Attitude of Dental Students towards the Rubber Dam Use in Operative Dentistry.

AIM: Operative dentistry and endodontics are the two major areas where rubber dam is used extensively with special emphasis to train students on its application during dental curriculum. The purpose of the present study was to evaluate the attitude of dental students toward the use of rubber dam in operative dentistry clinics along with emphasis on evaluation of its prospective application after graduation.
MATERIALS AND METHODS: A structured questionnaire-based analysis was performed among internship students of a dentistry program, Batterjee Medical College, Jeddah, Saudi Arabia. The questions were based on training, latex allergy, and selection of jaws for application of rubber dam and prospective use of rubber dam during practice.
RESULTS: A completed questionnaire by all participants (n = 110) was analyzed and subjected to statistical analysis. Around 80.9% of the students agreed that adequate and satisfactory training for rubber dam placement was imparted while 59.1% agreed that they enquire about latex allergy before placement of rubber dam. Further, 85.5% of the students planned to use rubber dam for all procedures after graduation.
CONCLUSION: A promising response was exhibited by this group of future dentists toward the application of rubber dam during restorative procedures. Copyright:

INTRODUCTION

The rubber dam system was introduced to the world by Dr. Sanford Barnum in 1864, thereafter it has seen many evolutions, and today, it has become an integral part of dental procedures. Rubber dam use is encouraged worldwide as an aid in isolation of the operative area, provision of aseptic field, infection control, ingestion or aspiration of dental instruments, and/or materials. It also provides patients' comfort and assists the operator in protection of soft tissue.[12] Operative dentistry and endodontic treatment are two major areas where rubber dam is used. Textbooks in these specialties emphasize and recommend rubber dam use during endodontic and operative procedures to provide high standard care. Besides, from a medicolegal aspect, to avert malpractices, it is imperative to use rubber dam; the failure to do so could lead to serious consequences.[3]

As stated, “no other technique, treatment, or instrument used in dentistry is so universally accepted and advocated by recognized authorities and so ignored by practicing dentists,” it is the time for dental professional to self-evaluate and adopt the isolation protocol in practice.[4] Further, during a dental graduation program, dental schools put emphasis on rubber dam application right from the first patient encountered by the student. Although, the matter of fact is that whether students will firmly adopt the rubber dam practice during their clinical practice need to be evaluated periodically and prospectively.[56] Therefore, it becomes a commitment for the institute to evaluate the attitude of students toward its usage during graduation. Such an assessment can be accomplished by simple questionnaire-based surveys.[1]

The purpose of the present study was to evaluate the attitude of dental students toward the use of rubber dam in operative dentistry clinics. It also emphasized the evaluation of its prospective application of the rubber dam after graduation in general dentistry practice.

MATERIALS AND METHODS

A structured questionnaire of 12 questions comprised both open- and closed-ended questions [Appendix 1]. It was distributed to 110 students of a dentistry program studying in Batterjee Medical College, Jeddah. The questionnaire comprised both open- and closed-ended questions. All students were informed that participation in the survey was optional with due respect to their anonymity. Completed questionnaires were submitted by all the students as none declined to participate. After collection of responses from the students, data were entered in an Excel sheet for statistical analysis. Percentages for responses were calculated for all the questions using arithmetic calculations.

