Syrian Senior Dental Students’ Perception, Educational Satisfaction, and Attitude Regarding the Usage of Rubber Dam

INTRODUCTION

Moisture control means excluding saliva, sulcular fluid, and gingival bleeding from the operation field and preventing the handpiece spray and restorative materials from being aspirated or swallowed. The creation of dryness by the exclusion of mouth sections and humidity from the operative field is essential for rightly performing most restorative procedures.

The rubber dam has many advantages in most branches of dentistry and is mandatory for legal considerations. The usage of the rubber dam is a must in recent endodontic and operative dentistry practice because it provides a clean operating field, isolating the tooth from salivary contamination, preventing the inhalation or ingestion of dental instruments and materials,¹ and protecting the oral soft tissues and gingiva from contact with solutions used during dental treatments, such as sodium hypochlorite and phosphoric acids. Rubber dam decreases aerosol contamination and cross-infection by up to 98.5% if it is used during conservation procedures,^2–5 and may also reduce transmission of acquired immunodeficiency syndrome, hepatitis, and tuberculosis.^3,6,7 It is made of latex, but nonlatex rubber dam sheets are available for patients with latex sensitivity.⁸ The use of dental dam is the standard of care.^9,10 With the understanding of the basic principles and a well-qualified dental assistant, a single tooth can be isolated in only a few seconds. Many reasons have been reported for the lack of rubber dam use which include patient objection, time consumption, cost of materials, and shortage in training. In current cariology and endodontics, both undergraduate education in the use of rubber dam and its later practical use should belong to standard knowledge and skills.¹¹ This study aimed to determine the perception, educational satisfaction, and attitude of dental students (fourth and fifth years) regarding their use of rubber dam.

MATERIALS AND METHODS

Anonymously, a piloted questionnaire was delivered to fourth- and fifth-year dental students in Damascus (governmental) and Syrian private (private) dental schools in August 2019. Survey preparation depended on the study of Mala et al.,¹² Abdulrab et al.,¹³ and Tanalp et al.¹⁴ The pilot study was conducted on a random sample of students (n = 15) to be sure that the questions were clear. A total of 380 survey (14 questions) forms were distributed. The questions were closed ended, divided into five groups as following (demographic, utilization of rubber dam, students’ opinions about the usage of rubber dam, students’ opinion about the difficult sides regarding rubber dam usage, expressions of students regarding various aspects of rubber dam, and opinion of students about postgraduation usage of rubber dam). The mode of answering the questions was variable [(yes or no), (always, never, rarely, and sometimes), (I agree, I disagree)]. A data analysis were carried out using SPSS version 25. A descriptive statistical analysis was done, and a Chi-square test was performed for qualitative data comparing. Results were evaluated at a significant level of p < 0.05.

RESULTS

Out of 380 questionnaires, 346 were completed and returned with response rate of 91.05%.

As it is shown in Table 1, 170 (49.13%) were female respondents, whereas 176 (50.87%) were male respondents, 80 (23.12%) were in the fourth year, and 266 (76.88%) in the fifth year. The majority (70.23%) always did not ask their patients about latex allergy, with a significant statistical difference between the studied two dental school (p < 0.05). A total of 317 (91.62%) did not use rubber dam for pediatric patients, 163 (47.11%) never used it in case of amalgam restoration, but 185 (45%) always used it with composite restoration (p < 0.05). A total of 214 (61.85%) of the students used to apply rubber dam after access cavity preparation (p < 0.05). A total of 178 (51.45%) of the students did not take an adequate education regarding the use of rubber dam. Furthermore, 213 (61.56%) never used rubber dam during working on teeth with large tissue loss (p < 0.05).

The most important advantage for rubber dam was creating isolation and an aseptic field as reported by 83.24% of the participants (p < 0.05; Table 2). Most of the students (262, 75.72%) reported that choosing the clamp and its adaptation was the most difficult stage of rubber dam usage (p < 0.05; Table 3).

Table 4 summarizes agreements or disagreements of students toward different aspects of rubber dam. The Chi-square test revealed that no statistically significant effect was present among responses in Table 4 except for the inability to establish an adequate isolation without using rubber dam and the opinion about rubber dam is more necessary in maxillary teeth (p < 0.05). Table 5 shows the opinions about the postgraduation usage of rubber dam. A total of 153 (44.22%) of the students intended that following graduation, they will use rubber dam for all the procedures indicated (p < 0.05).

