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What You Should Know About the EPA’s Rule on Dental Amalgam Separation

The dental profession has long acknowledged the impact of dental amalgam on the environment. In the year 2014, the American Dental Association adopted nine principles on keeping amalgam particles out of dental office wastewater. Then, following consultation between the ADA and the Environmental Protection Agency, the EPA finally issued a final rule on amalgam separation on June 9, 2017; now, most dentists have until July of 2020 to comply.

 

EPA rules for Dental Wastewater

 

The final rule sets guidelines on everything from how to dispose of amalgam waste to minimum efficiency standards for amalgam separators (right down to the decimal point.) Though they may appear daunting, these regulations are not far from the existing APA best practices, and practitioners who start now should have no trouble meeting their obligations by 2020.

 

Dental Economics magazine has published a helpful summary of the rule. These are the main takeaways for dentists and other dental professionals looking to incorporate amalgam separation into their practices.

 

Who Needs to Use an Amalgam Separator?

Most dental offices in the United States are subject to the EPA’s rule on amalgam separation. In most cases, even those practitioners who do not place amalgam fillings must begin using amalgam separators. However, there are notable exceptions.

  • Certain dental specialists may be exempt from the rule, including practices that specialize in oral pathology, oral and maxillofacial radiology, orthodontics, periodontics or prosthodontics.
  • The rule does not apply to mobile units.
  • Dental practices that neither place nor remove amalgam except in limited circumstances (which the rule defines as fewer than 5% of procedures or nine cases per year) may not have to use an amalgam separator.

If your practice falls into one of these categories, it is possible you may not have to start using an amalgam separator. However, certain localities have dental amalgam pre-treatment requirements, and many states have rules that exist alongside the EPA’s new guidelines.

 

How Does the EPA’s Final Rule Differ from ADA Best Practices?

Although the American Dental Association worked with the EPA to develop the requirements, the result does differ from the ADA’s best practices in several important ways. The most significant differences are:

  • Amalgam separator efficiency requirement. The ADA recommended that dental offices use a system that removes at least 95% of amalgam particles from wastewater, in line with 2008 ISO 11143 standards. The EPA requires an amalgam separator to be 2008 ISO 11143–certified and remove 99% of amalgam particles.
  • Frequent inspections. The EPA imposes onerous inspection requirements on all dental offices that use an amalgam separator. Dental professionals must inspect the equipment as per Manufacturer Instructions and generate a visual inspection log that details who conducted the inspection, the results of examining each device, and a summary of any follow-up actions. 

Most amalgam separators manufactured and sold in the United States and Canada claim to operate at 99% efficiency. However, dentists who have already invested in the equipment should confirm that their system meets the EPA requirements before 2020.

 

How Can Dentists Demonstrate Compliance?

The rule requires that dental practitioners report compliance annually to their respective state Control Authority.

 

The Control Authority differs state-to-state, but it is typically an EPA regional office, a local wastewater utility, or a state environmental agency. Dentists in Alabama, Connecticut, Mississippi, Nebraska and Vermont should report to their state environmental agency; dentists in all other states can contact their regional EPA office to find out who acts as the Control Authority in their state.

 

You can read more about the importance of dental amalgam separation and tips for compliance on our blog.

 

 Please visit www.dds-epa.org for FREE record keeping software and more information.

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It’s Time to End These 6 Persistent Veterinary Dental Myths

Veterinary dentists and pet owners alike want what is best for their animals. Unfortunately, the subject of pet dental care is plagued with harmful misconceptions.

 

 

Is “dog breath” normal? Should dogs chew bones? Is it safe for groomers to use dental equipment? These are among the persistent veterinary dental myths we want to address in this article.

 

1. Bad Breath Is Normal in Dogs

Myth: Even healthy pups can have foul-smelling “dog breath”; it’s just one of those things that come with owning a dog.

 

Fact: In dogs and other pets, halitosis is a clear sign of gingivitis or oral infection.

 

The idea that “dog breath” is normal is a common misconception. The truth is that dogs with halitosis almost always suffer from significant to severe periodontal disease.  

 

Halitosis occurs when anaerobic bacteria in the mouth certain amino acids. Although it can result from gingivitis alone, oral infection is by far the most common cause.

 

Chronic bad breath is a clear sign that a pet needs veterinary attention.

 

2. It is Safe for Dogs to Chew Bones

Myth: A canine’s powerful teeth and jaws are built to chew through hard materials like bone.

 

Fact: Chewing bones poses numerous health hazards to dogs.