Appendix 1

Questionnaire for rubber dam and collated data

Statements with objectives	n=110
Do you think you have been given adequate and satisfactory training regarding rubber dam? Yes/No	89 (80.9%)
Do you ask your patients whether they have any allergy to latex before rubber dam use? Yes/No	65 (59.1%)
Posterior restorations can be placed more easily once rubber dam has been applied. Yes/No	101 (91.8%)
Rubber dam enables clearer access when placing restorations. Yes/No	94 (85.4%)
Rubber dam makes radiographic procedure difficult. Agree/Disagree	96 (87.3%)
Rubber dam extends treatment procedure time. Agree/Disagree	68 (61.8%)
Assistance is necessary during rubber dam application. Agree/Disagree	49 (44.5%)
Restorations placed under rubber dam have a greater longevity than those placed without. Yes/No	95 (86.4%)
Rubber dam is more necessary while working in the
Mandible	49 (44.5%)
Maxilla	6 (5.5%)
Both	55 (50%)
During which stage of restoration do you use rubber dam?
Following anesthesia before cavity preparation	106 (96.4%)
After cavity preparation before placement of restorative material	4 (3.6%)
In your opinion, the greatest advantage offered by the rubber dam is?
Aseptic working area	48 (43.6%)
Prevention of swallowing or aspirating particles or instruments	17 (15.5%)
Easy access to cavity preparation and restoration	28 (25.5%)
All of the above	17 (15.4%)
Following graduation:
I intend to use the rubber dam during all procedures indicated	94 (85.5%)
I intend to use it only during restorative procedures	4 (3.6%)
I intend to use it only during root canal treatment	12 (10.9%)

RESULTS

A completed questionnaire was returned by all participants (n = 110), and data were entered for statistical analysis. Regarding adequate and satisfactory training for rubber dam placement, 80.9% of the students gave positive response while 59.1% agreed that they enquire about latex allergy before placement of rubber dam. Whether rubber dam placement eases placement of posterior restoration and enables clear access was agreed upon by 91.8% and 85.4% of the students, respectively. However, most of the students agreed that radiographic procedures become difficult to perform with rubber dam placement (87.3%) and 61.8% suggested that it extends the treatment time. 44.5% of the students need assistance during placement of rubber dam. Half of the students agreed that rubber dam should be used in both jaws while 44.5% wanted to it use only in mandibular tooth restorations.

About 86.4% of students agreed that restorations placed under rubber dam have a greater longevity as compared to those placed without he rubber dam. The utmost advantage provided by rubber dam chosen was facilitation of aseptic work area (45.3%), followed by ease of cavity preparation and restoration (26.4%). Further, 96.4% of the students agreed that rubber dam placement should be done following anesthesia before cavity preparation.

85.5% of the students intended to use rubber dam for all procedures upon graduation, while 10.9% and 3.6% of the students planned to use it for root canal treatment and restorative procedures, respectively.

DISCUSSION

Rubber dam is a valuable utility in operative and endodontic procedures, and it addresses safety and quality issues. During dental procedures, patients' comfort and time management are key factors, and rubber dam, undoubtedly, helps in both. Nevertheless, rubber dam application finds reluctance in general dental practice. Rubber dam application training during dental graduation plays an important role in inculcating its implementation by future general dentists. This necessitates the dental schools to periodically evaluate the learners during clinical training.[47]

The present study was a questionnaire-based study in which 110 students participated to answer 12 structured questions. This study was planned to evaluate the attitude of dental students toward the application of isolation practice during restorative and other dental procedures. Further, it intended to understand the outlook of students to follow the teachings of dental school during general dental practice after graduation.

In this study, regarding adequate and satisfactory training for rubber dam placement, 80.9% of the students gave positive response. However, in their study at College of Dentistry, Qassim University, by Al-Haj Ali and Al-Mohaimeed, 64.6% agreed to adequate training. Further, we found that 59.1% of the students ask about latex allergy to patients before placement of rubber dam.[8] Likewise, a study by Al-Abdulwahhab et al. found that 66.7% of the students asked their patients about allergy to latex prior to isolation.[9]

Whether rubber dam placement eases placement of posterior restoration and enables clear access was agreed upon by 91.8% and 85.4% of the students, respectively, in our survey. Similar findings were observed by Mala et al. in their study on final-year dental students in Wales and Ireland.[1]

Most of the students agreed that radiographic procedures become difficult to perform with rubber dam placement (87.3%) in our study. A study by Akbar et al. in Al Jouf University dental students also showed that students faced difficulty in making radiographs while using rubber dam.[10] This was in agreement with a study of Tanalp et al. and Khathoon and Raj in student and general dentist populations, respectively.[36]

