Evaluate your office/practice and assess the surfaces and materials that comprise the space.
Light switches, doorknobs, and other regular areas will need extra attention paid for cleaning and disinfection to reduce the risk of spreading germs.
Now it’s time to execute on what you’ve developed.
To ensure optimal cleaning/disinfecting, thoroughly read the manufacturer's instructions for all products.
During any cleaning and disinfecting, ensure that you’re wearing gloves and other required personal protective equipment (PPE).
3. Maintenance and Revision
Continue to update your implemented plan based on evolving guidelines.
Also, keep an eye out for potential blind-spots you might have had during the development stage.
How to Properly Clean & Disinfect a Surface
People tend to conflate ‘cleaning’ and ‘disinfecting’ when they’re really two separate processes. One valuable source of information breaks down the dual-process in very straightforward terms:
For cleaning, your primary focus is the removal of germs, dirt, and impurities from surfaces. This way, you’ll mitigate the potential for infections to spread.
After cleaning is when disinfectant products do their best work. They kill the lingering germs on surfaces, thus further offsetting the possible spread of infection.
As has been established in the previous section, wear gloves and any other necessary PPE to keep yourself safe. Given that you’re working in a dental office, additional protective equipment should be considered.
Clearing Up the Confusion: Cleaners Versus Disinfectants
Cleaning can be performed with water and either soap or detergent.
Conversely, disinfectants are generally sprays, concentrates, and wipes—all of which can be employed in preventing COVID-19.
According to the EPA and CDC, following the product label instructions is a non-negotiable must. Doing so will keep you informed on how long you should leave products on the surfaces to successfully eliminate germs. There’s also the matter of rinsing the product so that you don’t ingest harmful chemicals. Plus, you want to keep those products out of the reach of children.
Something else to consider is that it’s been suggested not to overuse or stockpile both disinfectants and PPEs. Given the current circumstances and the need to combat COVID-19, you need to do your part in preventing shortages in the case of emergencies.
Lastly, you might experience a situation where the EPA's requested disinfectants aren't accessible. In this instance, those same guidelines establish other ways to disinfect surfaces that are equally effective at staving off COVID-19.
Click here for a list of CDC and EPA-requested disinfectants.
Other Crucial EPA & CDC Guidelines to Consider
Naturally, running a dental practice exposes you, your staff, and your clients to an array of excess germs compared to the average business.
Thus, measures must be in place to protect everyone who'll come into contact with your practice and the surrounding community. This means stringent social distancing rules must be maintained.
Furthermore, all practice staff should be wearing cloth face coverings and frequently washing their hands. Keep on top of federal, state, tribal, territorial, and local guidelines as they continue to evolve and shift in nature.
Adapting to the New Normal
These guidelines might seem a little bit intense, and something of a headache on top of everything else required to run your practice. After all, being successful in the dental industry requires in-depth focus and dedication outside of keeping your office COVID-proof.
However, maintaining these cleaning and disinfecting standards contributes to the greater good of society. All while keeping your practice safe. And eventually, at least until there’s a vaccine, these methods will slowly become second nature.
Above all else, you’ll find that these measures offer you tremendous peace of mind!
PPE, short for personal protective equipment, has always been important to dental professionals. It helps us protect ourselves and our patients from the spread of germs and disease. But with the COVID-19 pandemic this year, wearing PPE is more crucial than ever.
Healthcare professionals are now the most at-risk group for coronavirus as they work in close contact with patients. The challenges surrounding PPE use, as well as the risk of PPE failure is unfolding before our eyes.
As a result, PPE must be used vigilantly by all healthcare professionals, including dentists and dental hygienists.
But one side effect of PPE that isn’t often discussed is the severe skin damages it can cause – especially when preventative measures aren’t taken to combat it.
Here, we’ll highlight how the use of PPE can result in skin damage, how to minimize skin damage, and how your own dental practice can be proactive in mitigating the risk.
