Tips for Chairside Whitening


More Than Cleaning

Incorporate elective services into routine visits

Standardizing and organizing examination protocols creates a framework for recare and restorative visits. Here is an “old school” way to integrate whitening acceptance into your daily routine. The two key pieces of equipment for this tip are: a hand mirror and a shade guide.

Shade GuideOne way to increase whitening business is for assistants and hygienists to make a habit of doing a “color analysis” for each patient. With the patient looking into a mirror, simply say to them, “We know that teeth can change color over time. What I’d like to do now is to determine the current color of your teeth. I’ll need your help with this part.” This immediately gets the patient involved in their care and gives you an opportunity to talk whitening options.

Each operatory (hygiene too) should be equipped with shade guides. Set it up from lightest to darkest; make sure the shade guide also includes newer ‘bleaching’ colors. Hold the shade guide so that your patient can see the colors.

Next, have the patient guide the selection of the shade–this gives them an idea of what their teeth could look like. If your patient has an interest in whitening, he/she will normally take up the issue with you and you will have permission to ask other questions. These might include: “Other than the color shifts, is there anything else that you notice about your smile?”

Thanks to mainstream media, talk shows and magazines, patients are more knowledgeable about tooth discoloration, malodor and the importance of a healthy mouth to overall health. Incorporating something as basic as a shade guide review (at least yearly) is a powerful way to make regular inquiries into all of your aesthetic services.

Tips and Pointers in Selecting Shades

  • For most accurate results, the colors in the room should be neutral as well as the patient’s clothes. Drape the patient with a neutral gray bib or towel when taking a shade. It neutralizes the eyes’ color perception.
  • Female patients: If applicable, remove lipstick.
  • Make sure teeth are not dehydrated.
  • The mouth of the patient should be at eye level.
  • Determine the amber or gray color type of the patient.
  • Determine the base shade of the patient and remove matching shade group (Chromascope).
  • Determine the shade intensity within the shade group.
  • Compare the selected shade once again with the natural tooth.
  • Color Map: Note range of shade, striations, and color banding or mottling. Close examination will reveal a blending of various colors.
  • Collaborative Whitening: All team members can perform color assessments.

In sum, incorporating simple, “old school” basics into your protocols will help your patients understand the full menu of services offered by your practice and can help drive elective procedures such as whitening

Avoid Occupational Hazards


Dentistry: It’s Risky Business

Reduce the risk of occupational hazards by avoiding chemical culprits

In addition to infectious diseases and muscle injuries, dental professionals encounter a number of workplace hazards. Dental staff are exposed to toxic chemicals throughout the day, including those found in products used to clean and disinfect instruments and surfaces. Long-term exposure can increase the risk for developing life-threatening diseases and allergies, which is why it’s important to take the necessary precautions when working with these chemical hazards:

Glutaraldehyde

USES/MATERIALS: Glutaraldehyde is widely used as a cold sterilant to disinfect and clean heat-sensitive equipment. It is found in desensitizers, high-level disinfectants and sterilants.

RISKS: Glutaraldehyde is toxic and a strong irritant. Exposure to glutaraldehyde causes severe eye, nose, and throat irritation, as well as headaches and drowsiness. It is the main source of occupational asthma among healthcare providers.

ALTERNATIVES: Glutaraldehyde-free desensitizers and high-level disinfectant solutions are available. Teethmate Desensitizer from Kuraray delivers sensitivity relief by creating hydroxyapatite to seal dentinal tubules and cracks in enamel. Sporox II from Sultan is a powerful hydrogen peroxide-based sterilant and high-level disinfectant for heat-sensitive instruments. Cidex OPA from Johnson & Johnson and Rapicide OPA/28 HLD from Crosstex are high-level disinfectants with rapid high-level disinfection times – nearly nine times faster than glutaraldehyde-based solutions.

Phenols

USES/MATERIALS: Phenols are used as a disinfectant and antiseptic and can be found in some infection control products, including surface disinfectants.

RISKS: The Environmental Protection Agency lists disinfectants that contain phenols as “corrosive and toxic.” Exposure to phenols causes irritation of the skin, eyes and mucous membranes.

ALTERNATIVES: PureLife does not carry any products that contain phenol. Alternatives include BioSURF Surface Disinfectant from Micrylium, which kills TB in 50 seconds and does not contain any harmful phenols or aldehydes, and CaviCide1 from Kerr TotalCare, which has a 1-minute TB kill time and is fragrance-free, bleach-free and phenol-free.

Triclosan

USES/MATERIALS: Triclosan is an antibacterial agent found in many hygiene products, including toothpastes, hand soaps, hand sanitizers and lotions.

