Mercury in dental amalgam
Safe or toxic?

Dental amalgam, a dental restorative material that contains a mercury alloy, has been used since the early days of dentistry. Most dentists consider amalgam harmless. It is the restorative material of choice for dentists and patients alike because of its many qualities, particularly the following:

• Physical properties
• Ease of handling
• Resistance
• Effectiveness
• Durability
• Cost advantage over other materials

Until the 1970s, the only criticism surrounding the use of dental amalgam was its silver colour. No one worried about the fact that it contained a metal alloy mixed with mercury, a substance with toxic properties. Given that it presented no danger once mixed and chemically bonded to the alloy, dental amalgam was considered innocuous.

This belief was called into question in the 1970s, when a researcher discovered that mercury vapour could escape from the amalgam. Thus began the mercury controversy and its attendant fear campaign that proved groundless in the long run. A U.S. study conducted by the American Council on Science and Health (ACSH), a consumer watchdog association, concluded in 1998 that questions raised by the presence of mercury in dental amalgam had been an unnecessary concern.

In fact, scientists who subsequently studied the issue established that while mercury vapour emanating from amalgam is a recognized fact, the quantities thus released and to which patients are exposed are minimal and pose no health threat.

Research has shown that only a fraction of the mercury vapour (approximately 10%) is absorbed from dental amalgam and that most of this amount is absorbed by the lungs and expelled by the body.

A comparison was made of mercury content in patients before and after receiving an amalgam restoration and before and after its extraction. It was noted that dental amalgam did not significantly contribute to an individual's total daily mercury exposure or absorption.

Another study showed that total daily mercury absorption in all its forms (including from dental amalgam, food, air and water, through natural means or from human activity) was 2.3 micrograms per day. The Environmental Protection Agency (EPA) has set the reference dose (daily oral exposure likely to be without an appreciable risk of deleterious effects during a lifetime) at 5.8 micrograms per day.

In addition, the International Union of Pure and Applied Chemistry has established the lowest-observed-effect level (LOEL) for mercury at 38 micrograms per day. The World Health Organization has established this level at 40 micrograms per day.

This reassuring data, without trivializing mercury exposure, clearly establishes the safety of dental amalgam as currently used in modern dentistry.

ODQ Board of Directors
May 2005

Infective endocarditis

Dental Patients with Total Joint Replacement

Guidelines - Managing Obstrutive Sleep Apnea with Mandibular Advancement Devices

Publication :	2006
Editor :	Ordre des dentistes du Québec
Download :	Document (PDF 40 Kb)

Bloodborne Infections
and Public Protection

Publication :	November 2008
Download :	Document (PDF 162 Kb) (French only)

ODQ Guidelines Relative to Fluoride Supplements

The Ordre des dentists du Québec supports the appropriate use of fluorides in the prevention of dental caries as one of the most successful preventive health measures in the history of health care. The availability of fluorides from a variety of sources, however, is a current reality which the practising dentist needs to take into account in dealing with patients. This is particularly true of children under the age of six, where exposure to more fluoride than is required simply to prevent dental caries can cause dental fluorosis. There is no evidence of any health problems being created by such exposure, but it is prudent to attempt to limit exposure to the optimal levels required for continuing dental caries protection. Current levels of fluoride intake from all sources are difficult to establish for any given area, but the dentist should consider general intake to the extent possible in recommending fluoride supplementation.

The following suggestions are consistent with these principles:

