The number of damaged gingival tissues after placing a rubber dam is greater if?

The correct answer is based on the understanding of how a rubber dam functions and its impact on gingival tissues. When the distance between holes in a rubber dam is too small, it can lead to increased tension on the surrounding gingival tissues. This tension can cause trauma or damage to the gingiva, particularly if the rubber dam is stretched too tightly across these points.

The gingival tissues may become irritated or contused due to the increased pressure and restricted blood flow, leading to inflammation or even damage over time. This is why maintaining an appropriate distance between the holes is crucial for the integrity of the gingival tissue during dental procedures.

In contrast, the other options do not directly relate to increased damage to the gingival tissue in the same way. Large distances between holes may reduce tension on the tissues and promote better overall comfort, while the size of the punctured holes may not significantly affect tissue health unless they are excessively large. Additionally, not using lubricant can lead to discomfort but does not fundamentally change the risk of tissue damage in the same manner as improper hole spacing does.