RISKS: Studies have suggested that triclosan may disrupt hormones that play an important role in reproduction and development, while other research indicates that triclosan may contribute to the development of drug-resistant bacteria. The FDA is currently evaluating its safety, but has found no evidence to support triclosan as being more effective than plain soap and water in preventing the spread of diseases. Minnesota has already passed a bill that will ban the use of triclosan in most retail hygiene products beginning in 2017.

ALTERNATIVES: Toothpastes that contain stannous fluoride, including all Crest toothpastes, are effective alternatives to triclosan. Purell® Green Certified Instant Hand Sanitizer from GOJO USA and Gibraltar Barrier Cream from Micrylium are triclosan-free hand care products that also contain moisturizers to condition skin.

Latex

USES/MATERIALS: Latex is most commonly found in gloves. Other dental materials that contain latex include latex dams, gutta-percha, mixing bowls, orthodontic elastics, some suction tips, bite blocks and amalgam carriers.

RISKS: Healthcare workers exposed to latex gloves and other latex-containing medical devices are at risk of developing latex allergy. Adverse reactions can be classified as true latex allergy (Type I hypersensitivity) or allergic contact dermatitis (Type IV hypersensitivity). True latex allergy is a reaction to the latex proteins. These proteins can infiltrate the body through skin and mucosa. Reactions can range from erythema and hives to anaphylaxis, a potentially life-threatening condition. Conversely, allergic contact dermatitis is a reaction to the chemical additives used in the manufacture of latex gloves. Symptoms take several hours to develop, and include swelling, redness, itching, and blistering/cracking of the skin.

ALTERNATIVES: Staff with true latex allergy require the use of non-latex gloves, such as nitrile, neoprene or vinyl. Staff with allergic contact dermatitis require the use of vinyl gloves, as nitrile and neoprene gloves contain the same chemical additives found in latex gloves.

 

The Downfall of Reusing Disposables


The Downfall of Reusing Disposables

If one line of defense tumbles, the rest will likely follow

In recent years, disposable products have become the gold standard of infection control protocol. These single-use items are intended to be used on one patient and discarded. They should not be sterilized in an autoclave due to the heat-intolerance of their materials. Compared to reusable (or multi-use) products, disposable products reduce the probability of patient-to-patient cross-contamination and potential cross-infection.

In the not-so-distant past, “reusable” was more common than “disposable.” You may even remember when procedural items, such as saliva ejectors and prophy cups, were cleaned and sterilized to be reused on another patient. Since then, the FDA has repeatedly stated that it is unaware of any data that would establish safe and effective cleaning/sterilization conditions necessary for reuse of any disposable device (OSAP, 2012). Similarly, the CDC advises using single-use devices on one patient only and disposing of them appropriately. However, it is still generally accepted by dental professionals that many single-use products are safe to reuse if sterilized, such as…

BURS

Whether burs are single-use or multi-use remains a contested issue. Cleaning can be difficult due to burs’ intricate physical construction, and repeated processing cycles can deteriorate the cutting surfaces enough to potentially break during patient treatment. These factors, coupled with the knowledge that burs exhibit signs of wear during normal use, might make it practical to consider them single-use. A fair amount of resources are spent scrubbing burs and diamonds prior to sterilization, which equates to longer intervals between patients. From an infection control viewpoint, treating burs as single-use eliminates the risk of patient–to-patient cross–infection.

DISPOSABLE MOUTH MIRRORS

Plastic mouth mirrors are great alternatives to traditional mouth mirrors in that they significantly reduce cross-contamination. However, they are not meant to be reused and their plastic materials are not suitable for the autoclave. Because mouth mirrors are inserted directly into the patient’s mouth, improper sterilization practices can greatly increase the risk of patient-to-patient cross-infection.

FACE MASKS

Unlike most disposable items, which are single-use in the sense that they may only be used on one patient, face masks are only as effective as their designated time limit. The length of time that a mask protects against infection and cross-contamination depends on its ASTM level (according to FDA guidelines):

ASTM Level 1: 15-20 minutes

ASTM Level 2: 30-40 minutes

ASTM Level 3: 60+ minutes

Why the wide discrepancy between what is regulated and what occurs in the practice? For one, complying with every OSHA regulation and CDC guideline is easier said than done. And, because devices that were considered reusable twenty years ago are now deemed one-time use, adapting to new practices is slow to change. Plus, the misconception that disposables cost more could explain the discrepancy. On average, a dentist spends $20 in disposables to set up an operatory, which fluctuates depending on the number of patients seen per day.

However, the monetary savings gained by reusing disposables are minor when compared to the huge costs of an infection control breach. Although reuse of common disposable items may seem harmless, little things can accrue to a big problem. When it comes to infection control, loosening the slack in one area lessens the overlap and effectiveness of your total chain of infection control. Think of it as a line of dominos — once the first one falls, the rest fall along with it.

