So many patients come to me saying they had their first root canal done without a rubber dam. After seeing my shocked expression, they try to excuse the oversight by their previous clinician—“Well, things have changed and now there is newer technology so that must be why!”  or In dentistry, what is a rubber dam used for? Is it really that important?”

Little do they know that the rubber dental dam was introduced in the 1860’s, so it’s nothing new in dentistry… AND it’s a pretty essential tool.

The Origin of the Rubber Dam History lesson! The first dental rubber dam was put in place in 1864 by a young American dentist, Dr. Sanford Christie Barnum, who needed a solution to keep the tooth cavity he was working on dry and free from saliva. He had issues keeping the rubber sheet he was using around the tooth—a process that was perfected when the rubber dam punch and clamps were created in 1882.

In other words, rubber dams have been in use for well over 100 years

That said, it shouldn’t be up to the patient to understand what rubber dams are used for in dentistry, nor to advocate for their use in the first place. It is their dentist who should know the risks associated with NOT employing rubber dams, regardless of the hassles associated with applying them.

If I have a patient with a previously treated tooth, and a rubber dam was NOT used, I know that—no matter how beautiful the root canal looks on the radiograph—there is a chance the tooth could be contaminated. 🦷😓 Rubber dams really are that important. If one wasn’t used, that might very well be the reason a root canal failed and a patient is still experiencing pain.

So in Dentistry, What Is a Rubber Dam Used for, Anyway?

I’ll go so far as to say that the number of retreatments for root canals would be greatly reduced if dentists used rubber dams, because they’re essential for keeping the tooth free of bacteria during treatment. 

And then there’s the whole other aspect of patient safety. The risk of the patient ingesting sodium hypochlorite or another irrigant (which, HELLO, no one wants!) is very real if you don’t use a rubber dam.

This begs the question: why are rubber dams absent in so many dental practices? Some dentists have abandoned (or never adopted) rubber dam use, thinking that the time involved didn’t pay off in treatment outcomes or patient experience. Which is so short-sighted!

Others leave rubber dams alone, thinking the advances in general dentistry have eliminated the need for them (a need which, you may have noticed, definitely still exists!). With new isolation systems (ie. Isolite), some dentists may feel the job can get done with less hassle—no need to add a rubber dam to the list of to-do’s in a case like this.

But they’re wrong. These isolation systems still don’t prevent procedural mishaps where patients can swallow a file or irrigants. That’s serious stuff!

OK, you might still be thinking … What are rubber dams used for in dentistry exactly? Why are they so important? To put a very fine point on it, they protect the patient and facilitate the removal of all bacteria from the tooth. I’ll just come out and say it: when it comes to root canals, a rubber dam MUST be used. 

I’m Not the Only One Who Thinks This Way!   

The American Associations of Endodontists, in its Quality Assurance Guidelines and Position Statement of 2010, said, “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.”

And then there’s this:

In the United States any lawsuit is lost if the rubber dam has not been used during an endodontic treatment. (1)


It doesn’t get more serious than that, y’all. It’s so serious I hope you will think about it every time you SHOULD be using a dental rubber dam.

Using Rubber Dams Has Many Benefits

So now that we’ve put to bed any arguments to the contrary, let’s review the many, MANY advantages of using rubber dams in endodontic procedures. Here’s the great Dr. Arnaldo Castellucci’s succinct list of reasons to use rubber dams, which I absolutely adore:

  • Patients are protected from ingestion or, worse, inhalation, of small instruments, dental fragments, irrigating solutions, or irritant substances, etc.
  • The opportunity to operate in a clean surgical field.
  • Retraction (very important for working in the posterior areas) and protection of the soft tissues (gums, tongue, lips, and cheeks), which are sheltered from the cutting action of the bur.
  • Better visibility in the working area. The advertisement of a famous manufacturer of instruments for the positioning of the rubber dam correctly reads: “Do better what you see and see better what you do.”
  • Reduction of wasted time: the patients, fortunately with a few rare exceptions, cannot converse except with great difficulty; besides, they will certainly not have to rinse their mouths every five minutes.
  • The dentists and dental assistants are protected against infections that can be transmitted by the patient’s saliva.
  • The dentists are more comfortable, as they may work at a less hurried pace and may be free to step out briefly to attend to a question, leaving the patients well protected with the rubber dam and the dental assistant close to them. This also makes time to perform a hygiene check to make sure everything is as it should be.
  • Better tactile sensitivity during the cleaning and shaping procedure. Without the rubber dam, the dentists, aware of the risk of causing the patients to ingest or inhale an instrument, hold the files in such a way that they will not slip from their fingers. The pressure they apply to the grip of these instruments reduces the sensitivity of their fingers and precludes using the instruments to perform delicate procedures. With the rubber dam in place, on the other hand, they may hold the instruments delicately, without fearing that they may slip from their hand.
  • Patients are more comfortable, as they do not feel that their mouth is invaded by hands, instruments, and liquids. Patients increasingly appreciate the use of the rubber dam. On occasion, they may ask whether it is a new invention, and once they have tried it, they do not want to have future treatment without it.

My Rubber Dam Tools and Tips for Dentists

Now that the benefits of using rubber dams in dentistry are clear, I will share my tips as a practicing endodontist, using rubber dams day in and day out.

  • If you want to reduce the quantity of clamps, the top three clamps I use the most are a 14A, 14, and 2A. I use the 14A clamp for the majority of my molars. I use a 14 clamp for a molar that has been prepared for a crown and I use a 2A for the majority of my premolars, anteriors and canines. You can also get creative and clamp an adjacent tooth or teeth as well.
  • Now, nothing is perfect, so when your rubber dam isn’t 100% right, you can reinforce it with some Opaldam for added protection. Who doesn’t want that? Using Opaldam in combination with your rubber dam also prevents sodium hypochlorite leakage from getting under the dam, so saliva doesn’t creep up past the dam’s barrier.
    (Want more tips like this? Check out my blog “My Top Endodontic Tools to Get a Root Canal Job Done.”)

What’s Your Biggest Takeaway?

I want you to promise me right now. Next time you’re doing a root canal you’ll use a rubber dam, right? 

Let me hear you say it! 

It takes a few minutes to get the hang of, but it is so SO worth it. For you AND your patient. Hey, you can even teach your team how to place it so you can skip that part altogether. 

I swear, you’re going to grow to love working with these handy, and TIME TESTED tools. It’s going to add such ease to your procedures, you’ll never even think about skipping them again. 

Have I made a believer out of you yet? Let me know in the comments below!

–  Sonia