Influence of rubber dam on objective and subjective parameters of stress during dental treatment of children and adolescents - a randomized controlled clinical pilot study

BACKGROUND Rubber dam is recommended for isolating the working field during adhesive dentistry procedures; however, dentists often omit rubber dam, particularly in paediatric dentistry, supposing that it would stress the patient. AIM The aim of this study was to evaluate stress parameters during a standardized dental treatment procedure performed with or without rubber dam. The treatment time was measured as a secondary outcome variable. DESIGN This study was designed as a randomized, controlled, clinical study with 72 patients (6-16 years; mean age, 11.1). During standardized fissure sealing procedures, objective parameters of stress (e.g., skin resistance, breath rate) were recorded. The operator's stress level was measured by pulse rate. Subjective pain (patients) and stress perception (operator) were evaluated by an interview. RESULTS The breath rate was significantly (P<0.05) lower and the skin resistance level was significantly higher during treatment with rubber dam compared to the control group. Subjective pain perception was significantly lower for the test group. The treatment time needed for the fissure sealing procedure was 12.4% less in the test group. CONCLUSION Isolation with rubber dam caused less stress in children and adolescents compared to relative isolation with cotton rolls if applied by an experienced dentist.

Assessing the sustainability of water governance systems: the sustainability wheel

We present and test a conceptual and methodological approach for interdisciplinary sustainability assessments of water governance systems based on what we call the sustainability wheel. The approach combines transparent identification of sustainability principles, their regional contextualization through sub-principles (indicators), and the scoring of these indicators through deliberative dialogue within an interdisciplinary team of researchers, taking into account their various qualitative and quantitative research results. The approach was applied to a sustainability assessment of a complex water governance system in the Swiss Alps. We conclude that the applied approach is advantageous for structuring complex and heterogeneous knowledge, gaining a holistic and comprehensive perspective on water sustainability, and communicating this perspective to stakeholders.