Safe Practices in Dentistry: Out with the Old in with the New

Having recently published a post regarding the dangers of amalgam fillings, I was eager to further explore the web for related topics in dental medicine. In particular, I decided to search the blogosphere for topics that focus on the alternative and more efficient techniques that professionals are using to ensure quality care and safety for their patients. As a dentist in the making, it is critical to gain a comprehensive understanding of the current trends in all areas of dentistry so that I am able to effectively employ them with my own patients in the future.

The first post I came across was within The Endo Blog entitled Research Update: Direct Pulp Capping with MTA. The blog was created by Dr. Edward Carlson D.D.S and Dr. Jason Hales D.D.S., M.S., two endodontists with training from West Virginia University. Apparently, endodontists are now using a Mineral Trioxide Aggregate as a direct pulp capping agent (see picture to above), which appears to be a safer and more successful material. It was refreshing to see that the experts in the specialty fields of dentistry are not the only ones starting to engage in new and improved technological advances; general dentists are also getting involved. The other post that interested me was within Glen Ellyn’s blog, Smile. Dr. Ellyn, pictured below, is a high tech dentist with more than 27 years of experience in cosmetic, sedation, and implant dentistry. On a more general level, his post entitled Dentists Using Dangerous Dental Labs, appropriately warns consumers to inquire about the origin of their fillings, dentures, and veneers due to a recent discovery of dangerous levels of lead found in porcelain dental crowns. I have offered a few comments to both posts, and have also placed them below for your convenience.Comment: (Research Update: Direct Pulp Capping with MTA)

Although I am naïve to the field of endodontics, I found your post intriguing because, on the other hand, I am very aware of the issue involving the health hazards of certain materials used in dental work. It was only recently brought to my attention that harmful substances are found not only in fillings, but in dentures, veneers, and in capping agents as well. From my understanding, MTA is a type of cement that is easy to use, more predictable than traditional materials used for capping, and more importantly, safe for the patient. As I am sure you are aware, many practitioners are unfortunately reluctant to incorporate the use of newer and safer material in their practices, so the inclusion of the data that supports the use of MTA as a direct pulp capping agent is appropriate and necessary in your post. You state that, “Over a 9 year period of observation, the authors found that 49 of 53 teeth had a favorable outcome on the basis of radiographic appearance, subjective symptoms & cold testing,” which seems remarkable. Since practitioners are trained to rely solely on evidence based dentistry and medicine, it might be beneficial to include additional cases similar to the study in your post to sell other dentists on this new product. Regrettably, the fact that it can do wonders for the patient, by inducing cell proliferation, cytokine release, and hard tissue formation, is still not enough to convince all professionals to use MTA. As you have mentioned, it can also potentially be used by a wide variety of specialists and general dentists, which should also add to the benefits of MTA and encourage its use. My question to you is, how can other specialists besides endodontists employ this material? I am curious to know because, although I do not expect to enter the field of endodontia, I want to integrate the best and safest materials in my own practice in the future. By informing dentists of all types about the applications of MTA, perhaps more MTA will be put to use, making the dentist’s job easier, which could ultimately yield more successful and safer outcomes.

Comment: (Dentists Using Dangerous Dental Labs)

First, I want to say that I think it is excellent that you are making the public aware of the potential harmful consequences resulting from toxins that may be found in their dental repair components. Your brief post regarding this topic was the only one I encountered in my exploration throughout the blogosphere. It is unfortunate that other professionals are not showing as much concern for their patients’ safety. This issue was brought to my attention after recently publishing my own post regarding the health hazards of amalgam fillings. Reading the research on the subject of the consequences of mercury within these restorations and how some dentists are reluctant to discontinue their use was disturbing. It was even more appalling to read in your piece that this is not only an issue with fillings, but that there are also dangerous materials within caps, crowns, dentures and veneers. The fact that millions of dental prostheses are actually made in labs in China, India, the Philippines, Mexico, Eastern Europe, and Costa Rica is also new to me. There is no question that the United States is one of, if not the most, technologically advanced countries in medicine and research. Do you agree that dental products and supplies could be made safer if manufactured under the eye of the prestigious professionals within our nation, or even under the scrutiny of the FDA? The inclusion of more stories in future posts, similar to the account of the woman being sickened by lead-tainted dental work from China, may sway more experts and dentists into adopting some method of policing the dental components utilized in this country. I certainly concur with you when you state, “It is unfortunate that many dentists who have felt the pressures of managed care and rising costs are reducing the standard of care by using dental laboratories that may not meet the standard of professional care that patients deserve.” I enjoyed reading your post, and hope you find a moment to respond to my comments. Thanks for your time.