1. Fluoride supplements are only required for high dental caries risk patients and may be unnecessary if the patient is receiving adequate fluoride from other sources.
2. Before prescribing fluoride supplements, a thorough clinical examination, dental caries risk assessment and informed consent with patients/caregivers are required.
3. The Canadian Consensus Conference on the Appropriate Use of Fluoride Supplements for the Prevention of Dental Caries in Children, held in November 1997 suggested that high caries risk individuals or groups may include those who do not brush their teeth (or have them brushed) with a fluoridated dentifrice twice a day or those who are assessed as susceptible to high caries activity because of community or family history, etc.
4. The estimation of fluoride exposure from all sources should include use of fluoridated dentifrice and all home and child care water sources. Dentists should be aware of the average fluoride exposure in their area. The possible impact of fluoride reducing factors within the home such as the use of unfluoridated bottled water of some reverse osmosis devices should be taken into account.
5. Lozenges or chewable tablets are the preferred forms of fluoride supplementation. Drops may be required for individual patients with special needs.
6. The use of fluoride supplements before the eruption of the first permanent tooth is generally not recommended. When, on an individual basis, the benefit of supplemental fluoride outweighs the risk of dental fluorosis, practitioners may elect to use these supplements at appropriate dosages on younger children. In doing so, the total daily fluoride intake from all sources should not exceed 0.05-0.07 mg F / kg body weight in order to minimize the risk of dental fluorosis.
7. Following the eruption of the first permanent tooth and the associated decrease in the risk of dental fluorosis at this stage of development, fluoride supplements in the form of lozenges or chewable tablets may be used to deliver an intra-oral fluoride dose. A lozenge or chewable tablet containing 1 mg fluoride delivers the same amount of fluoride intra-orally as brushing with an average load (1 mg) of a 1000 ppm fluoride dentifrice.

ODQ Board of Directors
May 2001

Safety of Human Cells, Tissues and Organs for Transplantation

The final version of the Guidance Document Safety of Human Cells, Tissues and Organs for Transplantation is now available on the Health Canada website, located at: www.hc-sc.gc.ca/dhp-mps/brgtherap/reg-init/cell/index-eng.php.

This document provides an overview as well as an interpretation of the Safety of Human Cells, Tissues and Organs for Transplantation Regulations (CTO Regulations). It is intended to help readers determine whether the CTO Regulations apply to their activities and if so, give more details as to meeting the regulatory requirements. If you have any questions concerning the CTO Regulations themselves or this guidance document; please contact the CTO Unit of the Biologics and Genetics Therapies Directorate email at BGTD_PPD_DPP@hc.gc.ca.

Implant-Supported Rehabilitation

Implant-Supported Rehabilitation - Guidelines

 

Publication :	June 2018
Editor :	Institut national d'excellence en santé et en services sociaux  (INESSS)

Declaration on the frequency of
recall examinations adopted by the ODQ

Recall frequency is patient specific, based on the individual needs of the patient. In the best interest of the oral health of the majority of patients in Quebec, a minimum of twice yearly recall is indicated.

ODQ Board of Directors
November 1998

Publication :	2010
Editor :	Ordre des dentistes du Québec
Download :	Document (PDF 3,2 Mb) (French only)

Guidelines for the use of pit and fissure sealants

Objectives

Recognize the use of pit and fissure sealants for the prevention of dental caries and the control of incipient caries limited to enamel.

Scientific evidence

Since the end of the 1970s, numerous random comparative studies have demonstrated that sealants are effective in preventing pit and fissure caries of permanent teeth. Furthermore, longitudinal studies have demonstrated the effectiveness and safety of sealants in stopping the progression of caries in enamel.

Benefits

Reduction in the prevalence of dental caries and control of caries in enamel at a minimal biological cost.

Recommendations

Based on scientific evidence, pit and fissure sealants may be recommended for the prevention of dental caries and the control of caries in enamel. Their judicious and selective use must be based on caries risk assessment of each patient and each tooth by a dentist. The dentist is also required to render a diagnosis, prepare the tooth surface, apply an adequate amount of sealant and provide the appropriate follow-up.

Validity

A bibliography supporting these recommendations is available upon request at the head-office of the Ordre des dentistes du Québec. These guidelines will be subject to periodic revision.

ODQ Board of Directors
October 1998

Guidelines for the Modalities of Conscious Sedation

Note: Download (PDF 142Kb) tables and appendix.

Issued: May 2000

Note: These guidelines are currently under revision.

Position of the Ordre des dentistes du Québec on teeth whitening products

Whitening natural teeth using products containing peroxide or special whitening toothpaste is becoming increasingly popular with the public. Given this widespread interest, a vast range of products is now available on the market in various forms, from gels to self-adhesive strips, kits with trays, chewing gum and mouthwash.

