Many products used in a health care facility become hazardous waste when discarded. These can include batteries, cleaning chemicals, dental amalgam, disinfectants, lab reagents, paints, pharmaceuticals, and radiology chemicals. Because hazardous waste regulations are confusing and health care wastes are complicated, the Minnesota Pollution Control Agency (MPCA) has been working with hospitals since 2002 on appropriate hazardous waste management. MPCA recognizes other health care facilities such as clinics, dentists, long term care, pharmacies and veterinarians also generate hazardous waste and may not be aware the regulations apply to them. The MPCA in conjunction with the Minnesota Technical Assistance Program (MnTAP), a non-regulatory pollution prevention program at the University of Minnesota, is starting an initiative to assist these businesses with compliance and waste reduction.
The initiative will consist of a cooperative effort by the MPCA, MnTAP, and related trade associations to provide outreach to non-hospital health care facilities with:
The MPCA views the initiative as an opportunity to provide assistance and allow time for non-hospital health care facilities to come into compliance with hazardous waste regulations. Following the initiative, the entire Minnesota health care industry will be subject to full enforcement of hazardous waste regulations. Metro county hazardous waste programs may already be fully regulating hazardous waste in health care facilities.
If you would like to get a head start, please contact Brandon Finke at the MPCA (651) 757-2358 or firstname.lastname@example.org to schedule a site visit.
March 24, 2009
Crowns subjected to testing conditions far more extreme than found in mouth
CHICAGO, March 24, 2009—Comprehensive testing and analyses by the American Dental Association (ADA) found no detectable amount of lead released from the 102 porcelain-metal dental crowns evaluated even under extreme laboratory testing conditions.
Scientists from the ADA Division of Science and the ADA's Paffenbarger Research Center (PRC) laboratories in Gaithersburg, Md., conducted the tests in response to concern over the safety of dental crowns. The PRC laboratory analyzed 44 porcelain powders -raw materials used to make dental crowns-from different manufacturers and 102 finished porcelain-metal crowns produced by domestic and foreign dental laboratories.
Scientists evaluated dental materials for lead content, release of lead
Lead can be found in a number of porcelain products such as dinner plates and figurines. Feldspathic porcelain is a natural mineral that is mined from the earth and refined for dental use. As such, porcelain will contain naturally occurring trace elements of lead in varying concentrations, depending on the source and refining process.
In assessing for total lead content, ADA scientists completely dissolved the powders and finished crowns, and measured the amount of lead remaining in the solution, finding only trace amounts of the naturally occurring element. The results ranged from below detectable to 113 parts per million (ppm) in the 44 porcelain powders, and an average of 46 ppm in the 102 porcelain dental crowns.
Second, but more importantly, the researchers also tested the finished crowns for the release of lead (to test the potential body exposure to the element) under laboratory conditions far more extreme than could occur in the mouth. This testing yielded no measureable lead escaping from the porcelain crown (with a limit of detection at one ppm), even under accelerated acidic conditions at elevated temperatures.
"Based on all the information to date, both from our own testing as well as reports of other analyses, we are confident that no measurable levels of lead are released from dental crowns made from dental porcelain typical of available sources," explains Clifton Carey, Ph.D., administrative director, PRC.
He added, "Moreover, we intentionally added lead to a separate sample of dental crowns and found that even up to 500 ppm of lead levels, no measurable amount was released. This was a much higher total concentration than any laboratory-fabricated crown tested."
Questions were raised in February 2008 about lead in dental restoratives such as crowns and bridges when an Ohio woman speculated in a news report that the problems she experienced with her bridge might be because of its manufacture at a dental laboratory in China. At a time when other products from China were under scrutiny, the local news station investigated the issue and sent the bridge to a local laboratory for lead testing. The station then had several dental crowns manufactured in China tested, and one crown reportedly tested positive for lead. At the time however, no accepted standardized method existed to measure lead content of dental materials such as porcelain, or whether lead is released from dental crowns in the mouth.
ADA commits time, resources to design lead test, conduct laboratory testing
The ADA reacted quickly to the news story, notifying member dentists, posting information for the public and contacting the Food and Drug Administration (FDA) and the Centers for Disease Control and Prevention (CDC) to ensure that the agencies were aware of the issue.
In addition, the ADA designed a new research method to measure lead concentration, obtained sample dental crowns from laboratories in China, the U.S. and other countries, and then tested the crowns to determine the amount of lead present and, most importantly, whether any lead is released from the crowns.
The ADA has shared these test results with the CDC and the FDA—the regulatory agencies responsible for protecting the public's health. In addition, the ADA has posted information on www.ada.org for dental professionals and the public.
March 9, 2009
ADA creates brochures with National Osteoporosis Foundation
Chicago, March 9, 2009—Dental patients who have been alarmed or confused by recent news reports about how osteoporosis medications might affect their oral health now have a brochure to help them separate fact from fiction. The American Dental Association (ADA) collaborated with the National Osteoporosis Foundation to create the brochure, "Osteoporosis Medications and Your Dental Health," which will be available in dental offices this month.
The brochure explains that some patients who have taken bisphosphonates, a common class of drugs taken by those with osteoporosis or low-bone density, have developed bisphosphonate-associated osteonecrosis of the jaw. Osteonecrosis of the jaw is a rare but serious condition that can cause severe damage to the jawbone. This condition is diagnosed in patients who have an area of exposed bone in the jaw that persists for more than eight weeks, who have no history of radiation therapy to the head and neck and who are taking, or have taken, a bisphosphonate medication.
The chance of developing osteonecrosis of the jaw for patients who take bisphosphonates is unknown; however researchers agree that the chance appears to be very small. In fact, 94 percent of people diagnosed with osteonecrosis of the jaw are cancer patients who are or have received repeated high doses of bisphosphonates intravenously. The remaining 6 percent diagnosed with osteonecrosis of the jaw took oral bisphosphonates.
