Dental-Dam for Infection Control and Patient Safety during ... - MDPI

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Dental-Dam for Infection Control and Patient Safety during Clinical Endodontic Treatment: Preferences of Dental Patients Ahmad Madarati 1 , Seema Abid 1 , Faisal Tamimi 1 , Ali Ezzi 1 , Aya Sammani 1,2 , Mohamad Bachar Abou Al Shaar 3 and Muhammad Zafar 1,4, * 1

2 3 4

*

Department of Restorative Dentistry, College of Dentistry, Taibah University, Al Madinah, Al Munawwarah 41311, Saudi Arabia; [email protected] (A.M.); [email protected] (S.A.); [email protected] (F.T.); [email protected] (A.E.); [email protected] (A.S.) Department of Substitutive Restorative Dental Sciences, Faculty of Dentistry, Aleppo University, Aleppo, Syria Department of Preventive Dental Sciences, College of Dentistry, Taibah University, Al Madinah, Al Munawwarah 41311, Saudi Arabia; [email protected] Department of Dental Materials, Islamic International Dental College, Riphah International University, Islamabad 44000, Pakistan Correspondence: [email protected]; Tel.: +966-50-754-4691

Received: 9 August 2018; Accepted: 13 September 2018; Published: 14 September 2018

Abstract: Background: A number of factors (first experience, treating clinician and time to place dental-dam) may influence patients’ preferences regarding dental-dams. In general, patients accept placing it and that it must be used for teeth isolation during endodontic procures for the sake of patient safety and infection control. Objectives: The aim of this study is to investigate preferences and experiences of patients using dental-dam (DD) isolation during root canal treatment (RCT) and to explore influencing factors among the residents of Madinah Munnawara, Saudi Arabia. Methods: Following an ethical approval and a pilot study, a self-administrated questionnaire was distributed to 305 patients attending endodontic clinics at the Taibah University College of Dentistry (TUCOD) over six months. Patients voluntarily participated in the study after understanding the methodologies and signing a consent form. They were asked to fill out a questionnaire on their experiences and preferences in placing the DD during RCT. Data were analyzed using the Chi-square test at p = 0.05. Results: The response rate was 91%. There was no significant correlation between patients’ preferences and their race, age and gender (p > 0.05). The majority of participants (74.3%) would prefer to use a DD in their next session (p < 0.001). This preference negatively correlated with the time required to place a DD and the duration of the current visit (p < 0.001). While most of those who would prefer to use a DD in their next visit were pleased with how it was placed in the current session (76.6%), most of those who would not do so (66.7%) were uncomfortable. Overall, the highest proportion of participants (40.2%) reported that prevention of instrument swallowing was the most important advantage of DD isolation (p < 0.001). Conclusions: Overall, DD isolation for RCT is generally well accepted by patients regardless of their country of origin, gender, education and awareness of its advantages. Patients’ safety was the most attractive advantage for patients to the application of the DD. The time required to place the dental dam and first visit experience in placing the DD affect patients’ future preference. Keywords: root canal; clinical endodontics; dental pulp; general practice; restorative dentistry

Int. J. Environ. Res. Public Health 2018, 15, 2012; doi:10.3390/ijerph15092012

www.mdpi.com/journal/ijerph

Int. J. Environ. Res. Public Health 2018, 15, 2012

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1. Introduction The dental-dam (DD) has been an ideal tool for tooth isolation and a standard of care in dentistry, especially during root canal treatments (RCT) [1]. Historically, Barnum introduced the concept of DD isolation to dental professionals in 1864 [2]. An aseptic operating field by isolation from oral and salivary contamination is a great and significant advantage of the DD for both the operator and the patient during endodontic treatment [3]. It also allows for safe insertion of inter-appointment medicaments necessary to disinfect the root canal system [4,5]. From patient as well as clinician perspectives, two major aspects are essential; patients’ safety and cross-infection control. The dental dam is a fundamental tool that protects patients by preventing inhalation or ingestion of endodontic instruments [6] and retracting soft tissues [7]. Unfortunately, there are many reports of inhalation or ingestion of endodontic instruments during root canal treatment as a result of not considering DD isolation [6–13]. In addition, the DD promotes better cross-infection control for both patients and the dental team [3], especially in cases of communicable diseases such as acquired immune deficiency syndrome (AIDS) and viral hepatitis. The dentists and dental assistants are protected against infections which can be transmitted by the patient’s saliva. A previous study reported that using a DD is an excellent barrier to the potential spread of infectious disease in the dental office [3]. Despite these advantages, DD isolation during root canal treatment is still not adopted in dental practice in many countries [14–17]. The major barriers of using DDs include: challenging placement techniques, time consuming (from a dentist’s point of view), lack of training during undergraduate training, and cost of equipment and materials [16,18–21]. In addition, patient discomfort and rejection have been proposed as barriers for using DDs [16,17,19,22,23]. However, a few reports showed that patients have no objection to DD application and they prefer having it placed in future visits [24,25]. A recent study has shown slight improvement in using DDs in Saudi dental practices [17] compared to a previous report [26]. However, there is no study on patient perception regarding the importance of using DD isolation as a tool for better cross-infection control and safe endodontic procedures. In addition, there has been no reports on patient preference on placing DDs during RCTs. Hence, there is a need to investigate these important aspects within the Saudi community. This is especially true as the professional environment is not the same in different countries with different cultures. In addition, unlike other countries, Saudi Arabia has a large diversity of patients from different countries, which may have great impact. To our knowledge, the current study was the first to systematically explore, in depth, these factors on patient preference. Therefore, the aim of this study was to investigate opinions, experiences and preferences of patients on placing DDs during RCTs. Specifically, it aimed to estimate the frequency of patient acceptance of placing DDs and to explore affecting factors. The survey mainly aimed to answer the following questions:

Would there be any significant difference between patients who would prefer placing a DD in a future visit and those who would not? Could patient acceptance be influenced by factors such as DD application time and length of the treatment session with the DD in place? Which policy do patients prefer (mandatory, optional) to increase the use of DDs in dental practice?

Consequently, the study aimed to test the following null hypothesis: There would be no significant differences between the proportion of patients who would prefer using DD in the future and that of patients who would not. 2. Materials and Methods This observational descriptive study was ethically approved by the Taibah University College of Dentistry Research and Ethics Committee (TUCDREC) and conducted between January and June 2017. A pilot self-administrated questionnaire (Appendix A) was distributed to a group of


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patients that underwent RCTs in the clinics at the TUCOD to ensure that the questions were easily understood and that all relevant aspects were included. Convenient sample size over a period of six months was determined, taking into consideration the sample sizes of three previous studies (110, 179 and 220 patients) [24,27,28]. This study included the following governmental centers in Madinah Munawara: the TUCOD and King Fahad General Hospital (KFGH). A total of 305 patients were approached for voluntary participation after they underwent a session of a root canal treatment procedure. The investigator explained the aims and methodologies of the study to the patients and confirmed that all information would remain confidential and anonymous. In addition, patients were assured that their decision to complete the survey would not affect the dental service they would receive in the future. Upon acceptance to participate in the study, patients were asked to sign a consent form. They were requested to hand the questionnaire form, upon completion, to a third person, who was not related to the study. Responses were collected, and data were entered into SPSS 20 for Windows software (SPSS Inc., Chicago, IL, USA) and analyzed using the Chi-square test at the 0.05 level of significance. 3. Results 3.1. Response Rate and Preference of Using a DD in the Next Session Out of 305 patients who were invited to the study, 278 patients accepted to complete the survey; resulting in a 91.1% overall response rate. The proportion of participants who would prefer using a DD in the next session (81.6%) was significantly greater than those who would not (18.4%) (p < 0.001) (Table 1). There was no significant difference between Saudi and Non-Saudi patients. Table 1. Participant preferences for using a dental-dam (DD) in the next visit (%) and its correlation with participant countries of origin. Countries of Origin Participant Preference in Using a DD in the Next Visit

Saudi Arabia

Arab Asian

Arab African

Asian

African and Western Countries

Total *

Would Prefer Would not prefer Total

126 (85.1) 22 (14.9) 148 [56.6] (100)

28 (80) 7 (20) 35 [14] (100)

18 (78.3) 5 (21.7) 23 [9.1] (100)

23 (69.7) 10 (30.3) 33 [12.5] (100)

19 (90.5) 2 (9.5) 21 [7.9] (100)

214 (81.6) * 46 (18.4) 260 (100)

* The values in brackets [ ] and parentheses ( ) are the proportion of each country of origin’s category and the overall proportions of participants preference on using a DD in the next visit, respectively.

3.2. Age and Gender of Participants The proportion of male participants (45.2%) was not statistically significant from that of females (54.8%) (p = 0.115) (Table 2). In addition, the proportion of male participants who would prefer to use a DD in the next visit (79.7%) was not statistically significant from that of females who would do so (83.2%) (p = 0.530). Significantly, more patients (31.1%) were 21–30 years old (p < 0.001); with no significant difference between males and females (p = 0.057). Overall there was no correlation between participant age and their preference in using a DD in the next visit (p = 0.07). 3.3. Participant Education Whilst the highest proportion had a Secondary School degree (48.6%), the lowest had completed University Postgraduate Study (4.4%), followed by University and Primary School degrees (26.9% and 21.3%, respectively). These differences were statistically significant (p < 0.001) (Table 2). There was no correlation between participant education level and their preferences in using a DD in the next visit (p = 0.090).


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Table 2. The correlation of participant gender, age (years) and level of education with their preference on using a DD in the next visit ((%) and [%]). Participant Age (Year, %)

Participant Gender

15–20

21–30

31–40

41–50

Over 50

Total

Male (45.2) Female (54.8) Total

29 (23.6) 42 (29.8) 71 (26.8) [71.8]

44 (35.8) 38 (27) 82 (31.1) [89]

25 (20.3) 42 (29.8) 67 (25.4) [74.6]

12 (9.8) 14 (9.9) 26 (9.8) [84.6]

13 (10.6) 5 (3.5) 18 (6.8) [100]

123 (100) [79.7] * 141 (100) [83.2] 264 (100) [81.6]

Participant Preferences in Using a DD in the Next Visit

Primary

Secondary

University

Postgraduate

Total

Would prefer Would not prefer Total

40 (19.4) 15 (30.6) 55 (21.6)

98 (47.6) 26 (53.1) 124 (48.6)

57 (27.7) 6 (12.2) 63 (24.7)

11 (5.3) 2 (4.1) 13 (5.1)

206 (100) 49 (100) 255 (100)

Participant Education Level (%)

* The values in brackets [ ] represent the proportions of participants who would prefer using a DD in the next visit.

3.4. Centre and Clinicians Providing Treatments The proportion of participants who would prefer using a DD in the next session and were treated at the KFGH (95.7%) was significantly greater than those who would do so and were treated at TUCOD clinics (74.4%) (p < 0.001) (Table 3). While the highest proportion of patients at TUCOD were treated by undergraduate students, the highest proportion of patients at KFGH were treated by an endodontic consultant (p < 0.001). Patient preference on using a DD in the next visit significantly correlated with classification of the treating clinicians (p < 0.001). The vast majority of patients treated by consultants (93.2%) would prefer to use a DD in the next visit, which was significantly greater than those treated by undergraduate or postgraduate students (61.2% and 66.7% respectively). Table 3. The correlation of preferring to use a DD in the next visit and the place that provided the endodontic treatment (%). TUCOD = Taibah University College of Dentistry. KFGH = King Fahad General Hospital. Centre Providing Treatments TUCOD (65.2) KFGH (34.8) Total

Clinicians Providing Endo Consultant

Endo Postgrad or Demonstrator

Intern

General Dental Practitioners

Undergrad Students

Total

36 (22.2) 42 (48.8) 78 (31.5) [93.2]

23 (14.2) 1 (1.2) 24 (9.7) [66.7]

36 (22.2) 9 (10.5) 45 (18.1) [86.7]

0 34 (39.5) 34 (13.7) [88.2]

67 (41.4) 0 (0) 67 (27) [61.2]

162 (100) [74.4] * 86 (100) [95.7] 248 (100) [81.6]

* The values in brackets [ ] represent the proportions of participants who would prefer using a DD in the next visit.

