Isolation in Dentistry

Isolation of the operating area in dentistry is the separation of a tooth or a group of teeth from other oral tissues, saliva and blood. It can be done by a variety of methods and is mainly done to improve the access, visibility and reduce the contamination.

The idea of dental isolation was first put forward by Sanford Christie Barnum, an American dentist from New York in 1864. He had used a rubber sheet to isolate the teeth, which was subsequently developed further in 1882 by SS White.

Need for isolation in dentistry

1. To control excessive salivation in the patients, especially children.
2. To control excessive tongue movements
3. By using a rubber dam, we separate the rest of the oral tissues from the operating area, thus minimizing the danger of aspiration of small instruments or foreign particles
4. It is convenient to the dentist as it improves visibility
5. The property of the restorative materials are at their best when used in moisture-free environment.

Goals of isolation

There are three primary goals of isolation in dentistry. They are:

1. Moisture control: Isolation helps to exclude saliva, gingival bleeding and crevicular fluid from the operating field.
2. Prevention of aspiration: Complete isolation helps to prevent the risk of aspiration of instruments such as endodontic files, tooth debris or any aerosols.
3. Tissue retraction: Supportive soft tissues such as tongue and cheek can cause hindrance in the treatment and they also pose a risk of undue harm during the use of high-speed airotor. Hence, isolation helps in retraction of these tissues.

Criteria for ideal isolation techniques

1. The isolation technique should be easy to apply and should not injure soft and hard tissues.
2. It should be comfortable for the patient.
3. It should aim to provide retraction so as to enhance the visibility for the operator.
4. It should help in the prevention of moisture contamination.
5. It should perfectly isolate the area of operation.

Different methods of isolation used in dentistry

There are different methods used to isolate the teeth while carrying out dental procedures. They can be broadly divided into direct and indirect methods.

DIRECT METHODS:

1. Rubber Dam
2. Cotton rolls
3. Gauze piece
4. Dri angle
5. Mouth props
6. Mouth mirrors
7. Absorbent wafers
8. Suction devices
9. Gingival retraction cord

INDIRECT METHODS:

1. Comfortable position of the patient
2. Local anesthesia- causes vasoconstriction and hence reduces pain and salivation.
3. Drugs- Anti sialogogues (medications that reduce the flow of saliva) like Atropine
4. Anti-anxiety drugs (medications that reduce the apprehension and anxiety levels in patients)
5. Muscle relaxation

RUBBER DAM

Rubber dam was first introduced in the year 1864 by S.C. Barnum. It is a thin stretchable latex material which becomes a barrier when appropriately applied to selected teeth. The rubber dam helps to define the operating field by isolating one or more teeth from the oral environment. By doing so, it also gives the most complete control over moisture in the mouth and also retracts the soft tissue.

Advantages:

• It provides a dry and clean operating field
• Improved access and visibility to the dentist
• Improves the properties of dental materials potentially
• Protects the patient and operator
• Operating efficiency

Disadvantages:

Although rubber dam offers many advantages it cannot be used in patients with latex allergy.

Another demerit with rubber dam is that it is time consuming.

Contraindications:

There are some conditions that may preclude the use of the rubber dam are:

• Partially erupted teeth
• Extremely malpositioned teeth
• Some third molars
• Patients suffering from asthma or with nasal obstructions

Equipment used for rubber dam:

Applying rubber dam is a complicated process and requires the use of following tools.

• Rubber dam sheets: These are usually available in various thickness ranging from thin (0.15mm) to special heavy (0.35mm). Thicker sheets are more resistant to tear and is recommended when performing Class V restorations in anterior teeth. Thinner sheets are used when the contacts between the teeth are tight.

These sheets have a dull and a shiny side. Care should be exercised while placing the rubber dam that the dull side is facing towards the occlusal surface and towards the operator. This is done because the dull side is less reflective. The most commonly used sheets are dark, heavy and 6X6 inches.

• Template/stamp is an inked pad or paper which produces a series of dots on the rubber corresponding to the average positions of the teeth in the arch. Care should be exercised that the top edge of the rubber sheet should be just below the patient’s nose, thus covering the mouth but not the nose.
• Holder or Frame
• Rubber dam punch is an instrument having a rotating disk with six holes of varying sizes and a tapered, sharp-pointed plunger to punch the holes. It is used to make round holes of different diameters, largest hole being for molars and the smallest for mandibular incisors.
• Clamps/ retainers are small metal clips which fit the cervix of the tooth and hold the rubber dam in position.

There are essentially two parts of the clamp – a bow and a jaw.

BOW: Rounded portion of the clamp.

JAWS: Prongs that seat around the tooth create the extension and balance necessary to stabilize the clamp.

These clamps are either winged or wingless.

• Clamp forceps are specialized instruments used to place, adjust and remove the clamps.
• Dental floss is used to carry the rubber past a tight contact point. It also acts as a safety procedure when tied to a clamp so that it becomes easy to retrieve if swallowed.
• Lubricant- A water-soluble lubricant is usually applied in the area of the punched holes so that it easily passes through the proximal contacts.
• Scissors

The American Associations of Endodontists in its Quality Assurance Guidelines and Position Statement of 2010 says that “Tooth isolation using the dental dam is the standard of care; it is integral and essential for any nonsurgical endodontic treatment. One of the primary objectives of endodontic treatment is disinfection of the root canal system. Only dental dam isolation minimizes the risk of contamination of the root canal system by indigenous oral bacteria. The dental dam also offers other benefits, such as aiding in visualization by providing a clean operating field and preventing ingestion or aspiration of dental materials, irrigants and instruments.” (Courtesy- AMERICAN ASSOCIATION OF ENDODONTISTS: AAE Position Statement, 2010)

COVID-19 AND ISOLATION IN DENTISTRY:

In the recent era of pandemic, isolation has become even more crucial so as to mitigate the risk of virus spread by aerosols. In this unprecedented situation, where there are no previously laid out guidelines, we should strictly adhere to standard isolating techniques like rubber dam to reduce the risk of cross-contamination.

At Dr. Sachdeva’s dental clinic, we are doing everything to reduce the risk for our patients and staff. We take these following protective measures to make our operating area a safe place.

1. Use of PPE (Personal Protective equipment)
2. We always advise the patient to use pre-rinse mouthwash
3. We use a high suction flow, wherever possible.
4. Our operating room is clean and well-ventilated
5. We advocate the use of isolation protocols wherever possible.

Dr. Rajat Sachdeva is one of the best oral and maxillofacial surgeons around in Delhi. He has an experience of more than 17 years in this field. He has a keen eye for detail and strives to provide a high quality, ethical treatment to his patients. He has a warm personality and understands the impact of a good smile on patient’s wellbeing. We are also proud to announce that our clinic has invested heavily in acquiring new and latest surgical technology ensuring that our patients get the best treatment possible.

Our endeavor is to make the best quality dentistry available to all patients at affordable prices. All the treatments available at our practice is cost-effective with high standards.

We have an excellent follow-up team wherein we maintain detailed records of our patients and reach out to them regularly even after the treatment is over.

We are a 24*7 team who works round the clock to provide services to our patients. Book your consultations today!