Effective isolation during dental procedures is a fundamental prerequisite for achieving optimal clinical outcomes. Isolation refers to the separation of the operative site from the rest of the oral cavity, thereby minimizing contamination from saliva, blood, or other oral fluids. This technique facilitates better visibility, reduces the risk of cross-contamination, and enhances the efficacy of dental materials, particularly in restorative and endodontic procedures. Among the methods available, rubber dam isolation is considered the gold standard due to its superior sealing capability, moisture control, and patient protection from accidental aspiration or ingestion of instruments [1]. However, alternative methods such as cotton rolls, cheek retractors, and high-volume suction are also commonly employed, especially when rubber dam application is impractical.

Undergraduate dental students are trained extensively in both theoretical and practical aspects of isolation. However, the degree to which they translate this knowledge into practice varies widely. Studies have shown that knowledge, attitude, and practice (KAP) assessments can provide insight into the effectiveness of educational programs and identify areas where further training may be required [2]. Isolation techniques are introduced early in the undergraduate curriculum, but their consistent application depends on multiple factors, including perceived clinical difficulty, time constraints, patient cooperation, and availability of materials. Furthermore, attitudes toward rubber dam use, for instance, are often influenced by the student’s own clinical experiences and the emphasis placed on its importance by supervising faculty [3].

The importance of proper isolation cannot be overstated in operative dentistry and endodontics. It directly affects the longevity and success of restorations, bonding strength, and the control of infection within the operative field. Incomplete isolation may lead to marginal leakage, reduced adhesion, secondary caries, and ultimately, restoration failure [4]. Additionally, improper moisture control can affect the performance of light-cured composite resins and endodontic sealers, highlighting the need for rigorous adherence to isolation protocols [5]. These technical implications reinforce the necessity of training dental undergraduates not only in the mechanics of applying isolation methods but also in the rationale behind their use.

KAP studies serve as a valuable tool in assessing the knowledge level, personal beliefs, and actual behavior of students with regard to clinical protocols. In the context of isolation, such studies can shed light on whether students understand the scientific basis of the practice, whether they perceive it as important, and whether they actually implement it in clinical settings. Understanding the gaps between knowledge, attitude, and practice is essential to developing interventions that bridge these divides. For instance, students may acknowledge the benefits of rubber dam use yet avoid it due to time constraints or lack of confidence in placement technique [6]. Similarly, positive attitudes may not necessarily lead to consistent usage if the importance of isolation is not reinforced regularly during clinical postings [7].

Assessing these aspects among undergraduate students is crucial, particularly as they transition from preclinical simulation to real patient care. Moreover, such evaluation is also relevant in preparing students for professional practice, where adherence to evidence-based protocols is essential for patient safety and treatment success. Evaluating students’ competence and compliance in isolation techniques contributes to improving dental education and fostering a culture of high-quality, safe dental care [8].

Therefore, the present study was undertaken to evaluate the knowledge, attitudes, and practices regarding isolation techniques among undergraduate dental students using a structured questionnaire approach. This assessment aims to identify educational gaps and recommend curriculum modifications to enhance clinical competency and procedural standards among future dental practitioners [9,10].

A cross-sectional, questionnaire-based study was conducted among undergraduate dental students enrolled in the clinical phase of their training at a recognized dental institution. The objective was to assess their knowledge, attitude, and practices (KAP) regarding the use of isolation techniques during various dental procedures. Ethical clearance was obtained from the institutional ethics committee prior to the commencement of the study.

The study population included third-year, final-year, and internship-level students who had clinical exposure to restorative, endodontic, and surgical procedures. Students who had not yet begun clinical training or were unwilling to participate were excluded. A structured, pre-validated questionnaire was designed and administered in both printed and electronic formats to ensure maximum participation.

The questionnaire comprised four sections. The first section collected demographic details such as age, gender, and academic year. The second section assessed knowledge regarding various isolation techniques, their indications, and their importance in different dental procedures. This section included multiple-choice questions with a single correct answer. The third section evaluated students' attitudes toward the routine use of isolation methods, perceived benefits, perceived barriers, and willingness to use techniques such as the rubber dam. The final section focused on actual practices adopted during clinical work, including frequency of rubber dam usage, alternative isolation techniques used, and factors influencing their choices.

The content validity of the questionnaire was established by subject experts in operative dentistry and public health. A pilot test was carried out on a small sample of students to ensure clarity, relevance, and internal consistency. Modifications were made based on feedback from the pilot group before final administration.

Data collection was carried out anonymously to encourage honest responses. Responses were compiled and entered into Microsoft Excel for analysis. Descriptive statistics such as frequencies and percentages were used to summarize categorical variables. Chi-square tests were employed to evaluate associations between academic level and KAP scores. A p-value of <0.05 was considered statistically significant.

The results were analyzed to determine overall knowledge scores, attitude trends, and frequency of isolation practices among the different academic levels. Correlations between knowledge and practice, and between attitude and practice, were also explored. The findings were interpreted to identify key areas of deficiency and to recommend improvements in curriculum delivery and clinical reinforcement strategies.