At PureLife, you don’t have to risk sacrificing your line of infection control defenses to achieve a happy bottom line. We offer a wide variety of top-quality, cost-competitive disposable items for any procedure. Call us at 877-777-3303 or visit PureLifeDental.com for our complete list of disposables.

A Guide to Latex Glove Allergies


The Root Cause

The dental professional’s guide to latex glove allergies

Natural rubber latex is a material found in many dental supplies—mainly exam gloves. In the past decade, there has been a significant increase in the number of healthcare professionals reporting allergic reactions to latex.  Since frequent exposure to latex products can lead to increased sensitivity, healthcare professionals are at a higher risk of developing an allergy to latex proteins.

TYPES OF REACTIONS

Generally, people attribute any latex glove-related reaction as an “allergy,” but there are actually two types of latex reactions: Allergic contact dermatitis (Type IV hypersensitivity) and true latex allergy (Type I hypersensitivity).

TYPE IV HYPERSENSITIVITY: Allergic contact dermatitis is a reaction to the chemical additives used in the manufacture of latex gloves (OSAP, 2013). Symptoms take several hours to develop, and include swelling, redness, itching, and blistering/cracking of the skin. Patients and staff with allergic contact dermatitis require the use of vinyl gloves, as nitrile and neoprene gloves contain the same chemical additives found in natural rubber latex.

TYPE I HYPERSENSITIVITY: Conversely, true latex allergy is a reaction to the latex proteins. These proteins can infiltrate the body through skin and mucosa.  If latex lightly powdered gloves are used, aerosolized latex proteins can also enter the respiratory system during gloving and ungloving (OSAP, 2013). Reactions can range from erythema and hives to the most severe reactions characterized by anaphylaxis. Patients and staff with true latex allergy require the use of non-latex gloves, such as nitrile, neoprene or vinyl.

LATEX-SAFE CHECKLIST

Apart from dental healthcare workers, those “at risk” for allergic reactions are patients with asthma, a history of hay fever, or allergies to trees, grasses, animals, dust, molds and certain medications.  Dentists can use this checklist to provide a latex-safe facility for patients and staff with possible or documented latex allergy:

  • Screen all patients for latex allergy (e.g., obtain their health history)
  • Be aware of some common predisposing conditions (e.g., spina bifida, urogenital anomalies, or allergies to avocados, kiwis, nuts, or bananas).
  • Be familiar with the different types of hypersensitivity and the risks that these pose for patients and staff.
  • Consider sources of latex other than gloves, including prophy cups, rubber dams, and orthodontic elastics.
  • Provide an alternative treatment area free of materials containing latex.
  • Remove all latex-containing products from the patient’s vicinity and adequately cover/isolate any latex-containing devices that cannot be removed from the treatment area.
  • Give patients with latex allergy the first appointments of the day to minimize inadvertent exposure to airborne latex particles.
  • Frequently clean all working areas contaminated with latex powder/dust.
  • Frequently change ventilation filters and vacuum bags used in latex-contaminated areas.
  • Have latex-free kits (e.g., dental treatment and emergency kits) available at all times.
  • Be aware that allergic reactions can be provoked from indirect contact as well as direct. Hand hygiene is essential!
  • Communicate latex allergy procedures (e.g., verbal instructions, written protocols, posted signs) to other personnel to prevent them from bringing latex-containing materials into the treatment area.
  • If latex-related complications occur during or after the procedure, manage the reaction and seek emergency assistance as indicated.

“Off-Label” Benefits of Varnish


Beyond the Label

The “off-label” benefits of using fluoride varnish for caries prevention

Dentists and hygienists have been applying high-concentration fluoride compounds directly to patients’ teeth for over 50 years. Interestingly, there has been an uptick in the number of fluoride varnishes being introduced in the last several years. According to the FDA, varnish is indicated for use as a desensitizer and cavity liner, but many are recognizing its “off-label” use as a topical fluoride treatment. With all the fluoride products and delivery systems on the market, does fluoride varnish measure up?

FLUORIDE GEL AND FOAM

The most widely used fluoride application in dental practices is 1.23% acidulated phosphate fluoride (APF) gel (Sheehan 2001). In 1993, 1.23% APF foam hit the market. It is claimed to deliver the same protection as APF gel with 75 percent less fluoride, which lessens the risk of a toxic amount being accidentally swallowed. However, some research has shown that both foam and gel deliver the same amount of fluoride.

FLUORIDE VARNISH

shutterstock_71177302First introduced in the 1960s under the trade name Duraphat, sodium fluoride varnish is relatively inexpensive, easily applied to exposed root surfaces, and prolongs contact time between fluoride and enamel, thereby achieving deeper fluoride uptake (Sheehan 2001). The benefits of fluoride varnishes also include long-term fluoride release and a higher delivery of fluoride into cementum. Varnish has been used as an effective anticaries agent in Europe and Canada for over three decades (Sheehan 2001). It has not yet been approved for use in this capacity in the United States; rather, it has been cleared by the FDA for use as a desensitizing agent and cavity liner. Caries prevention is regarded as a drug claim, and companies would be required to submit appropriate clinical trial evidence for review before this product could be marketed as an anticaries agent.