3.5. Advantage of Using a DD Overall, the highest proportion (44.8%) of patients reported that prevention of instrument inhalation or ingestion is the main advantage of DD use (p < 0.001), with no significant differences between the proportion of those who would prefer to use a DD in the next visit (46.8%) and those who would not (39.1%) (p = 0.416) (Table 4). The lowest proportion (8.1%, all of them would prefer to use a DD in the next visit) reported that cross-infection control is the main advantage. Table 4. The correlation of participant preference in using a DD in the next visit and the DD advantages they reported (%). Participant Preferences in Using a DD in the Next Visit

Easy Work

Irrigant Safe Use

Prevent File Swallowing

Better Cross Infection Control

Better Treatment Outcome

Other

Total


25 (11.4) 12 (26.1) 37 (13.7)

26 (11.8) 2 (4.3) 28 (11.9)

103 (46.8) 18 (39.1) 121 (44.8)

22 (10) 0 (0) 22 (8.1)

5 (2.3) 7 (15.2) 12 (4.4)

27 (17.7) 5 (15.3) 32 (17.1)

220 (100) 46 (100) 266 (100)


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3.6. Time Required for Placing the DD Overall, the highest proportion of patients (72.3%) needed up to one minute to place the DD by the treating clinician (p < 0.001), with a significantly greater proportion of those who would prefer to use a DD in the next visit (77.9%) compared to those who would not (52.2%) (p < 0.001) (Table 5). Overall, there was a significant correlation between participant preference in using a DD in the next visit and the time taken for placing the DD in the current visit (p = 0.001). Table 5. The correlation between participant preferences in using a DD in the next visit and factors related to the current treatment session (time to place DD, duration of the current session, personal experience of the current session and dentist explanation to participants on reasons for DD usage). Time (minutes) Required for Placing DD (%)


Up to 1

Up to 2

Up to 3

Over 3

Total


169 (77.9) 24 (52.2) 193 (72.3)

22 (10.1) 0 22 (8.2)

2 (0.9) 6 (13) 8 (3)

24 (11.1) 16 (34.8) 40 (16.5)

217 (100) 46 (100) 263 (100)


Long

Short

Reasonable

Total


41 (18.5) 26 (52) 67 (24.3)

23 (10.4) 0 (0) 23 (8.3)

158 (71.2) 24 (48) 182 (67.4)

222 (100) 31 (100) 272 (100)

Time Duration of Session with DD in Place (%)

Current Experience in Placing DD


Pleasant

Would prefer Would not prefer visit Total

169 (76.8) 7 (14) 180 (65.7)

UncomfortablePainful 30 (13.6) 35 (70) 65 (23.7)

10 (4.5) 5 (10) 15 (5.5)

No Comment

Total

11 (5) 3 (6) 14 (5.1)

220 (100) 50 (100) 270 (100)

Did the Clinician Explain the Reasons for DD Use?


No

Yes in Details

Yes Briefly

Total


60 (27.6) 13 (26) 73 (26.9)

87 (40.1) 17 (34) 104 (39.9)

70 (32.3) 20 (40) 90 (33.2)

217 (100) 50 (100) 267 (100)

3.7. First Visit Experience Significantly, most participants (65.7%) were pleased with the placing of the DD in the first (current) visit (Table 5). Overall, there were significant differences between those who would prefer to use a DD in the next visit and those who would not (p < 0.001). The highest proportion of those who would prefer to use a DD in the next visit were pleased with how it was placed in the current session (76.8%). By contrast, the highest proportion of those who would prefer not to use a DD in the next visit were uncomfortable with the placing of the DD in the current session (70%). 3.8. Duration of Current Session with DD in Place Overall, the highest proportion of patients (67.4%) reported that the duration of the current session with a DD in place was reasonable (p < 0.001), with a significantly greater proportion of those who would prefer to use a DD in the next visit (71.2%) compared to those who would not (48%) (p < 0.001) (Table 5). 3.9. Explanation of Reasons for DD Use Significantly, the majority of patients (73.1%) reported that the dentist explained the reasons for using a DD (p < 0.001) (either in detail (39.9%) or briefly (33.2%) (p = 0.189)). However, this did not affect participant preferences on placing a DD in the next visit (p = 0.568) (Table 5).


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3.10. Policy of Using DDs The highest proportion of patients reported that placing the DD should be optional (up to dentists) (41.2%), followed by those who believe it should be mandatory (33.1%) or optional (up to patients) (23.9%) (Table 6). These differences were statistically significant (p = 0.002). Whilst the highest proportion of those who would not prefer placing a DD in the next visit and believed that the DD should be optional (up to patients) (52%), the lowest of those who would prefer placing a DD reported the same policy for DD placement (17.6%) (p < 0.001). Table 6. The correlation of participant opinion on the best policy of DD use and their preference in using a DD in the next visit (%). Policy for Using DD (%)


Mandatory

Optional (Up to Patient)

Optional (Up to Dentists)

Not Needed

Total

Would prefer Would not prefer

85 (38.3) 5 (10)

39 (17.6) 26 (52)

98 (44.1) 14 (28)

0 (0) 5 (10)

222 (100) 50 (100)

4. Discussion Survey studies can provide valuable information about preferences, opinions, attitudes, experiences, and demographics of participants. However, such studies should be carefully conducted, so that results are representative and can be generalized [29,30]. Survey studies have shown diversity of DD usage during RCTs worldwide [14–17,19–21]. DD isolation during RCTs has been considered a standard of care due to its many advantages [1]. However, it is still not being commonly used by dental clinicians because of different claims such as inconvenience to the clinician, increased treatment cost and prolonged treatment time [21]. According to some recent studies, patient discomfort and rejection have been reported as possible restraints [24,25,28]. This is especially true as some aspects, such as community culture and the dental profession environment, vary among different countries and hence may affect patient preferences. In addition, gender, age, race and the education level of patients, as well as the duration of DD placement, may have an impact. Therefore, this study aimed to investigate in depth attitudes, experiences and preferences of patients receiving RCTs in governmental Saudi dental practices. The proportion of male participants (45.2%) was not statistically significant from that of females (54.8%), which reflects good study sampling. In addition, there was no significant difference between males and females regarding age groups, although the highest proportion of them (31.1%) were 21–30 years old. There were significant differences among participant level of education. While the highest proportion had a Secondary School education (47%), the lowest proportion of them had a University Postgraduate Studies degree (4.4%). Nevertheless, results showed that patient gender, age, country of origin and education level did not have any significant impact on their preferences on placing DDs. In contrast, Stewardson and McHugh’s [28] results showed that women in one subgroup preferred DD use. Also, Vedavathi et al. [31] showed that female patients had a positive attitude and preferred the use of DDs in the future. The highest proportion of participants in our study (65%) were pleased with the placing of a DD during the session, after which they completed the questionnaire. These findings are consistent with those obtained in previous studies [25,27,28]. One possible reason is that patients compared the current treatment experience with that of previous RCTs without a DD. Another reason is that patient attitude is dependent to some extent on the experience and skill of the dentist providing the treatment, which in turn leads to faster and more comfortable application of DDs. Previous studies showed that good experience and positive attitudes of the dentists placing the DD and performing the treatment reflects on positive attitudes of patients [24,28]. Our results showed that a relatively short time was required to place a DD (about 1 minute) in 75% of cases. The results also revealed a significant positive correlation between participant preferences in using a DD in the next visit and the time required for placing a


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DD. This is, however, in contrast to results of previous studies in which the time required to place a DD had no influence on patient preference on future DD use [24,28]. Apart from this discrepancy, it is accepted that a short time required for DD placement usually reflects good dental practice and sufficient experience. It was reported previously that placing a DD, even in the hand of inexperienced dentists, does not take more than few minutes [24,25,32,33]. It could be argued that the good patient acceptance in our study was because patients might have thought that their negative response would have likely affected future treatment eligibility. However, such an assumption can be excluded because patients were assured that their response would not affect their right to receive dental treatment. Furthermore, the majority of patients (82%) preferred placing a DD in the next visit. Moreover, the highest proportion of those who would prefer a DD in the next visit were pleased with how it was placed in the current session (77.7%). Our results showed that the proportion of participants who would prefer using a DD in the next session and were treated at KFGH (95.7%) was significantly greater than those who would do so and were treated at TUCOD clinics (74.4%). This may confirm our assumption, as indicated earlier, that different treatment environments can affect patient attitudes and preferences. Those treated by undergraduate students were the least likely to prefer using a DD in the next visit. On the other hand, the vast majority of those who were treated by endodontic consultants (93.2%) would prefer using a DD in the next visit. While the highest proportion of patients at TUCOD were treated by undergraduate students, the highest proportion of patients at KFGH were treated by endodontic consultants. However, the clinician providing RCTs may be another environment factor that may affect patient preferences. Therefore, these results should be carefully interpreted, and such a conclusion should be drawn with caution. It was obvious that the experience of placing a DD in the first session did have an impact on patient overall attitudes. The highest proportion of those who would not prefer to use a DD in the next visit were uncomfortable with the current experience of DD placement. We assumed that a thorough explanation of the advantages of using a DD may positively affect patient preferences. However, the results did not show such an impact whatsoever, with only 27.4% of patients confirming that the dentist did not explain why a DD would be used. One possible reason for such a result is that the majority of patients (81.9%) would prefer to use a DD in the next visit in the first instance. These findings, however, contradict with those of Kapitan et al. [27], where explanation of DD use in detail prior to the procedure had a significant impact on patient preferences. Nevertheless, these results again support the reality that whether a patient had a good experience in the first session most likely determines their preference in using a DD in the next visit. This study revealed how patient experiences and attitudes towards placing a DD, whether acceptance or rejection, reflected on their opinion regarding the length of the current session time. The majority of those who would prefer to use a DD in the next session (72%) thought that the current session duration was reasonable. By contrast, most of those who would not prefer to use a DD in the next session (52%) thought that the current session was long. These results were inconsistent with those of previous studies where the duration of the treatment while the DD was in place had no influence on patient preferences on DD placement [24,27,28]. Patient safety is usually the first priority in medical and dental fields. The current study reflected this fundamental concept as the highest proportion of participants (46.8%) reported that the most important advantage of using a DD is the prevention of accidental swallowing of files, although this had no significant influence on the patients preferring to use a DD in the next visit. It is likely that patients who were better informed tend to cooperate more, even if they were not satisfied with the application of the DD. In earlier studies, patients indicated that a DD was beneficial to both dentists and the patients [24,27]. The possible explanation for our results could be the information given to patients regarding DD use prior to the procedure. This is especially true with the fact that instrument inhalation is a life-threating accident [34,35] and is not uncommon [6–13]. This might also explain the positive attitude of patients because of the feeling of security due to the placement of a DD. Susini


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et al. reported that 36% of instrument ingestion cases required hospitalization [7]. This implies that nothing surpasses the safety of the DD while treating dental patients. The lowest proportion of patients highlighted the importance of DDs as a barrier in spreading infection. Patients may assume that cross-infection control policies are already well established and followed by the dental team, especially in governmental dental clinics. Nevertheless, the DD not only minimizes the risk of contamination of the patient’s root canal system by indigenous oral bacteria, but also protects the dentist and dental assistant against infections which can be transmitted by the patient’s saliva [3]. A previous study investigating the frequency of DD use in Saudi dental practice revealed that the majority of participants (90.7% endodontists and 74.1% general dental practitioners suggested a mandatory use policy of DDs in dental practice [17]. An almost similar trend was found in our study, as the second highest proportion of patients believed that DDs should be mandatory (32.2%). Patients were usually neither aware of regulations and bylaws of the dental profession, nor all aspects of DD placement for RCTs. This may explain why the highest proportion in our study (40.9%) reported that the decision to use DDs should be made by the dentist. However, this perception, to some extent, was limited to those who would prefer the placing of a DD in the next visit. The highest proportion of those who would not prefer the placing of a DD in the next visit believed that placing a DD should be based on patient preferences (51.6%). This trend within this group of patients was obvious when 9.1% of them reported that a DD is not needed. The discrepancies between the current study and previous studies are based on specific aspects of patient acceptance of placing a DD during RCTs. This validates the conduction of our study and confirms our assumption, in the first instance, that different dental profession environments may affect the preferences, perceptions and opinions of patients on using DDs. However, there are certain limitations; this study only included patients attending the governmental sector clinics. Therefore, conducting further research including private sector patients is recommended. In addition, we believe that including additional centers from Middle-Eastern and European countries may show the real impact of various environmental, economic and cultural factors on patient preferences. Nevertheless, this study added further proof that patients, overall, have no objection towards the placing of a DD during RCTs. Hence, further research is needed in an attempt to close the gap in using DDs between the undergraduate training stage and post-graduation practice. 5. Conclusions Within the limitation of the current study, it can be concluded that patients generally accepted having a DD placed and were willing to undergo RCT procedures under DD isolation for future visits. Patient safety remains the most attractive advantage for patients to the application of DD use. Patient factors such as race, age, gender and level of education did not have any remarkable impact on patient preference in placing a DD during root canal treatment. Additionally, the time required to place a DD, first experience in placing a DD, treating clinician and sector of dental services seem to be the key factors influencing patient preferences. Author Contributions: A.M. is the founder of the study, wrote the proposal, the introduction, part of the discussion, and finalized the results section, revised the manuscript and led the research team. S.A. did the data collection and wrote a part of the discussion. F.A. and A.E. wrote methods, data entry and statistical analysis. A.S. and M.B.A.A.S. revised the statistics and results and wrote a part of the discussion. M.Z. critically reviewed and revised the manuscript for intellectual content and acted as a corresponding author. All authors read and agreed to the content of the final manuscript. Funding: This research received no external funding. Acknowledgments: Authors would like to thank all patients who participated in this study. Conflicts of Interest: The authors declare no conflict of interest.

