What is an Amalgam Separator and Why Do I Have to Have One?

amalgam silver filling

An Amalgam Separator is a device which traps amalgam fragments from dental office wastewater thus reducing the amount of amalgam and the mercury it contains from entering the sewage system. As of July 14, 2017, the Environmental Protection Agency (EPA) made a final ruling on the mandatory use of Amalgam Separators in dental practices because the field of dentistry is the leading source of mercury discharge into wastewater. The date of compliance for all dental practices is July 14, 2020. The use of an Amalgam Separator is thought to suppress at least 99% of potentially harmful mercury entering the public sewage system. Although most dentists don’t place it anymore, it’s still encountered daily in the treatment of teeth containing amalgam.

Amalgam separators use filtration, sedimentation, centrifugation, or a combination of these methods to remove the amalgam waste. The average cost of an Amalgam Separator is $800-900 with the installation running around $250-300. Operational cost per year is around $500.

You need to do your homework regarding Amalgam Separators. There are chairside models and central systems installed at the vacuum pump. The chairside models are easy to install and can be effortlessly connected by a team member. A Central System must usually be installed by a dental technician or a plumber. Some models use sedimentation tanks, and others operate with filters. The units that run on sedimentation tanks tend to operate with less expense. The ones that operate on filters can be very costly due to the expense and disposal of the filters. 

Maintenance is minimal and typically involves only replacing the container once it's full which occurs every six to twelve months depending on the size of the practice. The container must be sent to a certified amalgam waste company. If you choose a unit that has filters, the size of the practice will determine how often the filter will need to be changed. The model chosen must also be ISO-Certified (International Organization for Standardization) for effectiveness. However, most models exceed this standard.

There are some exceptions to the new EPA requirement. Practices such as Oral Surgery, Periodontic, Orthodontic, and Prosthetic don’t usually deal with amalgam and are exempt from mandatory use an Amalgam Separator.

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Is Periodontitis Contagious?

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Periodontitis is an ongoing infection which affects and destroys the soft tissues and bone supporting the teeth. Studies reveal that the bacteria that causes this infection lives in the saliva and can be passed from person to person. The pathway of transmission is believed to be among family members through kissing, sneezing, sharing glasses and utensils, and sharing food.

Technically speaking, the odds of contracting periodontal disease from another person is rare, but taking steps to protect yourself and your family is prudent. Following are some helpful tips:

  1. If you are diagnosed with periodontal disease, complete all recommended treatment. Treatment greatly reduces the harmful bacteria living in your mouth.
  2. After treatment, be faithful to your maintenance regiment. Keeping the harmful bacteria suppressed in your mouth is important.
  3. Make sure each family member sees the dentist at least twice per year for prophylaxis and examination. Not only will this ensure optimal health, but also provide for early diagnosis if periodontal disease is suspected.
  4. Encourage optimal oral hygiene habits for the entire family. Provide appropriate essentials such as toothbrushes, dental floss, mouthwash, and interdental aids.
  5. Keep sharing glasses, utensils, and food to a minimum.

Having periodontal disease doesn’t mean you can’t have close contact with your family. Your dental professional can give you further instruction based on the level of disease present in your case.

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Hand Washing 101 For Healthcare Providers

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The Centers for Disease Control provides handwashing guidelines for healthcare providers. While washing your hands may seem second nature, when dealing with patient care, you must correctly wash your hands to protect the patient and yourself against unwanted germs.

Hand hygiene refers to cleaning your hands by the following methods: regular soap and water, antiseptic hand wash, antiseptic hand rubbing with alcohol-based sanitizer, or surgical hand antisepsis. Even though you will probably be wearing gloves, it’s imperative to thoroughly clean your hands before and after donning gloves to reduce the spread of potentially harmful germs between yourself and the patient.

There are two approved methods for hand hygiene which include washing with soap and water or rubbing with alcohol-based hand sanitizer. Washing with a non-antibacterial soap is the least effective method, and alcohol-based sanitizers are the most effective. Washing with antiseptic soap lies in the middle. Generally speaking, if hands are visibly dirty, soap and water are recommended. However, if hands aren’t visibly soiled, alcohol-based sanitizers are in order.

Cleaning the hands should be done in the following instances:

  • Before and after eating
  • Before and after any contact with the patient’s intact skin
  • After contact with blood, body fluids, mucous membranes, or open wounds
  • After contact with any medical equipment surrounding the patient
  • Before and after removal of gloves
  • Before and after using the restroom

The CDC technique for washing with soap and water:

  • Wet hands with room temperature water (continued exposure to hot water can dry the skin)
  • Apply the manufacturer recommended amount of soap to the hands
  • Rub hands vigorously together for 15 seconds while covering all surfaces of each hand
  • Rinse thoroughly with water
  • Use a disposable towel to dry the hands and use the same towel to turn off the faucet

When using an alcohol-based sanitizer, the CDC recommends applying the amount as directed by the manufacturer onto the hands covering all surfaces and rubbing at least 20 seconds or until the hands feel dry.