Types of Common Skin Damage While Using PPE
A new study on medical workers treating COVID-19 patients discovered that 42.8% of staff experienced serious skin damage linked to the use of PPE. These items included masks, goggles, face shields, and protective gowns.
The study consisted of 2,732 medical respondents. They were among the first healthcare workers fighting coronavirus in emergency departments, screening clinics, isolation areas, infectious branches, and as well as voluntary staff who wore PPE.
According to the study’s findings, 1,844 medical respondents experienced 4,735 skin injuries, equating to 2.6 skin injuries per respondent. Stage 1 injuries were registered by 81.1% of the respondents, 18.3% experienced stage 2, and 0.6% suffered from deep tissue injury.
Researchers discovered three main types of skin injuries relating to PPE: device-related pressure injuries, moisture associated skin damage, and skin tear.
Various factors increased the risk of skin damage. These include heavy sweating, longer daily wearing time, being male, and using grade 3 instead of grade 2 PPE.
Interestingly, skin injuries were more common in males than females, with 59.7% of men experiencing damage compared to 40.5% of women. Doctors were also more likely to suffer skin damage from PPE than nurses, with 51.9% of doctors experiencing injuries than 41.6% of nurses.
Skin injuries from PPE were also more common in the following groups:
Those wearing grade 3 PPE compared those wearing grade 2 (88.5% versus 21.0%)
Those using PPE longer than four hours than those with daily use time equal to or less than four hours (47.3% versus 18.7%)
Those older than 35 than those younger than 35 (46.3% versus 41.2%)
Those with considerable sweating than those without considerable sweating (91.3% versus 17.8%)
Avoiding Skin Damage When Using PPE
The same study also concluded that the treatment of skin injuries relating to PPE was insufficient.
Only 17.7% of respondents applied prophylactic dressings and lotions that protect the skin. Medical staff and managers overlooked skin protection during the early stages of the coronavirus pandemic, and respondents received no training or education in prevention.
To prevent damage to the skin when using PPE, dentists and hygienists are advised to use preventative methods such as prophylactic dressings and lotions to avoid tear and injury. If you so become injured, these wounds must be treated immediately with hydrocolloid dressing, oil, or cream to ensure a quick recovery and to avoid infection when treating patients.
Preparing for PPE Skin Injuries During a Pandemic
That’s because medical staff and managers overlooked skin protection during the early stages of the coronavirus pandemic. As well as this, respondents received no training or education in prevention and didn’t know how to use dressings.
Of course, in the height of the pandemic, the risk of skin injury is unlikely to be a priority. But today, as dentists and dental hygienists prepare to reopen, we can and should be vigilant.
To reduce the risk of skin injuries and infection in wearing PPE, dental professionals should provide their staff with resources and training in skin protection; and protective items should be chosen and distributed to staff according to guidelines.
Since the spread of the coronavirus, researchers have focused their efforts on the development of a vaccine to protect people from contracting the virus. But scientists estimate that an effective and publicly available vaccine could take up to 18 months to create.
In the meantime, scientists are looking for ways to reduce the rate of infection to keep from overwhelming hospitals worldwide.
But can gargling mouthwash really help fight the spread of this virus?
Let’s take a closer look at this new research.
Research on Mouthwash and Coronavirus
Published in the journal Function, a team of international researchers implemented a scientific review of over 100 articles to learn whether mouthwash can reduce transmission of this coronavirus in the early stages of infection.
SARS-CoV-2, the strain that causes COVID-19, is a virus with a fatty (lipid) membrane. The team states that previous studies prove that ingredients often found in mouthwashes can disturb the infection's lipid membrane. This then reduces its spread.
Coronavirus-tackling mouthwash ingredients are said to include ethanol, chlorhexidine, cetyl pyridinium chloride, and hydrogen peroxide.
The researchers also evaluated existing formulations of mouthwash on their potential to disturb the SARS-CoV-2 lipid envelope based on the concentration of the potent ingredients used. It was concluded that several of them warrant clinical assessment.