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Treating Public Health 2018, 15, Clinician: x 9 of 119 of 11 9 of 11 Patient PatientInformation: Information: Patient Information: Patient Information: Appendix Appendix A A TreatingTreating Clinician: Clinician: - TheTooth - type Tooth (No) - of type Tooth (No) -notype Tooth (No) - oftype Tooth (No) type (No) Conflicts ts of Interest: of Interest: authors authors declare noNative Interest: conflict conflict of The interest. authors declare no conflict of interest. Native - declare spoken -language: spoken Native language: interest. spoken Arabic language: English Arabic English Other:.............. Arabic Other:.............. English Other:.............. English Other:.............. - -TheConflicts Native spoken language: viron. Public Int. Health J. Environ. 2018, Int.Any 15, Res. J. (No) xEnviron. Public Int. Health Res. J. Environ. Public 2018, Health Res. 15, xPublic 2018, Health 15, x condition:................................... 2018, 15, x condition:................................... 9 of 11 9 of 11 9 of 11 9 of 11 - Res. Tooth - Patient type Tooth (No) type Survey Survey Questionnaire Questionnaire relevant Any or relevant serious Any or medical relevant serious or medical serious medical condition:................................... Information: Patient Information: Patient Information: Patient Information: Patient Information: Any relevant or serious medical condition:................................... Appendix dix A A Appendix A How- old are How you: -oldare How 15–20 you: old 20–30 are 15–20 you: 30–40 20–30 15–20 40–50 30–40 20–30 Over 40–50 30–40 50 Over 40–50 50 Over 50 Information: Patient Information: Treating Treating Clinician: Clinician: - Conflicts spoken Native -old language: spoken Native - language: spoken Native Arabic - language: spoken Native Arabic English language: spoken no Arabic English Other:.............. language: no Arabic of English Other:.............. Arabic English Other:.............. Other:.............. 15–20 20–30 30–40 40–50 Over 50 English - - Conflicts are you: ts Patient of Interest: TheNative authors ofHow declare Interest: of Conflicts no The Interest: conflict authors of of The Interest: interest. declare authors The no declare conflict authors of declare conflict interest. conflict interest. ofOther:.............. interest. Gender: - Gender: Male- Female Gender: Male Female Male Female viron. Res. Public Health 2018, 15, x - relevant J. Environ. Res. Public Health 2018, Int. J.15, Environ. Res. Public Health 2018,9 15, of x11 9 of 11 Any - relevant Any orInt. serious Any - relevant or medical serious Any - relevant or medical condition:................................... serious Any relevant ormedical condition:................................... serious orxmedical condition:................................... serious medical condition:................................... condition:................................... urvey Questionnaire Questionnaire Native - - spoken Native language: spoken language: Arabic English English Other:.............. Other:.............. - - Survey Gender: Male Female - - Questionnaire Tooth -Education Tooth type (No) type (No) Education level:…………………………………………… - Arabic Education level:…………………………………………… level:…………………………………………… dix A Appendix Appendix AHow Appendix A A How old are you: old How are 15–20 you: old How are 20–30 15–20 you: old How are 30–40 20–30 15–20 you: old are 40–50 30–40 20–30 15–20 you: Over 40–50 30–40 20–30 15–20 50 Over 40–50 30–40 20–30 50 Over 40–50 30–40 50 Over 40–50 50 Over 50 -of Any - relevant Any orTreating serious or Clinician: medical serious medical condition:................................... - relevant Education level: . .of . Interest: .interest. . . .condition:................................... . . . The . . . .authors . . Conflicts . . . .declare . . . . of . .no . . conflict . . . . . The . of . . interest. . . . . . . declare . . . . . . no . . . conflict of interest. greating Clinician: Clinician: ts Interest: TheGender: authors declare no Conflicts conflict of Interest: authors Patient Patient Information: Information: Gender: Male Gender: Female Male Gender: Female Male - before? Gender: 30–40 Female Male 40–50 Female Male Female 1. Have 1. you Have ever 1. had you RCT ever Have had you RCT ever before? Yes had RCT No Yes before? 50 No Yes No How - oldHow are you: old are 15–20 you: 15–20 20–30 20–30 30–40 40–50 Over 50 Over Questionnaire Survey Survey Questionnaire - Survey Education -Questionnaire Education level:…………………………………………… - Questionnaire Education level:…………………………………………… - (No) Education level:…………………………………………… -language: Education level:…………………………………………… level:…………………………………………… Int. Environ. Res. Public Health Int. 2018, J. Environ. 15, xlanguage: Res. Int. Environ. 2018, Int.Res. Environ. Public Health Res. Public 2018, Health 15, x 2018, 15, x 9 of 11 ooth type (No) -J.Have type -Tooth Native -Female spoken spoken Public Arabic J.Health Arabic English J.15, English x Other:.............. Other:.............. - Tooth - type Gender: (No) Male Female Male 1.2. had RCT before? Yes No 2.you Have everNative 2. experienced youA ever Have experienced you rubber ever experienced dam rubber placement? dam placement? dam placement? dix A Gender: Appendix Appendix A rubber g Clinician: Clinician: Treating Clinician: -ever Any - relevant Any relevant or serious or serious medical medical condition:................................... condition:................................... -Clinician: Education - 1.Treating Education level:…………………………………………… level:…………………………………………… Have No Yes No but you not Yes for but No RCT not Yes ever for Yes but RCT not RCT for Yes for RCT Yes forRCT Have 1. Treating you 1.you had Have ever RCT 1. had before? Have ever RCT 1. you had before? Have Yes RCT you No had for before? Yes ever RCT No had RCT before? Yes RCT No before? Yes No Yes No atient Information: Information: Patient Interest: authors Conflicts declare of Interest: nodam Conflicts conflict The authors ofof interest. Conflicts Interest: declare ofThe Interest: noauthors conflict The declare of authors interest. no declare conflict no of interest. conflict of interest. 2.Conflicts HaveofInformation: you ever The experienced rubber placement? How old How areold you: areyou: 15–20 15–20 Survey 20–30 20–30 Questionnaire 30–40 30–40 40–50 40–50 Over50 Over 50 Questionnaire Survey Questionnaire viron. Int. J. Res. Environ. Public Int. J. Res. Health Environ. Public 2018, Res. Health 15, Int. Public x J. 2018, Environ. Health 15, x 2018, Res. Public 15, x Health 2018, 15, x 9 of 11 9 of 11 9 of 11 9 ofplacement? 11 ooth type (No) Tooth type Tooth (No) type Tooth (No) type (No) 1. Have 1. you Have ever you had ever RCT had before? RCT before? Yes No Yes No 2. Have 2. -you ever 2.you experienced Have ever 2. experienced Have ever rubber 2.RCT you experienced Have dam ever placement? experienced ever rubber placement? experienced dam rubber placement? dam rubber placement? dam 3. Compared 3. Compared to the 3. previous Compared to the experience, previous toyou the experience, previous how was experience, the current was the how experience current wasplacement? the experience of current DD placement? experience of DD placement? of DD ativeNative spoken spoken language: language: Have Arabic Arabic English you language: for Other:.............. Other:.............. rubber RCT English how Other:.............. No Yes but not Yes fordam -Native Gender: -spoken Gender: English Male Male Female Arabic Female Appendix A Appendix A Appendix Appendix A A ever Noserious Yes ever No but condition:................................... not Yes No for but RCT not Yes dam No for Better but Yes RCT not Yes for for but RCT Yes RCT not Yes for but RCT RCT not for for comment RCT RCT forRCT Yes for RCT Almost the Almost same the Almost same No Worse the Better same for Cannot Worse Yes Better Yes Cannot Worse comment Cannot comment g 2. Clinician: Treating Clinician: Treating Clinician: ny relevant Any relevant serious or -experienced medical medical relevant condition:................................... or serious medical condition:................................... Patient Information: Patient Information: Patient Information: Have 2.ofor you Have experienced rubber rubber placement? dam placement? -Any Education -declare Education level:…………………………………………… level:…………………………………………… tsInformation: Conflicts of Interest: Conflicts Interest: The authors ofyou The Interest: Conflicts declare authors The no of authors conflict Interest: no declare of conflict The interest. authors no of conflict interest. declare of interest. no conflict 3. Compared to the previous experience, how was of theinterest. current experience of DD placement? ow old How old you: are No you: 15–20 15–20 for 20–30 How doctor old 20–30 Did 30–40 are you: 30–40 40–50 3.15–20 the 40–50 Compared Over 20–30 50 Over to 50 30–40 DD? 40–50 afor Over 50 are No Yes Compared but J.--Yes not RCT not for Yes RCT for RCT Yes for RCT 3.-language: 3. to 3.Res. the Compared previous to 3. the Compared previous experience, to previous experience, how the previous was experience, how the thethe previous was experience, how the experience current experience, how the experience current was of DD the current was placement? of DD theexperience current placement? of DDexperience placement? of DD placeme 4. Did the 4. the 4. explain doctor Did the explain reasons doctor the for explain reasons using for acurrent reasons using DD? using DD? viron. type Res. Public Health Int. 2018, Environ. 15, xbut Public Health 2018, Int. J.the 15, Environ. x Res. Health 2018, 15, xwas 9ahow of 11experience 9of ofDD 11 placement? ooth (No) - Tooth type (No) -Public Tooth type (No) Survey Questionnaire Survey Questionnaire Survey Questionnaire Survey ative spoken Native Compared spoken Arabic Native -Have spoken English Native language: spoken Other:.............. Arabic language: toArabic English before? Arabic English English Other:.............. Almost the same Better Worse Cannot 1. 1.language: you Have ever you had ever RCT had before? RCT Other:.............. Yes comment No Yes Questionnaire No Other:.............. ender: Gender: Male Male Female Female Gender: Male Female Almost the Almost same the Almost Better same the Almost Worse Better same the Almost Worse Better Cannot same the comment Worse Better Cannot same comment Worse Better Cannot comment Worse Cannot comment Cannot comment Yes in detail Yes (explanation in detail Yes (explanation in was detail clear) (explanation was Yes clear) briefly was Yes (fair clear) briefly or poor) Yes (fair briefly or No poor) (fair or No poor) No dix Appendix A Appendix A A Appendix A viron. Res. Public 15, xAny of 11 ny serious Any --medical relevant or relevant serious Any or relevant medical serious medical serious condition:................................... medical condition:................................... 3.relevant Compared 3. or-Health Compared to2018, the previous to the-condition:................................... previous experience, experience, howorcondition:................................... was how the was current the Information: current experience experience of DD placement? of9DD placement? Patient Information: Patient ducation level:…………………………………………… level:…………………………………………… Education level:…………………………………………… Clinician: Treating Clinician: Treating Clinician: Treating Clinician: tsInformation: ofEducation Interest: The authors Conflicts declare ofthe Interest: no The of authors interest. Conflicts declare of Interest: no for conflict The of authors declare no conflict of interest. 4.Treating Did doctor explain the reasons using ainterest. DD? 2. Have 2. conflict you Have ever you experienced ever experienced rubber rubber dam placement? dam placement? ow you: Almost How 15–20 - old How are -you: old 30–40 How are 15–20 you: old to are 15–20 you: taken Over Cannot 30–40 20–30 15–20 50 a 15, 40–50 30–40 20–30 40–50 30–40 50 aOver 40–50 50 Over are Almost Did the same the Better same Better Worse 40–50 Worse Cannot comment comment viron.old Res. Public 2018, 15, x20–30 Int. J.to Environ. Res. Public Health 2018, xexplain of minutes 11 50 9 of 11 4.-Health 4. the doctor Did 4.the explain doctor Did 4.the the explain doctor Did reasons 4.20–30 the the explain doctor Did for reasons using the the explain doctor for reasons DD? using the for reasons aOver DD? using the for reasons DD? using for a9DD? using a DD? 5. Time 5. taken Time apply 5. taken Time the apply rubber the dam:.................. to rubber apply the dam:.................. rubber minutes dam:.................. minutes no No Native (explanation Yes Noof but Yes not but for not RCT for-(No) Yes for Yes RCT for RCT Survey Questionnaire Survey Questionnaire Survey Questionnaire ative spoken language: Arabic -detail English spoken Other:.............. language: Native Arabic spoken English language: poor) Other:.............. Arabic English Other:.............. ts ofyou Interest: authors declare conflict interest. Yes in was clear) Yes briefly (fair or No ave .Questionnaire Have ever you-The had ever RCT 1. before? RCT Have before? you Yes ever Yes No had -Yes No RCT before? Yes clear) No -had Tooth type (No) Tooth type -RCT Tooth -was type Tooth (No) type (No) ender: Male Female Gender: Gender: Male Gender: Female Male Female Male Female Yes in detail Yes in (explanation detail Yes in (explanation detail was in (explanation clear) detail Yes was in (explanation Yes clear) detail briefly was (explanation Yes (fair briefly or Yes clear) poor) (fair briefly was or Yes clear) No poor) (fair briefly or Yes No poor) (fair briefly or No poor) (fair or No poor) No viron. Public Health 2018, 15, Int. x J.6. Environ. Res. Health 2018, 15,pleasant xDD: 9 of 11uncomfortable 9 of 11 dix ARes. Appendix A Appendix A 4.relevant Did 4.the Did doctor the explain doctor explain the reasons the reasons for using for aofDD? using 6. Was the Was placing the 6.Public of placing Was the the DD: placing the ofdeclare the (comfortable) pleasant DD: (comfortable) pleasant interest. uncomfortable (comfortable) painful uncomfortable painful cannot painful cannot cann ny or-The serious medical -Conflicts Any relevant or serious -a DD? medical Any relevant condition:................................... or serious medical condition:................................... ts of Interest: authors declare no conflict of of Interest: interest. The authors no conflict of ducation level:…………………………………………… Education -2. Education level:…………………………………………… -condition:................................... Education level:…………………………………………… level:…………………………………………… 3. Compared 3. Compared toPatient the to previous the previous experience, experience, how was how the was current the current experience experience of DD of placement? DD placement? gTreating Clinician: Treating Clinician: Clinician: Treating Clinician: 5. Time taken to apply the rubber dam:.................. minutes ave .dix you Have ever you experienced ever experienced rubber Have rubber you dam ever placement? dam experienced placement? rubber dam placement? Patient Information: Information: Patient Information: Patient Information: Yesyou: detail was clear) was are clear) Yes briefly to (fair poor) (fair or poor) No No A are comment comment 5.indetail Time 5.in(explanation taken Time to 5.(explanation taken apply Time to 5. thetaken apply rubber to 5. the taken apply dam:.................. rubber Time the taken apply dam:.................. rubber to the minutes apply dam:.................. rubber the minutes dam:.................. rubber dam:.................. ow old Yes 15–20 20–30 -comment 30–40 How Time old 40–50 you: Over Yes 50 15–20 -briefly or How 20–30 old are 30–40 you: minutes 40–50 15–20 minutes Over 20–30 50 minutes 30–40 40–50 Over 50 Almost for Almost the same the same Better Better Worse conflict Worse Cannot Cannot comment comment tsQuestionnaire ofInterest: The authors declare Conflicts of conflict Interest: of interest. The authors declare noRCT ofinterest. No Yes No but Yes not but for not RCT for Have RCT Yes No for Yes RCT but RCT not for RCT RCT Yes for Survey Questionnaire Survey Questionnaire ave ever 1. had Have RCT 1.before? you ever 1. no you Yes had Have ever RCT No you had before? ever RCT had before? Yes No before? Yes No -Yes No ooth - you type Tooth -(No) type Tooth (No) type -Native (No) Tooth type (No) ender: Public Male Female -Appendix Gender: Health Male minutes Female --(comfortable) Gender: Male Female -6. spoken language: -How Native DD: Arabic spoken English language: Other:.............. spoken Native Arabic language: pleasant English language: Arabic Other:.............. English Arabic uncomfortable English Other:.............. dix A 6. Was the placing the DD: pleasant uncomfortable painful cannot 5. ARes. Time Time to taken apply the rubber the dam:.................. rubber dam:.................. minutes viron. Int. J.5. Environ. Health Res. 2018, Public 15, Int. Health xto J.apply Environ. 2018, 15, Res. xof Public 2018, 15,find xDD: of 11 9 uncomfortable of 11 9 Other:.............. of 11 6.taken Was the Was placing 6. the Was of placing 6. the the DD: Was of placing 6. the find the pleasant Was of placing the the pleasant (comfortable) of placing the Native pleasant DD: (comfortable) of the with pleasant DD: (comfortable) uncomfortable spoken DD (comfortable) uncomfortable (comfortable) uncomfortable painful painful cannot comment painful cannot painful cannot painful canno 7. How 7. did How you find 7. did the you session did the you with session the the DD with session in the place? DD in place? the in9 place? Questionnaire 4. Did 4. the Did doctor the doctor explain explain the reasons the reasons for using for a using DD? a DD? ducation level:…………………………………………… Education level:…………………………………………… Education level:…………………………………………… ompared .ave Compared to the to previous the previous 3. experience, Compared experience, how to the was how previous the was current the experience, current experience experience how of was DD the of placement? DD current placement? experience of DD placement? g Clinician: Treating Clinician: Treating Clinician: Any relevant or serious Any medical relevant condition:................................... or serious Any relevant medical Any or relevant condition:................................... serious or medical serious condition:................................... medical condition:................................. you ever 2. experienced Have 2. you rubber Have ever 2. you experienced dam Have ever placement? you experienced rubber ever experienced dam rubber placement? dam rubber placement? dam placement? Information: Patient Information: Patient Information: Patient Information: dix A Appendix A comment comment comment comment comment Long DD: Short Long pleasant Reasonable Short Long (comfortable) Reasonable Short Reasonable comment uncomfortable Cannot comment viron. Res. Public Health 15, x the Int. J.Cannot Environ. Res. Public Health 2018, 15, xpainful 9 of 11 7.2018, How did you the session with the DD in place? 6. Was 6. same the Was placing the placing of of the DD: pleasant (comfortable) Cannot uncomfortable comment painful or cannot no Yes in find Yes detail detail (explanation (explanation was clear) was clear) Yes briefly Yes briefly or (fair poor) poor) No cannot No 40–50 Survey Questionnaire Almost Interest: Almost the the same Better Worse Almost Worse the Cannot same Cannot comment Better Worse Cannot comment -Better old are you: -in 15–20 How comment 20–30 old are -30–40 you: How 15–20 40–50 - old are How 20–30 Over you: old 50 (fair RCT are 30–40 15–20 you: 40–50 20–30 15–20 Over 30–40 30–40 Over 40–50 50 Over 50 ts of Conflicts of authors Interest: declare The Conflicts authors conflict of declare Interest: of interest. no The conflict authors of interest. declare no conflict of interest. No you Yes butThe not for No RCT How Yes Yes No but for not Yes RCT for No but RCT not Yes for but Yes RCT not for for RCT Yes RCT for RCT Yes for RCT gQuestionnaire Clinician: ave ever had RCT before? 