Using rubberdam in private practice?

[jacksonkelly]

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I have a question....do general dentists and endodontists on this forum use rubberdam in their private practice when doing endo?

I'm asking this because I'm working as an associate in a private office. Now the owner and 2 other associates don't use rubberdam with endos. They are experienced doctors and been practicing for a long time.
I personally use rubberdam in 99% of my endo cases. But one time the doctor who owns the practice made a sarcastic comment once when saw me working with complete isolation. He said " I feel I'm back in dental school"
Personally I use it because that's how I was trained, makes the endo easier for me, liability issues of course and I feel safe that files nor hypochlorite would not go down my pt's throat.
So what do you guys think? Is it just a dental school thing or am I too picky regarding my tx or are they just wrong?!

 

[odontologia]

I understand what you mean. RDI is the standard of care when doing endos period. If you are taken to the board and you didn't use RD w/ur endo, you will be most likely be in some sort of trouble including a letter of concern and have to re-take some stupid endo course, which all could have been avoided by using a RD in the first place. Who cares what they say, it's not their license on the line.

 

[DavesNotHere]

I have a question....do general dentists and endodontists on this forum use rubberdam in their private practice when doing endo?

I'm asking this because I'm working as an associate in a private office. Now the owner and 2 other associates don't use rubberdam with endos. They are experienced doctors and been practicing for a long time.
I personally use rubberdam in 99% of my endo cases. But one time the doctor who owns the practice made a sarcastic comment once when saw me working with complete isolation. He said " I feel I'm back in dental school"
Personally I use it because that's how I was trained, makes the endo easier for me, liability issues of course and I feel safe that files nor hypochlorite would not go down my pt's throat.
So what do you guys think? Is it just a dental school thing or am I too picky regarding my tx or are they just wrong?!

i've come across the same thing, the old timers don't use rubber dams...my attendings have even tried to dissuade me from using them on a few cases...

while i don't think you need them for everything we used them for in dental school, for endos i think they should always be on there...why risk bacterial/salivary contamination, bleach leak, or file aspiration...plus they shut the patient up..they take 2 min to put on at most, and ur assistant can do it

 

[tinman831]

I understand what you mean. RDI is the standard of care when doing endos period. If you are taken to the board and you didn't use RD w/ur endo, you will be most likely be in some sort of trouble including a letter of concern and have to re-take some stupid endo course, which all could have been avoided by using a RD in the first place. Who cares what they say, it's not their license on the line.

This is the most important point here. With endo being one of the fields with the largest malpractice claims, why take any chances? It's something you can have your assistant do for you while you attend to other matters and it also keeps the area neat and clean.

 

[peg lateral]

I have a question....do general dentists and endodontists on this forum use rubberdam in their private practice when doing endo?

I'm asking this because I'm working as an associate in a private office. Now the owner and 2 other associates don't use rubberdam with endos. They are experienced doctors and been practicing for a long time.
I personally use rubberdam in 99% of my endo cases. But one time the doctor who owns the practice made a sarcastic comment once when saw me working with complete isolation. He said " I feel I'm back in dental school"
Personally I use it because that's how I was trained, makes the endo easier for me, liability issues of course and I feel safe that files nor hypochlorite would not go down my pt's throat.
So what do you guys think? Is it just a dental school thing or am I too picky regarding my tx or are they just wrong?!

They are wrong. Rubber dam isolation is standard of care for endo. Not using isolation during endo has malpractice written all over it if something did happen (i.e. swallowed or aspirated file, sodium hypochlorite incident).

 

[beannaithe]

Yeah, I'm going to voice the same fact as everyone else. Rubber dam isolation is the standard of care. If you're not using it and anything happens, then you are subject to lawsuits with no legal leg to stand on. If your boss wants to play with fire, let him. It's not up to him to tell you how to practice dentistry.

My rule of thumb is if I can't isolate with a rubber dam and can't build it up, ect. I refer to endo.

 

[mike3kgt]

http://www.aae.org/uploadedFiles/Pu...nd_Position_Statements/dentaldamstatement.pdf


As like many "rule bending" things your senior dentist may push upon you, nothing will ever happen unless something goes wrong with doing endo without a rubber dam. Now if something goes wrong and you stand behind your treatment and manage your patient incredibly well (and communicate well), you will probably be OK.

When a breakdown in communication happens or you do something REALLY serious, like drop a file and it goes down the trachea or you have a hypochlorite accident... you have ABSOLUTELY no leg to stand on if you are found without using isolation. If an accident does occur and you were using the dam, you can still have issues but you can always sit back and say "at least I was using a rubber dam"

Use the rubber dam, 100% of the time for endo, no excuses. The patient refuses rubber dam?? Refer to an endodontist or let your co-associate treat the patient. I've been in that exact situation before. Let them take the risk... getting paid 30% of an endo is not worth the risk. 😉

The biggest reason why you may be get comments from your senior docs or co-associates is that by sticking to your guns and using isolation, it makes them look bad or makes them look like they are practicing below the standard of care. You will never win this argument... if they give you grief, tell them that you respect their decision to not use the rubber dam but ask them to please respect your decision to use it. If they don't respect your decision, either suck it up or get out.

Good luck!

 

[jacksonkelly]

Thanks my fellow Doctors for your replies.

I'm definitely holding my ground and use rubberdam for all my endo cases 🙂
I wanted a clarification if not using RD is like a private practice trend.....which is obviously not

Thanks again for everyone's input 👍

 

[tinman831]

Thanks my fellow Doctors for your replies.

I'm definitely holding my ground and use rubberdam for all my endo cases 🙂
I wanted a clarification if not using RD is like a private practice trend.....which is obviously not

Thanks again for everyone's input 👍

Don't ever let anyone push you into doing something you're not comfortable doing. Always go with your gut.... unless you know it's wrong. In that case, refer. 😉

 

[bigbadaboom]

rubber dam for every procedure that involves the pulp chamber - RCT, pulpotomy, post placement, pulp capping, etc.


many dentists use rubber dam for everything, even crown preps - yes, crown preps! they prep to the dam and take it off to finish the margins.

ideally anytime you do any kind of adhesive dentistry - like placing composite or bonding veneers you want very good isolation.

implant restoration also need good isolation - those screws are tiny and can easily get dropped and aspirated.

 

[OhioDMD]

Rubber dam for all endos and pulpotomies (* I am one of the old guys) standard of care for
these procedures but you ought to take a serious look at the isodry/ isolite system for dry
field isolation. In many ways it is superior to a rubber dam. IMHO.

 

[omaralt]

Rubber dam for all endos and pulpotomies (* I am one of the old guys) standard of care for
these procedures but you ought to take a serious look at the isodry/ isolite system for dry
field isolation. In many ways it is superior to a rubber dam. IMHO.

i love isolite, and cant imagine working without it anymore. besides the fact that it gives you great isolation; it also retracts the tongue and cheek and provides a bite block for the patient. however for endo i would still prefer rubber dam since it protects the soft tissues from bleach,etc.

 

[HupHolland]

I use a rubber dam for all restorative dentistry, even some crown preps (mandibular molars specifically), as long as it isn't totally impractical to put it on.

However, I don't apply it the way we were taught in school. I punch one large hole for the clamp and then cut a slit about 1 cm extending anterior (that connects to the clamp hole). This allows acceptable isolation, shuts the patient up, keeps the tounge/cheek out of the way and only takes 15s to apply and literally saves minutes during the procedure.

So my question is: why NOT use the rubber dam?

Hup

PS- I'm doing a residency so don't have the luxury of having an isolite. Otherwise, I'd probably use one of them.

 

[Ninety]

Isolite seems to be great!