 

Much as dogs love to gnaw on a good bone, it’s not necessarily good for them. While it’s true that dogs benefit from having something to chomp on, there are many reasons why hard materials like bone, antlers and chicken’s feet are not a safe choice:

  • A dog’s teeth are susceptible to fractures, which are immensely painful and may require surgical treatment.
  • Bones and other firm materials can splinter into sharp pieces, causing gum or tongue lacerations, or becoming embedded under the gum line.
  • Bones are a serious choking hazard.
  • Since bones are not digestible, they can cause stomach and intestinal problems if swallowed.

Dr. Fraser Hale, a veterinary dental specialist, recommends owners use the “kneecap rule” to decide whether a toy is suitable for a dog. The rule goes like this: if you wouldn’t want someone to hit you in the kneecap with it, your dog shouldn’t be chewing on it. 
 

3. Dental Chews and Dental Formula Food Will Improve a Pet’s Oral Health

Myth: Using products marketed as ‘dental chews’ or ‘dental formula food’ can help improve an animal’s teeth and gums.

Fact: Not all pet dental products are effective.

It isn’t difficult to find chew toys, treats, and pet food that carriers the ‘dentist-approved’ label. Well-meaning pet owners collectively spend millions of dollars on these products each year.

However, not all ‘dental formulas’ are beneficial for an animal’s teeth (not more than the average bag of kibble, at least.)

Veterinary dental specialists recommend that pet owners look for the Veterinary Oral Health Council (VOHC) seal of approval before purchasing a product that purports to promote good oral health. The Council’s work is approved by the American Veterinary Dental College.

 

4. Dental Scaling by a Groomer Can Prevent Oral Health Issues

Myth: Dental scaling services offered by pet groomers are a good way to keep a pet’s teeth clean and healthy.

 

Fact: Non-professional dental scaling is cosmetic only and does not prevent or treat oral disease.

 

It is illegal in many places for pet groomers to offer non-professional dental scaling (NPDS). However, in some regions, the myth persists that this service can help pets stay healthy.

 

Dental scaling involves using dental equipment to scrape debris from the surface of an animal’s teeth. Some groomers purchase these tools and offer scaling services to clients at a lower cost than a professional dental cleaning performed by a vet.

 

Unfortunately, this non-professional dental scaling is merely cosmetic. Groomers lack the knowledge to identify oral health treatments, nor the ability to prescribe treatment. Without anaesthetic, they cannot remove disease-causing bacteria below the gumline.

 

Veterinary dental specialists recommend pet owners avoid these services, as they do nothing improve oral health.

 

5. You Can Judge A Pet’s Oral Health by Its Appetite

Myth: If an animal is still eating, it must not have dental issues.

 

Fact: Many pets will eat despite severe oral pain.

 

It’s true: loss of appetite and difficulty chewing are tell-tale signs of periodontal disease. However, these are far from the only signs, and many dogs, cats and other pets will not stop eating just because they’re in pain.

 

When an animal is in pain, they will often instinctively try to conceal it. It’s typical for an animal with serious oral health issues to clean their bowl as usual.

 

This is one reason why it’s important for owners to stay vigilant about their pet’s oral health and be aware of other warning signs, such as:

  • Red or bleeding gums
  • Pawing at the mouth
  • Loose or missing teeth
  • Facial swelling
  • Nasal discharge
  • Gum recession

Pet owners should also take steps to prevent these issues at home; which leads to the final veterinary dental myth that must be quashed.

 

6. Dogs Don’t Need to Have Their Teeth Brushed

Myth: Dogs clean their teeth naturally by gnawing on bones and chew toys, so they don’t need to have their teeth brushed.

 

Fact: Daily brushing is the best way to prevent oral health issues in dogs.

 

By the age of 3, over 85% of dogs have some degree of periodontal disease.

 

It begins when bacteria form plaque on the teeth, gradually working their way under the gums. Over time, oral bacteria damage the supportive tissue around the teeth. In serious cases, periodontal disease can destroy the gum, bone and ligaments holding teeth in place and even infect the bloodstream.

 

Fortunately, there is a simple way to deter this prevalent problem: regular brushing.

 

As demonstrated by this video, the process is no different from how we humans brush. Dog toothpaste is available in appealing flavours like chicken and seafood. Eventually, the routine can become as natural as brushing our own teeth.

 

Vets and veterinary dentists should encourage this practice among every owner they advise.

 

Dental Equipment and Supplies for Veterinary Specialists

Sable Industries is a premiere supplier of quality dental handpiece parts, dental equipment, and other dental supplies. We strive to provide the best tools of the trade to dentists, registered dental hygienists, and veterinary dental specialists across North America.

 

Contact us to inquire about our solutions for veterinary dental specialists.