In the present study, 61.8% of the students reported that rubber dam placement extends the time for treatment. Al-Haj Ali and Al-Mohaimeed in their study at College of Dentistry, Qassim University, found that 77.9% of the students needed extra time for dental dam placement that subsequently increased the treatment time. 44.5% of the students needed assistance during the placement of rubber dam.[8] This was in agreement with a study of Khathoon and Raj in dentist population.[6] This may be attributed to difficulty in placing the rubber dam in initial phase of training, as the students get more experienced with the system, the placement time may decrease further.

The present study found that 86.4% of the students accept the fact that rubber dam placement improves the longevity of restorations. Similarly, Al Sabri et al. in a study at private dental colleges in Buraidah observed that students in both institutes agreed with the opinions that rubber dam is needed for proper isolation in operative procedures.[11] They further observed that restoration placed under rubber dam have a superior durability than those not placed with rubber dam was preferred reply by most of the students of both the colleges (99% and 97.8%). Further longitudinal studies that follow up restorations done with and without rubber dam may enlighten this faction expansively.

In our findings, half the students agreed that rubber dam should be used in both the jaws while 44.5% wanted to use only in mandibular tooth restorations. This was in disagreement with a study of Khathoon and Raj in dentist population.[6]

The utmost advantage provided by rubber dam chosen was facilitation of aseptic work area (45.3%), followed by ease of cavity preparation and restoration (26.4%). This is in agreement with Tanalp et al. and Khathoon and Raj.[36] Further, in the present study, 15.5% of the students selected the option to prevent accidental swallowing or aspirating particles or instruments is a major advantage of rubber dam usage. A study conducted by Ahmad et al. for compliance of Saudi dental students with infection control guidelines found that 99% of the students were using rubber dam for isolation. They further stated that extra protection may be accomplished by the regular use of a rubber dam to significantly decrease microbial contamination of the air during restorative procedures.[12] However, Al-Amad suggests that additional precautions like covering heads with suitable protective wear are needed during the usage of rubber dam.[13]

In the present study, 96.4% of the students agreed that rubber dam placement should be done following delivery of local anesthesia and before the starting of cavity preparation. However, this finding is contrary to the findings of Tanalp et al.[3]

In our survey, 50% of the students opted for necessity of using rubber dam on both the jaws. The mandible was ranked as the jaw where rubber dam placement was more necessary by most students by Tanalp et al.[3] which is contrary to our findings wherein 44.5% of the students agreed to place isolation in the lower jaw. However, majority of the students charted that rubber dam is more essential while working in the mandible in a study by Abdulrab et al.[14]

While 10.9% and 3.6% of the students planned to use it for root canal treatment and restorative procedures, respectively, 85.5% of the students intended to use rubber dam for all procedures upon graduation in this study. This is in agreement with a study by Al-Abdulwahhab et al.[9] in Riyadh dental college interns. Similar findings were noted by Abdulrab et al.[14]

Numerous studies conducted on general dentist populations reveal that there is a low proportion of rubber dam usage for isolation. The reasons include discrepancies in perception of rubber dam use during clinical training and the general practice after graduation. Furthermore, factors such as clinical setup, duration of clinical experience, and desire to improve in competencies by pursuing continuing education play a vital role in its application. Nevertheless, the onus is on the dental schools to implement its usage during training so that more compliant generation of practitioners will start applying rubber dam.[15161718]

CONCLUSION

The present study shows a positive attitude of dental students toward the use of isolation in dental procedures. Teaching effective method of rubber dam application during clinical training at dental schools can boost students' confidence and minimize the time required for placement so that the students will probably adapt to use the rubber dam during their practice. Yet, it encourages performing further studies on general dental practitioners, especially the practicing alumni of the institute to cognize the use of rubber dam.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.