 Hello everyone, welcome back to another session in dentistry and more Today we have rubber damp from operative dentistry so rubber damp is nothing but a thin square sheet of Rubber which is used to isolate operative site from the rest of the mouth So which basically contains a hole in the middle which allows the dentist to isolate the treatment area Using a dental clamp around the tooth And they are basically made of latex, but there are also non-latex alternatives are available So this session is about The rubber damp its components how to fix a rubber damp how to remove a rubber damp So moving on so rubber damp provides some best possible isolation in in 1864 SC Barnum, New York City Dentist introduced a rubber damp into dentistry So it is used to define the operating field by isolating one or more teeth from oral environment and this damp Eliminates saliva from the operating site and Retract the soft tissue so the advantages are As we all know it provides a dry clean field And there will be improvement of access and visibility by eliminating the more moving structures such as the tongue, lip, cheeks and saliva from Operating field and retraction and also the protection of soft tissue because in operative procedures There are chances of insurers of tissue then prevention of inhalation and ingestion of foreign bodies the files and other things Improved properties of dental materials because most of the times when it is mixed with saliva the properties or the actual properties will be reduced and it aid in patient management and it prevents the cause infection and it minimizes Mouth breathing during inhalation sedation procedure But the main problems associated with rubber lamp It's the most difficult part. It's its Installment usage is very alarming the private practitioners because it is very time-consuming and the patient most of the patient is Not very happy with this So patients objection and time-consuming is the one which prevents most of the dentists to use in their clinical practice And which cannot be used in case of extremely malposition teeth That is one of the thing because if we have a properly alien teeth, it is very easy, but if it is a malposed teeth it's very difficult to fix and the children who are suffering from asthma or some other respiratory infections or mouth breathing we just cannot apply this because The present condition of the child may exaggerate Moving on the armamentarium. So it consists of a lot of components such as sheets Rubber Dump clams then the rubber Dump frame or holder then the retainer forceps or the punch forceps and the rubber Dump templates or Stamps dental flows and finally the widget So this is the finally placed rubber Dump. I can see the tooth. So this is the tooth, which we are going to work on it and This is a retainer the frame and This is a sheet So the rubber Dump sheet as you see here. It is available as rolls or sheets maybe five or square in size thin medium heavy and extra heavy Thickness are available color could be mostly the blue or green that is the most unique colors which helps the dentist to It is dentists favoring colors because it prevents optic illusion when looking at a blood for a long period of time So it creates optic illusion. So in order to neutralize the Such optical illusion most of the colors in surgical or medical field will be blue or green So it is to provide good contracts with the surrounding and maybe flavor for the children The second one is a rubber Dump clam or retainer. So this is a clam or retainer It is used to secure the Dump to the teeth that are to be isolated and to Minimally the track the ginger issue. It does two purposes one is Secure the Dump and the second one is it to attract the ginger tissue. So it has got parts such as the bow then it has got two Jaws and you can see the prongs four prongs two on each jaw so these two jaws the The left jaw and this right jaw is connected by a bow. So this pointed parts which connects to the tooth are known as prongs So they are four prongs two jaws and one bow So we have this retainer two types one is winged and the second one is wingless Okay, so you can easily make out this is wingless and this is wing you can see the wings On both side of this jaw, this is the wings which is absent here. This is wingless So the retainer is nothing but the clam So return with wing like projection on the outer aspect of the jaw This is the outer aspect of jaw it provides extra retraction of the rubber Dump from the field of operation So it pushes the rubber Dump Towards the apical side and it also gives extra retraction So these wings are passed through the punched holes in the dam and the dam and the retainer placed together on the concern tooth So after placement the dam is slipped carefully over the wings onto the tooth So once you see the picture of step-by-step We'll easily understand this procedure Next we have the wingless retainer which is not having any wings You can see there is no wings. So the retainer is first placed on the tooth and The dam then stretched over the clamp onto the tooth The third component is a rubber dam holder or frame here we attach the entire sheet So it is used to maintain the borders of the rubber dam in position We have Young's holder. It is a U shaped metal frame with small metal projections for securing the borders of rubber dam Then the ash pattern which is most suitable for children then Swenska and her frames are suitable for taking radiographs This fourth component is a rubber dam retainer forceps Okay stocks and rear forceps are there and also ash type is there So it is used for the placement and removal of the retainer from the tooth So we keep retainer at the tip of it For both the purpose that is to keep the retainer on the tooth and also to remove the retainer from the tooth So that is rubber dam retainer forceps Then we have rubber dam punch which is used to make holes in the dam because we need to create holes so that the tooth comes out of the hole and This rubber dam will be beneath the tooth surrounding the tooth with the retainer in position So it is like a rotating metal disc which has five to six holes of Different size according to the size of teeth as you can see There will be six or five holes based on the size of the teeth and they'll be a sharp pointed plunder Which is to create the hole in the rubber dam sheet The next one is a rubber dam template