It was noted that the lipid envelope doesn’t vary when viruses mutate; if the method is effective, then it should still work against any new coronavirus strains that develop.
Gargling mouthwash containing the above ingredients may inactivate the virus in the throat, which in turn could help prevent coughing and sneezing, according to the study, although we still lack concrete evidence of this effect.
Scientists are calling for more research on whether mouthwashes could protect people against the spread of coronavirus. The quicker such evidence is evaluated and published, the faster the public can help protect themselves from coronavirus using new methods.
Further Research Is Necessary
In test-tube experiments and various clinical studies, some mouthwash formulas contain enough known virucidal ingredients to combat lipids in similar enveloped viruses. However, gargling mouthwash hasn’t yet been recommended by major public health bodies as a way to prevent coronavirus.
In the study, the team concluded there was an urgent need to test the success of ingredients found in mouthwashes in clinical trials. It isn’t clear whether oral rinses could have any effect in battling coronavirus, as safety and exposure are also things that must be considered.
The scientists noted that the pathogen is, “highly sensitive to agents that disrupt lipid bio-membranes.” If successful, this could prove that the agents found in distributed mouthwashes could be used for other strains of coronaviruses. These are strains that could lead to any illness from the common cold to SARS.
Mouthwash brands such as Listerine have been advising consumers not to use mouthwash as a method of fighting COVID-19.
“LISTERINE® mouthwash has not been tested against the coronavirus and is not intended to prevent or treat COVID-19. Consumers should follow the preventive measures issued by the World Health Organization, including washing hands frequently, maintaining social distance and avoid touching your eyes, nose and mouth,” the website notes.
Protecting Yourself From COVID-19
The researchers behind the study make it clear that their work is speculative. More studies must be conducted to learn whether mouthwashes are appropriate for defence mechanisms against the spread of coronavirus.
Nevertheless, the work demonstrates that this is an important area to study. This research is urgent by the current global public health crisis, and learning new ways to protect against strains of coronavirus is critical.
As we wait for potential new studies, it’s crucial to continue to follow mandated protective methods to protect yourself and others from contracting coronavirus.
Consumers should follow the preventative methods of safety, as announced by the World Health Organization. These methods include washing hands often, maintaining social distance from others, and avoiding touching your eyes, nose, and mouth.
There's no denying the array of adverse health consequences associated with failing to brush one's teeth - yet many of your patients probably still struggle with maintaining regular and thorough brushing.
Of course, we must continue to press forward and encourage patients to brush!
As you know, daily brushing prevents harmful bacteria from causing oral infections (e.g., tooth decay and gum disease). However, as we develop a deeper understanding of the oral-systemic link, it is clear that oral health has a strong connection to a wide variety of conditions beyond the oral cavity.
For example, there's reason to believe that keeping up with oral hygiene can protect from severe respiratory infections; a study from 2011 has linked gum disease to poor lung health.
Brushing regularly also fends off bacteria called fusobacterium nucleatum. High levels of this bacterium have been found in patients with colorectal cancer.
The bacteria connected to gum disease, P. gingivitis, is also believed to contribute to worsened rheumatoid arthritis. In studies with mice, researchers found a form of rheumatoid arthritis RA was further exacerbated with the addition of P. gingivitis, which promoted bone and cartilage breakdown.
The Science Behind Oral Health's Impact on Heart Health
When your patients brush their teeth twice a day – for at least two minutes – the risk for cardiovascular disease is lessened. Various studies have been performed on this subject, looking at it from different angles.
In the next section, we'll look at several studies that highlight how vital brushing teeth is to your patients' heart health.
One study assessed how lacking in oral hygiene causes bacteria to emanate in the blood. This leads to body inflammation, which is conducive to an irregular heartbeat and heart failure.