That being said, fluoride varnish is still an effective caries prevention solution. According to CDC Recommendations, a prescribing practitioner can use fluoride varnish for caries prevention as an “off-label” use. The American Academy of Pediatric Dentistry emphasized in a 1996 recommendation, “Unapproved does not imply an illegal use. The word unapproved is used merely to indicate lack of approval, not to imply disapproval or contraindication based on positive evidence of a lack of safety or efficacy.”

“Although varnishes are not FDA-approved as a topical fluoride treatment […] many studies show they are clinically as effective, if not more so, than APF treatments.”
       – Dr. Timothy Wright, Professor of Pediatric Dentistry, University of North Carolina

fluoride-treatmentSeveral reviews of the use of fluoride therapies in preventing dental caries have been published since the year 2000, including 2 evidence-based reports. The Cochrane reviews of this topic concluded, “Fluoride varnishes applied professionally two to four times a year would substantially reduce tooth decay in children.” In addition, an expert panel of the American Dental Association recently concluded, “Fluoride varnish applications take less time, create less patient discomfort and achieve greater patient acceptability than fluoride gels, especially in preschool-aged children.”

Studies examining the effectiveness of varnish in controlling early childhood caries are currently being conducted in the United States. More research on fluoride varnish is likely to continue in both Europe and North America to determine optimal fluoride concentration, the most effective application protocols, and its efficacy relative to other fluoride modalities (CDC 2001).

AVAILABLE VARNISH PRODUCTS

PureLife offers the top brands of fluoride varnish, including Vanish by 3M ESPE, NUPRO White Varnish by Dentsply Professional, DuraShield CV by Sultan Healthcare, Duraflor Halo by Medicom, and the BPA-free Embrace Varnish by Pulpdent. To learn more about these great products, call our product experts at 877-777-3303.

Preempting Allergic Reactions

Allergic Reactions to Dental Materials

Be prepared to react quickly to a patient’s adverse reaction

While in the dental chair, a patient can suddenly experience an adverse reaction to a drug, product, or material. Those most susceptible to allergic reactions are patients with asthma, a history of hay fever, or allergies to trees, grasses, animals, dust, molds and certain medications. Tailoring dental products to a patient’s health history is a proactive yet precautionary practice to minimize the occurrence of an adverse reaction. In the event that an adverse reaction does occur, recognizing the symptoms and reacting quickly is critical.

PROBLEM: LATEX

doctor-latex-gloves-stock-gtty

MATERIALS: Latex is most commonly found in gloves. Other dental materials that contain latex include latex dams, gutta-percha, mixing bowls, orthodontic elastics, some suction tips, bite blocks, and amalgam carriers.

SYMPTOMS: Adverse reactions can be classified as allergic contact dermatitis (Type IV hypersensitivity) or true latex allergy (Type I hypersensitivity). Allergic contact dermatitis is a reaction to the chemical additives used in the manufacture of latex gloves (OSAP, 2013). Symptoms take several hours to develop, and include swelling, redness, itching, and blistering/cracking of the skin. Conversely, true latex allergy is a reaction to the latex proteins. These proteins can infiltrate the body through skin and mucosa. If latex lightly powdered gloves are used, aerosolized latex proteins can also enter the respiratory system during gloving and ungloving. Reactions can range from erythema and hives to the most severe reactions characterized by anaphylaxis.

PRECAUTIONS: Patients with true latex allergy (Type I hypersensitivity) require the use of non-latex gloves, such as nitrile, neoprene or vinyl. Patients with allergic contact dermatitis (Type IV hypersensitivity) require the use of vinyl gloves, as nitrile and neoprene gloves contain the same chemical additives found in natural rubber latex.

PROBLEM: LOCAL ANESTHETICS

Local_anesthesiaMATERIALS: Allergic reactions are only caused by ester-type anesthetics, which are used for topical application rather than local injection. Ester-type anesthetics, such as procaine, propoxycaine and chloroprocaine, are more
commonly known by their brand names: Novocain, Ravocaine, Nesacaine and Hurricaine. Amide-type anesthetics, like lidocaine, mepivacaine and prilocaine, can cause reactions resembling allergic reactions, but the anesthesia itself is not a true allergen.

SYMPTOMS: Most patient-reported “allergic” reactions to local anesthetics — namely heightened anxiety and increased heart rate — are really sensitivities to epinephrine. Occasionally, patients might experience a toxicity reaction, which can be attributed to preservatives (methylparaben) or antioxidants (bisulfites) contained in the solution. A toxicity reaction is more common when the anesthetic is used plain (i.e., does not contain a vasoconstrictor), which prevents the anesthetic from leaving the anesthetized site too rapidly.

