The Rubber Dam Misconception

You're listening to The Dr. Phil Klein Dental Podcast from Viva Learning.com. Welcome to the show. I'm Dr. Phil Klein. Today we'll be talking about the rubber dam, something we used in dental school all the time. And then when the pandemic hit, it once again became a very trendy topic. We all know that a properly placed dental dam promotes a moisture-free, uncontaminated working environment. The quality procedure environment is superior to those performed without one. So why the title, The Rubber Dam Misconception? To answer this question is our guest, Shannon Pace Brinker. She is an international speaker, author, and dental assistant for over 32 years. Shannon is the founder and owner of the Academy of Chairside Assisting, which is an online training platform for dental assistants. Shannon has taught over 60,000 dental assistants across the U.S. and Canada and is one of the most well-known dental assistants in the country. Before we get started, I would like to let our audience know that Shannon will be presenting a live webinar on VivaLearning.com titled The Rubber Dam Misconception. It is scheduled for Wednesday, May 11th at 7 p.m. Eastern Time, 4 p.m. Pacific. Simply visit VivaLearning.com to register. The webinar is free and you can earn live interactive credit. If you are listening to this podcast after the webinar, you can go on to VivaLearning.com. and type in Brinker, B-R-I-N-K-E-R, and you'll find the on-demand version of that webinar. Shannon, it's a pleasure to have you on Dental Talk. Phil, thank you so much for having me today. So you talk a lot about isolation in your training programs, and certainly more offices are using rubber dams all the time, and the pandemic, of course, has something to do with that. So why the title, The Rubber Dam Misconception? Well, Phil, I will tell you, I think the biggest misconception is the fact that it's hard to place, and takes a long time and that is totally not the case which is why we wanted to talk about this uh on this podcast and most importantly leading into the webinar that we're going to be doing to show how fast you can place a rubber dam so before we get too deep into the placement tricks which i'm going to ask you about do you think a lot of dentists are not using rubber dams because they're either uh frustrated with the process of putting it on or is it the patient that's uncomfortable with this rubber dam on which is not great for the patient either but i guess it once it's on it's not so bad so where are we with the challenges and what's going through the mind of a dentist when he's supposed to put a rubber dam on Well, I think part of it goes back to dental school, you know, and all the stories that I've heard from dentists when they're in school, how they have to sit out in the waiting room and they're all lined up with the rubber dam on. And so I think that's some of it. But really and truly, if you if you really have great training, you're trained by someone that really just. takes you through step one, step two, step three. I think that is where we can really change the mindset. It's always about not having the right clamp or we didn't have the materials right in our fingertips. So, you know, where we could just open a drawer and right there it is. Having the right, you know, having, I guess, the right training as far as knowing what clamps we really need. We don't need a thousand clamps. Make it very simple. But most importantly, training the team to do this. I mean, my doctor doesn't do. rubber dam placement. I do the rubber dam placement. But the other thing is I think sometimes we just assume the patient really is going to you know, just look upon like, I can't believe you guys are doing this or not want this done. But in our practice, it's not really a choice. It is just comes with the territory and it is part of the procedure, pretty much part of every procedure. And and I will tell you, before I even say anything, the person that really inspired me was was Dr. Pop and and his his whole. analogy of what rubber dam can can can do for your practice and i'll tell you um he's an artist but he really inspired me to want to place more rubber dam because he made it so simple and so easy and i think we're just looking at something that's so complex when it really isn't yeah so that's a really good point so it's like anything else you know when you doing a home improvement project one of the most important things to do of course you have to know what you're doing but you need the right tools you have to have everything in front of you that you need right you can't be running to the garage every time you realize you need something because it's just going to frustrate you and you're never going to get it done and you're not going to want to do it again so preparation is number one and as a retired endodontist rubber dams was of course an invaluable tool for us we can't do a procedure without a rubber dam absolutely the clamp is really important it has to fit you have to have it right there in front of you you can't be looking for it you don't need that many you're absolutely right and then of course you need the training on how to put it on properly because you know you don't want that rubber dam to tear when you're putting it on because that's