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Can Chewing Xylitol Gum be Good for Your Teeth?

 

Most of us chew gum, and we chew it for a variety of reasons. Whether it’s a piece before a first date, or after a particularly strong cup of coffee, many of us use the chewy stuff to keep our mouths smelling clean and fresh as we go about our day.

 

We see gum promoted in advertisements as something you can use not only to keep your breath smelling fresh; but to whiten and clean your teeth, improving your oral health.

 

Exaggerated marketing, or bona-fide fact? The answer lies in the ingredients of the gum you choose to chew.

 

The Potential Benefits

 

It comes as no surprise that if you’re chewing gum with a lot of sugar in it, it’s going to be bad for your teeth. Sugar promotes the growth of plaque bacteria, which in turn promotes the development of cavities, the decay of enamel, and other issues.

 

It’s because of this that many companies, such as Wrigley’s, have begun to use both aspartame and a substance known as Xylitol as a substitute for sugar in their products.

 

A naturally occurring compound that has been shown to prevent tooth decay, the National Centre for Biotechnology Information writes that Xylitol, “reduces the levels of mutans streptococci … in plaque and saliva by disrupting their energy production processes, leading to futile energy cycle and cell death … Consumption of xylitol chewing gum for >3 weeks leads to both long-term and short-term reduction in salivary and plaque S. mutans levels.

 

Sounds pretty good, doesn’t it? Less bacteria on your teeth means less enamel-eating acid created, which means a healthier mouth. Brands like Confadent advertise and discuss their use of Xylitol as a safe alternative to aspartame, and a plaque reducer.

 

According to Delta Dental of California, “With xylitol use over a period of time, the types of bacteria in the mouth change and fewer decay-causing bacteria survive on tooth surfaces.

 

Potential Drawbacks

 

This sounds like a big-time benefit for your pearly whites, but how do the results compare to projection? Some research shows that the evidence regarding the long term benefits of Xylitol as a dental hygiene product is still unclear.

 

According to a review published by the American Dental Association in 2015, while there is some evidence that Xylitol may reduce tooth decay over a period of years, the evidence is low quality.

 

Research published by the Cochrane Library website suggests that there just isn’t enough high quality evidence to confirm that Xylitol prevents tooth decay.

 

Philip Riley, M.P.H., of the School of Dentistry at the University of Manchester in the UK, is quoted as writing, “More well-conducted, randomized placebo-controlled trials that are large enough (in terms of number of randomized participants) to show a difference, if one exists, are needed.

 

The Cochrane Library review stresses in its conclusions, “We found some low quality evidence to suggest that fluoride toothpaste containing xylitol may be more effective than fluoride-only toothpaste … The effect estimate should be interpreted with caution due to high risk of bias and the fact that it results from two studies that were carried out by the same authors in the same population.

 

So, What to Do?

 

In the end, the conclusions are yours to draw based on the evidence given, but it’s safe to say that chewing gum with Xylitol is better for your teeth than its sugary counterparts. While there needs to be some more research done to better reinforce this conclusion, Xylitol has indeed been shown to reduce cavity causing bacteria in the mouth.

 

Still, if you want to keep your teeth healthy, at the end of the day no gum is a substitute for regular brushing and flossing. For more information on Xylitol, its benefits and drawbacks, you can check out this article from Access Dental, or this one from Delta Dental.

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4 Tips to Prevent Chairside Burnout

 

Everyone has a bad day at work from time to time. But if you find yourself feeling physically, mentally and emotionally drained on a regular basis, you may be on the road to chairside burnout.

 

Chairside Burnout

 

It’s not hard to see why dentistry has one of the highest burnout rates of any profession. While rewarding, the work of a dental hygienist can also be enormously stressful. Hygienists often deal with long hours, tight schedules, and fussy patients in a fast-paced, high-pressure environment. One study found one in eight dental hygienists leaves work feeling emotionally exhausted by the demands of the job.

 

Follow these steps to prevent stress from leading to full-blown chairside burnout.

 

1) Know the Signs

 

Stress is hard to miss, but it’s not always as easy to see a burnout coming. The daily marathon of cleanings and consultations leaves little time to stop and think about yourself. Recognizing the signs of burnout is the first step to preventing it.

 

Burnout is marked by feelings of hopelessness, cynicism, and resentfulness. Once stress takes its toll, a normally-cheerful hygienist may start to become impatient and critical. The job may feel less rewarding or purposeful than it did in the beginning. Enthusiasm is replaced by a lack of energy, leading to less productivity. Some people suffer unexplained headaches or other physical complaints.