The researchers examined the results provided by 161,286, aged 40 to 79, who had no history of the conditions mentioned above. After routine medical examinations, information was collected about various health factors, including oral health and oral hygiene behaviours.
There was a follow-up after 10.5 years that showed 3% of participants with an irregular heartbeat and 4.9% with heart failure.
The findings revealed that those brushing their teeth 3-plus times per day had a 10% lower risk of experiencing an irregular heartbeat. It was also decided that adhering to those best-practice oral hygiene standards generated a 12% lower risk of heart failure after the 10.5-year follow-up.
Though, these findings didn't consider things like age, sex, socioeconomic status, regular exercise, alcohol consumption, body mass index, and comorbidities (e.g., hypertension).
Another study that was presented to the American Heart Association took an in-depth look at heart health.
More specifically, those involved in the research examined whether a person's teeth-brushing habits impacted their risk of experiencing a heart attack, heart failure or stroke.
682 people were queried about their oral hygiene habits. It was found through various mechanisms that those brushing less than twice per day for less than two minutes were at an increased risk of those negative heart-centric consequences.
Compared to those brushing at least twice a day for at least two minutes, less frequent brushers presented a three-fold higher possibility of experiencing those heart-related ailments.
The Facts Speak for Themselves: Oral Health is Simply “Health”
Some patients might brush aside (pardon the pun) the importance of brushing their teeth. They might mistakenly believe that keeping their mouths clean and fresh is mostly aesthetic in its function.
However, with the above information, you can show to your patients how vital brushing their teeth can be to their overall health.
Dental patients must have a full understanding that oral health isn't its own category. Instead, what happens in our mouths plays a role in the rest of our bodies. Such a notion should be a primary focus in how we all care for ourselves.
Your dental practice has undoubtedly felt the impact of COVID-19.
But when the dust settles from the crisis, and you begin to adapt to the new normal, people will begin to think about their oral care. Think about everyone who has put off receiving cleanings, checkups, and fillings due to shutdowns!
While you shouldn’t struggle too much to book patients, there might be hiccups along the way. Below are some helpful strategies that can help you bounce back and even thrive in a post-coronavirus world.
How Should You Prepare to Re-Open Your Dental Practice?
As we mentioned a moment ago, there’s likely going to be a backlog of patients needing dental care after emergency shutdowns come to an end. It’s been months, and people have neglected their oral health for too long.
Dental experts have pointed out that before the pandemic, there was a struggle in finding available, quality staff. Now, with time on your side, you can assemble a high-level team capable of efficiently managing the abundance of appointments that will flood your practice.
If you reopen without the personnel to keep things running smoothly, you may stumble out of the gate.
Prepare Your Staff For A New Reality
Now, you might be thinking: “But how can I get my staff ready for a post-COVID practice?”
The answer to this question is straightforward: communication.
A mistake of many practice owners has been a failure to keep in touch with furloughed staff, who would naturally fear the worst. Merely making a phone-call to your temporarily laid-off team members and updating them on where things stand could go a long way....even if it’s to tell them you’re not sure where things stand just yet.
Now, with rumblings about re-openings becoming more frequent, communication is more critical than ever. You can go over game plans, let everyone know about safety/sanitation expectations, and discuss how teamwork can help your practice make up for the lost time.
What to Expect In The Days and Weeks Prior to Re-opening
Frankly, your practice should expect some road bumps before re-opening.
Given the nature of this pandemic, and how scared everybody is, there’s going to be hesitation with dental practices. After all, even though most practitioners keep safe and adhere to strict cleanliness standards, there will always be concerns about the transfer of germs.
The government should be providing your province, city, town, or region with expectations or guidelines of post-COVID standards and practices. Customers will also likely have an array of questions about what measures are in place to keep them safe.
Be understanding and empathetic with these questions, as well as transparent about what you know and don’t know.
Lastly, expect some hesitation from past patients who usually schedule maintenance checkups and cleanings. Many people are going to be out of work and without dental insurance, unable to afford your services.