PRECAUTIONS: Anesthetic cartridges without a vasoconstrictor should be used for patients with epinephrine sensitivity, or when a patient has severe heart disease or recent myocardial infarction. Topical anesthetics should be used sparingly, as excessive amounts or contact with the oral section of the pharynx could intensify a reaction.

PROBLEM: COLOR DYE

food_coloringMATERIALS: Color dyes are typically found in prophy pastes, mouthwashes, fluorides and colored gloves. Red and yellow dyes are the main types of dyes that cause allergic reactions. Red #40, Yellow #5 and Yellow #6 are types of artificial dyes, whereas annatto is a natural coloring substance that comes from seeds of the annatto tree (Yacono, 2011).

SYMPTOMS: Skin irritations, such as eczema or hives, are common symptoms that develop after the ingestion of a particular dye. In rare cases, certain dies can cause anaphylactic shock. The effects of color dyes on behavioral issues—especially in children—are currently being researched.

PRECAUTIONS: Dye-free prophy pastes, fluorides, rinses, etc. are available alternatives and should be used with patients reporting a dye allergy, or as an option for pediatric patients.

Where in the World…

Gray Market Goods: Bad For Business

Are your dental supplies putting your patients at risk?

It’s hard to pass up a good bargain when you see it. However, there is more than meets the eye when it comes to dental products offered at deeply discounted pricing. These goods may actually be “gray market” goods — those intended for international sale, but which are rerouted back to distributors in the US and made available to dentists at very low prices. They can seem like a good deal, but there are risks associated with the gray market:

  • Products are often sold “as is” with no returns or warranties
  • Safety recalls are often not communicated to the end-user
  • Products may be counterfeit or altered to fit foreign specifications
  • Products might be expired or stored in improper conditions
  • Legal liability is held solely with the purchaser, not the manufacturer

Each of these conditions puts both the dentist and the patient at risk, so it’s important to know where your dental products are coming from. There are four distinct red flags for identifying a gray market product: 

1. LOW PRICE

If a product is selling at a significantly lower price that seems too good to be true, it probably is. Low price is the most obvious red flag of gray market goods.

2. UNAUTHORIZED DISTRIBUTOR

There are many reputable dental distributors out there that only carry products they are authorized to sell. However, a number of internet-based dental dealers have recently emerged in the industry. Some are unauthorized dealers that will redirect goods intended for foreign sale back to the US, and then re-sell them on their website. If ordering from a web-only supplier, pay special attention to the product prices. If you find they are substantially lower than other distributors’ pricing, you may have encountered a gray market site.

3. ALTERED OR UNUSUAL PACKAGINGNonUSsticker

Because gray market products are intended for a market outside the United States, they are manufactured with different specifications and usually with different labels. If you check your stock and see a product that doesn’t look quite right, ask yourself these questions:

  • Is the language on the package something other than English?
  • Is the packaging smeared, uneven, or of lesser quality than you have previously seen with products of the same brand?
  • Is the product name current or a previous name from an earlier version of the product?
  • Is the bar code or any aspect of the product description blocked out?
  • Is the product marked “For export only” or “Not registered for sale in the United States?”

4. EXPIRATION DATE

Has the product expired? Does it appear that the expiration date has been changed? If you notice a package that meets any of these criteria, don’t hesitate to reach out to the manufacturer of that brand or product. When it comes down to it, although discounted dental products are available, the cost of overcoming the potential problems for patients caused by gray market products can be far greater than the amount saved.

At PureLife, providing quality products to our customers is our top priority, which is why we offer money-back guarantees on all purchases. Also, we only purchase products from authorized manufacturers. We couldn’t live up to these promises with gray market products, so we simply don’t buy them!

PureLife is proud to be an authorized distributor of these great brands

PureLife is proud to be an authorized distributor of these great brands

Bad News for BPA

Bad News for BPA

New research links BPA exposure to disrupted enamel formation and childhood obesity, among other problems

Bisphenol A (BPA), a chemical compound found in many everyday plastic products, caused widespread alarm outside of dentistry in 2010, after several studies linked it to health problems. Many manufacturers of plastic bottles, particularly those used by children, were prompted to exclude the substance from their formulations.

Since the first composite resin was introduced in the 1960s, dental composites and sealants containing BPA have been developed. Within the last 25 years, researchers have reported detectable levels of BPA in patients treated with dental sealants. This year alone, more and more evidence is mounting against BPA, with new studies suggesting that exposure to BPA may have harmful effects on human health, particularly during a child’s early development years.