1. Yes Have No you ever had RCT 1. before? Have you Yes ever No had before? Yes 20–30 No50 ooth type (No) Tooth type (No) Tooth type (No) ative - Res. spoken Native - 7. language: spoken Native language: spoken Arabic Native language: Arabic English spoken Arabic English language: Other:.............. English Other:.............. Arabic Other:.............. English Other:.............. viron. Public Health 2018, 15, x 8. Int. J. Environ. Res. Public Health 2018, 15, xadvantage 9 DD of a11DD? 9 of comment comment Long Short Reasonable Cannot comment How 7. did How you 7. find did How you the 7. session find did How you the 7. with session find did How you the the with DD session find did in you the the place? with DD session find in the the place? with DD session in the place? with DD in the place? in place? 8. What is the What most 8. is important the What most is important advantage most important advantage of using a of DD? using a DD? of using Gender: Male Female Gender: Male Gender: Female Gender: Male Female Male Female Survey Questionnaire 5. Time 5. taken Time to taken apply to apply the rubber theoffor rubber dam:.................. dam:.................. minutes minutes ts of Interest: The authors declare no conflict of interest. Conflicts Interest: The authors declare no conflict of interest. gQuestionnaire Clinician: Treating Clinician: .d the Did doctor the doctor explain explain the 4. reasons Did the reasons the for doctor using for explain using a DD? a the DD? reasons using a DD? ompared to the 3. previous Compared 3. experience, Compared to 3. the previous Compared how to the was previous experience, the to the current previous experience, how experience was experience, how the of current was DD how the placement? experience current was the experience current of DD experience placement? of DD placement? of DD placement? ooth type (No) ny relevant Any relevant or Any serious relevant or medical serious or Any medical condition:................................... serious relevant medical condition:................................... or serious condition:................................... medical condition:................................... Long the Short 2. Reasonable Short Long Res. Reasonable Short Long Protection Reasonable Short Long in 2. Reasonable Short tissue Reasonable Cannot comment Cannot comment Cannot comment Cannot of comment Cannot comment Aseptic working Aseptic field working Aseptic field working Protection of field soft you ofdam soft Better tissue treatment soft level:…………………………………………… Better tissue treatment quality Better quality treatment quality ave ever experienced rubber dam Have placement? you ever experienced rubber ever placement? experienced rubber dam placement? Information: Information: Patient Information: viron. Public Health 2018, 15, xLong J. Environ. Public Health 2018, 15, xHave 9 of 11 9 of 11 dix ARes. Appendix APatient Appendix A - did Education level:…………………………………………… - Education level:…………………………………………… -place? Education -Protection Education level:…………………………………………… 7. you How 7. did How you find you find session the with session the with DD in the place? DD 8.(explanation What isInt. the most important advantage of using a DD? Yes in Yes detail inyou: detail (explanation was you: Yes clear) was in detail clear) Yes (explanation briefly Yes briefly (fair or (fair clear) or poor) pleasant No Yes briefly No or dentistry) poor) No ts Interest: The declare no conflict Conflicts of interest. of Interest: The declare no(fair conflict of g- of Clinician: Clinician: Almost the same 15–20 Better Almost 6. the Worse Almost same Cannot Almost Better same comment the for Worse Better same was Worse Cannot Better comment Cannot Worse 50 comment Cannot comment Was 6. the Was placing the placing of the DD: the authors DD: and pleasant (comfortable) uncomfortable dentistry) uncomfortable painful painful cannot cannot ow old How are -(No) old How are authors you: old -are Treating 15–20 20–30 How old 20–30 15–20 30–40 are you: 30–40 20–30 40–50 15–20 40–50 30–40 Over of 50 20–30 poor) Over 40–50 50 30–40 Over 40–50 (comfortable) Over 50interest. Easy work Easy for dentists work Easy and dentists work assistant for and dentists (four-handed assistant (four-handed assistant dentistry) (four-handed No Yes but not for RCT Yes for RCT No Yes but not for RCT No Yes for Yes RCT but not for RCT Yes for RCT ooth type Tooth type (No) Information: dix Aspoken Appendix A Long What Short Long Native Short Reasonable isReasonable most Cannot comment comment 8. language: the What most 8.you the important 8.language: is the What important advantage most 8.Cannot is the What important advantage most ofis the important advantage most of alanguage: DD? using important advantage of abefore? DD? advantage of a Yes DD? using of abefore? DD? using DD? No ative - 1.8. is Arabic spoken What English - Other:.............. before? Native Arabic spoken using English Other:.............. using Arabic RCT English RCT Other:.............. Aseptic working field Protection soft tissue Better treatment quality ever had 1. RCT Have you ever Yes 1.of had No Have RCT 1. you Have ever you ever instruments No had abefore? Yes Yes No and materials ts Interest: The authors declare Conflicts no conflict of of Interest: interest. The authors declare no conflict ofhad interest. comment ender: - oftaken Gender: Male -(No) Gender: to Female Male rubber -Have Female Male Gender: comment Female to Male Female Safe use of Safe irrigants use of Safe and irrigants use medication of and irrigants medication areasons Prevent and medication swallowing Prevent swallowing Prevent of swallowing of instruments and materials of instruments andmaterials Survey Questionnaire Survey Questionnaire me .dQuestionnaire Time taken to apply apply the 5. the Time rubber dam:.................. taken dam:.................. apply minutes the rubber minutes dam:.................. minutes ooth type Tooth type (No) the doctor 4. explain Did the 4. the reasons doctor Did 4. the explain for doctor Did using the the explain aworking doctor DD? reasons the explain for reasons using the for DD? using for aDD DD? using awas DD? Aseptic working Aseptic working Aseptic field Protection Aseptic field Protection working Aseptic field of soft Protection tissue working field of soft Protection Better tissue field of soft treatment Protection Better tissue of soft treatment quality Better tissue of soft treatment quality Better tissue treatment quality Better treatment quality quality ompared to the previous experience, 3. Compared how was the to current the previous experience 3. Compared experience, of to how placement? the previous the current experience, experience how was of DD theplacement? current experience Information: Patient Information: dix A Appendix A ny relevant or serious medical Any relevant condition:................................... or serious medical Any relevant condition:................................... or serious medical condition:................................... ative spoken language: Arabic English Other:.............. viron. Res. Int. Public J. Environ. Health 2018, Res. Public 15, x Health 2018, Int. J. 15, Environ. x Res. Public Health 2018, Int. J. 15, Environ. x Res. Public Health 2018, 9 of 15, 11 x 9 of 11 9 of 11 o Easy work for dentists and assistant (four-handed dentistry) 8. What 8. is What the most is the important most important advantage advantage of using of a DD? using a DD? ducation Education level:…………………………………………… Education level:…………………………………………… level:…………………………………………… Education level:…………………………………………… -in Better cross-infection ever Better cross-infection detail Better control cross-infection the control Better anticipated Better control anticipated success Better rate anticipated success of the rate treatment success of the rate treatment of dam the treatment 2. Have you experienced 2. Have rubber you ever dam 2. experienced placement? Have 2. you Have ever rubber experienced you dam ever placement? experienced rubber dam rubber placement? placement? Questionnaire Survey Questionnaire Yes in detail (explanation Yes was detail Yes clear) in (explanation detail Yes Yes (explanation in briefly was (fair clear) (explanation was or poor) Yes clear) briefly was No Yes clear) (fair briefly or Yes poor) (fair briefly or No poor) (fair or No poor) No 7. How 7. did How you did find you the find session session with the with DD the in DD place? in place? Easy work Easy for work dentists Easy for work and dentists Easy assistant for work and dentists Easy assistant (four-handed for work and dentists assistant (four-handed for and dentists dentistry) assistant (four-handed and dentistry) assistant (four-handed dentistry) (four-handed dentistry) dentistry) g Clinician: Treating Clinician: Treating Clinician: Almost the same -15–20 Better Worse Cannot pleasant Almost the Better uncomfortable Almost Worse the Cannot same comment Worse Cannot as .Information: the Was placing the placing the6. of DD: the Was DD: the you: placing (comfortable) ofsoft (comfortable) the DD: 50 pleasant you: (comfortable) painful 50 painful Better uncomfortable cannot cannot painful cannot ow old you: How 20–30 old are Protection 30–40 15–20 -comment How same Over 20–30 old uncomfortable are 30–40 40–50 15–20 Over 20–30 30–40 40–50 Over 50 comment Patient dix Aspoken Appendix A40–50 ny relevant orlanguage: serious medical condition:................................... are Aseptic of Aseptic working field pleasant not Protection of tissue of soft tissue Better treatment Better treatment quality quality ative working Arabic -Information: field English Native for spoken Other:.............. language: not Arabic Yes English Yes Other:.............. Safe use of irrigants and medication Prevent swallowing of instruments and materials No Yes but RCT No Yes Yes for but RCT No for RCT No but Yes not for for RCT but RCT not for Yes RCT for RCT ofYes for RCT Long Long Short Short Reasonable Reasonable Cannot Cannot comment comment ave 1. you Have ever 1. you had Have ever RCT you had before? 1. ever RCT Have had before? Yes RCT you No ever before? Yes had No RCT Yes before? No Yes No Int. J. Environ. Int. J. Environ. Res. Public Res. Health Public 2018, Health 15, 2018, x 15, x Questionnaire Survey Questionnaire Safe use Safe of irrigants use Safe of irrigants and use medication Safe of irrigants and use medication Safe of irrigants and Prevent use medication of irrigants and swallowing Prevent medication and swallowing Prevent medication of instruments swallowing Prevent instruments swallowing Prevent and of materials instruments swallowing and materials instruments and of materials instruments and materials and mate 9. What 9. is the What most 9. is important the What most is important disadvantage the most important disadvantage of using disadvantage a of DD? using a DD? of using a DD? ts of Interest: Conflicts The authors of Interest: declare The no authors Conflicts conflict declare of of interest. Interest: no conflict The of authors interest. Conflicts declare of Interest: no conflict The of authors interest. declare no conflict of interest. mment comment comment ender: Male Female Gender: Male Female Gender: Male Female g Clinician: Treating Clinician: me taken to apply 5. Time the 5. rubber taken Time to dam:.................. 5. taken Time to the apply taken rubber minutes the todam:.................. apply rubber the rubber minutes dam:.................. minutes ow old you: 15–20 reasons 20–30 for 30–40 40–50 Over 50dam:.................. are Easy work Easy for work dentists forNative dentists and assistant and (four-handed (four-handed dentistry) dentistry) ooth type -doctor (No) Tooth type (No) -Arabic Tooth type (No) d the explain the 4. using Did the aassistant DD? doctor explain 4. the Did reasons the doctor forminutes using explain a DD? the reasons for using a DD? ny relevant or serious medical condition:................................... -apply Any relevant or serious medical condition:................................... ative spoken language: cross-infection -Dribbling English spoken language: Other:.............. Arabic English Better Other:.............. Better cross-infection control Better anticipated success rate of the treatment Better Better cross-infection Better control cross-infection Better control Better cross-infection Better anticipated control Better cross-infection anticipated control Better success anticipated control rate success of anticipated the Better rate success treatment of anticipated the rate success treatment of the rate success treatment of the rate treatment of the treatment Dribbling Hyper salivation Dribbling Hyper salivation Difficulty Hyper salivation Difficulty in swallowing in Difficulty swallowing or breathing in swallowing or breathing or breathing ducation level:…………………………………………… - 3.irrigants Education level:…………………………………………… - Education level:…………………………………………… Compared to the previous 3.experienced Compared experience, to 3. the how Compared previous was 3. the Compared experience, to current the previous experience how the experience, was previous of the DD current experience, placement? experience was the how current was of DD the experience placement current Survey Questionnaire ender: Male What 8. is What the most is the important most important advantage advantage of using ofYes ausing atoDD? ave 2.Clinician: you Have ever 2. you experienced Have ever you experienced 2. rubber Have experienced dam rubber you placement? ever dam rubber placement? dam placement? rubber placement? Safe use Female Safe of use of8. irrigants and medication Prevent of Prevent swallowing swallowing of instruments of instruments and materials and materials Treating Clinician: Yes in detail (explanation was clear) Yes briefly in detail (fair (explanation or dam was No Yes clear) in (explanation briefly (fair was or clear) poor) how No Yes briefly (fair or poor) No ex old are you: 15–20 -ever 20–30 -did medication 30–40 How the old 40–50 are you: Over 50 15–20 20–30 detail 30–40 DD? 40–50 Over 50 ow .gQuestionnaire did How you did find you the find session 7. the session How with the with you DD the find in DD place? the in session place? with the DD place? ooth type (No) -pleasant Tooth type (No) ny relevant or serious medical Any condition:................................... relevant or serious condition:................................... Conflicts Conflicts ofmedical Interest: of Interest: The The authors declare noDuration no conflict of interest. of interest. as the placing 6. of Was the 6. the DD: Was placing and 6. pleasant the Was of placing the (comfortable) DD: of placing the DD: the poor) uncomfortable pleasant (comfortable) DD: authors pleasant (comfortable) declare painful uncomfortable (comfortable) conflict uncomfortable cannot uncomfortable painful painful cannot or painful cannot cannot Information: Patient Information: Patient Information: dix A Appendix A Appendix A Appendix A Difficult communication Difficult communication Difficult with communication dentist with during dentist with treatment during dentist treatment during treatment Duration or process or Duration of process placement of process placement of placement Almost the same Better Almost Worse the same Cannot Almost Better comment the Almost Worse same the Better Cannot same Worse comment Better Cannot Worse comment Cannot comment 9. What is the most important disadvantage of using a DD? ducation level:…………………………………………… -for Aseptic Aseptic working working field field most Protection of softthe of tissue tissue Better Better treatment treatment quality No you Yes are No but not Yes cross-infection No for but RCT not Yes for but Yes RCT not No RCT Yes RCT for but 40–50 RCT not Yes for for RCT RCT Protection Yes for RCT Better Better cross-infection control control Better Better anticipated success success rate of rate treatment ofthe 9. What 9. isHave the What 9. is the What important most 9. is What important disadvantage most 9. is the What important disadvantage is of the important using disadvantage of aimportant DD? using disadvantage of a soft DD? using disadvantage of atreatment DD? using of a DD? using a DD?quality ender: Male Female Gender: anticipated Male most Female Long type Long Short had Short Reasonable Reasonable most Long Short Reasonable Cannot for Cannot comment comment Cannot comment ave ever RCT 1. before? you Yes ever had RCT 1. before? Have you Yes ever No had RCT before? Yes No g Clinician: Treating Clinician: ow old 15–20 -Pain 20–30 How 30–40 old are the you: 15–20 Over 50 20–30 30–40 place 40–50 50 mment comment comment comment ooth (No) -No Tooth type (No) me taken toyou: apply the rubber dam:.................. 5. Time taken minutes to apply the 5.the rubber Time to apply the minutes rubber dam:.................. minutes or discomfort Pain or discomfort for while Pain or the discomfort while DD is in place DD while isdam:.................. taken in the Impossibility DD is Impossibility inOver place of rinsing dentistry) Impossibility of mouth rinsing during mouth of rinsing treatment during mouth treatment during treatm Information: Patient Information: Easy work Easy work dentists for dentists and assistant and assistant (four-handed (four-handed dentistry) ative spoken Native language: spoken Arabic language: Native English spoken Arabic Other:.............. language: English Other:.............. Arabic English Other:.............. Dribbling Hyper salivation Difficulty in swallowing or breathing Dribbling Dribbling Hyper Dribbling salivation Hyper Dribbling salivation Hyper Difficulty Dribbling salivation Hyper Difficulty in swallowing salivation Hyper Difficulty in swallowing salivation or Difficulty in breathing swallowing or Difficulty in breathing swallowing or in breathing swallowing or breathing or breathing ducation level:…………………………………………… -doctor Education level:…………………………………………… 4.the Did the explain 4. the Did reasons the doctor for 4. explain Did athe 4.DD? the doctor Did reasons the explain doctor for using the explain reasons a DD? thefor reasons using afor DD? using a DD? Appendix Appendix A Ausing ender: Male Female Gender: Male Female ave you ever had RCT before? Yes No ompared 3. Compared to 3. the Compared previous to previous 3. experience, to the Compared previous experience, how to experience, was the how previous the was current how the experience, experience was current the experience current how of DD was experience placement? the of DD current placement? of DD experience placement? of DD placement? 9. What 9. is What the most is the important most important disadvantage disadvantage of using of a DD? using a DD? Questionnaire Survey Questionnaire Survey Questionnaire Survey Questionnaire hat . What is the most is the important most important 8. advantage What advantage is the of most using of important using a DD? a DD? advantage of using a DD? ave you ever experienced 2. Have rubber you ever dam experienced placement? 2. Have rubber you dam ever placement? experienced rubber dam placement? Unpleasant Unpleasant taste during Unpleasant taste treatment during taste treatment Other: during please treatment Other: specify:…………… please Other: specify:…………… please specify:…………… ooth type (No) -7. Tooth type (No) ow did find 7.serious the How session 7. did How you with find did the How you the DD session find did in place? you the with session find the the with DD session in the place? DD with the place? DD in place? Information: Patient Information: pleasant Safe use Safe of use irrigants of irrigants and medication medication in Prevent Prevent swallowing swallowing of of and materials and materials ny relevant - you Any or relevant medical or serious Any condition:................................... medical relevant condition:................................... or serious medical condition:................................... as the placing of the DD: Education 6. Was (comfortable) the placing of Native uncomfortable the 6.and DD: Was briefly the pleasant placing dentist painful (comfortable) of the cannot DD: instruments uncomfortable pleasant (comfortable) painful uncomfortab cannot Difficult Difficult communication communication Difficult communication dentist Difficult communication during dentist with communication treatment during dentist with treatment during Duration with treatment during dentist Duration or process treatment Duration or of process treatment placement (fair Duration or process placement briefly Duration or of process placement oror of process placement pla ative spoken language: the Arabic communication English with Other:.............. -with spoken language: Arabic No English instruments Other:.............. Yes in detail (explanation Yes was in clear) detail (explanation Yes or Yes in detail comment (fair was Yes (explanation in clear) or detail poor) Yes (explanation during was briefly clear) was ofof or Yes clear) poor) Yes No (fair briefly poor) (fairof orNo po Difficult with dentist during treatment Duration or process placement ducation level:…………………………………………… -- level:…………………………………………… Almost the Almost same the Almost same Better Worse same Almost Difficult Better Worse Cannot the same Worse comment Cannot Better comment Cannot Worse comment Cannot Dribbling Dribbling Better Hyper salivation Hyper salivation Difficulty Difficulty in swallowing in swallowing breathing or breathing ave you ever had RCT before? 