Influence of Rubber Dam on Objective and Subjective Parameters of Stress During Dental Treatment of Children and Adolescents

Abstract

Background: Dental anxiety is highly prevalent among children and can adversely affect cooperation, treatment efficiency, and long‑term oral health behaviors. Rubber dam isolation is widely used to enhance moisture control, but its impact on pediatric stress responses remains underexplored. Objective: To evaluate the influence of rubber dam isolation on physiological and psychological stress parameters in children and adolescents undergoing dental treatment. Methods: A comparative cross‑sectional study was conducted among 72 participants aged 6–16 years at a dental teaching hospital over one year. Participants received either rubber dam or cotton roll isolation during routine restorative procedures. Heart rate and systolic blood pressure were recorded at baseline, intra‑operatively, and post‑operatively. Subjective stress was assessed using the Facial Image Scale and Wong‑Baker FACES Pain Rating Scale. Group differences were analyzed using t‑tests and chi‑square tests with α ≤ 0.05. Results: Rubber dam isolation resulted in significantly lower intra‑operative heart rate (92.1 vs 98.6 bpm; p = 0.002) and systolic blood pressure (112.5 vs 118.3 mmHg; p = 0.012). Subjective anxiety and pain scores were also significantly lower in the rubber dam group (p < 0.001). Low anxiety levels were more common with rubber dam use (61.1% vs 27.8%). Conclusion: Rubber dam isolation effectively reduces both physiological and psychological stress in pediatric dental patients and enhances overall treatment comfort.