really frustrating when it tears just when you think you have it all set up it tears so what do you think are the most valuable tips and tricks for placement including the armamentarium of your setup if you would tell us about that please sure um well i will say the first thing is is that uh you know you you want to have everything in one place you know having a kit And that's what I basically made was, you know, having my punch that is, you know, your team has to understand the different dials on the punch. That's the first misconception. I think number one is I thought it was one size fits all because I'm always trying to I want to be efficient. I don't want to cut corners, but I don't want to waste time. And and so, you know, when I first got out of school, I wasn't trained by a very good person that trained me or a very good teacher. And and so really did not. You know, in my mindset, help me to understand that there are different sizes on the dial of the punch first. And knowing that why are we, you know, the right size basically for which teeth and having a guide for that. And knowing now that as the larger size is always the, you know, going to be our basically the clamp, you know, our anchor tooth. And it goes down from there, depending on coming to the midline. And then just knowing that, you know, we have a good frame and then having the right clamps. Again, you don't need a lot of different clamps. You may need a clamp that, you know, maybe is a partially erupted molar. I really only use maybe five clamps. And I'll go into that really in depth in the webinar as far as the training goes. But you really only need about five. And so in my kit, if you open my drawer right now and you looked at my office, you would see I really only use about five clamps because you just got to keep it really simple. And then having, I think, your team to understand that. The frustration that you talked about was, you know, the tear of the dam itself. Before, really, our selection, we either had to use latex and that was really all we had. Now we've got several non-latex, but there are some doctors that still like latex if the patient isn't allergic to it. And most importantly, you know, having the colors of green and purple and blue was great until now we have this black that is, I will say, my favorite because I love black gloves. I love, you know. black mask. I want my eye to go to the teeth. And I think that once a team understands that we can block everything out, because when we're trying to do, let's just say even cosmetic dentistry in general as a whole, you know, you want your eye to really focus on the tooth, not the patient's tongue moving all over the place, you know, bits and pieces of the crown breaking off. It makes it so much easier for us to have our eyes right on that tooth. We're not focused on anything else. And we just always think, you know, oh my gosh, and the patient. It's not going to like this. The patient's going to be upset with us for placing it. The patient doesn't know any better. And I will tell you that 80%, if not more, appreciate the fact that this is what we're doing. It all is how we say it, Bill. And you've had this conversation with me so many times when we've been on these podcasts. Everything we do is how we say it. And just explaining to them. patient, this is what we're doing today. And these are the reasons why. And most importantly, I think it looks great on the practice to know that we are taking those extra precautions, not only to make sure that the patient doesn't swallow any pieces of the filling or an old crown, but most importantly, we are using proper bonding techniques and having that proper isolation to increase bond strings. And that's been proven. And so at the end of the day, it's all in what we say. Back to the rubber dam, I will tell you that, you know, having greens and blues were great and that's all we ever had. But now that Cranberry has released this black carbon, I already had their carbon gloves because everything we do is black and we want to be chic. But when they came out with this, with the rubber dam, the carbon dam, I was like, oh my gosh. I mean, I could not wait to use it because I knew. First of all, it was really going to allow our eyes to really go right to the tooth and not be focused. But most importantly, for photography, because, you know, I love photos, photography and just a reflection of our products and really being able to focus on those areas. It is a beautiful product. And I mean that. I'll tell you, I'm so excited and hope that for anyone that's watching because, you know, rubber dam is you only can make it so exciting. Right. I think that you're missing out and really owe it to yourself to say, you know what? I want my team. I want my dental assistant to learn this placement because once they learn it, it's easy. It's just, you know, again, practice makes perfect, but boy, does it make our lives so much easier. And it's just all about the training. So what is the material that Cranberry uses for this black rubber dam? It really just launched. I've had it when they first were in the process of coming out with rubber dam. I was one of the first people to get it, to try it. And I remember telling Alan Wong, I was like, oh, my gosh, I was just so excited because