DAMAGED/FRAGILE TOOTH ENAMEL
diversity-group-children1New research from France has suggested that BPA exposure in children can adversely affect cells that produce tooth enamel, making it fragile or brittle. The researchers studied the effects of low daily doses of BPA on the teeth of laboratory rats. Results showed tooth enamel damage in the rats to be characteristic of a childhood tooth enamel condition called Molar Incisor Hypomineralisation (MIH), which occurs selectively in permanent incisors and first molars1.

MIH affects about 18% of children between the ages of 6 and 8. Children with MIH are highly prone to dental caries and are very susceptible to tooth sensitivity and pain. Connections between this condition and the results studied in the rats’ teeth are even stronger due to the fact that the age at which children develop their first molars and permanent incisors is the age at which studies show that humans are most sensitive to BPA.

INCREASED RISK OF CHILDHOOD OBESITY
A study examining the relationship between BPA and obesity in school-age children found that girls between 9 and 12 years of age with higher-than-average levels of BPA in their urine had double the risk of being obese than girls with lower levels of BPA2.

The study was conducted in Shanghai as part of a larger national study of puberty and adolescent health, and may provide evidence that confirms recent and past findings from animal studies – that high BPA exposure levels could increase the risk of children becoming overweight or obese.

BPA acts as an endocrine disruptor, a substance that disturbs the endocrine system. The endocrine system is a series of glands — such as the thyroid, pituitary, and adrenal glands — that releases hormones affecting sexual development, growth and metabolism. Some chemicals, like BPA, can alter hormone levels.

“Girls in the midst of puberty may be more sensitive to the impacts of BPA on their energy balance and fat metabolism,” said De-Kun Li, MD, PhD, principal investigator of the study and a reproductive and perinatal epidemiologist at the Kaiser Permanente Division of Research in Oakland, California2.

OTHER NEGATIVE EFFECTS
Other studies have suggested that BPA exposure affects the reproductive systems of laboratory animals. A study published in January by researchers at the New York University School of Medicine found that even low levels of BPA may put children and adolescents at a higher risk of heart and kidney disease. Another recent study linked BPA exposure to childhood asthma.

BPA-FREE ALTERNATIVES
Did you know that PureLife offers a variety of BPA-free products? For example, Venus Diamond and Venus Pearl composites by Heraeus Kulzer boast a patented BPA-free urethane monomer chemistry. Also, the Embrace line of cements and sealants from Pulpdent and the new Toothfairy BPA-Free Pit & Fissure Sealant from Septodont utilize an advanced BPA-free resin technology.

REFERENCES
1 Early BPA exposure may adversely affect formation of tooth enamel. (2013, June 13). Dental Tribune.
2 Chemical in plastics may double obesity risk in puberty-age girls. (2013, June 14). Jagran Post

Best Whitening Options

What’s In Your Whitening?

With patients requesting whitening procedures like they’re going out of style, now’s the time to brush up on your bleaching basics

‘Tis the season for whitening procedures, but sifting through the dozens of whitening systems on the market can be a headache for even the most seasoned dental professionals. There are many options available to dentists and consumers alike, including in-office whitening, office-distributed take-home kits, and a variety of over-the-counter products. Because of this, you might find your patients asking you, “what’s the best method?” The answer is partly subjective and includes consideration of the speed of whitening, in-office or at-home treatment, convenience, and cost.

Teeth whitening procedures are in demand for the Holidays

Teeth whitening procedures are in demand for the Holidays

Types of whitening agents

Tooth whitening is affected by (1) the concentration of the peroxide in the whitening agent and (2) the length of time it is in contact with the enamel. Higher concentrations are faster but lower concentrations can achieve the same result by extending the amount of time it is on the enamel. In-office products contain the highest concentration of active ingredients, making them more efficient in rapid whitening.

Types of active ingredients

There are two types of active ingredients that can be used for whitening procedures: carbamide peroxide and hydrogen peroxide. Both agents remove both intrinsic and extrinsic stains (unlike whitening toothpastes, which only remove extrinsic stains). Carbamide peroxide is a combination of urea and hydrogen peroxide. Once applied, it breaks down into these two components, thus releasing hydrogen peroxide. The addition of urea to hydrogen peroxide acts to stabilize the hydrogen peroxide and increases its shelf life. Thus, carbamide peroxide is most often found in OTC whitening products as well as some take-home kits. The hydrogen peroxide released is about 1/3 the concentration of the original carbamide peroxide, a process that takes about 4-6 hours. As a result, carbamide peroxide is best used in overnight trays.

In comparison, uncut hydrogen peroxide is less stable and more potent. High-concentration hydrogen peroxide whitening agents are more appropriate for in-office use.

