Elemental mercury is the primary component of dental amalgam. Mercury is a naturally occurring metal in the environment and can exist in liquid, gas or solid form when combined with other metals. Everyone is exposed to mercury through air, drinking water, soil and food. The concern is how much mercury exposure is too much before becoming mercury poisoning, and are mercury levels increasing as a result of interactions with other elements in the environment?
Mercury is released into the environment whenever a dentist removes an old amalgam filling from a cavity, or when excess amalgam is removed during the placement of a new filling. There is a concern that low levels of vapor can be inhaled and absorbed by the lungs even years after an amalgam filling is placed in a patient’s mouth, potentially causing long-term damage to the brain and kidneys. Due to the lack of scientific data surrounding this concern, little has been done over the years to limit the use and/or disposal of dental amalgam.
In 2009, the FDA issued a final rule that classified dental amalgam (dental amalgamator) as a Class II device accompanied by a document that designates special controls for dental amalgam. The Agency for Toxic Substances and Disease Registry (ATSDR) and the EPA have established mercury exposure levels aimed at protecting the most mercury-sensitive populations from the adverse effects of mercury vapor, namely pregnant women, developing fetuses and all children under 6 years old.
It is understood that a number of dental offices may already have an amalgam separator in place, whether to comply with existing state or local amalgam regulations, or because they voluntarily installed an amalgam separator. According to the new EPA ruling, dental offices with existing amalgam separators will not be penalized as long as the separator is certified to remove 95% of total mercury.
The EPA will not require existing separators that still have a remaining useful life to be retrofitted with a new separator, because of the additional costs incurred by dental facilities that proactively installed an amalgam separator ahead of the EPA’s proposed requirements, and because of the additional solid waste that would be generated by disposing of the existing separators.
As long as offices with existing separators continue to properly operate and maintain the separator and comply with BMPs and recordkeeping requirements, these offices will be deemed in compliance with the new ruling until ten years from the effective date of the final rule.
Dental X-rays are one of the most important part of your regular dental treatment. Your dentist uses the specialized imaging technology to look for hidden tooth decay – also called cavities – and can show dental issues such as abscessed teeth, dental tumors, and cysts. The purpose of these machines is to see things that are not visible by visual examination of the mouth alone. Dentists can use the images produced to see the teeth as well as the bones and soft tissues around them. Finding cavities, examining teeth roots, viewing tooth development, and checking the underlying bone health are all functions performed by various dental x ray machines.
When contemplating the change to digital dental in your practice, the choices can be confusing for the dentist. Dental radiography has evolved from film and chemical developers into a highly technical process that involves various types of digital x-ray machines, as well as powerful dental software programs to assist the dentist with image acquisition and diagnostic analysis of the acquired images. When making the decision to purchase x-ray equipment, the doctor needs to research the available options thoroughly, in order to make an informed choice for the “right” machine for his or her practice.
The first question that a doctor should ask themselves is, “What is the main type of treatment that I provide my patients?” If you are a general practitioner, a standard 2D panorex will provide all of the imaging requirements needed for such treatments as caries detection, diagnosis of TMJ issues, OPG images, and images of the patients entire detention in a single x-ray. Many of the newer 2D panoramic units also offer extraoral bitewing imaging capability, which allows the dentist to obtain a bitewing image without putting a sensor or periapical film inside of the patient’s mouth.
The orthodontist requires a way to obtain the size and form of craniofacial structures in the patient. For this reason, a cephalometric extension on the imaging x-ray device is necessary to acquire images that evaluate the five components of the face, the cranium and cranial base, the skeletal maxillae, the skeletal mandible, and maxillary dentition. The cephalometric attachment offers images such as frontal AP and lateral cephs.
If the practice is concentrated in endodontic and implant treatment, then a CBCT machine is the most practical method of providing the doctor with diagnostic tools such as mandibular canal location, surgical guides, and pre-surgical treatment planning with the assistance of powerful 3D dental software applications. The patient is benefited by the reduced radiation exposure provided by these machines.
Root canal treatment by root canal treatment equipment is the process of going inside the pulp space and removing the infected, dead tissue. The procedure involves removing the damaged area of the tooth (the pulp), cleaning and disinfecting it and then filling and sealing it. The common causes affecting the pulp are a cracked tooth, a deep cavity, repeated dental treatment to the tooth or trauma. The space is then disinfected and sealed with special materials.
Generally speaking, whatever the cause of root canal or pulpal disease, root canal or endodontic treatment will be necessary to save the tooth. All dentists receive training in endodontic treatment and can perform root canal procedures, but often a general dentist will refer individuals who need endodontic treatment to an endodontist, a root canal specialist.
Endodontists are dentists who have completed an additional two or more years of advanced residency training in the diagnosis and management of diseases and disorders of the dental pulp tester, and in the diagnosis of dental pain; their focus is therefore on saving teeth. In order to make a proper assessment and accurate diagnosis of which tooth is affected and exactly what is causing the pain, a thorough history and examination is necessary, together with a radiographic picture (x-ray) of the tooth or area.