I was just hoping that this was really going to be all I hoped it would be. And it is. The great thing about the rubber dam is it is very, very strong. And I personally don't like to use a very heavy. We'll talk about different grades and different thicknesses of rubber dam in the webinar. But but with that, you don't want something that's so thick that it just you can't even get it over the tooth, much less try to, you know. Hope that you can really floss interproximal areas. Let's just be honest. This one here, what I love is that they do have two different types. First of all, it is a latex and a non-latex, which is fantastic. The other thing is it does have a scent to it, which I will say that, you know, not a lot of rubber dams out there even have that. And so I think that's a great thing because we know anytime we're taking off an old crown. Doesn't smell too good. But the patient, you know, in the way that they feel about themselves, a lot of times it's already they're nervous. And most importantly, they already feel bad about, you know, having their dentistry done. I think this kind of just having that scent does help. And I think it also with, you know, lowers their anxiety. And they really thought about it right now. It's a medium gauge material. But I will tell you that it's not too thick and it's not too thin. It really. is the perfect thickness and making it really easy because when you've got so many choices for team, they get confused. You end up having materials that you didn't really need. And so here is either latex or latex free. And again, I think the medium gauge is really right where it needs to be as far as being able to place it and not having to worry about it. And so far I've used it with premolar clamps. I've used it for what we call a slit dam technique, which we'll talk about in the webinar where we actually use. a rubber dam for delivery. It's not just about the prep. We use it for delivery, which is so, I mean, oh my gosh. I mean, my doctor now, once I placed it the very first time for him and we did the slip dam technique for delivering of veneers. we have, we'll never go back. I mean, it just lowers the anxiety, I think, or lowers his anxiety. And I think that's what doctors need to understand is this is really for you. It's not just for the patient. You know, this is to lower the anxiety for you. And let's face it, everything that we drop with these chemicals, I don't care if you're super assistant, you're going to drop bonding agent. Edge tastes terrible. You know, everything we use in dentistry tastes bad. So as soon as that patient starts. you know, suction, you know how they do us, right? And I'm sure listeners are probably laughing right now. And once you drop something, they want to completely start suctioning or rinsing them right in a critical phase of delivery or prep. And we just can't, you know, sometimes we just can't do that. And with this rubber dam, you're not having to worry about things not only tasting bad. the patient moving around. I can tell you patients actually appreciate it. So I think that's what is probably the best part about it. And again, just learning the simple techniques of placement is all we need to overcome. Yeah. And part of that rubber dam misconception is exactly what you just said, Shannon, is that the rubber dam really does benefit the operator big time. As an endodontist, of course, I couldn't operate without a rubber dam. There's many times I go to the dentist in the past 10 years where the restorative dentist did not use a rubber dam. And like you said, interruptions occurred due to something dripping in my mouth or whatever. It certainly tastes caustic and tastes terrible where you don't want to swallow it. And it slows down the whole procedure. So over time, there's really a chair side savings. Now, it does take time to get the rubber dam on. And if you're not used to doing it, there's probably a learning curve. Could you give us an idea of how long it typically takes you to put a rubber dam on, whether it's using this cranberry rubber dam that you really love or another brand? What's the typical time? Sure. Well, I will tell you that the doctor will go ahead and anesthetize the patient and usually get up and go check hygiene. That's kind of the norm, you know. And so it takes me probably about three to four minutes to place it. And again, the biggest obstacle is what clamp goes for what tooth. Once we know, okay, am I going to, and one of the things that I learned, again, I keep saying, Dr. Pop, Dr. Colin Pop, I got to give him all the credit. Oh my gosh. I mean, just watching him, he doesn't even, sometimes he doesn't even punch a hole. You know, he just wants to isolate it and he'll work on the complete other side of the mouth. And I'll show a little bit of his, with his permission, I'm going to show a little bit of his work, which is, it's just. crazy find amazing and but one of the things that i think is if we know what clamp goes for what tooth and and we have a good clamp and having all the tools that we need we really are going to give them in the webinar Each step and even put together a downloadable guide for training, because this is, you know, once we practice and you can practice on a model. And that's what I always suggest first. Listen, I