Often referred to as ‘silver’ fillings, amalgam fillings are an incredibly popular dental option. In fact, they’re the most commonly used filling in Canada.
Consisting of metals such as mercury, copper, silver, and tin, amalgam fillings have the advantage of being inexpensive and long-lasting. Plus, putting them in place is relatively straightforward and hassle-free. Usually, your patients will only require one visit to complete these fillings.
However, you might’ve noticed more patients raising concerns about these restorations, especially those who have received amalgam fillings in the past.
Often, these conversations are rooted in the toxicity of mercury and its perceived effects on the patient’s health.
Dental Amalgam: A Quick Review
It’s worth noting that, yes, higher levels of mercury will adversely impact the brain and kidneys.
Further, research from the Food & Drug Administration (FDA) demonstrates that amalgam fillings are safe for adults and children above the age of six, with no known health problems linked to amalgam.
Less is known about the effects of amalgam on the long-term health outcomes of pregnant women, developing fetuses, and children under six-years-old. However, evidence suggests that infants are not at risk for adverse health effects from the mercury in the breast milk of mothers exposed to mercury vapour from dental amalgam.
Should Existing Amalgam Fillings Be Removed?
Interestingly, the risks of mercury are more than likely to be exacerbated in removing an amalgam restoration than leaving it intact.
Why? Because the toxic components are safely contained when the amalgam is left alone in your patients’ mouths, but could detach in the process removing the filling.
Though, like everything in this world, this isn’t a hard and fast rule. There are times when it’s best to replace these fillings.
Namely, once amalgam restorations reach the 2-year mark, it’s wise to consider replacements. Similarly, if this manner of filling is damaged in any way, they should be replaced. And provided such a restoration has irregular margins or overhangs and is causing resulting gingival inflammation, a replacement should likely occur. Lastly, any recurrent decay beneath the filling means that a replacement ought to take place.
Now, if a patient falls under the above categories but is currently experiencing health issues, you must consult their physician. Such ailments include memory loss, heart palpitations, deficiencies, a heavy viral or toxic load, or a sensitive nervous system.
Removal in the above cases could potentially trigger their sickness and make them far more ill.
How to Discuss These Matters with Patients
When consulting with your dental patients about keeping or removing their amalgam, the conversation should mainly center around mitigating harm.
First, you must set your patients at ease about any concerns they might have about long-term safety and potential associated with replacements. Have this conversation before you jot down any detailed notes of these discussions in your official records.
Furthermore, don’t be afraid to recommend a second opinion on the matter. Not only will this establish trust between you and your patient, but it’s a safe and sound practice as a dental professional.
Your patient’s health, well-being, as well as their mental state should be a top priority. Treatments must be in their best interest while adhering to the current practices and teachings that are deemed most sound by dental authorities.
Furthermore, since you spend practically all day helping people, you’re dealing with prolonged exposure to physical and psychological stress. Chairside burnout is a genuine and problematic issue for many hygienists.
Taking care of yourself as a dental professional is a must! Here, we’ll discuss 7 tips that’ll help you perform at your best on the job without compromising your physical or mental health.
1. Focus on Ergonomics
In short, ergonomics is the study of people’s efficiency in their working environment. Really, the idea is for you to be honed in to your own posture and position.
One example of an effective ergonomic measure is using anatomical or “handed” gloves instead of ambidextrous gloves (which put up to 33% more pressure on the thumbs and fingers). Also, remember to stretch regularly throughout the day!
2. Practicing Yoga
Since you’re a hygienist, you must find the balance between physicality and mentality. And breathing techniques employed in yoga can be that centring factor.
Yoga’s focus on breathing and posture helps combat the various musculoskeletal issues and burnout you might face.
Having first been used in Japan in the 1970s, cryotherapy exposes the body to a -100°C temperature for around one to four minutes. Cryotherapy chambers can be entire rooms or structures that resemble barrels that expose you, neck-down, to the liquid nitrogen.
There is an array of studies and scientific evidence that prove the value of these treatments. Namely, for dental hygienists, cryotherapy helps treat musculoskeletal pain and related ailments.
