The operative procedures that are performed in the patient's mouth should be regarded as major or minor surgical procedures. In dentistry, as in general surgery, isolation of the operative field is imperative, even for a simple filling.
OBJECTIVES OF WORKING FIELD ISOLATION
► Aseptic operating field: preventing saliva with oral pathogens from flowing in preparation cavity or root canals.
► Protection of patients against accidental swallowing or inhalation of small instruments (bur, endofiles etc.), filling materials and artificial crown particles.
► Moisture control (isolation of tooth from gingival fluid, saliva, gingival bleeding, and moist air due to relatively high humidity in oral cavity).
► Protection of patient against inhalation or swallowing of water from handpiece with dust of tooth preparation.
► Harm prevention: protecting soft tissues (tongue, cheeks) from mechanical trauma (e.g. by bur) and from chemical trauma (e.g. by sodium hypo-chlorite in endo treatment).
► Retraction of soft tissues (cheeks, lips) for better access.
There are several methods of performing field isolation in operative dentistry.
1. Rubber dam.
2. Cotton rolls (fig. 15.1, 15.2, a).
3. Dry tips (fig. 15.2, b).
4. Saliva ejector and high-volume evacuator.
5. Retractors.
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Fig. 15.1. Cotton rolls isolation in oral cavity
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Fig. 15.2. Cotton rolls (a) and dry tips (b)
Only rubber dams meet all requirements stated above for isolation of the working ield. The rubber dam is the most reliable method of isolation. The other methods may be combined with each other and may be used for isolation more or less successfully.
Developed by Sanford C. Barnum in 1864, the rubber dam is considered the optimal method to isolate a dental operative ield and to prevent moisture contamination during the placement of direct restoration and endodontic procedures.