So, when you’re trying to schedule appointments right before you re-open, some of your regulars might not be booking with you.
Whether you offer patients workarounds, such as the option to pay in installments, or you lower your prices is up to you. It might make sense to raise prices to make up for any potential loss in business due to the increased unemployment rate.
Your Practice Can Thrive in a Post COVID-19 World
Those in the dental industry have chosen one of the most practical fields of work in the world. No matter the state of the economy, people need their wisdom teeth taken out, cavities filled, and their teeth cleaned.
You’ve built a strong enough client-base to work around any COVID-related issues to successfully bounce back when the shutdown has reached its end. It’s what you do now, proactively, that will help you navigate the murky waters that will exist during life after COVID-19!
Given the circumstances, it is worth taking a closer look at the potential benefits and drawbacks of this commonly-used mouthwash.
What is Chlorhexidine?
Chlorhexidine (also known by its generic name, Chlorhexidine gluconate), is an antimicrobial oral rinse that, when coupled with regular tooth brushing and flossing, can be used to treat gingivitis. Chlorhexidine reduces the amount and diversity of bacteria in the mouth, which helps alleviate swelling, redness and bleeding of the gums caused by gingivitis.
Chlorhexidine is generally prescribed to patients for twice-daily use: once after breakfast and again right before bedtime. Like other kinds of mouthwash, patients are instructed to measure out about a half-ounce (15 milliliters) of the solution, swish it in their mouths for about 30 seconds, and then spit it out. Prescription mouthwashes with chlorhexidine have been widely available for more than 30 years.
However, mouthwash containing chlorhexidine has been shown to significantly increase the abundance of lactate-producing bacteria that lowers the saliva pH, which could increase the risk of tooth damage.
Why Oral Bacteria is Not Always a Bad Thing
Researchers at the University of Plymouth carried out a trial on the effects of mouthwash containing chlorhexidine, giving placebo mouthwash to subjects for a few days, followed by seven days of mouthwash containing chlorhexidine.
By the end of each period, the researchers analyzed the microbiome and pH levels in each person. They also looked at things like lactate, how well acids were neutralised (also known as saliva buffering capacity), as well as other factors related to oral health.
According to Dr. Zoe Brookes, co-author of the study and lecturer at the University of Plymouth's Peninsula Dental School, dental clinicians need more information about how mouthwashes can alter the balance of oral bacteria to in order to prescribe them correctly.
“This paper is an important first step in achieving this,” says Dr. Brooks.
Co-author Dr. Louise Belfield adds, “We have significantly underestimated the complexity of the oral microbiome and the importance of oral bacteria in the past. Traditionally the view has been that bacteria are bad and cause diseases. But we now know that the majority of bacteria – whether in the mouth or the gut – are essential for sustaining human health.”
The authors believe this is the first study to examine the impact of 7-day use of chlorhexidine on the oral microbiome – important insight, given the renewed popularity of this mouthwash in the current climate.
More information is still needed to determine how the chemical works on viruses, however, some suggest that chlorhexidine kills COVID-19 since it kills other viruses, like H5N1 (bird flu), H3N2 (influenza virus), and H1N1 (swine flu) and thus could help reduce the new infection rates among healthy people (or help to flatten the curve).
Tough times come and go, and one of the challenges is we never know exactly when they will strike. It could be a national emergency like COVID-19, a tragedy in your town, or even a personal setback.
In any case, these kinds of events can exacerbate what is already one of the biggest challenges in the dental profession: burnout.
Dentists, hygienists and other dental professionals report a very high incidence of stress and burnout, with concerns ranging from litigation to regulation to maintaining high standards of patient care.
What does burnout look like, and how can you avoid it in these difficult times? Below, we’ll help you recognize the warning signs and outline ways to build your resilience – whether times are good, bad, or somewhere in between!
What is ‘Burnout’ in the Dental Profession?