4. Visiting the Chiropractor
Chiropractors use a holistic approach to treating musculoskeletal disorders. Primarily, such treatments center around proper spine alignment. With the adjustments provided, chiropractic professionals believe that healing is enabled without the need for surgery or pharmaceuticals.
There is a wealth of techniques and methods of treatments, such as manual-diversified techniques. All chiropractors are different, so treatment lengths differ depending on their philosophy.
5. Treat Yourself to a Massage
While the title of this section suggests that massages are something of a treat, in your profession, they’re a necessity for keeping happy and healthy!
In utilizing rhythmical pressure and stroking, massage therapists help prevent, develop, maintain, rehabilitate and augment physical function while relieving pain.
Now, the benefits of massages can be short term, but they do improve lymph flow and prevent fibrosis, for instance. Also, they increase serotonin levels and provide endorphins, which helps with the anxiety and stress you may feel on the job.
6. Stick to Acupuncture
Not only does acupuncture have proven results, it’s specifically been useful for dental hygienists who’ve been suffering from musculoskeletal disorders.
This form of treatment theorizes that an imbalance in the body’s energy flow (or chi/qi) causes illness. This flow of energy is accessible through around 350 points on the body where thin needles are inserted to restore balance and harmony.
7. Take Time to Meditate
It’s believed by many that meditative practices play a big part in improving psychological, neurological, and cardiovascular function.
Best of all? There’s no gym membership or meditation guru needed. All you have to do is sit upright and still while focusing your attention on something like breathing.
With these 7 methods of self-care, you’ll feel happier and healthier in your dental practice!
Are you experiencing discomfort in your back molars or your gums at the back of your mouth? Do you have trouble opening and closing your jaws, bad breath or a low-grade fever? You may need a wisdom tooth extraction to remove an impacted third molar and prevent further discomfort and infection. Before you have your tooth removed, there are some critical facts you need to know about wisdom tooth extraction and the alternatives.
Alternatives to Wisdom Tooth Removal
Extraction is often recommended for wisdom teeth as a preventative measure to minimize misalignment, eliminate overcrowding, or when the tooth is infected. However, in some cases, you may not need to have your wisdom teeth removed.
A coronectomy is an alternative to wisdom tooth extraction and is recommended for patients when the wisdom tooth is impacted and presses on the lingual nerve or inferior alveolar nerve. These nerves control the sensation in your tongue, lips, and chin and can affect speech and chewing.
A coronectomy removes the crown of the tooth, leaving the roots in place. If the wisdom tooth root is not infected, a coronectomy may be an ideal alternative to wisdom tooth removal.
An operculectomy removes the gum tissue that can develop over a partially erupted wisdom tooth. Debris and bacteria can get caught in this tissue, causing painful infections and inflammation. Removal of the operculum reduces the risk of bacteria build-up and may prevent the need for a wisdom tooth extraction.
Bring a Chaperone to Your Appointment
Whether you have a wisdom tooth removal, operculectomy or coronectomy, your dentist will still administer anesthesia to make you more comfortable during the procedure. In most cases, the site will be numbed using a local anesthetic. However, for complex wisdom tooth extractions or if you suffer from dental anxiety, you may need to be sedated.
The side effects of sedation can take some time to wear off, so it is essential to bring someone along with you to drive you home after the procedure.
Rest with Your Head Raised
Your body’s natural reaction to tooth extraction is inflammation and swelling. However, uncontrolled swelling can lead to infection. To keep the swelling under control, rest with your head slightly elevated to drain fluid away from the area. You can also apply cold compresses to the side of your face and take over the counter anti-inflammatory medication.
Skip the Toothbrush
Avoiding brushing isn’t advice that you’ll usually hear from your dentist; however, you need to avoid using your toothbrush near the extraction site for the first 24 hours after surgery.
Also avoid spitting and rinsing, as well as drinking through a straw. The reason for this is that the blood vessels inside the empty tooth socket form a clot that seals the socket and prevents infection.
If the clot becomes dislodged, you are at risk of developing a condition called dry socket where the nerves of the tooth are exposed.
Stock Up on Soft Foods
Hard and chewy foods can aggravate the wound site, causing discomfort. Some nutritious foods for post-surgery recovery include yogurt, oatmeal, fruit and vegetable purees, eggs, and smoothies. Cold and tepid foods can also help to alleviate post-surgery swelling.