"Patients who take bisphosphonates for osteoporosis are encouraged to talk to their dentist so that their dentist can show them good oral hygiene practices as well as monitor their oral health," says Matthew Messina, D.D.S., ADA Consumer Advisor and a general dentist based in Ohio. "Patients should not stop taking their osteoporosis medications without speaking with their physicians."
According to the ADA, the benefits of osteoporosis medications greatly outweigh the risks of developing osteonecrosis of the jaw.
Osteoporosis is a serious condition that causes 2 million bone fractures a year, according to the National Osteoporosis Foundation. Half of women and 20 percent of men older than 50 will break a bone due to osteoporosis. Bisphosphonates are commonly prescribed to prevent broken bones. Common bisphosphonate medications include alendronate (Fosamax®), ibandronate (Boniva®), risedonate (Actone®) and zoledronic acid (Reclast®).
The "Osteoporosis Medications and Your Dental Health" brochures will be available in dental offices or for purchase by dentists on the ADA's Web site at www.ada.org. For more information about osteonecrosis of the jaw, please visit the ADA's Web site at http://www.ada.org/prof/resources/topics/osteonecrosis.asp or the National Osteoporosis Foundation's Web site at www.nof.org .
About the American Dental Association
Celebrating its 150th anniversary, the not-for-profit ADA is the nation's largest dental association, representing more than 157,000 dentist members. The premier source of oral health information, the ADA has advocated for the public's health and promoted the art and science of dentistry since 1859. The ADA's state-of-the-art research facilities develop and test dental products and materials that have advanced the practice of dentistry and made the patient experience more positive. The ADA Seal of Acceptance long has been a valuable and respected guide to consumer dental care products. The monthly Journal of the American Dental Association (JADA) is the best-read scientific journal in dentistry. For more information about the ADA, visit the Association's Web site at www.ada.org
Smiles Change Lives began treating patients in Minnesota in April 2008. This program, endorsed by the American Association of Orthodontists, was founded in 1997 in the Kansas City area to provide orthodontic care to children ages 11-18 whose parents/guardians cannot afford orthodontic treatment.
Families must apply to the program, followed by an orthodontic screening and finally a review by the local Minnesota Community Advisory Board. Once accepted, the patient is referred to a participating community orthodontist who agrees to treat the patient for free. The parents/guardians must pay an initial $250 fee once accepted into the program. Other funding for the administration of the program comes from donations by individuals and businesses. 3M has recently signed on to the program as the Official Orthodontic Industry Sponsor for 2008 and 2009.
The extensive application process requires a statement by the parents/guardians and the child indicating why they want and/or need orthodontic care, a referral from their dentist indicating general oral health and their most recent tax return. These documents are then evaluated by the Smiles Change Lives staff in Kansas City to determine financial need. An orthodontic evaluation is then conducted at the University of Minnesota Division of Orthodontics, and a local community advisory board, currently composed of John Beyer, Michelle Bergsrud, Kevin Denis, Keith Erickson, Steve Litton, Dan Shaw, Mike Salchert and Eileen Youngren, determine who receives the treatment based upon the application, the orthodontic evaluation and available funding. Treatment is provided by Minnesota orthodontists who are willing to participate in the program. Currently, there are 40 partner orthodontists in Minnesota eager to begin treating youth through the Smiles Change Lives program.
If you are aware of a child age 11-18 who has good oral hygiene, has lost most or all of their deciduous teeth, has a moderate to severe malocclusion and could benefit from orthodontic treatment, please have their parents/guardian contact the Smiles Change Lives program at 888-900-3554 or www.smileschangelives.org for an application.
You also may make a financial contribution to the program and designate it for Minnesota recipients. If you have further questions, please contact Steve Litton at 763-544-2211 or email@example.com.
Author: Dr. Steve Litton
Updated March 24, 2008
(to establish an Advanced Dental Hygiene Practitioner)
The Minnesota Dental Association believes expanding access to quality dental care to all Minnesotans should be a top priority for lawmakers. Low-income and rural areas are undeserved in our state, and we should be working to expand existing programs that reach these populations.
However, we have grave concerns about SF2895, a bill to establish a new dental hygienist or what proponents are calling an Advanced Dental Hygiene Practitioner (ADHP).
Under this legislation, this untested, unsafe and unaccredited hygienist would be allowed to cut and drill in patients’ mouths without a dentist present in the building for supervision. No other state legislature has gone to such an extreme of having non-dentists drill and extract teeth or perform baby root canals.
This hasty and drastic measure puts patients’ safety at risk.
The bill claims that a new hygienist position will help expand access. Far from it: The bill allows this new untested hygienist to practice anywhere in the state and does not require them to serve underinsured or uninsured populations.
The new hygienist program being proposed would not be accredited by the Commission on Dental Accreditation (CODA), which for decades has been the standard third-party accrediting entity for dental schools, as well as dental hygiene and dental assisting programs.
In addition, this proposal greatly expands the scope of practice for dental hygienists. It allows hygienists with half the formal education of dentists to perform these irreversible procedures without a dentist in the building to supervise. For instance, some orthodontic and prosthodontic procedures proposed are commonly done by specialty dentists with up to four years of post-doctoral residency.
Minnesota has some of the best dental care in the country for a reason: Fully trained dentists work with an exceptional dental team to provide the highest quality care. The MDA urges lawmakers to support existing programs already in place to expand access, rather than reach for such a drastic and unwise bill.
The Minnesota Dental Association is the voice of dentistry in Minnesota, representing 83 percent of practicing dentists. It is committed to the highest standards of oral health and access to care for all Minnesotans. You can learn more at www.mndental.org.