Factors associated with dental dam use during non-surgical root canal treatment: A national dental PBRN study

Objective: Dental dam (DD) isolation is widely recognized as the standard of care during non-surgical root canal treatment (RCT), yet its routine use by general dentists (GDs) remains inconsistent. This study utilized real-world data from the National Dental Practice-Based Research Network (“Network”) to quantify the frequency of DD use and identify practitioner and practice characteristics associated with it. Methods: A total of 153 Network dentists (49 endodontists, 104 GDs) enrolled 1860 adult patients requiring RCT across all six Network regions. After exclusions, data from 1701 patients were analyzed. Dentists recorded detailed pre- and post-treatment data for each RCT completed, including whether DD isolation was used. Statistical analyses were performed, including bivariate and multivariable models that adjusted for clustering of patients within practitioners. Results: Endodontists reported near-universal DD use (99%). GDs used DDs in 72% of the teeth that received RCT, with wide inter-practitioner variability (SD=40%). Among GDs, higher DD use was significantly associated with practicing in large group or academic settings (OR=6.2, p=.04) and being located in the Midwest or Western Network region (OR=5.2, p=.005). GDs who identified as White, Asian, or Hispanic had higher DD use compared to other groups (OR=2.9, p=.09). DD use among GDs was not associated with tooth type, nor with the GD's sex, age, or professional membership. Conclusions: Despite improvements in DD use compared to prior reports, substantial variation persists among GDs. Practice setting and Network region are the strongest predictors of adherence to DD use. Clinical Significance: DD use during RCT remains inconsistent among GDs, with practice setting and Network region strongly associated with adherence. Targeted institutional and regional strategies may improve compliance, ensuring safer, higher-quality care and reinforcing DD isolation as a critical clinical standard in endodontics.