As a healthcare professional, you wash your hands and apply sanitizers many times per day. Keeping your hands in good shape is the best defense against spreading germs. Lotions and creams are permissible, and ones approved for use with sanitizing methods will protect your skin and not interfere with the sanitation process.

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The Effects of the Opioid Epidemic in Dentistry

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The first use of opioids goes back as early as 3400 B.C. and was given for pain management, illnesses, and anxiety. The need for opioids has always been present, and the problem with this treatment regarding abuse and addiction has also remained. Unfortunately, pharmaceutical companies have tried to develop effective drugs safely with little risk of abuse or addiction without much success of introducing a safer alternative.

In 2017, the U.S. Departement of Health and Human Services (HHS) declared a public health emergency directly related to addiction and fatal overdosing because of misuse of prescription and non-prescription opioids. More than 42,000 deaths were the result of an opioid overdose in 2016, and 40% of those deaths were the consequence of a prescription opioid. Even the President of the United States has gotten involved with the war on Opioid misuse, and as a result of this growing crisis, the American Dental Association (ADA) has announced a new opioid policy.

This new policy presented by the ADA is as follows:

  1. “The ADA supports mandatory continuing education in prescribing opioids and other controlled substances.” It’s also recommended that the entire dental team becomes involved with this continuing education.
  2. “The ADA supports statutory limits on opioid dosage and duration of no more than seven days for the treatment of acute pain.” This statement is consistent with the Center for Disease Control and Prevention (CDC) guidelines. Most dental pain is of an acute nature, and studies have shown that nonsteroidal anti-inflammatory drugs (NSAIDs) are as effective or even more effective than opioids in the treatment of acute dental pain.
  3. “The ADA supports dentists registering with and using prescription drug monitoring programs to promote the appropriate use of opioids and deter misuse and abuse.” Programs are available to dentists which monitor prescription drugs and patients who may try to abuse the system.

Although dentists comprise a small fraction of the total prescriptions of opioids written, the ADA fully intends to make practitioners aware of the epidemic and play their part in managing the war on abuse and death due to overuse.

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Appointment Etiquette

Is it acceptable to ask a patient if you can move their appointment?

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The world of dentistry revolves around appointments which is great until something occurs that throws off the schedule. It happens inevitably, and when it does, is it acceptable to move a patient’s appointment? That depends on some very important guidelines which include proper training, communication, and follow through to ensure that the schedule flows properly and at maximum efficiency without offending and inconveniencing patients.

First of all, have a scheduling policy and make sure the entire team understands and follows it methodically. Most of the time, the front office will be in charge of appointments, but it’s a good idea to have the entire team on board. The schedulers should have a good understanding of how appointments work and how to schedule to maximize production while running on time. If the scheduling is done properly in the first place, moving appointments will be kept to a minimum.

Second, when scheduling patients initially, know what to say and how to say it so that if changing the appointment is necessary at a later date, it will be simpler. Ask the patient if it’s permissible to contact them regarding their appointment and the best way for them to be reached (phone, text, email). Explain that you may contact them as the appointment gets closer if it’s found that there’s a more convenient time for their schedule.

Third, keep detailed notes concerning any conversations with the patient about an appointment change. It’s also prudent to indicate if the patient mentions any days or times that are off limits. Keeping detailed records assures that unnecessary calls aren’t made which may irritate the patient. Correspondence should include information such as who called, when the call was made, and what appointment was offered. If it’s necessary to leave a message,  it’s imperative that the details are documented and that everyone is on the same page. For example, if you leave a message, make sure that the patient understands that they must contact the office regardless or the original appointment time will remain unchanged.

Fourth, verify that the detailed notes are read by whoever is phoning the patient. Save yourself embarrassment by knowing what the patient likes relevant to appointment days and times. Don’t tell them that you are calling because someone canceled last-minute because it’s negative. Tell them that you remember them saying that they prefer morning appointments and that you happen to have a morning opening. Saying something like this shows the patient that you are thinking of them and looking out for them as well.

Finally, don’t move the patient’s appointment more than once. Never continue to call patients to move their appointment. Also, if a patient does allow you to move their appointment, make a note of it and thank them when they arrive at the office.

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