Operative Dentistry

Plugging amalgam in a sinking ship

December 14, 2010 By Trish Walraven Leave a Comment

Tomorrow the an FDA panel will “probe cavity fillings” (that’s really the title of this segment shown on CBS this evening):
http://www.cbsnews.com/stories/2010/12/14/eveningnews/main7150398.shtml

Once again the media is out to sensationalize the debate by conjuring up images of daily vomiting, years of sinus congestion, and children who can’t go an hour without a seizure or two. And once again, it is mercury that is the alleged culprit.

If it really were as bad as it appears for the few people that are willing to testify before the panel, don’t you think that there would be a significantly larger population of people affected by mercury poisoning?

Four years ago, a panel decided that further study was necessary to understand whether amalgams give off more vapors when being placed or removed versus the amount of mercury vapor produced with chewing and brushing.

Maybe they were on to something there! What the FDA should do is launch a study of mercury levels in the blood, urine, and body tissues of the dentists who regularly place and remove amalgams, correlating symptoms described by those afflicted with mercury toxicity with the dentists in the study. If those symptoms are consistent in the dentists who have high levels of mercury, then go from there to decide whether amalgams are truly a problem.

The ADA stands behind the science. And until it is refuted, they are doing the right thing by not wavering on their position.

UPDATE – December 20th, 2010

Last week, an advisory panel to the US Food and Drug Administration (FDA) convened a professional panel review to again look at the safety issues associated with mercury amalgam in dentistry. A group of scientists and dental and medical professionals, lead by the International Academy of Oral Medicine and Toxicology (IAOMT), had called for FDA to reconsider its July 2009 “no risk” classification of mercury fillings. The FDA panel concluded that there are no huge scientific flaws in the agency’s 2009 finding that mercury-based dental fillings are safe for adults and children aged 6 years and older. The panel, however, recommended that the FDA look at more data, including the latest data, on the possible health risks dental amalgam poses to pregnant women and their fetuses and to young children, particularly nursing infants whose mothers have these fillings. The panel also said the FDA should consider adding warnings for these groups to the material’s product instructions.  The ADA commended the panel’s call for continued research while offering support for the FDA’s current amalgam regulation. The panel’s call for more scientific data acknowledged concerns of dental amalgam opponents who link mercury exposure to dozens of diseases ranging from autism to Alzheimer’s disease.

Hunka Hunka Burnin’ Handpiece

September 26, 2010 By Trish Walraven 2 Comments

Now this is just sad. It seems as though a perfect storm of poorly-maintained handpieces, numb lips, and inattentive dentists has come together in a flurry of reports that patients are getting burned at the dental office.

Really burned, not like they’re getting ripped off burned. First, second, and third degree burns. The Food and Drug Administration (FDA) is so concerned, they’ve even created a letter for you to send to your handpiece manufacturer, since they’re not naming names as to whose products are heating up the most.

Most of the manufacturers already received this letter last month in response to the FDA’s new safety alert. In the meantime, they are recommending that clinicians:

Are vigilant about maintaining electric dental handpieces and electric oral bone-cutting handpieces according to the manufacturer’s instructions.
Verify with the manufacturer the appropriate routine service interval for your dental practice, based on the actual use of your electric dental handpieces or electric intraoral bone-cutting handpieces.
Train personnel to properly clean and maintain the electric dental handpieces or electric intraoral bone-cutting handpieces.
Develop a method for tracking maintenance and routine service for each dental handpiece or electric intraoral bone-cutting handpiece.
Examine the electric dental handpiece attachments and electric intraoral bone-cutting handpiece attachments prior to use. Do not use worn drills or burs.
Do not use poorly maintained electric dental handpieces or electric intraoral bone-cutting handpieces.
Report overheating to the manufacturer.

Elvis would have been ashamed that his song title had been so poorly used to get your attention in this article.

So make sure that its presence is not in vain.

Anesthesia buffering: Onpharma’s Onset

July 15, 2010 By Trish Walraven 13 Comments

After all the buzz in the past two years about a new type of carpule that also starts with an “O,” you may think you’ve seen this product before. In one sense it’s similar: it must be used in conjunction with your regular anesthetic instead of as an anesthesia alternative. What’s more exciting is that this just may change the way we prepare syringes for every single patient from now on.