1. Yes Have No you ever had RCT before? Yes No Aseptic Aseptic working working field field Protection Aseptic Protection of working soft of tissue soft field tissue Better Protection Better treatment treatment of soft quality tissue quality Better treatment quality No Yes but not for RCT No Yes Yes for but RCT not for RCT No Yes Yes for RCT but not for RCT Yes for RCT Long Short Reasonable Long Short Long Reasonable Short Long Reasonable Short Reasonable Cannot comment Cannot comment Cannot comment Cannot comment ave you ever experienced rubber dam placement? g Clinician: Treating Clinician: Treating Clinician: Treating Clinician: Better Better cross-infection cross-infection control control Better Better anticipated anticipated success success rate of rate the of treatment the treatment ow old are How you: old 15–20 are you: 20–30 How 15–20 30–40 old 20–30 are 40–50 you: 30–40 15–20 Over 40–50 50 20–30 Over 30–40 50 40–50 Over 50 mment comment comment 10. Do you 10. think Do you that 10. think using Do that you a rubber using think dam that a rubber using should dam a be? rubber should dam be? should be? Pain or discomfort Pain or discomfort Pain while or discomfort the Pain while DD or is discomfort the Pain in while DD place or is discomfort the in while Impossibility DD place is the in while Impossibility DD place is of the in rinsing Impossibility DD place is of in mouth rinsing Impossibility place of during mouth rinsing Impossibility treatment of during mouth rinsing treatment of during mouth rinsing treatment during mouth treatmen during Survey Survey Questionnaire Questionnaire Information: Patient Information: ny relevant orlanguage: serious medical condition:................................... - treatment Any relevant serious medical condition:................................... ative spoken Time Arabic discomfort English -dentist Native Other:.............. spoken language: or Arabic process English Other:.............. ever Difficult Difficult communication communication with with during dentist during treatment Time Duration rubber Duration or or process of placement of placement Pain or while the DD is in place Impossibility ofthe rinsing mouth during treatment Easy work Easy for work dentists for dentists and assistant Easy and assistant work (four-handed for (four-handed dentists dentistry) and assistant dentistry) (four-handed dentistry) 5. taken to apply 5. the Time rubber taken dam:.................. to 5. apply 5.No taken minutes to apply dam:.................. taken to apply rubber the minutes dam:.................. rubber dam:.................. minutes minutes ave had RCT before? Have 2. Yes you No ever had RCT before? Yes the No you Yes but not for for RCT d4.the doctor 4. the explain doctor Did the the explain doctor 4.1. reasons Did the explain the reasons for using doctor the for reasons atreatment explain DD? using for aOver the DD? using reasons aup DD? for using aTime DD? ender: -Did are Male Gender: Female RCT Male -the Yes Female Gender: needed Male Female ave you ever experienced rubber dam Have placement? you ever experienced rubber dam placement? ompared to the previous 3. Compared experience, to the how previous was 3. the Compared experience, current experience to how the previous was of the DD current experience, placement? experience how was of DD the placement? current experience of DD placemen Not needed Not Optional, Not Optional, up needed to patient Optional, to Optional, patient up to Optional, up patient to dentists up Optional, to dentists Mandatory up to Mandatory dentists Mandatory Unpleasant Unpleasant taste Unpleasant during taste Unpleasant during taste treatment Unpleasant during Other: taste treatment during please Other: taste treatment specify:…………… during please Other: treatment specify:…………… please Other: specify:…………… please Other: specify:…………… please specify:…………… ow old you: 15–20 20–30 30–40 40–50 How 50 old are you: 15–20 20–30 30–40 40–50 Over 50 hat is the most 8. important What 8. is advantage What most 8. is the important What of most using is the important advantage a most DD? important advantage of using advantage a of DD? using a of DD? using a DD? ooth type (No) Tooth type (No) Tooth type (No) Tooth type (No) ny relevant or serious medical condition:................................... -Prevent Any relevant or7. serious medical condition:................................... 9. What 9. is What the most is the important most important disadvantage disadvantage of using of ausing DD? a. .DD? you Pain or discomfort Pain or discomfort while the while DD is the in DD place is in Clinician: Impossibility place instruments Impossibility of rinsing of mouth rinsing during mouth treatment during treatment ow did find the session with 7. the How DD in did place? you find the session How with did the you DD find in the place? session with the DD in place? Treating Treating Clinician: ative spoken language: Arabic English Native spoken Other:.............. language: Arabic English Other:.............. Safe use Safe of use irrigants of irrigants and medication and Safe medication use of irrigants Prevent swallowing and swallowing medication of of Prevent instruments and swallowing materials and materials of instruments and materials Unpleasant taste during treatment Other: please specify: . . . . . . . . . . . . . Yes in detail Yes in (explanation detail Yes in (explanation detail was (explanation Yes clear) was in detail Yes clear) was briefly (explanation Yes clear) (fair briefly or Yes was poor) (fair briefly clear) or No poor) (fair Yes or briefly No poor) (fair No or poor) No ducation - the level:…………………………………………… Education level:…………………………………………… - Education level:…………………………………………… No you Yes but not for RCT Yes for RCT No Yes but not for Yes for RCT Almost same Better Almost Worse the of same Cannot Better comment Almost Worse the RCT Cannot same comment Better Worse Cannot comment 6. Was the placing of 6. the Was DD: the pleasant placing 6. Was of the 6. the DD: Was placing the pleasant of uncomfortable placing the DD: (comfortable) of the pleasant DD: painful (comfortable) pleasant uncomfortable cannot (comfortable) uncomforta painful un ender: Male Female -you Gender: Male Female ave ever experienced 2. rubber Have dam you ever rubber dam placement? Aseptic working field 15–20 Aseptic Would Protection working Aseptic working field Aseptic soft tissue Protection working field Better Protection field of treatment soft tissue Protection of soft quality Better tissue of soft treatment swallowing Better tissue treatment quality Better treatment quality quality ompared to the previous experience, how was the current of DD placement? ow old you: Unpleasant 20–30 30–40 -placement? 40–50 How old Over are 50 you: 15–20 success 30–40 40–50 Over Dribbling Dribbling Hyper Hyper salivation salivation should Difficulty Difficulty in in swallowing or breathing or breathing are Unpleasant Information: taste during taste treatment during treatment Other: please Other: specify:…………… please specify:…………… Long Short serious Reasonable Long experienced Short Reasonable Long 20–30 Short Reasonable Cannot comment (comfortable) comment Cannot comment 10. Do you 10. think Do you 10. that think Do using you 10. that athink Do rubber using you 10. that asuccess think dam Do rubber using you should that aexperience think dam rubber using be? that aanticipated dam rubber using be? should asession? dam rubber be? should be? should be? 11. 11. you Would prefer 11. you using Would prefer a DD in prefer the DD next using in session? the aCannot next DD in Yes the next No dam session? Yes ofNo Yes 50 No ny relevant or medical -condition:................................... Any relevant or serious medical condition:................................... Better Better cross-infection cross-infection control control Better Better cross-infection Better anticipated anticipated control success rate Better of rate the of treatment the treatment rate the treatment Information: Patient Patient Information: Patient Information: Tooth Tooth type (No) type (No) 10. Do you think that using a rubber dam should be? comment comment comment comment ducation level:…………………………………………… -No Education level:…………………………………………… No Yes but not for RCT Yes dam:.................. No for RCT Yes but not for RCT Yes for RCT Easy work for dentists Easy and work assistant Easy for dentists (four-handed Easy for work dentists assistant for dentistry) and dentists assistant (four-handed and assistant (four-handed (four-handed dentistry) dentistry) Almost the same Better Worse Not Cannot comment me taken Time 5. to taken apply Time to the taken apply rubber 5.reasons to the Time apply taken the dam:.................. rubber to apply minutes dam:.................. the rubber dam:.................. minutes ender: are Male Female -No Gender: Male Female Difficult Difficult communication with with dentist during during treatment current DD? Duration or process process of placement placement ave you 1. ever Have had you RCT ever before? 1. had Have RCT Yes before? you ever Yes had RCT before? dentist of No ompared to the previous experience, 3. Compared how was the to current the previous experience experience, DD how placement? was the experience of DD placement? d5.the doctor explain 4. the Did the doctor for using explain aand 4. DD? the Did reasons the doctor for using explain aup DD? the reasons for using a50 Not needed Not needed Optional, work Optional, up Not to communication needed patient Optional, up Not to needed patient Optional, up to Yes patient Optional, to dentists patient Optional, up to dentists patient Optional, Mandatory up to Duration dentists Optional, Mandatory up to dentists Mandatory up toor dentists Mandatory ofMandatory ow you: 15–20 20–30 -rubber 30–40 How old 40–50 are you: Over minutes 15–20 50 minutes 20–30 dentistry) 30–40 treatment 40–50 DD? Over 10.old Do 10. you Do think you that think using that a8. rubber using aneeded dam rubber should dam be? should be? hat isuse the most important advantage What of using is the aof DD? most important 8. What advantage is the most of using important aOther:.............. advantage of using aOther:.............. DD? hat . What is the most is the important most important 9. disadvantage What disadvantage is the most of using important using a DD? disadvantage a DD? of using a DD? ative spoken Native language: spoken Arabic language: English Native Arabic Other:.............. spoken English language: Other:.............. Native Arabic spoken English language: Arabic English Safe of irrigants Safe and use medication of Safe irrigants use of Safe Prevent irrigants and use medication of swallowing irrigants and medication and Prevent of instruments medication swallowing Prevent and swallowing Prevent materials of instruments swallowing of instruments and of materials instruments and materials and materials Not needed Optional, up to patient Optional, up to dentists Mandatory ducation level:…………………………………………… -References Education level:…………………………………………… pleasant Pain (explanation or Pain discomfort or discomfort the while DD the is DD in place iswas in place Impossibility the Impossibility of rinsing ofthe rinsing mouth during treatment treatment References References Patient Information: Information: Almost the same RCT Better was Worse Gender: Cannot Almost comment the same experience, Better Worse Cannot comment Yes inWas detail (explanation before? Yes in detail Yes briefly Patient (fair was Yes or in clear) poor) detail Yes (explanation No briefly (fair was or clear) poor) uncomfortable Yes No briefly (fair orpainful poor) during No 7. How did you find 7. session How did with you the 7.you find DD How the in 7. place? did session you How with find did you DD session find in place? with session DD in the place? DD in place? ender: placing Male Female -clear) Male while Female ave you ever had Yes No 1. ever had RCT before? Yes cannot No ompared to the 3. experience, how to was the the previous current how of placement? the current experience ofmouth DD placement? d6.the doctor explain the reasons for using athe DD? as the 6.Have the Was placing of the the DD: 6. placing of Was Compared DD: of the the placing pleasant DD: (comfortable) 11. of pleasant the DD: Have (comfortable) uncomfortable pleasant uncomfortable (comfortable) DD uncomfortable painful or cannot the cannot with cannot ave you ever experienced you ever 2. experienced rubber dam you placement? rubber ever experienced dam placement? rubber dam placement? Not needed previous Not needed Optional, up to patient to patient Optional, serious Optional, up to dentists up to dentists Mandatory Mandatory Aseptic working field Optional, Protection of soft Aseptic tissue working (comfortable) Better field treatment Protection Aseptic quality working of soft tissue field Better Protection treatment of soft quality treatment qua 11. Would 11. you Would prefer 11. you Would using prefer 11. you aup Would DD using prefer in the you asuccess Would DD using next prefer in the you session? aexperience DD using next prefer in the session? a DD Yes using next in No the session? aanticipated DD Yes next in serious No the session? painful Yes next No session? painful Yes of No Yes tissue No Better Dribbling 2. Dribbling Hyper Hyper salivation salivation the Dribbling Have Difficulty Difficulty Unpleasant Hyper in swallowing salivation in swallowing or breathing Difficulty or breathing in swallowing breathing ny relevant or Any serious relevant medical or serious condition:................................... medical Any relevant condition:................................... or medical Any relevant condition:................................... or medical condition:................................... Better cross-infection Better control cross-infection Better Better cross-infection Better anticipated control cross-infection control Better anticipated rate control Better of the anticipated treatment Better success rate success of the rate success treatment of the rate treatment the treatment Unpleasant taste during taste during treatment treatment Other: Other: please please specify:…………… specify:…………… reasons Long 4. Short Yes Reasonable Native Long Short No Reasonable Short Long aArabic Reasonable Short Reasonable ever Cannot comment Yes Cannot comment Cannot comment Cannot comment ducation level:…………………………………………… -clear) Education level:…………………………………………… Almost the same Better Worse C. Almost prefer Cannot the same comment you Better Worse Long Cannot comment Yes inwork detail (explanation was Yes (fair or poor) mment comment comment comment ave you ever had RCT before? Yes 1. No Have had RCT before? No 1. Loest, 1. Quality Loest, C. guidelines Quality Loest, C. guidelines for Quality endodontic for guidelines endodontic treatment: for endodontic treatment: Consensus Consensus treatment: report ofOther:.............. Consensus the report European of the report European Society of the of Society European of Society No Yes but for No not for Yes RCT but not Yes for for No RCT dentist Yes but for not RCT for RCT -during -for Native spoken spoken language: language: Arabic English dam English Other:.............. Easy dentists and (four-handed Easy work dentistry) dentists and Easy assistant work (four-handed for dentists and dentistry) assistant (four-handed d the doctor explain the for using Did the abriefly DD? doctor explain the reasons for using DD? 11. Would you using aRCT DD in the next session? Yes me taken to apply 5. the rubber Time taken dam:.................. to apply the 5. minutes rubber Time dam:.................. taken to apply the minutes rubber dam:.................. minutes Difficult Difficult communication communication assistant Difficult dentist with communication during treatment treatment with Duration dentist Duration during or process or treatment process of placement of 15–20 Duration placement or of ave you experienced rubber dam placement? 2. Have you ever experienced rubber placement? ow are -ever you: How 15–20 old are with you: 20–30 15–20 -RCT 30–40 How athe 20–30 40–50 old the are 30–40 Over you: 50 40–50 15–20 -Yes How Over 20–30 old 50 are 30–40 you: No 40–50 Over 20–30 50process 30–40 placement 40–50 dentistry) Over 50 11.old Would 11. you Would prefer you using prefer ais DD using in DD next in session? next session? Yes No Yes No hat is the most 9. important What 9. is the disadvantage What most 9. the important What most of is using the important disadvantage most a DD? important disadvantage of using disadvantage a of DD? using a of DD? using a DD? Endodontology. Endodontology. Int. Endod. Endodontology. Int. J. 2006, Endod. 39, J. 921–930. Int. 2006, Endod. 39, 921–930. J. 2006, 39, 921–930. 10. Do 10. you Do think you that think using that a using rubber a rubber dam should dam should be? be? References References References References References Any relevant Any relevant or serious or serious medical medical condition:................................... condition:................................... Safe use of irrigants and medication Prevent Safe use swallowing of irrigants and of instruments medication Safe use of and irrigants Prevent materials swallowing and medication of instruments Prevent swallowing and materials of instrume Yes in detail (explanation was clear) Yes briefly in detail (fair (explanation or poor) was No clear) Yes briefly (fair or poor) No 8. What is the most important 8. What advantage is the 8. most of What important using 8. is a the DD? What advantage most is important the most of using important advantage a DD? advantage of using a of DD? using a DD? ave you ever had RCT before? 1. pleasant Yes Have No you ever had how Yes No Pain or Pain or discomfort while while the Yes Pain DD the is or DD in discomfort place is (comfortable) in place Impossibility while Impossibility the DD ofbefore? is rinsing in of place rinsing mouth Impossibility mouth during during treatment ofplacement? treatment rinsing during treatment painful No Yes but not for RCT for RCT No Yes but not for RCT Yes for RCTmouth d7.the doctor explain the 4. reasons Did for using doctor aHave DD? explain the reasons for using awas DD? me taken to apply rubber dam:.................. minutes ow did How you 7. did find How you the did find session 7. you the with find session How the the did with session DD you the find place? with DD in the session place? DD in with the DD in place? ender: discomfort -ever Male Gender: Female to Male Female -the Gender: the Male RCT Female -place? Gender: Male Female ave you experienced rubber dam 2. placement? you ever experienced rubber dam placement? ompared 3. to Compared the previous the experience, 3. previous Compared how experience, to was the previous how current was experience, experience the current of experience DD placement? the of current DD experience of DD as the placing of 6.the the Was DD: the placing of the 6. DD: Was the pleasant uncomfortable placing (comfortable) of the DD: painful swallowing pleasant uncomfortable cannot (comfortable) painful placement? uncomfortable cannot Dribbling Hyper salivation Dribbling Dribbling Difficulty Hyper Dribbling salivation Hyper in swallowing salivation Hyper Difficulty or salivation breathing Difficulty in swallowing Difficulty in swallowing or breathing in or breathing or breathing 2. Elderton, 2. R.J. Elderton, A modern 2. R.J. Elderton, A approach modern R.J. to approach A the modern use of to approach rubber the use dam–1. of to rubber the Dent. use dam–1. of Pract. rubber Dent. Dent. dam–1. Pract. Rec. 1971, Dent. Dent. 21, Pract. Rec. 187–193. 