A total of 150 undergraduate dental students participated in the study, comprising 50 students each from third year, final year, and internship levels. The response rate was high, and the data collected was complete and usable for analysis.

Knowledge of Isolation Techniques:

Overall, 78% of students demonstrated satisfactory knowledge regarding isolation procedures. Interns had the highest proportion of correct responses (84%), followed by final-year students (76%) and third-year students (74%). Most students correctly identified rubber dam as the ideal isolation technique for restorative and endodontic procedures.

Attitude towards Isolation:

Attitude scores indicated that 65% of participants agreed that rubber dam isolation improves treatment outcomes. However, only 48% were confident in applying rubber dams independently, and 60% perceived time consumption as a barrier. A large proportion (72%) expressed willingness to use isolation regularly if adequate training and support were provided.

Practice of Isolation in Clinics:

Only 32% of students reported routine use of rubber dams in clinical practice. Cotton rolls and suction were more commonly used. Usage frequency increased with academic year: 20% in third year, 30% in final year, and 46% in interns. Common reasons for non-use included patient discomfort, lack of time, and inadequate training.

Correlation between KAP:

Students with higher knowledge scores demonstrated significantly better practices (p < 0.05). Similarly, a positive attitude toward isolation was moderately correlated with actual usage patterns.

Table 1: Distribution of Knowledge Scores by Academic Year

Table 2: Attitudes towards Isolation Techniques

Table 3: Self-Reported Clinical Practice of Isolation Methods

Table 4: Association Between Knowledge Score and Clinical Practice

Isolation is a foundational element of modern dentistry, directly impacting the quality, longevity, and success of various dental procedures. The present study aimed to evaluate the knowledge, attitude, and practices (KAP) related to isolation techniques among undergraduate dental students. The results highlight several important trends and educational gaps that merit further analysis and intervention.

A majority of students demonstrated moderate to high knowledge scores regarding isolation techniques. This aligns with existing literature suggesting that theoretical understanding of procedures like rubber dam usage is relatively well imparted during undergraduate education [11]. However, practical application appears to lag behind. Although interns had the highest knowledge scores, only 46% reported routine use of rubber dams. This indicates a disconnect between knowledge acquisition and clinical practice, which may stem from various operational and perceptual barriers [12].

Attitudinal responses further reinforce this gap. While 65% of students agreed that isolation improves treatment outcomes, more than half found rubber dam usage difficult or time-consuming. Previous studies have shown that even when dental students are aware of the clinical benefits, concerns regarding patient discomfort, procedural delay, and lack of confidence in placement often hinder consistent implementation [13,14]. The perception that isolation is cumbersome or irrelevant in routine cases may be perpetuated by inadequate reinforcement during clinical training.

The practice section revealed a strong dependence on alternative isolation techniques such as cotton rolls and high-volume suction. These methods, although useful, are not substitutes for complete isolation in procedures like adhesive restorations or endodontic therapy. Studies have emphasized that moisture contamination can significantly affect the adhesion and polymerization of restorative materials, thereby compromising treatment success [15]. The underutilization of rubber dams may thus result in suboptimal clinical outcomes despite adequate theoretical preparation.

One of the most notable findings in this study is the statistically significant association between higher knowledge scores and better clinical practice. Students with a strong theoretical foundation were more likely to adopt evidence-based protocols, including regular use of rubber dams. This is supported by literature that emphasizes the role of comprehensive training, repeated exposure, and positive clinical supervision in bridging the knowledge–practice gap [16,17].

Interestingly, attitude also influenced practice but not as strongly as knowledge. While many students expressed willingness to use isolation more frequently if training improved, the actual implementation remained inconsistent. This suggests that beyond cognitive understanding, behavioral and logistic factors play a substantial role in clinical decision-making. These include faculty encouragement, peer behavior, and patient cooperation, all of which shape a student’s approach to isolation in real-world scenarios [18-20].

Recommendations arising from this study include enhancing preclinical simulation exercises, increasing faculty-driven reinforcement during clinical postings, and incorporating checklists for procedural protocols. Students should also be educated about time-efficient rubber dam placement techniques and patient communication strategies to overcome resistance [21,22].

The study reveals that while undergraduate dental students possess moderate to high knowledge regarding isolation techniques, there is a significant gap in their practical application. Attitudinal factors such as perceived difficulty and patient discomfort, along with lack of confidence, contribute to low usage of rubber dams. Strengthening hands-on training, reinforcing clinical supervision, and addressing behavioral barriers are essential steps to improve adherence to proper isolation protocols. Bridging the knowledge-attitude-practice divide will ensure that future dental professionals provide safe, effective, and evidence-based care, enhancing both treatment quality and patient outcomes.