Onset™ is the name of a new buffering agent created by Onpharma™ Inc. that will be available as soon as the final FDA review is complete. If you can answer yes to these questions, read on:

Do you want to eliminate the sting that can be caused by the acidity of local anesthetic?

Would you like to be able to give an injection and go to work immediately?

Are you interested in a product that will help you get your patients profoundly numb, even when infection is present?

What about tissue necrosis? Would you like to prevent it if possible?

[Read more…]

To juice or papoose is the question

July 1, 2010 By Trish Walraven 21 Comments

papooseormask No one likes the idea of seeing a child being restrained. Especially not at the dental office. But on the same hand, if a child is admitted to a hospital, has thousands of dollars spent to knock them out with potentially risky gas, and is in need of a procedure that takes only minutes to perform, which care is the right one?

Notorious press has given the papoose board a bad name. Granted, its utilization can be abused, especially as seen in the story that was profiled on ABC’s 20/20. General anesthesia isn’t without its opponents as well, especially when a child dies.

With that somber note hanging in the air, you may want to revisit David After Dentist and pick yourself up with a little sedation dentistry humor. Even if you don’t agree that his dad should have ever posted the video on YouTube, it’s still so freakin’ funny.

Children who can’t be cooperative still need a means of getting their dentistry done, so pedodontists must make choices that sometimes include the use of papoose boards or general anesthesia. For entertainment’s sake, let’s just call this polarizing dilemma by another name: Hugs vs. Drugs.

	Hugs	Drugs
Familiar name	Papoose board restraint	“Knocked out with the mask”
Kinder-sounding euphemism	Protective stabilization	Inhalation anesthesia
Risks	Creation of dental phobias Inadequate relaxation resulting in poor pain management Difficulty in treating a lengthy, complicated case	Aspiration May affect the developing brain (autism/ADHD) Death
Benefits	Can be used quickly and inexpensively without much training	Instantaneous and complete patient control
Perception	Brute force and inhumane treatment seen in Medicare clinics	Clean, modern care paid for by inscos and private payer

There have been accusations from both sides: allegations of “nest feathering” by morally outraged dental anesthesiologists, abuses of public funds to pay for unnecessary procedures, the ultimatums given that any child restraint is considered grounds for lawsuits, equating papoose boards with third-world dental care, or offering general anesthesia for simple extractions when a combination of restraint and other sedation would be less expensive and as effective.

As a dental professional, it is your responsibility to make well-informed choices about sedation and restraint methods. For instance, individuals with autism or cerebral palsy may find that restraints are not only necessary, but even welcomed when compared to the use of drugs that can do more harm than the good that the dentistry is trying to achieve. Restraints may not be a better choice for toddlers whose biggest problem is a helicopter parent or two who are freaked out about the psychological trauma of having an irreparable tooth pulled. If a parent freaks, most likely so will the child, so it may be your choice to pander to the whiny world of children who are more in charge than their parents. After all, it’s no big deal to go under GA for a five-minute ear tube procedure with the ENT, right? That’s expected.

No matter what you decide to do, as long as you’re doing it from a level of comfort with your ability, and most importantly, from a sense of compassion, you should be able to confidently make the call for each patient, no matter where it falls on this line.

But sometimes, you just want to throw up your hands and say “AHHHHH I QUIT!” because you don’t know how to manage a patient. That’s when it’s awesome to have someone in your contact list who you trust to make this call.

And then pass the buck to them, because referring out can be very, very gratifying at times. DBSmile

Dental Infection Control Sucks

June 11, 2010 By Trish Walraven Leave a Comment

So maybe it was the equipment allowing backflow into patients mouths during extractions (blecch), or inadequate sterilization measures, but whatever the case, Hepatitis B has been officially contracted during dental procedures.

A free, volunteer-staffed program offered at a West Virginia high school found that three patients and two clinicians came down with Hepatitis B viruses that were tested and matched at a molecular level, indicating that the infections came from a common source.

All people involved at the Mission of Mercy clinic last summer were mailed letters last week encouraging that they be tested for the virus. The testing is being paid for by the state of West Virginia. (Insert your best West Virginia joke here. And then be ashamed of yourself for doing it).

If you have any response to this news, it should be to check your own infection control systems, to be sure that your high speed evacuation is up to par, that you aren’t just wiping down handpieces, and that every patient is treated with those universal precautions that were so important in dental school.

After all, you wouldn’t want this happening in an elite state, like Washington. DBSmile