Do you ever feel like using a rubber dam is a nuisance? That you don’t even want to try and put it on because it’s just too dang cumbersome?  Or maybe you feel like you just need a refresher on the most commonly used rubber dam clamps to facilitate the process? 

Well, I’ve got you. 💪 This is the rubber dam clamp guide you need so you can knock it out of the park on every single procedure ⚾

As I mentioned last week, the rubber dam is something that I can’t live without for so, SO many reasons. To refresh your memory—rubber dams are considered STANDARD in endodontics (what I’m saying is NOT OPTIONAL) and you could get in a lot of trouble if you don’t use one (ahem, I think you’ll recall that last week I mentioned this, but: According to the American Association of Endodontics, ⚠️ANY⚠️ lawsuit is lost in the U.S. if a rubber dam was not used). 

And for the record—the isolite is not the same as a rubber dam and is NOT accepted like rubber dams are. So, if this is what you are using, know that you can get in some deep trouble if something goes wrong and your patient decides to take legal action. 

At that point, it’s between you and the Endo gods.

Why You Need a Rubber Dam Every. Dang. Time.

The benefits of a rubber dam include keeping your operating field nice and isolated. Because, like, who needs to feel like they are Crocodile Dundee wrestling with the tongue and lips? Not this lady. No way. And on top of that, we all know that saliva is full of bacteria, so if you aren’t isolated, well, that saliva is going into your working field. If that happens, you can kiss that success rate goodbye. If saliva gets into your working field, your root canal is virtually useless, you might as well not do it.  

Another key benefit of the rubber dam is protecting your patient from your instruments and irrigants. It works as a barrier between small instruments, the patient’s mouth, the irrigants we use, and our patient’s throat and lungs. This function is the primary reason that the isolite cannot be substituted for a rubber dam. Besides, sodium hypochlorite (AKA bleach) tastes horrific. You could make a real enemy out of your patient if you get any in their mouth. 

Given the history of the rubber dam (as I mentioned in my last blog—the thing’s been around since 1864), it’s hard to write off. This thing has stood the test of time and still remains, like I said, the gold standard. 

So what’s keeping you from using a rubber dam? For many of us, it is a struggle to figure out which are the most commonly used rubber dam clamps to invest in, and how to seamlessly put them to use. 

No more struggles! Here begins your guide to rubber dam clamps.

Your Go-To Rubber Dam Clamp Guide

I feel that one of the main problems with using a rubber dam is the clamp. You might agree with me there, so I want to introduce you to a few hacks that may help you get that baby on without any hiccups. As always, my tips are always aimed at being efficient and economical. You don’t have to spend big bucks to get better and faster.  

My basic treatment setup only consists of a few clamps. You really don’t need much here to cover everything in this rubber dam clamp guide. Let me walk you through it. 🚶🏽‍♀️

I have two molar clamps in my setup. My favorite molar clamp is the #14A. 

This clamp works wonders on most molars, especially the big molars that have a considerable buccal-lingual dimension. When molars are that big, it gives more room for more canals, so think MB2 here too!!!

If you have a smaller molar or a molar that is crown prepped, you may want to try to use a #14 clamp. 

Now what do you do when neither of these clamps work? Or what if your molar is broken down?  Well, then pull out your handy dandy 12A and 13A. 

You’ll notice that one side is shorter than the other. So when decay has taken over part of the tooth and you have lost some of that tooth structure on one side (usually buccal or lingual), these clamps are perfect! Just make sure that the bow of your clamp always sits next to the distal.  And when you press on that bow, there is no movement. That’s the sign that you are ready to go!

Troubleshooting Issues with Some of Your Most Commonly Used Rubber Dam Clamps

When it comes to premolars, canines, and even maxillary anteriors my favorite clamp for is the #2A clamp. 

This clamp is so versatile and can be used on so many teeth, even a small or broken down molar. Another good backup for these teeth is the #1 clamp.

There is only one problem with the #2A clamp. It stretches out pretty easily, so over time, you will see that it just doesn’t have the same fit as it used to. This, my friends, is exactly why people get frustrated with the rubber dam. But, hey! This doesn’t have to be a big deal. All this means is that you need to buy some fresh clamps. Easy! Check out this picture of a stretched out clamp and what I call a “tight 2A!” Do you see the difference? (FYI: this can happen with any clamp, I just see it happening with the 2A the most).

So when you have a clamp that isn’t stable on that premolar or lateral incisor (that’s usually the culprit), don’t get frustrated, instead congratulate yourself because that means you used your clamp a lot and you are doing a lot of endo! Woohoo! 

Pass along the message to the rest of your team about what a “tight 2A” is and they will be happy to pop up and get you one so your endo is a breeze. And more than that, your patients remain safe. This tip works for molar clamps too, FYI. So if you are struggling, check to see if that clamp is stretched first.  

The last clamp that I use is the butterfly #9 clamp.

This is my go-to for the mandibular incisors, I don’t really use this clamp on any other teeth.  Though you could use it on a maxillary incisor if it’s skinny (like a maxillary lateral incisor). This clamp is meant for those thin teeth and you can tell because it’s hard to spread this clamp open to even get on a tooth in the first place.  

Making Rubber Dam Clamps Work for You (and Your Patients)

One last thing…don’t forget that even the most well-placed rubber dam can still have leakage, so use something like Opaldam (by Ultradent) to give it that final seal and feel confident that your root canals will be isolated and optimal.  

If you have issues with your rubber dams ripping, try Ultradent’s Derma Dam, it will change your life! And hey, if you join E-School, you get a discount code for all your shopping at Ultradent, which is going to seriously uplevel your practice (and let’s be honest, make your whole life a lot easier)! And that’s not the only discount code you get access to when you join us—doesn’t matter if it’s E-School Independent or E-School LIVE. 

I love to simplify all things endo. There is really no need to make it complicated—which is why I like to create resources like this rubber dam clamp guide that gives you vital endo knowledge in a short amount of time (and words!). 

People really try to overcomplicate so much of our work in endo. But I’m all about ease, baby. Bringing clarity to your practice and better results to your patients. And that makes for a happy dentist. 

Join me over in Eschool: Everyday Endo Made Easy for more tips and tricks like this. I will help you fast track your endo success. Promise!

– Sonia