The term "whitening" refers to any process intended to brighten teeth. Two types of products are used for this purpose. First, there are bleaching products that actually alter the colour of the tooth enamel by means of peroxide, a product that can reduce deep and surface stains. Then there are whitening products that do not change the colour of the enamel, but simply remove surface stains.

Bleaching products containing peroxide

There are two main types of bleaching products: those with a high concentration of peroxide, used under a light or laser in a dentist's office, and products distributed by dentists or sold over the counter, for use at home.

The most common side effects associated with bleaching products are temporary tooth sensitivity and occasional irritation of soft tissues. In some exceptional cases, teeth have been irreversibly damaged.

Whitening products

Whitening products, including toothpaste, chewing gum and mouthwash, contain abrasives or chemicals to improve tooth appearance. They reduce surface stains using light polishing or other actions that do not alter tooth colour.

The ODQ's position

Tooth bleaching using colour-altering products is a safe therapeutic choice, when carried out under a dentist's supervision and according to the manufacturer's recommendations. It may not be suitable for everyone, however.

The Ordre des dentistes du Québec recommends that patients, especially those with many fillings or crowns or heavy staining, consult their dentist to decide on the treatment that best suits them.

The Order also suggests that pregnant women delay bleaching treatment until after they have given birth. Children under age 12 should not use bleaching products.

ODQ Board of Directors
May 23, 2008

Temporomandibular Joint Disorders: Some considerations concerning diagnostic methods and treatments

Publication:	2012
Editor:	Ordre des dentistes du Québec
Download:	Document (PDF 48 Kb)

Publication :	2015
Editor :	Ordre des dentistes du Québec
Download :	Document (PDF 45 Kb)

L’utilisation des mesures de contention

 

CDA policy relative to the maintenance
of dental unit waterlines adopted by the ODQ

Dentists are encouraged to take steps to reduce any potential risk of dental unit
waterline micro organisms causing infection through the following waterline
maintenance procedures:

• Avoid heating water for the dental unit.
• At the beginning of each clinic day, purge all lines by removing handpieces, air/water syringe tips and ultrasonic tips and flushing thoroughly with water. The decrease in bacterial counts associated with such purging has been confirmed in two Canadian studies.^1,2 According to Barbeau et al,¹ 1996 and Whitehouse et al,² 1991, approximately a 5-8 minute purge is required to reduce bacterial counts to potable water standards (<500 cfu/ml).
• Run high speed handpieces for 20-30 seconds after each patient, to purge all air and water.
• Use sterile water or sterile saline when flushing open vascular sites and/or cutting bone during invasive surgical procedures.
• Follow manufacturer's instructions for daily and weekly maintenance if using bottled water or other special delivery systems.

CDA Board of Governors
September 1997

ODQ Board of Directors
November 1998

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1 - Barbeau, J. Tanguay, R. Faucher, E. et al. Multiparametric Analysis of Waterline Contamination in Dental Units.
Appl Environ Microbiol. 62:3954- 3959, 1996

2 - Whitehouse R.L.S., Peters, E., Lizotte, J. et al. Influence of Biofilms on Microbial Contamination in Dental Unit Water.
J. Dent 19:290-295, 1991.

These instructions, based on standard safety measures, were prepared by the Order to help dentists prevent the transmission of infectious diseases in their clinics.

 

Guide to Using a Computer System for Keeping Patient Records

 

Dental offices must comply with the provisions of the by-law in effect concerning the disposal of amalgam waste and hazardous waste. The requirements are as follows.

One of the mandates of the city of Montréal's environment and sustainable development department (Direction de l’environnement et du développement durable) is to ensure that amalgam separators are compliant, in particular by checking that they are ISO 11143 certified.

We consider it important to point out that some dentists may be using amalgam separators that do not comply with the by-law, since some equipment suppliers have not yet been able to produce proof of certification. The city of Montréal considers their equipment to be non-compliant.

The city wishes to remind dentists that the operator of a dental office, and not the equipment supplier, is solely responsible for applying the by-laws in effect on the Island of Montréal.