DISCUSSION

The goal of recent dental schools is to introduce well-qualified dentists on graduation. This is a challenge because of huge number of students and dental schools, and decreased numbers of qualified dental educators.^15,16 Almost all dental schools teach the students that the use of rubber dam is obligatory for most restorative treatments in children and adults.¹¹ So, this will have a significant positive effect on its usage after graduation. A total of 70.23% of the students in the recent study did not investigate latex allergy among their patients; this percentage is higher than in Abdulrab et al.’s study¹³ and Tanalp et al.’s study.¹⁴ This means proper orientation of students should be present to focus on the possibility of latex allergy prior to application of the rubber.¹⁷ A high number of students (317, 91.62%) do not use rubber dam in pedodontic patients, which is close percentage to some previous studies.^13,14 A total of 47.11% never used rubber dam in cases of amalgam restoration as in Akbar et al.¹⁸ but higher than the result of Abdulrab et al.¹³ However, the results regarding the use of rubber dam with composite restoration were compatible with Tanalp et al.¹⁴ Only 28.61% of the students apply rubber dam before access cavity preparation in root canal treatment; this value is low when compared with other studies.^13,19 Approximately 50% of the respondents declared that they did not have adequate and satisfactory education regarding rubber dam as in the study of Akbar et al.¹⁸ and Al-Haj Ali et al.²⁰ The majority of students in this study preferred not to use rubber dam when a tooth was with extensive tissue loss agreeing with Tanalp et al.,¹⁴ and this could be explained by the fact that large loss of tooth structure may cause a difficulty in adapting a regular clamp. The greatest advantage gained from rubber dam from the students’ point of view (83.24%) was to perform suitable isolation and an aseptic field, and this is similar to Abdulrab et al.’s study. The most difficult step in the rubber dam application was clamp choosing and application (75.72%), while in other studies (Abdulrab et al. and Tanalp et al.), this reached 73% and 84%,^13,14 respectively. This may be because students may not have adequate sizes and types of clamps, suitable for different cases as students in these schools buy the instruments by themselves. A total of 77% of the students in this study agreed that rubber dam eases restoration stage, and this result matches with that of Akbar et al.¹⁸ The majority of our students agreed that rubber dam allows a more successful treatments, a result which is consistent with many studies.^13,14,18 A total of 58% of the students felt that intended isolation cannot be found without rubber dam application comparing with high percentages of other studies.²¹ Rubber dam makes it easy to access the root canals; this thought were supported by 56.9% of the contributors, which is slightly more than the response in Tanalp et al.’s study.¹⁴ It is difficult to take a radiograph in the suitable position with the dam in place, and this is another disadvantage as reported by 90% of the students, and it is known that removing rubber dam during radiography is an accepted behavior as this step is performed with an instrument within the root canal, and the patient generally stays alone in the X-ray room. In this study, around 44.51% of the respondents agreed that dental dam is difficult to apply; a similar finding has been reported by Abdulrab et al.¹³ About half of the study sample reported that the too much components of rubber dam disturb them, but this percentage is still the lowest when compared with other studies.^13,14,18 The majority (91.9%) of students went with the statement “Patients do not like the rubber dam,” so this is contradictory to the dental literature.^22,23 Dental students may show ideal views about recent methodologies upon graduation; 48.27% of the students reported that they apply rubber dam only because they are obliged to following graduation, so additional efforts should be made to change this mistaken thoughts about the importance of rubber dam in safety measures in dental practice by showing students the happened accidents from ignoring the usage of dental dam and aftermath.¹⁴ Another study should be conducted to evaluate the efficacy of teaching plan modification.

CONCLUSION

Within the limits of this study

• Efforts should be paid to assure dental students to ask their patients about latex energy.
• Dental student should be oriented to use rubber dam in pediatric dentistry.
• It is necessary to persuade the students of the importance of rubber dam application in different procedures including amalgam and composite restoration, and this will guarantee the use of it after graduation.
• Providing suitable and impressive education regarding rubber dam usage should be revised in the syllabuses of the studied two colleges.

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