 

If you can relate to these signs, take time to gather your thoughts and reflect on your career as a dental hygienist. Try to understand where your negative feelings are coming from. Is it the physical demands of the work? Frustrating office politics? Lack of work-life balance? Like a bad toothache, you can only treat the problem once you’ve found the source of the pain.

 

2) Take Care of Yourself

 

Self-care is important in any career, but especially so for dental hygienists. You must make time in your busy day to do things that help you replenish your emotional energy, like walking the dog, taking a long shower, gardening, or listening to your favourite album. Use this time to focus on the present moment and practice positive thinking.

 

Since being a hygienist is physically demanding, it’s also important to take care of your body. Cardio is proven to help reduce burnout, and light exercise can help reduce the muscle and joint strain. If you’re feeling the burn, ask your doctor about physical therapy or other treatment for work-related injury.

 

3) Maintain a Work-Life Balance

 

Your work as a hygienist is important, but it doesn’t have to define who you are. Don’t fall into the trap of making life all about your job. If you’re constantly thinking about being chairside, even on your days off, you’ll only accelerate the burnout effect on your career.

 

Having things to look forward to outside of work is key to avoiding burnout. It can be something structured, like a college course or a sports league, or a casual hobby like photography. If you’re starting to feel burned out on the job, try something new in your off-time to instill new energy in your life.

 

4) Connect with Other Hygienists

 

It’s said that engagement is the antithesis of burnout, but when you’re having difficulty at work, it’s easy to forget why you pursued this career in the first place. People who experience chairside burnout often lose sight of the things they loved about being a dental hygienist.

 

One of the best ways to stay engaged in your work is to network with other dental hygienists. Your colleagues know the ups and downs of dentistry better than anyone. Sharing stories and advice will help you broaden your knowledge and keep in touch with your passion for dentistry. You can connect with others through online groups and forums, continuing professional development events, and your local hygienist association.

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Ergonomics in the Dental Office: Helping to Ensure You Remain Healthy and Comfortable

 

There has a lot of news recently about the injuries office workers can face if they do not have the proper ergonomic equipment available to them. Proper chairs, monitor height, and stretching exercises are just a few of the recommendations.

 

However, ergonomics is important in many professions, including dental practices.

 

Patients likely do not realize just how much physical work is involved on a daily basis for hygienists. However, the hygienists themselves soon come to realize the hard way when aches, pains, and nagging discomfort make themselves known.

 

Hygienist Jamie Collins, RDH, CDA, recently wrote about this subject for Dentistry IQ, covering the commonly known ailment nicknamed “hygiene hip.”

 

Aches and Pains

 

For most people, adjustments and medical appointments follow discomfort. Jamie admits this was also the case for her, but points out hygienists should follow the example set by dental schools and practice prevention.

 

After all, once discomfort sets in, it means your body is ailing.

 

Sometimes, these aches and pains indicate that issues are no longer reversible. You don’t want to spend all that time learning your craft only to find yourself in need of a career change because your body is ailing.

 

Hygiene Hip

 

As you likely know from your day-to-day duties, you often must spend time in unnatural positions, particularly if the patient complains about the angle you have them on. This increases your danger of hip injuries, and raises the possibility of upper and lower back, neck, and wrist issues.

 

Musculoskeletal Disorders

 

Have you started to experience problems like this? Chances are, you have.

Jamie points out that 64-93% of dental workers suffer from some kind of work-related Musculoskeletal Disorder. Stiffness, soreness, hip popping; are all signs of MSD, and indicators that you need to make some modifications.

 

Change Your Chair

 

How long have you had your operator chair? It is crucial for your body to have proper positioning throughout the day. If your current chair has become misshapen, or was not the best product to begin with, it is time to invest in a new saddle stool to improve your work posture. If the dentist is not willing to cover the cost, consider digging deep and buying the stool yourself. It beats spending time and money at the chiropractor and many uncomfortable days and nights.

 

Proper magnification and Instrumentation

 

Don’t forget the other equipment you work with. The better the magnification of the oral cavity, the less you have to bend, so consider adding a personal light to your loupes.

 

Practice preventive maintenance with your instruments. Sharp instruments decrease treatment time and physical strain, and a cordless handpiece helps to reduce possible wrist fatigue.

 

Breaks and Exercise

 

Frequent breaks help to prevent muscle fatigue, which leads to poor posture and discomfort. Practice stretching exercises during your shift, and be sure to exercise off the job. Pilates and yoga are very helpful, but Jamie emphasizes the key is to take time for your body and listen to its needs. Being comfortable aids productivity, which improves performance and the quality of care you can provide for your clients.

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