Managing sensitivity

Tooth sensitivity is a common complaint during tooth whitening that can actually be well-managed. Sensitivity results in sharp, painful impulses in individual teeth. Continuing to remind patients that these “zingers” are not abnormal is a good way to mitigate their distress. There are many options available to reduce and treat sensitivity:

  • Advising your patient to use a desensitizing toothpaste containing potassium nitrate for 2 weeks prior to their whitening procedure
  • Administering a whitening agent that contains potassium nitrate
  • Using potassium nitrate alone or with fluoride
  • Applying a high-level (5,000 ppm) fluoride dentifrice
  • Using amorphous calcium phosphate (ACP) in the whitening agent or as a stand-alone gel

Potassium nitrate desensitizes the nerves, while fluoride and ACP work by plugging the open dentinal tubules.

Equip your practice

At PureLife, we carry both in-office and take-home whitening systems, many of them available in several concentrations of hydrogen peroxide and/or carbide peroxide. To help with sensitivity issues, some even contain fluoride.

No matter which type of whitening products you use, there’s no doubt your patients will be asking for bleaching procedures. Having a handle on each specific type can save you money…and help your practice to be more efficient. Happy whitening!

Superpowers of Chlorhexidine

The Grime Fighter’s Secret Weapon

Fight bacteria with the antimicrobial powers of chlorhexidine

You probably know chlorhexidine as the active ingredient in mouthwashes and oral rinses. It’s approved by the FDA and the ADA for control of plaque and gingivitis, and studies have reported plaque and gingivitis reductions averaging 60%. In addition to its use in oral rinses, did you know that chlorhexidine gluconate is a powerful disinfectant and preservative? Here’s an overview of this safe, effective, and versatile “superchemical.”

powHOW IT WORKS
Chlorhexidine is a broad-spectrum biocide effective against Gram-positive bacteria, Gram-negative bacteria and fungi. Depending on its concentration, the molecule can kill bacteria as well as inhibit bacterial growth, providing a residual effect. Chlorhexidine inactivates microorganisms with a broader spectrum than other antimicrobials (e.g., antibiotics) and has a quicker kill rate than other antimicrobials (e.g., povidone-iodine) — killing nearly 100% of Gram-positive and Gram-negative bacteria within 30 seconds after application. And, with its low toxicity level, chlorhexidine is a safe treatment option that produces little side effects.

BENEFITS AND USES
Chlorhexidine has been used in more than 60 different pharmaceuticals and medical devices. Its wide application is due to its broad-spectrum efficacy, safety profile and substantivity on the skin with low irritation. Chlorhexidine is widely used as a disinfectant in a range of healthcare products, including:

  • Oral rinses, toothpastes and varnishes
  • Hard surface disinfectants
  • Dental unit waterline disinfectants
  • Evacuation system cleaners
  • Endodontic irrigation solutions
  • Hand sanitizers and lotions
  • Hand washing solutions
  • Wound and burn care products
  • Central venous catheters and needleless IV connectors

Chlorhexidine has become the gold standard in dentistry due to its ability to adhere to soft and hard tissue and maintain a potent sustained release. In oral applications, chlorhexidine binds to the mouth tissue, oral mucosa and teeth. It is then released over time to kill bacteria and fungi. This helps to reduce the bacterial count and prevents dental plaque. In hard surface applications, products with chlorhexidine in combination with alcohol have been shown to be more effective than alcohol alone. Chlorhexidine has also been applied to medical devices such as dental implants, vascular catheters, needleless connectors and antimicrobial dressings.

EXPERIENCE THE POWER
Try the amazing bactericidal, virucidal, and fungicidal properties of chlorhexidine for yourself! PureLife carries a wide range of safe and effective products containing chlorhexidine, including BioSURF Surface DisinfectantBioVAC Evacuation System Cleaneroral rinses and endodontic solutions.

All About Anesthesia

From Laughing Gas to Lidocaine

An inside look at the dynamics of anesthetics

DISCLAIMER: The material included in this article is intended for informational purposes only and does not constitute full prescribing information.

Evolution of Anesthesia

The concept of lowering the pain threshold has existed for centuries, but the first anesthetic agents — ether and nitrous oxide — weren’t introduced in dentistry until the 1840s. Anesthetics were used only during extractions until the first nerve block was introduced in the 1880s. Cocaine was the first local anesthetic used, and although effective for achieving profound anesthesia, was highly addictive. The first synthesized cocaine, procaine, was introduced at the turn of the 20th century. When mixed with a very small concentration of epinephrine, procaine was found to be highly effective, non-addictive and safe as a local anesthetic agent for most patients. Novocain procaine was widely used until it was replaced by lidocaine in the 1950s, which remains the gold standard to this day. The newest local anesthetic, articaine, has similar time of onset and profoundness of anesthesia as lidocaine, but is claimed to last two to three times longer.

A Closer Look at Local Anesthetics

Local anesthetics are the most widely used anesthetic agents in dentistry. The table at the bottom of this page shows the most common types of injectable local anesthetics in use today.