[Translation] “The operator of a dental office must ensure that all water that could possibly come into contact with amalgam waste is treated by an amalgam separator with at least 95% removal efficiency of dental amalgam by weight and certified ISO 11143 before being discharged into the sewer system.”

For more information, contact the city of Montreal Division du Contrôle des rejets industriels at 514 280-4330

• Consult the by-law (PDF 194 Kb) (in French only)

• Information leaflet (PDF 598 Kb) (in French only)

The new Environment Canada requirements concerning the disposal of dental amalgam waste stipulate that dentists must have implemented a number of best management practices, including:

• installing an ISO 11143-certified amalgam separator;
• using a certified hazardous waste carrier for recycling
  or disposing of amalgam waste;
• not discarding amalgam waste in the trash, down the drain,
  in the sharps container or with biomedical waste.

Protocol for the management of contaminated water

The municipality where you practice dentistry may issue, if necessary, a notice to boil water before drinking it. The following recommendations were developed, after consulting specialists, in order to respond to your needs.

During the entire time the notice is in effect

1. For all surgery relative to gums and bone, including root canal treatments, it is vital to use only apparatuses with sterile water or sterile saline solution.
2. For fillings or other dental interventions, such as polishing, the alternatives to remember are:
   
   
   1. use bottled, boiled, distilled or sterile water with an aspirator or a syringe;
   2. if your apparatus has a reservoir, it is sufficient to fill it with bottled, boiled or even sterile water. You must, however, drain the lines with this water before using it.
      
      
3. Patients must use boiled, bottled or distilled water to rinse their mouths.
4. Use clean water (bottled or previously boiled) to wash your hands or use antibacterial foam or gel.

These measures must be followed until the notice to boil water is lifted.

When the notice is lifted

1. If the dental unit is not equipped with a reservoir for sterile water, all the water lines must be opened to their maximum for at least 30 minutes in order to drain any contaminated water.
2. Once the water lines are drained, they must be disinfected according to the manufacturer's instructions if the unit is equipped with an integrated disinfection system.

N.B.: It is important that these procedures be followed even if the clinic was closed during the time the notice was in effect (e.g., if you are on vacation during this period).

ODQ Board of Directors
September 2001

The Order's Position on Management of Dental Waste

Dental offices produce a certain amount of waste every day, including hazardous waste that can harm the environment if it is not managed properly.

ODQ's Executive Committee adopted a resolution on best management practices for dental waste, with a view to protecting the environment. The goal is to limit and if possible eliminate environmental pollution owing to dental waste produced by dental offices in Quebec.

In doing so, the Order is endorsing the position statement adopted by Health Canada and supported by the Canadian Dental Association. The Order also recommends that the professional inspection protocol be amended so as to make Quebec dentists aware of applicable regulations and proper management of hazardous waste from dental offices.

Environment Canada has produced an electronic guide entitled Dental Wastes: Best Management Practices, which can be consulted at www.ec.gc.ca/mercury/da/onbmp/EN/main.cfm. The purpose of the guide is to inform dental professionals on how to manage hazardous waste so as to minimize the release of toxic substances into the environment.

The guide contains useful information on managing waste, pollution-prevention tips tailored to dental practices and details on waste-management regulations and legislation applicable to dental professionals.

Executive Committee
May 2006

See the sites below for information on contacting the organization that handles the recycling of hazardous waste in your municipality.
www.recyc-quebec.gouv.qc.ca
www.ecs-cares.com
http://ville.montreal.qc.ca

July 2, 2013

The Ordre des dentistes du Québec salutes the decision by the Direction de santé publique (DSP) to launch a campaign to fluoridate drinking water for half the population of Quebec over the next five years. This promising initiative reflects the importance for the DSP of the benefits linked to fluoridation for Quebecers.

The Ordre des dentistes du Québec, along with such international and national organizations as the World Health Organization and the Canadian Dental Association, unreservedly supports the fluoridation of drinking water, given its positive impact on dental health.