Burnout is a state of overall exhaustion that affects your mind, emotions, and body, caused by exposure to prolonged and excessive stress.
When you’re going through a personal struggle or affected by an event like COVID-19, there will always be times of greater stress in your life. Add that to the day-to-day challenges of managing your business and career… it’s easy to see how these forces combine into a recipe for burnout.
Burnout can stem from anything in your life that causes long-term stress. Living through a long, stressful period in your practice, whether your business is struggling to survive or overloaded with patients, is a common cause. Even if you don’t own the clinic directly, the strain from these types of situations can get to you – in fact, dental assistants show higher burnout scores in studies than other staff.
What Burnout Looks Like
Burnout makes every day feel like a bad day. It often feels like you have lost your passion for everything, and work that used to excite and challenge you suddenly seems dull and pointless. You may feel like nothing you do makes a difference, even when it does.
The main difference between ordinary stress and burnout is that burnout is a chronic condition. While stress is temporary, burnout is constant. When you’re experiencing stress, cynicism, exhaustion and frustration day in and day out, you could be experiencing dental burnout.
Everyone reacts differently to prolonged stress, so burnout won’t look the same in each person. It’s important not to discount your burnout simply because it looks different than someone else’s.
Physical illness, including headaches or digestive issues
Feeling exhausted no matter how much you sleep
Overall disengagement with work and your personal life
Once you’ve hit burnout, you may need professional help to recover. Don’t be shy about looking for a therapist, counsellor, psychiatrist or another mental health professional to help you get back on your feet.
How to Be Resilient and Avoid Burnout
The key to avoiding dental burnout is to prioritize your own needs. That can be very hard for dentists and hygienists, who feel they have such a strong obligation to others’ needs.
Because dentistry is a caregiving profession, it’s easy to get so focused on taking care of your patients and others in your life that you forget to nurture yourself. This is especially true if you spend a lot of time with patients, hearing their stories and sharing in their challenges.
However, you can’t give back when you’re pushed up against the wall. Taking care of yourself is how you maintain your ability to care for others.
Chances are you’re familiar with the notion of “self-care”, but many people are mistaken thinking it’s all about pampering yourself. Self-care goes far deeper than that. Pampering is great, but you need to take other steps as well!
Here are some ways to care for yourself:
Calm your mind with meditation or other mindfulness practices
Eat healthy meals that provide you with the energy you need
It’s estimated that 858,900 Canadian adults have been diagnosed with sleep apnea: a chronic condition that causes obstructed breathing sporadically throughout one’s sleep cycle. Without treatment, this condition can lead to serious complications and long-term health effects.
Fortunately, there are a variety of ways dental professionals can play a role in diagnosing, treating and helping patients mitigate the risks of sleep apnea.
Here, we’ll delve deeper into the research and review the role dentists and dental hygienists can play in helping patients with sleep apnea.
Obstructive Sleep Apnea: Cancer Risk and Other Health Complications
There is growing evidence to suggest a potential association between obstructive sleep apnoea (OSA) and cancer. Last year, researchers reviewed data on 20,000 adult patients with OSA from the European Sleep Apnoea Database (ESADA). Approximately 2% of these patients had a cancer diagnosis.
This new study highlights just one of the many adverse impacts of sleep apnea on one’s health. In addition to the potential link between OSA and cancer, adults living with untreated sleep apnea are at greater risk of developing high blood pressure, heart disease and diabetes.
There is also a discernable link between sleep apnea, strokes, and obesity, and chronic fatigue resulting from sleep apnea can increase the risk of these individuals being involved in motor vehicle accidents.
How Dental Professionals Can Help Patients with Sleep Apnea
So, how does this relate to our roles in the dental profession?
Although dental professionals are not able to diagnose patients with sleep apnea (diagnosis should be done at an accredited sleep center), dentists and dental hygienists can help screen patients for potential symptoms, guide them towards a proper diagnosis, and in some cases provide treatment to offset the effects of the condition.