1971, Dent. 21, Rec. 187–193. 1971, 21, 187–193. Not needed Not needed Optional, Optional, up to patient up to patient Optional, Optional, up to dentists up to dentists Mandatory Mandatory How old How are old you: are you: 15–20 15–20 20–30 20–30 30–40 30–40 40–50 40–50 Over 50 Over 50 Better cross-infection control Better anticipated Better cross-infection success rate control of the Better treatment Better cross-infection anticipated control success rate Better ofofthe anticipated treatment success rate of thetre tre Aseptic working field to Aseptic Protection working of soft Aseptic field tissue Protection working Better Aseptic treatment field working of soft Protection tissue quality field Better Protection soft treatment tissue of soft Better quality tissue treatment Better quo Unpleasant Unpleasant taste during taste during treatment Unpleasant treatment in Other: taste Loest, Other: please during please specify:…………… treatment specify:…………… Other: please specify:…………… Yes in detail (explanation was clear) Yes detail Yes briefly (explanation (fair or poor) was clear) No Yes briefly (fair or poor) No Long Short Long Reasonable Short Long Reasonable Short Long Reasonable Short Reasonable Cannot comment Cannot comment Cannot comment Cannot comment References References ducation level:…………………………………………… Education level:…………………………………………… Education level:…………………………………………… Education level:…………………………………………… No Yes but not for RCT Yes for RCT No Yes but not for RCT Yes for RCT 1. Loest, 1. C. Loest, Quality 1. C. Loest, guidelines Quality 1. C. guidelines Quality for 1. endodontic C. Loest, guidelines Quality for endodontic C. treatment: guidelines Quality for endodontic treatment: guidelines Consensus for endodontic treatment: Consensus for report endodontic treatment: Consensus of report the treatment: European Consensus of report the European Society Consensus of report the European of Society of report the European of Society of the European of Society Almost the same Almost Better the same Worse Better Almost Cannot the Worse same comment Cannot Better comment Worse Cannot comment me taken to apply the rubber dam:.................. 5. Time taken minutes apply the rubber dam:.................. minutes mment comment comment ave youplacing ever experienced rubber 2.pleasant dam Have placement? you ever experienced rubber dam placement? ompared to the previous experience, was the current 3.M.A.; Compared experience to of the DD previous placement? experience, how was the current experience of DD pla as the of3.the DD: dentist (comfortable) uncomfortable painful cannot Difficult communication Difficult with 3. Difficult communication how communication Difficult during with treatment communication dentist with Duration dentist with treatment during or dentist process treatment during Duration of placement treatment The Duration or process as Duration or process placement oraof process placement placement Cochran, M.A.; Cochran, Miller, 3. dentists M.A.; Cochran, Miller, C.H.; Miller, Sheldrake, M.A. C.H.; The efficacy M.A. Sheldrake, of efficacy the M.A. rubber of the efficacy dam rubber aofof barrier dam the rubber as to the barrier dam spread as toof athe of barrier spread to of the spread - C.H.; Gender: -Sheldrake, Gender: during Male Male Female work Female Endodontology. Easy work for Int. and assistant work for dentists Easy and The Easy dentistry) assistant for dentists work (four-handed for and dentists dentistry) (four-handed assistant (four-handed dentistry) dentistry Endodontology. Int. Endodontology. Endod. Int. J.to Endodontology. 2006, Endod. 39, J.Easy Endodontology. 921–930. 2006, Endod. 39, Int. J. 921–930. 2006, Endod. 39, Int. J. 921–930. 2006, Endod. 39, J.most 921–930. 2006, 39, 921–930. 11. Would 11. Would you prefer you prefer using a using DD in aa(four-handed DD the in next the session? next session? Yes No Yes assistant No and hat is the most important disadvantage 9. What of is using the most a DD? important 9. What disadvantage is the of important using a DD? disadvantage of using a DD? No Yes but not for RCT Yes for RCT No Yes but not for RCT Yes for RCT o 0. you Do think you that think using that 10. using a rubber Do a you rubber dam think should dam that should be? using be? a rubber dam should be? Almost the same Better Worse Cannot comment Almost the same Better Worse Cannot comment me taken to apply the rubber 5. Time dam:.................. taken apply minutes the rubber dam:.................. minutes mment hat 8. is What the 8. most is What the important most is the important 8. advantage most What important advantage is the of using most advantage of a important DD? using of a DD? using advantage DD? of using a DD? 1. Loest, 1. C. Loest, Quality C. guidelines Quality guidelines for endodontic for endodontic treatment: treatment: Consensus Consensus report of report the European of the European Society of Society of ave you 1.ever Have had RCT before? ever had pleasant RCT Yes 1. before? Have No you Yes ever No had RCT 1.previous before? Have you Yes ever irrigants No had RCT before? Yes materials No microorganisms microorganisms during microorganisms dental during treatment. dental during treatment. J. Am. dental Dent. J. treatment. Assoc. Am. Dent. 1989, J.Assoc. Am. 119, Dent. 141–144. 1989, Assoc. 119, 141–144. 1989, 119, 141–144. Pain or discomfort while Pain or the discomfort Pain DD is or in discomfort Pain place while or the discomfort Impossibility while DD is the in place DD of is rinsing the in Impossibility place DD mouth is in Impossibility during of rinsing Impossibility treatment of mouth rinsing during of mouth rinsing treatment during mouth treatment during treatment ompared toDid the previous experience, how 3. was the current to the experience of experience, DD placement? how was the current experience of DD placement? d the 4. doctor explain the doctor the reasons 4. explain Did for the the using reasons doctor aCompared DD? explain for using the awhile DD? reasons for using aplace DD? as the placing of the DD: 6. Was (comfortable) the placing of uncomfortable DD: pleasant painful (comfortable) place? uncomfortable swallowing painful cannot ow did you find the 7.you session How did with you the find DD in the 7. session How with did the you DD find in the place? session with the DD in -place? Education -Safe Education level:…………………………………………… level:…………………………………………… Elderton, Safe use of irrigants and medication use of irrigants Prevent Safe and use swallowing medication of Safe use ofPract. cannot and instruments irrigants Prevent medication swallowing and medication Prevent of instruments Prevent swallowing and of instrum materia o 2.Hyper Elderton, 2. R.J. 2. Apatient modern Elderton, R.J. 2. A approach modern Elderton, R.J. 2. A approach to modern the Elderton, R.J. use A approach to modern of the rubber R.J. use A approach modern of dam–1. the rubber approach Dent. to of dam–1. the rubber Pract. use Dent. to of dam–1. Dent. the rubber use Rec. Dent. of dam–1. Dent. 1971, Pract. Rec. 21, Dent. dam–1. Dent. 187–193. 1971, Pract. Rec. 21, Dent. 187–193. 1971, Pract. Rec. 21, Dent. 187–193. 1971,or Rec. 21, 187–193. 1971, 21, 18 Dribbling salivation Difficulty Dribbling in swallowing 921–930. Hyper or salivation breathing Dribbling use Hyper in swallowing salivation orand Difficulty breathing inDent. swallowing breathing Not needed Not needed Optional, detail Optional, up to Not up needed to patient Optional, 2006, Optional, Optional, up up to dentists up to patient to dentists to Mandatory Optional, Difficulty Mandatory up to dentists rubber Mandatory Endodontology. Endodontology. Int. Endod. Int. J. Endod. 2006, 39, J. 921–930. 39, Aseptic Aseptic working working Aseptic field Protection working field Aseptic Protection field of soft working Protection tissue of soft field tissue Better of soft Protection treatment tissue Better treatment of Better quality soft tissue treatment quality Better quality treatment quality Unpleasant taste during Unpleasant treatment Unpleasant taste during Other: Unpleasant taste please treatment during taste specify:…………… treatment during Other: treatment please Other: specify:…………… please Other: specify:…………… please specify:…………… Almost the same Better Worse Cannot comment Almost the same Better Worse Cannot comment Yes in detail Yes (explanation in (explanation was clear) Yes in was Yes detail briefly clear) (explanation (fair Yes or briefly poor) was (fair clear) No or poor) Yes briefly No (fair or poor) No mment comment Long Short Reasonable Long Short Reasonable Long Short Reasonable Cannot comment Cannot comment Cannot comment ompared to3.the previous experience, 3. Compared how was the to the current previous experience experience, of DD how placement? was the current experience of DD placement? d the doctor explain the reasons for using a DD? 4. Did the doctor explain the reasons for using a DD? Better cross-infection control Better cross-infection Better anticipated Better control cross-infection success Better Better cross-infection rate anticipated of control the treatment Better control success anticipated rate Better of anticipated the success treatment rate success of the ra tr as the placing of the DD: 6. Was pleasant the placing (comfortable) of the DD: uncomfortable pleasant (comfortable) painful cannot uncomfortable painful cannot ow did you find the session with the DD in place? ave you 2. ever Have experienced you ever rubber experienced dam 2. Have placement? rubber you dam ever placement? experienced 2. Have rubber you dam ever placement? experienced rubber dam placement? Cochran, 3. Cochran, M.A.; 3. dentist Miller, Cochran, M.A.; 3. C.H.; Miller, Cochran, M.A.; Sheldrake, 3. C.H.; Miller, Cochran, M.A.; Sheldrake, M.A. C.H.; Miller, The M.A.; Sheldrake, M.A. efficacy C.H.; Miller, The Sheldrake, of M.A. efficacy C.H.; the The rubber Sheldrake, of M.A. efficacy the dam The rubber of as M.A. efficacy the aNo dam barrier The rubber as efficacy the to a dam barrier the rubber spread of as the to aordam barrier the rubber oftreatment spread as to a dam barrier the spread as aDuration barrier the ofspread toor the o References References 1. Have 1. you Have ever you had ever RCT had before? RCT before? Yes Yes of No Difficult communication with during treatment communication dam–1. Duration with Difficult or dentist process communication during of placement treatment with dentist Duration during process ofofplacement to p 2. work 2.forwork Elderton, R.J. A modern R.J. A modern approach toDifficult the use toof the rubber use of rubber Dent. dam–1. Pract. Dent. Dent. Pract. Rec. Dent. 1971, Rec. 21, 1971, 187–193. 21, 187–193. Easy Elderton, Easy dentists Easy for work dentists for assistant Easy dentists and work (four-handed and for assistant (four-handed dentists dentistry) (four-handed and assistant dentistry) dentistry) (four-handed dentistry) Almost the same Better was Worse assistant Cannot Almost comment the same Better Worse Cannot comment ould 1. Would prefer you prefer using 11. using aand DD Would in aapproach DD the you in next the prefer session? next using session? What Yes adam DD or Yes No in the most No next session? minutes Yes No Yes inyou detail (explanation clear) Yes briefly (fair should poor) Yes in be? detail No (explanation was clear) Yes Yes briefly (fair or141–144. poor) No mment comment Long Short Reasonable Cannot comment No Yes but not No for Yes RCT but Yes not for RCT No Yes Yes for but RCT not for RCT No Yes for Yes RCT but not for RCT for RCT microorganisms microorganisms during microorganisms dental during microorganisms treatment. dental during microorganisms treatment. J. dental Am. during Dent. treatment. J. dental Am. Assoc. during Dent. treatment. 1989, J. dental Am. Assoc. 119, Dent. treatment. 1989, J. 141–144. Am. Assoc. 119, Dent. 1989, J. 141–144. Am. Assoc. 119, Dent. 1989, 141–144. Assoc. 119, 1989, 141–144. 119, oow you think that 10. using Do you 10. a rubber think Do you 10. that dam think Do using should you that a think rubber be? using that a rubber using dam a rubber should dam be? should be? d the doctor explain the reasons for using 4. a Did DD? the doctor explain the reasons for using a DD? me taken 5. to Time apply taken the to rubber apply 5. dam:.................. Time the rubber taken to dam:.................. apply minutes the rubber minutes dam:.................. did you find the session with 7. the How DD in did place? you find the session with the DD in place? hat is the most important 8. What advantage is the most of using important 8. a DD? advantage is the of using important a DD? advantage of using a DD? Pain orCochran, discomfort the is in Loest, place Pain or discomfort while of rinsing the Pain DD mouth or discomfort in place during treatment Impossibility while the DD is in place mouth materials Impossibility during treatment of rinsing 9. What isSafe the most important 9. What disadvantage the 9. most What important of using 9. isisdam the What aof disadvantage DD? most isbarrier important the of important using disadvantage a rinsing DD? disadvantage of using aof DD? using a DD? 3. use Cochran, M.A.; Miller, M.A.; C.H.; Miller, Sheldrake, C.H.; Sheldrake, M.A. The M.A. efficacy The of efficacy the rubber of the rubber as adam asmost atoplacement? barrier the spread to of the of spread of 1.irrigants Loest, 1.medication C. C. Quality guidelines guidelines for endodontic for endodontic treatment: treatment: Consensus Consensus report report of the of European the European Society Society of of m Safe Safe of3.irrigants use Safe of while irrigants and use medication of and DD use and Prevent ofQuality medication irrigants Impossibility Prevent swallowing and is Prevent swallowing medication of instruments swallowing of Prevent instruments and swallowing instruments materials and materials of and instruments materials and 2. Have 2. you Have ever you experienced ever experienced rubber rubber dam dam placement? Not needed Optional, the Not needed up to Not patient working needed Optional, Not Hyper Optional, in needed Optional, up to up patient Optional, up toAm. dentists to patient Optional, up the to Mandatory 119, patient Optional, up to dentists Other: Optional, up to dentists Mandatory up toquality tissue dentists Mandatory Other: Mandatory Yes in detail (explanation was clear) Yes briefly Yes in (fair detail or poor) (explanation No was clear) or Yes briefly (fair or poor) breathing No Long Short Reasonable Long Short Reasonable Cannot comment Cannot comment Aseptic working field Protection Aseptic of soft field tissue Protection Better Aseptic treatment working of soft tissue quality field Better Protection treatment of soft Better treatment quality Unpleasant taste during treatment Other: Unpleasant please taste specify:…………… during treatment Unpleasant taste please during specify:…………… treatment please specify:…………… d the doctor explain the reasons 4. for Did using the a doctor DD? explain the reasons for using a DD? me taken to apply rubber dam:.................. minutes 5. Time taken to apply the rubber dam:.................. minutes Dribbling salivation Dribbling Difficulty Hyper Dribbling in salivation swallowing Dribbling Hyper Difficulty breathing salivation Hyper in swallowing salivation Difficulty or Difficulty in swallowing in swallowing or breathing or b ow did you find the session 7. with How the did DD you find place? the session with DD in place? hat is the most important advantage of using a DD? microorganisms microorganisms during dental during treatment. dental treatment. J. Am. Dent. J. Assoc. Dent. 1989, Assoc. 1989, 141–144. 119, 141–144. ompared 3. toWas the Compared previous toexperience, previous 3. the how Compared experience, the to current how the previous was experience 3. the current Compared experience, of DD experience placement? to the was previous the current placement? experience, how was of DD theplacement? Endodontology. Endodontology. Int. Int. J. 2006, J. 39, 2006, 921–930. 39, 921–930. Better cross-infection Better cross-infection Better control cross-infection control Better Better cross-infection anticipated control Better anticipated Better success control anticipated rate success Better of the rate success anticipated of the rate treatment of success the treatment of the treatment as the6. placing the of the placing DD: 6.theof Was pleasant the DD: placing (comfortable) was pleasant ofEndod. the (comfortable) DD: uncomfortable pleasant treatment uncomfortable (comfortable) DD cannot rate painful uncomfortable experience cannot painful current cannotexperience No Endod. Yes No but Yes not but for not RCT forpainful how RCT Yes for of Yes RCT for RCT References nces References Easy work for dentists and Easy assistant work for (four-handed dentists and dentistry) Easy assistant work (four-handed for dentists and dentistry) assistant (four-handed dentistry) Yes in detail (explanation was clear) Yes Yes in briefly detail (fair (explanation or poor) was No clear) Yes briefly (fair or poor) No Protection Difficult communication in Difficult with dentist communication during advantage treatment the with communication Difficult dentist using communication during with treatment process dentist with of during placement dentist Duration treatment during or21, process treatment Duration of place Du or Long think Short Almost Reasonable dam:.................. Long modern Reasonable Cannot comment comment Aseptic working field of soft tissue most Better treatment quality 2. Elderton, Elderton, R.J. ADD A modern approach approach torubber the use to the of rubber use ofsame rubber dam–1. dam–1. Dent. Dent. Dent. Pract. Rec. Dent. 1971, Rec. 21, 187–193. 187–193. the same Would Better the same Worse 2. Better Cannot Almost (comfortable) Worse comment the same comment Better Difficult Almost Worse Cannot comment Better or Worse should Cannot comment ould prefer 11. using 11. DD you Would in 11. the you next Would using prefer session? ais you using prefer Yes the aCannot DD using next to No in session? the aCannot next in session? the Yes next No session? Yes Duration Yes Pract. No me taken to apply the rubber 5.Short Time minutes taken apply the rubber dam:.................. minutes mment comment comment hat isyou the most important advantage 8. What of using the aR.J. DD? important of using DD? oAlmost you that using aaimportant rubber dam 10. should Do you be? think that using 10. aDD Do you dam think should that be? apleasant rubber dam be? as the placing of the DD: prefer pleasant 6. Was uncomfortable the of painful the DD: aNo cannot (comfortable) 1971, uncomfortable plac pa 9. is What the 9. most isQuality What the important most is 9. disadvantage most What important disadvantage isendodontic the of most disadvantage using important of amedication DD? using of disadvantage adiscomfort DD? using aplacing DD? of using aEuropean DD? 3. Compared 3. Compared toin the to previous the previous experience, experience, how was how the was current the current experience experience of DD of placemen DD .hat est, Loest, C. Quality C. guidelines guidelines 1.the for Loest, endodontic for C. Quality treatment: guidelines treatment: Consensus for Consensus endodontic report of treatment: the of European theThe Consensus Society report Society of of of the European Society of Safe use of irrigants and and Safe medication use of irrigants Prevent and swallowing Safe use of of report instruments irrigants Prevent and swallowing and medication materials of instruments Prevent swallowing and materials of instruments and materi Pain or discomfort while Pain the DD or is place Pain while Impossibility or discomfort the Pain DD or is discomfort of in while rinsing place the mouth Impossibility while DD is the in during place DD of is treatment in rinsing Impossibility place mouth Impossibility of during rinsing tre o Easy work for dentists assistant (four-handed dentistry) 3. Cochran, 3. Cochran, M.A.; Miller, M.A.; Miller, C.H.; Sheldrake, C.H.; Sheldrake, M.A. The M.A. efficacy efficacy of the rubber of the rubber dam as dam a barrier as a barrier to the spread to the spread of of Aseptic working field Protection ofsoft Aseptic tissueworking Betterfield treatment Protection qualityof soft tissue Better treatment quality

