Rubber dam use for children's dental treatment reduced patient and operator stress


Rubber dam is recommended for isolating the working field during adhesive dentistry procedures. However, dentists often omit rubber dam, particularly in paediatric dentistry, supposing that it would stress the patient. The aim of this study was to evaluate subjective and objective stress parameters in children and adolescents during dental treatment when using rubber dam compared to relative isolation with cotton rolls and saliva ejector.

72 patients aged between 6 and 16 were randomised to receive fissure sealants under rubber dam (Test group  n=34) or using rolls and saliva ejector (Control Group n=38).  The patients parameters of stress (pulse rate, breath rate, skin resistance, blood pressure) were recorded at five measuring points as was the operators pulse. The patient’s  subjective pain perception during treatment was recorded using a questionnaire as was  the operators subjective mental and physical stress.

They found

  • Significantly higher subjective perception of pain during treatment in the control group
  • The control group had significantly higher breath and pulse rate,s but there were no differences in skin resistance response or blood pressure.
  • Both the operators pulse rate and self-perceived mental and physical stress were lower when using rubber dam
  • Time required to place the sealants was 12.4% lower in the rubber dam group

They concluded

This study reveals that in the hands of an experienced dentist, isolation with rubber dam is less stressful for children and adolescents than isolation with cotton rolls and can save valuable treatment time.


Ammann P, Kolb A, Lussi A, Seemann R. Influence of rubber dam on objective and subjective parameters of stress during dental treatment of children and adolescents – a randomized controlled clinical pilot study. Int J Paediatr Dent. 2012 Mar 8. doi: 10.1111/j.1365-263X.2012.01232.x. [Epub ahead of print] PubMed PMID: 22404253.



Share on Facebook Tweet this on Twitter Share on LinkedIn Share on Google+
Mark as read
Create a personal elf note about this blog
Profile photo of Derek Richards

Derek Richards

Derek Richards is a specialist in dental public health, Director of the Centre for Evidence-Based Dentistry and Specialist Advisor to the Scottish Dental Clinical Effectiveness Programme (SDCEP) Development Team. A former editor of the Evidence-Based Dentistry Journal and chief blogger for the Dental Elf website until December 2023. Derek has been involved with a wide range of evidence-based initiatives both nationally and internationally since 1994. Derek retired from the NHS in 2019 remaining as a part-time senior lecturer at Dundee Dental School until the end of 2023.

More posts - Website

Follow me here –