Determining Total Dose:

The total dose (mg) of a local anesthetic is a function of its concentration (%). For any given percent solution, the easiest way to calculate dose is to move the decimal one place to the right (reflecting mg/ ml) and then doubling it for the dose per cartridge (one cartridge = ~2 ml of solution). For example, one cartridge of 3% mepivacaine is equivalent to ~2 ml at 30 mg/ml, or ~60 mg total. Similarly, 2 1/2 cartridges of 2% lidocaine is equivalent to ~5 ml at 20 mg/ml, or 100 mg total.

Addition of Vasoconstrictors:

Solutions containing a vasoconstrictor like epinephrine increase the duration of the anesthetic by slowing down its rate of absorption. They vary in concentration, representing grams of solute dissolved in milliliters of solvent. The most common is epinephrine 1:100,000 (10 micrograms/ml). Higher concentrations may provide better hemostasis at the surgical site compared to lower concentrations. Remember, 1:200,000 (5 micrograms/ml) is half the concentration of 1:100,000. Similarly, 1:50,000 (20 micrograms/ml) is double the concentration of 1:100,000.

Adverse “Allergic” Reactions:

It is not unusual for patients to claim they are allergic to local anesthetics, when most likely they are sensitive to epinephrine. Since epinephrine is a hormone produced in the body, it is impossible to be allergic to it. However, some patients occasionally experience symptoms resembling an allergic reaction, which can be attributed to preservatives (methylparaben) or antioxidants (bisulfites) contained in the solution. Solutions without a vasoconstrictor should be used in these types of cases, or when a patient has severe heart disease or recent myocardial infarction

anesthetics chart

SOURCES

1 Perno Goldie, M. (2009). The evolution of analgesia and anesthesia in oral health care. RDH (29) 9

2 Becker, D. & Reed, K. (2006). Essentials of local anesthetic pharmacology. Anesthesia Progress, 53 (3), 98-109

Oral-Systemic Connection

Dentists: The New Disease Detectives

The eyes are the windows to the soul, but the mouth is the window to overall health

Ironically, oral healthcare is considered separate from the rest of the healthcare system. But, new research has revealed an important connection: oral health can impact overall systemic health. Dentists are now taking on a new role in healthcare, becoming the lead investigators in preventive cardiology, diabetic care, and inflammatory disease.

bacteria

BACTERIA GOES BEYOND THE MOUTH
The mouth is the port of entry for most of the pathogenic bacteria that affect our health, making it a hotspot for potential infections and diseases. Without proper oral hygiene, the body’s natural defenses cannot combat the high levels of bacteria that cause oral infections, such as dental caries and gingivitis. Bacteria also cause oral inflammation associated with periodontitis—the most common inflammatory disease in humans and affecting 85% of the US adult population. Inflammatory diseases that can be triggered by oral inflammation include cardiovascular disease, diabetes, kidney disease, Alzheimer’s disease, pneumonia, preterm and low-weight births, and various cancers.

The larger medical community is now addressing this issue. Dr. Marc Penn, MD, PhD, former director of the Cardiac Intensive Care Unit at Cleveland Clinic, considers periodontal disease as “an important source of inflammation in reference to cardiovascular disease.” Dr. Bradley Bale, MD, mirrors this view, stating, “One of the reasons heart attacks are not being prevented is because healthcare providers are not recognizing the link between cardiovascular disease and oral-systemic health.”

ORAL-SYSTEMIC HEALTH LINK
Here are a few statistics that suggest a strong correlation between oral and systemic health:

  • Even as few as two professional cleanings per year can reduce the risk of heart attack by 25% (American Heart Association)
  • Obstructive sleep apnea affects 20 million people and increases the risk for cardiovascular disease, but effective treatment of sleep apnea can add ten years to a person’s lifespan
  • Appropriate periodontal treatment has been shown to be as effective in lowering the A1C levels in diabetic patients as most medications, but without the adverse side effects
  • Reduction in oral inflammation in diabetic patients can reduce their yearly overall healthcare costs by up to 25%

PERSONALIZED MEDICINE AND DENTISTRY

Tray Setup

With evidence supporting the link between oral and systemic health, dentists are able to customize care with different combinations of treatments. By treating patients according to their overall health risk factors, a visit to the dentist becomes more than just an oral checkup, but a total wellness exam. This new approach may include a traditional dental exam plus expanded diagnostic testing, such as a microbial assessment, genetic testing, salivary diagnostics and health risk assessment. Many of these tests are available to dental professionals as an added level of prevention.

The future of dentistry involves total alignment with the broader healthcare system. The medical and dental communities are now starting to view oral health as a key player in overall health, but the next step will involve collaboration between dentists and physicians to create personalized medical plans. Dentistry has always been one of the few medical sects specializing in prevention. The best way to avoid disease is to prevent it from happening in the first place, and it all starts with the mouth.