or stamp so it is like a template which is With holes in it which provides a template for the size of the tooth Which needs to be created for the placement So both have position of the teeth marked on them and I used to transfer them to the rubber dam sheet for the holes to be punched so this gives the idea of the size of the tooth if you want to create a Hole which is a maxillary central incisor which you are going to work on it so you can use this template if it is a Second molar lower second molar you can use this template So this template has different size Then we have dental flows which is tied around the retainer before carried to oral cavity to prevent the accidental aspiration of the clamp And widget an elastic which is used to secure the dam around the teeth On the distal side or the farthest side from the clamp So how do we prepare the patient for rubber dam? So this rubber dam can be presented as a raincoat that keeps the tooth dry and held On by a button which is clamped and kept straight by a port hanger, which is a frame. So this is a Frame and this is a clamp So local anesthesia should be administered where a clamp may impinge on the jujava. Okay, which is very optional So the first step is testing and lubricating the proximal contacts. So first we need to use a dental flows To test the inter proximal contact and remove the debris from the tooth to be isolated Second one is the punching the hole so you can use a template the punch rubber dam punch using this one you can create a Hole in the rubber dam sheet Based on the tooth which you are going to work Then lubricating the dam. So the assistant Can lubricate both sides of the rubber dam in the area of punched hole. Okay So using a cotton roll or a gloved fingertip to apply the lubricant So the lip sand corner of the mouth may be lubricated with petroleum jelly in order to prevent any type of irritation Then we have Selection of the retainer so We have many varieties of many types of retainer based upon the Size of the tooth because it is varies from central and size of premolars and molars so the rubber dam retainer forceps will be used to Keep the retainer in desired tooth And there will be a flow style in the position because as we mentioned There will be a flows tied to this in order to prevent accidental aspiration Then we need to test the retainer stability and retention So first test the retainer stability by lifting gently in an occlusion direction with a finger once we Placed in position Slightly lift towards the occlusion direction with a fingertip under the bow of the retainer So an improperly fitting retainer will be shaking or easily dislodged Then positioning the dam over the retainer so with the forefinger stretch the Particular hole of the dam over the retainer and then circles the tooth and will be on the rubber dam sheet The seventh step is apply the napkin So once the operator gathers a rubber dam in the left hand where the assistant can insert finger and thumb of the right hand Through the napkin opening and grasp the bunched dam held by the operator Then positioning the napkin so the assistant pulls the bunched dam through the napkin and positioned it on the patient face Then we can attach the frame so it's the last step we can attach the frame so that It will be in position So there will be Projections here so we can stretch it and connect to the metallic projections which is present outwards which will be projected outwards from the each order Then attaching the nap strap so this assistant attaches the next strap to the left side of the frame and passes it behind the patient's neck and Operator attached to it To the right side of the frame Then if there is a tooth distal to the retainer the distal edge of the posterior anchor hole should be Pass through the contact to ensure a seal around the tooth Then if the stability of the retainer is questionable a lot of fusing modeling Compound can be used now to secure it in position Then the operator passes the sceptre through as many contacts as possible without the use of dental tape by stretching the Sceptre dam for fingers each of the septum must not be allowed to bunch or fold Then use Waxed dental tape to pass the Pass through all contacts then tape is preferred over flow because it is wider dimension more effectively carries the rubber sceptre through contacts Then invert the dam into the gel sulcus to complete the seal around the tooth and prevent leakage So finally with the edges of dam Invert Interproximately complete the inversion facially and legally using an explorer while the assistant directs his stream of air into the tooth Then we can use a saliva injector Because most patients are able and usually prefer to swallow the saliva. It is optional So a properly applied rubber dam will be positioned and it will be comfortable to the patient and The patient should be assured that the rubber dam does not prevent swallowing or closing the mouth when there is a pause in the procedure And check to see that the completed rubber dam provides maximal access and visibility for the operator Whereas the removal of rubber dam first one is stretch the dam facially pulling the septal rubber away from the general tissue Then protect the underlying tissue by placing the finger between fingertip between beneath the septum Then in case the retainer forceps is unnecessary to remove any compound And because it will break free as the retainer is spread and lifted from the tooth After the retainer is removed release the dam from the anterior anchor to and remove the dam and frame simultaneously So wipe the patient leap and napkin immediately after the dam and frame are removed The step five rinse the teeth using a high volume Evacuator then Lastly lay the teeth of rubber dam or a light colored flat surface or hold it up to the operating light to determine that No portion of the rubber dam Has remained between or around the teeth such a remnant would cause ginger well inflammation So make sure that nothing remains in the operating field So that was all about Rubber dam I have explained the components and step by step procedure so it is Commonly asked as a question in operating industry or conservative industry We need to explain the components and so all steps need not to be explained can Skip any of these steps So you can combine many steps So I will come up with a new topic in the industry and more. Thank you