Bleeding Is Normal After Surgery
Although you may have stitches in the tooth socket, it is normal to experience some bleeding after surgery. Your dentist packs the empty socket with gauze which you should hold firmly in place for 30 minutes. Repeat until the bleeding abates. If the bleeding is excessive, call your dentist immediately.
Symptoms that you shouldn’t ignore include fever, numbness, increased swelling, pus from the wound or nose, and trouble swallowing or breathing. Any of these symptoms could indicate infection or nerve damage and need to be assessed by your dentist immediately.
Keep Your Wound Clean
There are several ways you can keep your mouth clean and hygienic. Rinsing with a saltwater solution helps to eliminate bacteria, clear debris from around the extraction site, and reduce discomfort after surgery.
Combine one cup of warm water with ½ a teaspoon of salt and gently swish the solution around your mouth for 20-30 seconds. Instead of spitting out the rinse, tip your head over the sink and open your mouth to expel the water gently.
Wisdom tooth extraction is a standard procedure to prevent impacted wisdom teeth from affecting your remaining teeth and jawbone. However, it isn’t always necessary to have your tooth extracted.
Dr. Fadi Swaida first graduated from the University of Western Ontario with an Honors BSc in Biology before graduating from the University of Manitoba’s Faculty of Dentistry. He is an active member of his church and enjoys football and being by the water! His outgoing personality and fun-loving character will ensure you always feel welcome at Dentist North York.
Recently, writers at Today’s RDH posed its readers a rather thoughtful question:
How do you, as a dental hygienist, define ambition?
A total of 82 dental hygienists, young and old, shared their answers. And it probably won’t surprise you to learn that every one of them had a slightly different approach!
Many of the people surveyed equated ambition to career growth, and outlined what they planned to move forward: sharpening their skills, furthering their education and so on.
Some thought back to the reasons why they entered the profession in the first place, while others took “ambition” to mean broadening their role as a hygienist.
Perhaps the biggest takeaway from this survey is the desire dental hygienists have to do more. The responses paint a colourful picture of all the ways this career can evolve.
In the spirit of the new decade, let’s celebrate a few of the ways our fellow dental hygienists have defined their ambition in 2020 and beyond!
1. Focusing on Preventative Dental Care
“My ambition is to bring the public forward in knowledge of what a dental hygienist is and start having people get healthy. Change the model of dental health from restoring and treating disease to prevention.”
Bit by bit, the model of dental health is evolving from a restorative approach to a preventive one. And no one is in a better position to champion this shift than dental hygienists! Since you work closely with patients even before they require treatment, you’re in the perfect place to impart advice that can benefit their oral health for years to come.
2. Deeper Role in Day-to-Day Operations
“Ambition is the continuation of advancement, whether in the continued pursuit of clinical excellence or transitioning into different aspects of patient care.”
“Looking beyond the dentition to the entirety of the head and neck and oral/oropharyngeal cavity. Embracing all there is to know about not just the oral-systemic link, also the cancers of the head and neck oral and Oropharynx, and our role in each area.”
“Ambition would be to work on legislation to advance a dental hygienist to a position like a PA. Not necessarily the dental therapist model but very close.”
Do you dream of one day being able to practice hygiene independently? Wish you could apply your knowledge of dental care delivery in a senior role? Well, you’re far from alone in that! In fact, there are scores of dental hygienists out there hoping to expand our opportunities outside of the operatory.
Hygienists are increasingly seizing the chance to lead initiatives, manage teams, and advising policy. There are more non-traditional career opportunities for hygienists in healthcare, management and sales than ever before! What’s more, some hygienists, like the individual quoted above, are also advocating for a broader clinical scope of practice ‒ perhaps along the lines of a dental therapist.
5. Mastering the Art and Science of Hygiene
“My definition of ambition in the dental hygiene profession is someone who does their best work on each and every patient.”
It’s an exciting time to be a registered dental hygienist. As the scope of practice continues to expand, so too will the career opportunities...but only for those who are prepared to take them!
Whether you’re just starting out in your career or well along the path, it’s never too late to refine your knowledge, improve your skills, and continue your hygiene education.
