“Doc, I Can’t Breathe!” (Why a Rubber Dam Might be the Answer)

By Dr. Aaron Nicholas

September 26, 2023

The patient had been anesthetized (block for the lower left and infiltration for #8) and I was just starting to prep a very small lesion on #8. Every few seconds he would move to get out from under the handpiece. So, I asked, “What’s going on right now?”

“Doc, I can’t breathe!”

That is not exactly what you want to hear at the start of an appointment. Since the patient didn’t show any signs of distress, I asked him to take a deep breath. Problem solved.

It seems silly, but frequently when we lay patients back for their appointment they start to panic because they now have to actively maintain their airway. Usually, this is done by pushing their tongue forward or by dropping it below the occlusal plane of the mandibular teeth. Then, the dentist or assistant starts manipulating the tongue and the patient must push back to maintain the airway. Naturally, when this pushing contest starts the tongue expands as it pushes back, further obstructing the airway and complicating the problem.

Alternatively, lay a patient back and place a rubber dam. Frequently, the patient immediately becomes a “mouth breather” for the same reason; but, now there is something obstructing the flow of oxygen. Then you hear, “Doc I can’t use one of those things.”

We all know that the appointment is a completely different experience for the patient and the team. But, sometimes it can literally feel like life or death to our patients.

So, how do we make this a more comfortable experience for everyone involved?

I’ve tried handing the patient a mirror and coaching them on how to place their tongue so that they can breathe easier (this almost never works). Usually, I just try to gently hold the tongue away from where I’m working.

But for those extreme cases, a rubber dam can actually be your best friend. By placing it and cutting a breathing hole in the middle of the dam, it can keep the tongue out of the way and allow the patient a larger degree of freedom. With a hole placed like this, it allows the assistant to go to the corners of the mouth through the hole rather than trying to lift the rubber dam and possibly popping off the clamp.
So, the next time you’re having one of those appointments with one of those patients, try using a rubber dam to solve the problem. You might be surprised.

P.S. Join Dr. Aaron Nicholas October 13th in Las Vegas, Nevada for his One Hour Molar Root Canal Buildup and Crown course
(DSN members receive a $300 discount) or join DSN to chat with him inside of the Endo Simplified room.