Survey Questionnaire Survey Questionnaire Survey Questionnaire ConflictsConflicts of Interest: of Interest: The authors Thedeclare authors no declare conflict noof conflict interest. of interest.


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References 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. 26.

Loest, C. Quality guidelines for endodontic treatment: Consensus report of the European Society of Endodontology. Int. Endod. J. 2006, 39, 921–930. Elderton, R.J. A modern approach to the use of rubber dam–1. Dent. Pract. Dent. Rec. 1971, 21, 187–193. [PubMed] Cochran, M.A.; Miller, C.H.; Sheldrake, M.A. The efficacy of the rubber dam as a barrier to the spread of microorganisms during dental treatment. J. Am. Dent. Assoc. 1989, 119, 141–144. [CrossRef] [PubMed] Carrotte, P.V. Current practice in endodontics: 3. Access is success, and rubber dam is easy. Dent. Update 2000, 27, 436–440. [CrossRef] [PubMed] Lynch, C.D.; McConnell, R. Attitudes and use of rubber dam by Irish general dental practitioners. Int. Endod. J. 2007, 40, 427–432. [CrossRef] [PubMed] Taintor, J.F.; Biesterfeld, R.C. A swallowed endodontic file: Case report. J. Endod. 1978, 4, 254–255. [CrossRef] Susini, G.; Pommel, L.; Camps, J. Accidental ingestion and aspiration of root canal instruments and other dental foreign bodies in a French population. Int. Endod. J. 2007, 40, 585–589. [CrossRef] [PubMed] Govila, C. Accidental swallowing of an endodontic instrument: A report of two cases. Oral Surg. Oral Med. Oral Pathol. 1979, 48, 269–271. [CrossRef] Kuo, S.; Chen, Y. Accidental swallowing of an endodontic file. Int. Endod. J. 2008, 41, 617–622. [CrossRef] [PubMed] Goultschin, J.; Heling, B. Accidental swallowing of an endodontic instrument. Oral Surg. Oral Med. Oral Pathol. 1971, 32, 621–622. [CrossRef] Fredekind, R.E.; McConnell, T.A.; Jacobsen, P.L. Ingested objects: A case report with review of management and prevention. J. Calif. Dent. Assoc. 1995, 23, 50–55. [PubMed] Israel, H.A.; Leban, S.G. Aspiration of an endodontic instrument. J. Endod. 1984, 10, 452–454. [CrossRef] Lambrianidis, T.; Beltes, P. Accidental swallowing of endodontic instruments. Dent. Traumatol. 1996, 12, 301–304. [CrossRef] Going, R.E.; Sawinski, V.J. Parameters related to the use of the rubber dam. J. Am. Dent. Assoc. 1968, 77, 598–601. [CrossRef] [PubMed] Joynt, R.B.; Davis, E.L.; Schreier, P.H. Rubber dam usage among practicing dentists. Oper. Dent. 1989, 14, 176–181. [PubMed] Marshall, K.; Page, J. The use of rubber dam in the UK. A survey. Br. Dent. J. 1990, 169, 286–291. [CrossRef] [PubMed] Madarati, A.A.; Younes, H.A.B. Survey on the modalities of rubber dam usage for root canal treatment. Taibah Univ. Med. Sci. 2016, 11, 152–158. [CrossRef] Madarati, A.A. Why dentists don’t use rubber dam during endodontics and how to promote its usage? BMC Oral Health 2016, 16, 24. [CrossRef] [PubMed] Whitworth, J.; Seccombe, G.; Shoker, K.; Steele, J. Use of rubber dam and irrigant selection in UK general dental practice. Int. Endod. J. 2000, 33, 435–441. [CrossRef] [PubMed] Mala, S.; Lynch, C.D.; Burke, F.; Dummer, P.M.H. Attitudes of final year dental students to the use of rubber dam. Int. Endod. J. 2009, 42, 632–638. [CrossRef] [PubMed] Ryan, W.; O’Connell, A. The attitudes of undergraduate dental students to the use of the rubber dam. J. Ir. Dent. Assoc. 2007, 53, 87–91. [PubMed] Ahmad, I. Rubber dam usage for endodontic treatment: A review. Int. Endod. J. 2009, 42, 963–972. [CrossRef] [PubMed] Hill, E.E.; Rubel, B.S. Do dental educators need to improve their approach to teaching rubber dam use? J. Dent. Educ. 2008, 72, 1177–1181. [PubMed] Filipović, J.; Jukić, S.; Miletić, I.; Pavelić, B.; Malˇcić, A.; Anić, I. Patient's attitude to rubber dam use. Acta Stomatol. Croat. 2004, 38, 313–317. Görduysus, M. Rubber Dam’in Hastalar TarafındanKabul Edilebilirligi ˘ Üzerine BirDegerlendirme ˘ Calısması. Hacettepe Dishekimli˘gi Fakültesi Dergisi 2006, 30, 8–12. Al-Fouzan, K.S. A survey of root canal treatment of molar teeth by general dental practitioners in private practice in Saudi Arabia. Saudi Dent. J. 2010, 22, 113–117. [CrossRef] [PubMed]


