The Importance of Rubber Dam Isolation in Endodontics Throughout COVID-19 Outbreak

Dear Editor,

Due to the recent pandemic outbreak in the 21st century, COVID-19 has impacted the daily activities of patients and healthcare professionals, particularly dentists. Once the COVID-19 infection was considered highly contagious, security conditions were adopted, such as social isolation and distancing. However, recent studies have shown that during social isolation, dental emergency rates related to the irreversible pulpitis diagnosis increased significantly ^1,2.

The main reason why COVID-19 has severely impacted dentistry is the aerosol created by high-speed handpieces, saliva aspirator suction tips, dental chair spittoons and other devices ⁽³⁾. A recent study shows that the coronavirus is present in the human enzymes located in the salivary glands ⁴, which aerosols from the high-speed handpieces may disseminate throughout the environment and would be the main contamination route for dental surgeons ⁵.

During the COVID-19 outbreak, countries such as Brazil have allowed dentists to perform emergency treatments only. However, these treatments must be performed according to the international guidelines for the COVID-19 infection prevention and control ⁶, which provide guidance on personal protective equipment and disinfection methods.

Most urgent treatments are related to pulp and periapical pain origin. The rubber dam isolation device, developed in the 19th century by Saford Barmun ⁷, must be used in these endodontic treatments. The absolute isolation procedure has become routine in Endodontics due to its numerous advantages, such as the significant reduction in accident risks and the preservation of aseptic protocol.

However, some professionals neglect this procedure, reporting difficulties in its handling ^8,9. In order to increase the safety of dentists during the COVID-19 pandemic, the use of rubber dam isolation, mainly in endodontic procedures, is essential to the coronal access once the high-speed handpiece produces higher aerosol volume ⁹. This conduct can reduce at least 70% of patients’ salivary fluids in the composition of the aerosols ^10,11 and thereby, significantly reduces the microorganism suspension in the environment ^11,12.

Thus, while COVID-19 pandemic continues, new cases are still being reported and vaccination is not yet released for the population, the worldwide recommendation is the mandatory use of rubber dam isolation in dental procedures, as a mean to reduce the chance of contamination and to contribute to keep dental office teams and patients safe and protected.

References

• ¹
  Yu J, Zhang T, Zhao D, Haapasalo M, Shen Y. Characteristics of Endodontic Emergencies during Coronavirus Disease 2019 Outbreak in Wuhan. J Endod 2020;46:730-735.
• ²
  Ather A, Patel B, Ruparel NB, Diogenes A, Hargreaves KM. Coronavirus Disease 19 (COVID-19): Implications for Clinical Dental Care. J Endod 2020;46:584-595.
• ³
  The Workers Who Face the Greatest Coronavirus Risk By Lazaro Gamio. ‘ ‘https://www.nytimes.com/interactive/2020/03/15/business/economy/coronaviru s-worker-risk.html ’. Published 15 March 2020. AccessedJune 2020.
  » https://www.nytimes.com/interactive/2020/03/15/business/economy/coronaviru s-worker-risk.html
• ⁴
  Sabino-Silva R, Jardim ACG, Siqueira WL. Coronavirus COVID-19 impacts to dentistry and potential salivary diagnosis. Clin Oral Investig 2020;24:1619-1621.
• ⁵
  Peng X, Xu X, Li Y, Cheng L, Zhou X, Ren B. Transmission routes of 2019- nCoV and controls in dental practice. Int J Oral Sci 2020;12:9.
• ⁶
  COVID-19 COVID-19: infection, prevention and control (IPC). URL: ‘ URL: ‘https://www.gov.uk/government/publications/wuhan-novel-coronavirus-infection- prevention-and-control ’. Published 10 January 2020/ Last updated 20 October 2020. AccessedOctober 2020.
  » https://www.gov.uk/government/publications/wuhan-novel-coronavirus-infection- prevention-and-control
• ⁷
  Grossman LI. Pioneers in endodontics. J Endod 1987;13:409-415.
• ⁸
  Marshall K. 'Dam it - it's easy!' - or is it?. Br Dent J2017;222:839-840.
• ⁹
  Samaranayake LP, Reid J, Evans D. The efficacy of rubber dam isolation in reducing atmospheric bacterial contamination. ASDC J Dent Child 1989;56:442-444.
• ¹⁰
  Cochran MA, Miller CH, Sheldrake MA. The efficacy of the rubber dam as a barrier to the spread of microorganisms during dental treatment. J Am Dent Assoc 1989;119:141-144.
• ¹¹
  Rautemaa R, Nordberg A, Wuolijoki-Saaristo K, Meurman JH. Bacterial aerosols in dental practice - a potential hospital infection problem? J Hosp Infect 2006;64:76-81.
• ¹²
  Al-Amad SH, Awad MA, Edher FM, Shahramian K, Omran TA. The effect of rubber dam on atmospheric bacterial aerosols during restorative dentistry. J Infect Public Health 2017;10:195-200.

Publication Dates

• Publication in this collection
  23 Nov 2020
• Date of issue
  Nov-Dec 2020

History

• Received
  21 June 2020
• Accepted
  25 Aug 2020