a surgical drape: Protection against AIDS and hepatitis. Gen Dent 1989;37:236-7. |
|2.||Murray MJ. Value of the rubber dam in operative dentistry. J Am Acad Gold Foil Oper 1960;3:25-31. |
|3.||Barnum SC. History of the discovery of the dam. Can J Dent Sci 1877;4:88-9. |
|4.||Ahmad IA. Rubber dam usage for endodontic treatment: A review. Int Endod J 2009;42:963-72. |
|5.||Cohen S, Schwartz S. Endodontic complications and the law. J Endod 1987;13:191-7. |
|6.||Gergely EJ. Rubber dam acceptance. Br Dent J 1989;167:249-52. |
|7.||Samaranayake LP, Reid J, Evans D. The efficacy of rubber dam isolation in reducing atmospheric bacterial contamination. ASDC J Dent Child 1989;56:442-4. |
|8.||Cochran M, Miller C, Sheldrake M. The efficacy of the rubber dam as a barrier to the spread of microorganisms during dental treatment. J Am Dent Assoc 1989;119:141-4. |
|9.||Consensus report of the European Society of Endodontology on quality guidelines for endodontic treatment. Int Endod J 1994;27:115-24. |
|10.||Rugg-Gunn AJ, Welbury RR, Toumba J. British Society of Paediatric Dentistry: A policy document on the use of amalgam in pediatric dentistry. Int J Paed Dent 2001;11:233-8. |
|11.||Jenkins SM, Hayes SJ, Dummer PM. A study of endodontic treatment carried out in dental practice within the UK. Int Endod J 2001;34:16-22. |
|12.||Marshall K, Page J. The use of rubber dam in the UK. A survey. Br Dent J 1990;169:286-91. |
|13.||Whitworth JM, Seccombe GV, Shoker K, Steele JG. Use of rubber dam and irrigant selection in UK general dental practice. Int Endod J 2000;33:435-41. |
|14.||Lin HC, Pai SF, Hsu YY, Chen CS, Kuo ML, Yang SF. Use of rubber dams during root canal treatment in Taiwan. J Formos Med Assoc 2011;110:397-400. |
|15.||Gilbert GH, Litaker MS, Pihlstrom DJ, Amundson CW, Gordan VV, Group DC. Rubber dam use during routine operative dentistry procedures: Findings from the Dental PBRN. Oper Dent 2010;35:491-9. |
|16.||Joynt RB, Davis EL, Schreier PH. Rubber dam usage among practicing dentists. Oper Dent 1989;14:176-81. |
|17.||Mala S, Lynch CD, Burke FM, Dummer PM. Attitudes of final year dental students to the use of rubber dam. Int Endod J 2009;42:632-8. |
|18.||Ryan W, O'Connel A. The attitudes of undergraduate dental students to the use of the rubber dam. J Iri Dent Assoc 2007;53:87-91. |
|19.||Koshy S, Chandler NP. Use of rubber dam and its association with other endodontic procedures in New Zealand. N Z Dent J 2002;98:12-6. |
|20.||Likert R. A Technique for the Measurement of Attitudes. Arch Psychol 1932;140:1-55. |
|21.||Gergely EJ. Rubber dam acceptance. Br Dent J 1989;167:249-52. |
|22.||Stewardson DA, McHugh ES. Patient's attitudes to rubber dam. Int Endod J 2002;35:812-9. |
|23.||Hill EE, Rubel BS. Do dental educators need to improve their approach to teaching rubber dam use? J Dent Educ 2008;72:1177-81. |
|24.||Lynch CD, McConnell RJ. Attitudes and use of rubber dam by Irish general dental practitioners. Int Endod J 2007;40:427-32. |
|25.||Christensen GJ. Using rubber dams to boost quality, quantity of restorative services. J Am Dent Assoc 1994;125:81-2. |
|26.||Al-Fouzan K. A survey of root canal treatment of molar teeth by general dental practitioners in private practice in Saudi Arabia. Saudi Dent J 2010;22:113-7. |
|27.||Nair PN, Sjogren U, Krey G, Kahnberg KE, Sundqvist G. Intraradicular bacteria and fungi in root-filled, asymptomatic human teeth with therapy-resistant periapical lesions: A long-term light and electron microscopic follow-up study. J Endod 1990;16:580-8. |
|28.||Sjogren U, Figdor D, Persson S, Sundqvist G. Influence of infection at the time of root filling on the outcome of endodontic treatment of teeth with apical periodontitis. Int Endod J 1997;30:297-306. |
|29.||Lambrianidis T, Beltes P. Accidental swallowing of endodontic instruments. Endod Dent Traumatol 1996;12:301-4. |
|30.||Kuo SC, Chen YL. Accidental swallowing of an endodontic file. Int Endod J 2008;41:617-22. |
[Figure 1], [Figure 2]
[Table 1], [Table 2]