Your dentist or endodontist will check your medical history and current medications to ensure your health and treatment safety. If you are very nervous, an oral sedative or anti-anxiety medication may be helpful — discuss the options with your dentist or endodontist ahead of time.
Preliminary treatment to remove the decay and the source of infection of the pulp is necessary, along with a determination of whether the lost tooth structure can be restored. If a fracture of the tooth has reached the pulp, or infection is associated with gum disease, it could be more difficult, if not impossible, to save the tooth.
Nowadays, root canal treatments are performed with advanced techniques and materials, making them far more comfortable and faster. After root canal treatment is complete, your restorative dentist will usually place a crown on your tooth to safeguard against fracture.
Dental offices that place or remove amalgam fillings are required to install and properly maintain an amalgam separator. Depending on the brand, a separator can be purchased from virtually any supply vendor or purchased directly from the manufacturer. Whatever separator is purchased; it is important that the system is promptly installed in order to comply with the new regulations. Proper documentation management is an integral part of this program to ensure that a certificate of recycling is kept on file, and a replacement canister is purchased once the marked fill line is reached or 12 months from the date of installation, whichever occurs first.
The regulations do not specify a minimum amount of time needed before replacing a used filter/canister, but the regulations do state and mandate that the manufacturer guidelines for replacement be followed. Since each amalgam separator is required to conduct testing for the ISO certification based on a 12-month replacement maximum, most amalgam separators are required to be replaced every 12 months or once the canister is full. This not only ensures that the separator is functioning as certified, but also to prevent the separator from moving into bypass mode, which would allow the wastewater to flow unrestricted or filtered directly into the separator. The EPA recommends that an amalgam separator should be monitored monthly to ensure the canister is replaced per the manufacturer’s instructions for use, and that a backup canister is kept on site to ensure proper replacement is conducted at the appropriate time.
Most separators are compatible with both large- and small- capacity dental offices and can be used with dry vacuum or wet vacuum systems. That being said, it is best to check with the manufacturer or distributor to make sure the right amalgam separator system is purchased.
The amalgam separator is installed before the main vacuum line intersects with the plumbing in other parts of the building, and separates solids before reaching the wastewater. The typical plumbing configuration in a dental office involves a chairside trap for each chair and a central vacuum pump with a vacuum pump filter. Chairside traps and vacuum pump filters remove approximately 78% of dental amalgamator particles from the waste stream. These chairside traps cannot be cleaned or washed; they must be recycled to ensure that amalgam particles are properly managed.
Most separator designs rely on the force of the dental facility’s vacuum to draw wastewater into the separator. These separators are estimated to reduce the discharge of metals to POTWs by at least 8.8 tons per year, about half of which is comprised of mercury.
Most amalgam separators use sedimentation processes to filter solids. The high specific gravity of amalgam allows effective separation of amalgam from suspension in wastewater. The weight of amalgam is 2x – 3x that of most sediments found in dental wastewater, which allows the particles to separate and settle at the bottom of the canister.
Effective and efficient infection control in the dental office is essential for the safety of patients and to ensure that productivity does not suffer. Infection control programs all include the cleaning and sterilization of reusable dental instruments and devices. Care must be taken by the dental healthcare professional to ensure that all instruments are cleaned prior to sterilization, and that this is carried out in a safe manner to avoid injury and puncture wounds. Use of closed-system cassettes reduces the risk to dental healthcare professionals when executing infection control programs.
When using dental ultrasonic scalers, washers and sterilizers, it is important to always follow the manufacturer’s instructions. It is also important to consult with the manufacturer of dental instruments and devices as needed to ensure complete sterilization and to avoid damage to these items. Assurance of sterility of instruments and devices can be obtained through the use of one of several tests, and these tests must be performed regularly to ensure that the sterilizer is sterilizing all instruments and devices and that these are safe for use on patients.
Dental autoclave sterilizers have been known to play a significant role in the daily functioning of dental operatories and are recently becoming even more advanced and efficient due to advances in technology. Sterilizers such as The Midmark M11 UltraClave? Automatic Sterilizer now provide an intuitive display and simple prompts that help you easily select the cycle you need…
Parameters such as time, pressure and temperature vary according to the type of sterilizer, materials being sterilized and individual models within sterilizer brands. The first step in determining the settings for the sterilizer is to refer to the manufacturer’s instructions.
Sterilizers are medical devices, requiring clearance by the Food and Drug Administration before manufacturers may offer them for sale. The FDA requires rigorous testing to ensure an adequate margin of safety in each cycle type described in the instructions. Failing to follow the instructions of the manufacturer is ill advised, since it may result in inadequate sterilization of the instruments or devices in the sterilizer. It is never appropriate to use a household device, such as a toaster oven, for sterilization of dental instruments, devices, or equipment.