Most people see their dentist or dental hygienist more often than their doctor, and the first signs of sleep apnea are frequently those found in the oral cavity.
For example, an enlarged tongue and/or tonsils, GERD, and tooth grinding/bruxism are telltale red flags for untreated sleep apnea. Upon discovering these indicators, dental professionals can interview the patient to screen for other potential sleep apnea symptoms.
Patients showing symptoms of this condition should be referred to their family physician. From there, a review of a patient’s overall medical history can occur to rule out the presence of sleep apnea.
If you’ve been going back and forth on amalgam and whether you should continue using it in your practice, the findings of a new study could provide some clarity.
For two full years, five undergraduate students at Loma Linda University examined the impact of extreme contaminations on amalgam fillings during condensation. The goal of these dedicated research design students was to determine the shear-strength degradation effects on dental amalgam.
The researchers assessed the reaction of amalgam to gross contamination during condensation under the following elements:
Handpiece lubrication oil
The results, published under the title, “Amalgam Strength Resistance to Various Contaminants,” demonstrated that amalgam is capable of withstanding “worst-case-scenario” levels of contamination equally or better than its alternatives, including resin-modified glass ionomer.
Just How Well Does Amalgam Retain Its Strength?
To summarize, here’s a breakdown of the findings discovered in the research discussed above:
Amalgam strength wasn’t reduced to a significantly statistical extent (p= 0.05) by water contamination.
Compared to water and blood-contaminated water, saliva reduced in between both.
In saliva, the final remaining strength was the same or more than the uncontaminated strengths recorded in the available literature for other restorable materials (e.g., composite resin, resin-modified glass ionomer, glass ionomer.)
Amalgam strength degradation was at its most significant – at around 50% – when fully immersed in handpiece lubrication oil during condensation. However, contamination from handpiece lubrication oil was proven to be highly unlikely in practice.
Still, the oil contamination resulted in amalgam strengths were the same or more than other available restorative materials while exceeding the minimum compressive strength of 35,000 pounds per square inch
How Do the Alternatives Compare to Dental Amalgam?
The results above already indicate the dental amalgam can withstand contaminative circumstances better than many alternatives.
Let’s look closer at the alternatives and see how they stack up.
1. Composite Resin Fillings
As the most regularly used alternative to dental amalgam, composite resin fillings are tooth-coloured and white. Acrylic resin is the primary material used in the making of these fillings—and they’re reinforced with powdered glass filler.
It’s common for composite resin colours to be customized to match surrounding teeth. They’re also often light-cured by blue light in layers to lead into the last restoration.
Yes, there’s no doubting the strength and blending capabilities of these fillings. Also, they don’t need much removal of healthy tooth structure for placement.
But they come up short in other aspects.
First and foremost, the composite resin is harder to place than amalgam—plus, they’re infinitely more expensive. Lastly, while they are strong, these fillings appear to be less durable than amalgam.
2. Glass Ionomer Cement Fillings
Organic acids (such as eugenol), bases (such as zinc oxide), and potentially acrylic resins can be found in glass ionomer cement.
Glass ionomer fillings are tooth-coloured like composite resin, and its properties seem most ideal for more meagre restorations.
These fillings cure on their own and don’t necessitate a blue light for the setting process.
While ease of use and quality of appearances are definite plusses with glass ionomer cement, they’re not particularly useful for more significant restorations.
Is Amalgam Usage Long for this World?
Of course, we can’t forget that these findings are only part of a bigger picture on the use of dental amalgam.
The material’s mercury content makes dental amalgam a public health and ecological risk, particularly after its removal. On July 14, 2017, the Environmental Protection Agency (EPA) finalized regulation specifically targeting the use and disposal of dental amalgam. In Canada, dentists must use amalgam traps and filters to collect amalgam waste and recycle it appropriately.
As such, many dentists – as a protective measure – are opting to use alternatives to amalgam for health, safety and ecological reasons.
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.