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Position of the Ordre des dentistes du Québec on Water fluoridation

The Ordre des dentistes du Québec supports the judicious use of fluoride with a view to preventing dental caries, including the fluoridation of drinking water.

Fluoride acts in several ways to prevent and slow the development of caries. It prevents the demineralization of tooth enamel and encourages remineralization. The pre-eruptive systemic effect occurs while teeth are forming and maturing.

Fluoride is incorporated into the tooth enamel and dentine at that point and makes them more resistant to caries. The post-eruptive systemic effect is the topical action of the fluoride excreted in oral fluids after ingestion.

The fluoride contained in most toothpaste, some brands of mouthwash and professional applications by dentists also has a topical action on teeth.

Water fluoridation

Along with the World Health Organization, the Canadian Dental Association and Quebec public health authorities, the Ordre des dentistes du Québec considers that water fluoridation is an effective, safe and inexpensive public health tool for reducing dental caries among people of all ages.

Accordingly, and so as to improve all Quebecers’ dental health, the Ordre des dentistes du Québec encourages everyone to use fluoride and endorses the efforts of organizations working to encourage Quebec municipalities to fluoridate their drinking water.

ODQ Board of Directors
March 2008

Code d’éthique et de conduite des membres du conseil d’administration et des comités de l’Ordre des dentistes du Québec

 

Policy of the Ordre des dentistes du Québec regarding documents and information accessible without restriction

 

Mission of the Order

The Ordre des dentistes du Québec was founded to protect the public. Its mission is to maintain quality dental services through adherence to high standards of practice and ethical conduct, and to promote oral health among Quebecers.

Mission of the Journal

The Journal de l’Ordre des dentistes du Québec (the Journal), published by the Public Affairs and Communications Department, is a tool for strengthening the dental community. Its mission is to provide members with various information relating to the Order, in particular as concerns its activities, services, decisions and policies. The Journal also contributes to upgrading and maintaining dentists’ knowledge by publishing scientific articles on different aspects of dentistry.

Editorial content

Each issue of the Journal contains regular columns of interest to members and scientific articles on a theme chosen by the Public Affairs and Communications Department, in co-operation with the person in charge of scientific content in the Journal. The publisher, i.e. the Ordre des dentistes du Québec, reserves the right at all times to refuse to publish any material that conflicts with the mission of the Order.

Advertising content - Goods and services

Barring exceptional cases, advertisements (in French) for goods and services may be printed in the Journal or included as inserts with the magazine. Note that advertisements carried in the Journal must not mention the price of the product or service concerned, regardless of whether it is the regular price or a special offer. All advertising be approved in advance by the publisher. The fact that an advertiser’s goods and services appear in the Journal does not constitute an endorsement or guarantee of their quality or content by the Ordre des dentistes du Québec. The publisher may at all times refuse to publish an advertisement or advertising insert if its content conflicts with the Code of Ethics, acts and regulations governing the practice of dentistry or the mission of the Order.

Advertising content - Training activities

The Journal accepts advertisements for training activities given by preferred partners recognized by the Order, as stipulated in its Continuing Dental Education Policy. These partners are Quebec dental societies, Quebec dental schools and their affiliated university hospital centres, Quebec specialists’ associations, study clubs approved by the Order, the Federation of Dental Specialists of Quebec and the Association des chirurgiens dentistes du Québec. It is the policy of the Journal not to accept advertisements related to training courses offered by dentists, promoters or other parties if that training is related to a product, treatment approach or technique, for example.

The publisher reserves the right to publish summary information in the Journal related to national and international conventions and congresses (e.g. location, date and contact information).

Rates

The rates charged for classified advertisements, subscriptions and advertising space are published on the Order’s Website and reviewed annually during the budget preparation process. The Order also grants its preferred partners a reduction on the regular rate for advertising space.

Publication frequency

The Journal de l’Ordre des dentistes du Québec is published six times a year.

Copyright

All articles, texts, illustrations and photos published in the Journal are the property of the Ordre des dentistes du Québec. When articles are accepted for publication, the copyright is transferred to the Journal de l’Ordre des dentistes du Québec, which may later authorize the reproduction of part or all of the material published.