The teething process can be difficult for both parents and young ones alike. It’s only natural that parents want to protect their children from anything that might be causing them pain ‒ but they don’t always want to treat the problem with pharmaceuticals.
So, many parents look for homeopathic, all-natural solutions for their toddler’s teething problem.
Recently, dental professionals have noticed the growing trend of parents are treating their toddler’s gum pain with a natural teething necklace. Let’s take a closer look at what this alternative ‘healing’ method entails.
What are Teething Necklaces?
Natural teething necklaces are abundantly available and can be purchased for about $20 from boutiques and big-box stores alike.
The necklace is made of something called Baltic amber, which was formed over 45 million years ago. It’s an organic fossil resin that’s produced by pine trees native to northern Europe and the Baltic Sea. This unique amber has been used since ancient times as both an ingredient in perfumes and in folk medicine.
People who believe in the healing properties of Baltic amber claim it soothes teething symptoms because it releases succinic acid. Apparently, the substance is absorbed as an analgesic through a child’s skin.
Is There Any Merit to This Homeopathic Treatment?
In short, no. There’s no scientific data that can prove these necklaces are useful in any way as treatments. Conversely, research suggests that this homeopathic healing device actually does much more harm than good.
The Cruel Reality of Teething Necklaces
Upon even the most surface-level investigation, you’ll find that succinic acid won’t be dispersed from your child’s necklaces unless it’s heated at 200 Celsius.
If the piece of jewelry breaks, a small bead might enter a toddler’s airway, causing them to choke. It’s also possible that the necklace can get caught on a child’s crib then wrap too tightly around their neck, causing strangulation.
Then, the jewelry might cut toddlers’ gums – which can lead to an infection.
For further context, studies by researchers from Nova Scotia tested the strangulation risk of 15 amber teething necklaces purchased from retailers in Canada. Their results showed that nearly half failed to open after applying 15 pounds of force for 10 seconds, which is an industry-standard.
Talking to Parents About Teething Necklaces
It’s always challenging to tell parents they’re doing something wrong with raising their children.
Therefore, when you notice a toddler wearing a teething necklace or a parent informs you that they’re utilizing the method, be sensitive to their situation.
Still, as a professional, you can inform them of the dangers that we’ve discussed above. In many cases, most parents will realize your advice is coming from a good place, so they’ll likely take immediate action.
You must provide these parents with a list of viable alternatives. After all, it’s unfair to drop a bomb about the teething necklace with no other solutions in mind.
Here are some practical alternatives to a teething necklace:
Large plastic toys that are safe for chewing
Cold or frozen cloths
Frozen bananas or apples
Massaging the gums
While we do understand any hesitation about traditional medicine for children, a mild pain reliever won’t do any harm when given to a toddler sparingly.
The Final Verdict on Teething Necklaces
Parents can go to unusual lengths to protect their children from pain. Sometimes they hear about alternative treatments that sound too enticing to pass up.
After all, an ancient analgesic with healing powers catered specifically to teething pain makes for an enticing proposition.
However, as an informed dental professional, you must discourage parents from purchasing these necklaces. It’s then equally as crucial that you provide viable alternatives to help with teething pain symptoms, so parents can take comfort in your care for their toddler.
As dental professionals, we’re constantly looking for ways to help patients feel safe and comfortable under our care.
Unfortunately, there’s little we can do to change the fact that dentistry is, by nature, quite invasive. We still have a ways to go when it comes to finding less invasive means to diagnose and treat our patients.
One promising solution in this area is saliva testing ‒ a fast, cost-effective diagnostic tool which requires no painful pokes or scrapes. Saliva tests are increasingly utilized as a noninvasive way to monitor oral health status, disease onset and progression, and treatment.
Here, we’ll look at the reasons why more and more dentists are welcoming saliva test kits into their practices.
Why Use Saliva Testing in Dental Practice?
Saliva is a truly flexible fluid. Yes, it helps us eat, speak and maintain good oral health ‒ but it also contains a wealth of biochemicals that can tell us a great deal about a person’s overall health.