practice over and over and over. I learned from Dr. Ron Jackson many, many years ago, bring in the rubber dam all the way to the midline, always made it easier. And he's like, Shannon, don't just isolate two or three teeth, because I was always trained to do two or three teeth. And and he would he would tell me every single time, no, go all the way to the midline and then. it'll make your life easier. And I just stuck with that. And so between, you know, his foundation, his techniques, and then seeing and knowing what I know now from Dr. Colin Popp, who actually has, he's from Dubai. And he has this whole thing called rubber damology. It's amazing. Now, I will tell you, I'm going to share with him carbon's dam because he's been using a different rubber dam. And and one of the things that I will tell you is he talks a lot about photography when I was taking his course. And the one thing I hate about photography is a reflection, you know, especially if you're trying to do mirror shots to take our step by step to show you, you know, every step of the way of how to place these rubber dams or even do bonded procedures. We always got a reflection. And so now. The one thing that is very different that I don't want to forget about the rubber dam is that it basically has this matte finish that we're used to on one side. You know, a lot of times it's matte on one side and then has a little bit of powder on the other. This one is the only one out there that is matte on both sides. And the reason that they did that was really for photography. So I was like, oh, my gosh, finally, somebody's listening. So that reflection isn't there. And we know these overhead lights now have, you know, LED overhead lights. And that reflection is critical and crucial to our eyes. So we almost just I think that they thought of everything, because if we didn't have that, the doctors got loops on and then we've got the overhead light. You know, again, our whole reasoning for placement. or part of it anyway, isolation, but also having that eye go straight to the tooth. When we get this reflection, it's hard to look at it sometimes. And by having the matte finish, again, we don't have that bounce of light. And I think that, again, when you think about everything that they've thought of, having the right thickness, most importantly, having latex or non-latex, and then having a key guide. in the kit that shows us exactly where those holes should be punched. And then knowing that we don't have this bounce of light, it's really going to be great. I can't wait for you guys to try it and get your feedback. And you can even get some samples on their website. Um, and, uh, and try it out, you know, but again, I will tell you, I've been shocked at the last couple of courses that I've given, especially one that I gave in Indiana towards the end of the year last year. And we had about 30 assistants. And do you know that 27 out of those 30 practices of assistants that attended that course place rubber dam. So before we only thought about four to 5% of the population in the U S were placing it. Of course, COVID bumped us up to about nine to 10, but I can tell you now, I think it's even, it's growing. And it's all about the training because nobody's teaching us how to place rubber dam anymore. So what's the best way for a dental assistant in a dental practice to learn the most efficient way to place a rubber dam? Should they be watching a video on YouTube or going to one of your classes or can they read about it in a book that's illustrated? What's the best way to get it? Yeah, I think for me, I break it down really simple. So I think, first of all, get them on that webinar that we're going to give for for you here in just a few weeks. Most importantly, getting into that webinar and then and then having a download. One of the things that I will say is, you know, I had a lot of people train me and teach me good things. And so we really just did a combination of a lot of of the people that taught me. And I kind of put it into one and just having a quick, you know. This is what you need to know about your hole punch. And this is the clamps and what clamps are going to be used for which area of the mouth. And I've got like a whole diagram of the mouth. So they'll know these clamps are for this because we've got all these numbers. Oh, my God, I think there's like 100 different clamps. We have a three page, you know, just step by step of all these little things. But most importantly, the diagram of the mouth with. the clamps and so once i think team members just go through that i know every office has old models save them it doesn't matter if it's a stone model we just really need to you know practice and practice and practice and i think that is something that you know we need to do a couple of times but most importantly if we don't have these models or have something that they can use to practice on because you don't always want to practice on a patient we'll get more efficient at it and giving us the time doctor to practice as well fantastic to learn about the rubber dam misconception have a great evening Shannon. thanks so much for your information and we're really excited about your upcoming webinar well i'm excited too so thank you for your time and look forward to seeing you at the webinar