27. 28. 29. 30. 31. 32. 33. 34. 35.

11 of 11

Kapitan, M.; Hodacova, L.; Jagelska, J.; Kaplan, J.; Ivancakova, R.; Sustova, Z. The attitude of Czech dental patients to the use of rubber dam. Health Expect. 2015, 18, 1282–1290. [CrossRef] [PubMed] Stewardson, D.; McHugh, E. Patients’ attitudes to rubber dam. Int. Endod. J. 2002, 35, 812–819. [CrossRef] [PubMed] Fink, A. The Survey Kit, Volume 2: How to Ask Survey Questions; Sage Publications: Thousand Oaks, CA, USA, 1995. Lydeard, S. The questionnaire as a research tool. Fam. Pract. 1991, 8, 84–91. [CrossRef] [PubMed] Vedavathi, B.; Murthy, S.; Nadig, R.; George, J. Patients’ Attitude to Rubber Dam: A Short-term Study—Short Communications. World J. Dent. 2011, 2, 167–168. Gergely, E.J. Desmond Greer Walker Award. Rubber dam acceptance. Br. Dent. J. 1989, 167, 249–252. [CrossRef] [PubMed] Jones, C.M.; Reid, J.S. Patient and operator attitudes toward rubber dam. ASDC J. Dent. Child. 1988, 55, 452–454. [PubMed] Fresa, R. Il Consenso Informato in Odontoiatria; CG Edizioni Medico Scientifiche: Torino, Italy, 1998; 205p. Heling, B.; Heling, I. Endodontic procedures must never be performed without the rubber dam. Oral Surg. Oral Med. Oral Pathol. 1977, 43, 464–466. [CrossRef] © 2018 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).