In addition to oral health conditions, trace amounts of proteins and other substances linked to other systemic diseases can filter into saliva from blood serum. These salivary biomarkers have been investigated for detection and monitoring of diseases such as:
Various cancers, including oral squamous cell carcinoma
Herpes simplex virus 1 or 2
Chlamydia trachomatis and Neisseria gonorrhoeae
Unlike a blood sample, saliva (along with secretions from specific oral glands, mucosal transudate and gingival crevicular fluid) is painless and readily available to collect from patients for analysis.
In many cases, it is possible to collect and test saliva samples right there in the dental office using portable, rapid test kits. When laboratory analysis is required, saliva samples have greater stability than blood in transportation.
Suppose a patient comes to you with telltale signs of inflammation: painful, bleeding gums and the early stages of gum recession. You don’t need a saliva test to tell you that this patient is likely suffering from gingivitis. However, the results test could inform an individualized treatment approach that could provide the best possible outcome for them.
As Dr. Nagelberg explains, a salivary test report would specifically indicate which antibiotics are indicated for each type of bacteria found in the saliva sample. A patient who is dealing with high-risk, highly pathogenic bacteria such as Porphyromonas gingivalis and Tannerella forsythia would benefit from a treatment plan that is based on their increased risk of periodontal disease.
Efforts are underway to further the development of rapid, point-of-care tests to evaluate oral fluids. Ongoing research indicates that saliva could eventually be used to detect heart disease, diabetes, cancers and other conditions. Refinement of oral fluid tests may shed further light on our understanding of the oral-systemic link.
Imagine using a simple, chairside test to detect all manner of oral and systemic diseases. This could be the future of diagnosing periodontal disease, assessing cavity risk and more!
The Future of Saliva Testing in Dentistry
The development of salivary testing for the dental practice is still in its early stages.
Currently, there is still no established, uniform criteria for collecting human saliva in the dental practice. Although oral fluid testing by clinical laboratories is regulated to ensure test results are accurate, the regulations do not address the validity of the test. Additionally, to date, there are no FDA-approved salivary diagnostic tests for evaluating the risk of periodontal disease or dental caries.
Still, saliva testing for oral and systemic disease holds many advantages that make it ideal for use in dentistry. Surveys show that these types of chairside tests are appealing to dentists and patients alike.
I don’t need to tell you how stressful a dental office can be on any given day! However, new research from the University of Plymouth indicates that this time pressure can lead to results much more dangerous than a missed lunch or reduced time for mental breaks throughout the day.
In fact, we know now that dentists are much more liable to miss crucial details when reviewing patient x-rays if they’re crunched for time.
What the Research Says
Despite dentistry’s infamy as a stressful field, very little research has been done to examine the effects of stress on a dentist’s performance.
In March 2019, researchers asked forty dentists to interpret x-rays with and without the addition of time pressure. Afterward, these dentists were also asked to rate their stress levels during their session with a time crunch versus their diagnostic session without time pressure.
Understandably, the dentists in the study reported feeling much more stressed when working under time constraints. Additionally, their performance was significantly hindered when pressured for time.
In other words, time pressure meant that dentists were more likely to make diagnostic errors and overlook potential warning signs offered by x-rays ‒ a devastating effect that has the potential to put patients in danger of missed diagnoses and worsening health.
Of course, I’d be remiss not to mention the potential legal complications of missed diagnoses for any practice, too!
Addressing the Problem
The risks documented in this study may land more personally than you expect. Instead of discarding this poignant research as something which could never happen in your own office, take some time to learn and implement a few tools to create a lower-stress environment within your practice.
Whether you realize it or not, it’s easy for the fear and tension of your patients to seep into your own conscience while you’re working.
Avoid this by being perceptive of your patients’ anxiety, showing empathy and understanding to patients who are stressed out by their visit, and encouraging them to take a couple of long, deep breaths.
Not only will this improve your quality of care and improve the patient experience, but it will reduce your stress, too!
2. Exercise self-care at work.
Whether this means taking a quick break to enjoy your favourite tea, meditating during lunch, or simply showing compassion for yourself while you’re on the clock, make sure that self-care practices don’t stay at home during the day. Drink plenty of water, stretch, and consume well-balanced food during breaks and lunch.
If your body feels better, your mind will feel better, too.
3. Pinpoint what’s stressing you out.
Before you can reduce stress, you must work to identify the sources of stress.
