Dental Tribune United Kingdom Edition

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Gracey ad_GB_A4_2012.indd 1 16.02.12 14:38 T he September issue of Oral Health included an article by Dr Ellis Neiburger en- titled Rubber dam hazards. The contextual inaccuracy, skewed perspective and postulatory bias of the author was disingenuous at best and horrifying at its worst. I’m not certain how it managed to secret itself into our beloved cen- tenarian journal, but it did. Before I comment on the text, I’d like to share a scientific article with you published by Smith and Pell in the British Medical Journal in 2003 (entitled Parachute use to prevent death and major trauma related to gravitational challenge: systematic reviewofrandomisedcontrolledtri- als) to give my concern about this article’s publication an element of gravitas. The abstract reads: Objectives: To determine wheth- er parachutes are effective in pre- venting major trauma related to gravitational challenge. Design systematic: Review of randomised controlled trials. Data sources: Medline, Web of Science, Embase, and the Cochrane Li- brary databases; appropriate In- ternet sites and citation lists. Study selection: Studies showing the effects of using a parachute during free fall. Main outcome measure: Death or major trauma, defined as an in- jury severity score > 15. Results: We were unable to iden- tify any randomised controlled tri- als of parachute intervention. Conclusions: As with many inter- ventions intended to prevent ill health, the effectiveness of para- chutes has not been subjected to rigorous evaluation by using ran- domised controlled trials. Advo- cates of evidence-based medicine have criticised the adoption of interventions evaluated by using only observational data. We think that everyone might benefit if the most radical protagonists of evi- dence-based medicine organised and participated in a double blind, randomised, placebo-controlled, cross-over trial of the parachute. Not wishing to misjudge nor malign the author, I searched the many publications attributed to Dr Neiburger in the literature us- ing Google Scholar. My personal favourite was Similar mandibular osseous lesions in Tyrannosaurus Rex and man,1 followed closely by Voodoo Barbie and the dental of- fice,2 not to be outdone by Water line biofilm dangers—A tempest in a teapot.3 Of note, none of the ref- erences pertaining to the hazards were dated beyond 1990. As to the inaccuracies, rather than repeating the text, I’ll an- swer the “factoids”: rubber dam is routinely used in the vast ma- jority of endodontic and restora- tive procedures by contemporary dentists; sterilisation of the rubber dam can be done readily; reuse is the most scurrilous of the factoids proposed; colour is not an issue, in fact it can be used to enhance photographic documentation; the physical and chemical properties of the dam enable it to be used with most if not all dental materi- als and its strength cannot be in dispute,astheaverageendodontic procedure does not require mul- tiple replacement; damage from clamps occurs because of improp- er placement; the sheer enormity of clamp sizes and design allows for literally any clinical situa- tion with tissue injury essentially non-existent; there are a raft of alternatives to clamp placement (Fig1);theissuespertainingtotime for placement, phobias, material residue in pockets anon … even providing a rebuttal to the text gives it a undeserved credibility. Rubber dam hazards? Dr Kenneth Serota gives his opinion Fig 2 Fig 1