1. Syed AK, Godavarthy DS, Kumar KK, Poosarla CS, Reddy GS, Reddy BV. Estimation of salivary superoxide dismutase, glutathione peroxidase, catalase in individuals with and without tobacco habits. J NTR Univ Health Sci. 2021;10:27–32.
2. Suneetha M, Ramya A, Afroz Kalmee S. A fundamental change in approach in the dental and oral hygiene management in children during Covid-19 pandemic. IOSR J Dent Med Sci. 2020;19(12):16–20.
3. Devi Priya B, Afroz Kalmee S, Danda OE, Dasarathi A. Root end filling material: which is better in marginal adaptation? An in vitro study. Int J Med Biomed Stud. 2021;5(1):112–8.
4. Danda OE, Kumar CHL, Syed AK, Danda D, Danda H. Comparative evaluation of tensile bond strength of endodontic sealers to dentin and gutta-percha – an in vitro study. Int J Med Sci Diagn Res. 2021;5(1):35–8.
5. Anuradha C, Dasarathi A, Danda OE, Lakshman Kumar CH, Afroz Kalmee S, Suneetha M. Assessment of knowledge, attitude and practice towards COVID-19 among final year dental students in post-lockdown period: an online questionnaire-based study. IOSR J Dent Med Sci. 2021;20(1):10–5.
6. Reddy KH, Syed AK, Alivelu D, Danda H, Alla R. A randomized split-mouth clinical trial of desensitizer agents for tooth sensitivity. Int J Res Med Sci. 2021;9:2430–4.
7. Priya B Devi, Swetha B, Sarada C, Jerry Aldrin J, Sudharani T, Afroz Kalmee Syed. Comparison of rotary and reciprocating file systems using CBCT: an original study. Turk J Physiother Rehabil. 2021;32(3):40374–81.
8. Viral BM, Rashmi D, Afroz KS, Akriti M, Priyanjali D, Alice, et al. Comparative study of various methods for estimation of blood loss in postpartum hemorrhage: an original research. Turk J Physiother Rehabil. 2021;32(3):45222–8.
9. Suneetha M, Ramya A, Dasarathi A, Ahmed TS, Abedi SA, Afroz Kalmee S. Age estimation among children in a tertiary hospital in Andhra Pradesh using Demirjian’s and Cameriere’s methods. IOSR J Dent Med Sci. 2021;20(3):17–20.
10. Devi Priya B, Afroz Syed, Arora M, Dasarathi A, Danda H. Influence of various irrigants on the accuracy of two electronic apex locators in locating simulated root perforations. Int J Med Biomed Stud. 2022;6(3):119–23.
11. Manek P, Shah R, Gupta N. Detection and Management of ADRs in a Tertiary Hospital in India. AIJRRLSJM. 2023;6(2):123–130. doi: 10.22259/2639-6736.0602005.
12. Manek P, Patel S, Sharma A. The Evolution of Orthodontics: Advancements, Innovations, and Transformative Technologies. Academia Journal of Medicine. 2022;5(1):45–52. doi: 10.47008/ajm.2022.5.1.05.
13. Miao C, Yang X, Wong MCM, Coletto D, Pun H, Glenny AM, et al. Rubber dam isolation for restorative treatment in dental patients. Cochrane Database Syst Rev. 2021;(9):CD009858.
14. Falacho RI, Coelho AS, Marto CM, Marques D, Fernandes A, Paula AB, et al. Clinical in situ evaluation of the effect of rubber dam isolation on bond strength to enamel. J Esthet Restor Dent. 2021;33(1):76–83.
15. Alzahrani MH, Alenzi FH, Alruwaili FA, Alshammari AF, Alshammari FH, Alshammari NF, et al. Knowledge, attitude and practice of dental students regarding use of rubber dam during clinical procedures. Saudi J Oral Dent Res. 2022;7(12):333–40.
16. Milanovic M, Dimitrijevic M, Juloski J. Isolation with rubber dam: knowledge, training and attitudes of final-year dental students in Belgrade. Sci World J. 2020;2020:3753274.
17. Kumar V, Sharma A, Gupta A, Tyagi A, Saxena P, Choudhury A. Barriers in rubber dam isolation behaviour of dental students during adhesive restorative treatments: a cross-sectional study. Cureus. 2022;14(10):e30112.
18. Alenezi MA, Aldokhayel SA, Al-Hazmi RS, Alghamdi MS, AlHajri MA, AlRafedah AM. Rubber dam isolation survey among dental students in Al Qassim University. J Pharm Bioallied Sci. 2023;15(2):489–94.
19. Rafique S, Zafar MS, Farid H, Almas K. Rubber dam isolation in clinical adhesive dentistry: a prevalence study. J Contemp Dent Pract. 2019;20(4):496–500.
20. Shenoy VU, Ahmed R, Rao A, Rao A. Evaluation of senior dental students' general attitude towards the use of rubber dam: a survey among two dental schools. J Dent Educ. 2014;78(10):1408–15.
21. Rubber dam isolation – when and why to use it? BDJ Student. 2021;28(1):12–3.
22. de Amorim RG, Ferreira MA, Leite-Cavalcanti A, Lima R, de Farias-Neto A. Rubber dam versus cotton roll isolation on composite resin restorations in primary molars: a randomized clinical trial. BMC Oral Health. 2022;22(1):449.