Need some help? The top five causes of stress in the field of dentistry are: running behind schedule, excessive workload, causing a patient pain, caring for anxious patients, and treating patients who don’t show up on time.
Once you have a better idea of what’s stressing you out, you can take more targeted steps to adjust and relax.
4. Be positive.
Attitude is everything. Even if you’re not feeling positive, search for the humour in the day’s situations and put a smile on your face.
Not only will patients value this positive attitude, but it will also keep stress and burnout at bay!
It’s a Team Effort
One final note! It may be tempting to discard this research and these strategies if your role within your dental practice doesn’t involve the diagnosis of patients or x-ray review. However, don’t think for a moment that it’s not important for every member of a functioning dental practice to learn stress management in the workplace!
While the study discussed above specifically investigated x-ray diagnoses by dentists, dental hygienists and assistants are equally susceptible to making mistakes or sacrificing thorough care when office stress gets high.
I want to emphasize that the tips I’ve offered above apply not just to dentists, but to everyone.
Embrace them as you work to improve your practice’s environment, eliminate stress, and prioritize the best possible patient care.
Dental waste management is an important aspect of your dental practice management.
Dental waste or bio waste accumulates throughout any given day in a busy dental practice. This clinical waste can include human tissue, bodily wastes, pharmaceutical products, syringes, needles, swabs and so on. Additionally, it may include x-ray fixer, developer and gypsum found in dental molds.
As in all healthcare facilities, these wastes need to be disposed of safely without any negative impact on the environment. Health and safety protocols are set to guide these disposal activities.
Amalgam – used as a restorative material – is made up of several chemicals bound together by mercury. The removal of old fillings and shaping/polishing of new fillings creates mercury-containing waste that poses a threat to the environment. Mercury has been declared a dangerous substance under the Canadian Environment Protection Act, 1999 and can do much harm if allowed to enter the environment through scrap, vapors, or waste water.
A Canada-wide standard states that amalgam traps and filters to collect the waste be implemented as a dental office’s best practice, allowing it to be recycled or disposed of in such a way that it does not enter the sewage system. An approved waste carrier should be contacted for recycling or disposal.
Used x-ray fixer and developer contains silver and are classified as hazardous under Ontario Regulation 347. Municipal bylaws place concentration limits on heavy metals such as silver entering the wastewater system which can affect aquatic life.
A dental practice should collect used fixer and developer solutions in separate containers provided by an approved waste carrier or supplier, who will then recycle or safely dispose. Silver recovery units can also be used to reclaim the silver from the fixer solution. Once the recovery cartridge is full, an approved waste carrier can recycle or dispose. Alternatively, dental practices can switch to digital equipment, eliminating the need for x-ray machines.
X-ray packets and aprons contain lead which is also classified as hazardous under Ontario Regulation 347. Lead can contaminate the soil and groundwater if disposed to landfill. An x-ray film manufacturer will often provide containers for recycling or disposal through an approved waste carrier. Lead aprons must not be disposed to the regular waste system. Approved waste carriers must be utilized for disposal.
Biomedical wastes are also classified as hazardous under Ontario Regulation 347. Bodily wastes may include blood-soaked materials, and human tissue. Extracted teeth, gauze, surgical gloves, and saliva-soaked materials are not included under the definition of biomedical waste provided they do not contain blood.
Blood-soaked materials should be collected in yellow liner bags marked with the biohazard symbol and disposed of through an approved biomedical waste carrier. If blood-soaked materials are stored on-site for more than 4 days, they should be stored in a refrigerated area, locked and separate from other supply areas.
Sharp objects used in a dental practice may include syringes, needles, and other sharp instruments such as scalpel blades and clinical glass and should be separated from any human waste. Sharps containers are puncture-resistant and leak proof and designed specifically for safe containment and disposal of these items.
Disinfectants and Other Chemicals
There are many chemicals used in dental clinics for sterilizing, disinfecting and cleaning. Some of these chemicals may be explosive if released to sewers in large enough quantities. Many of these chemicals can affect the environment adversely.
Follow the directions on Material Safety Data Sheets (MSDS) for the proper handling and disposal of all chemicals in the dental practice. Contact your local municipality for guidelines on disposal of solvents such as ethers, alcohols, acetone or chloroform.