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

Bloodborne Infections
and Public Protection

Publication :	February 2005
Editor :	Ordre des dentistes du Québec
Download :	Document (PDF 146 Kb)

CDA Statement of principle on
the delivery of oral health care
adopted by the ODQ

The dentist is accountable for the patient's overall oral health care and coordinates delivery because he or she is the only professional qualified by educational preparation to provide a comprehensive differential diagnosis of oral health status, to plan and render treatment and to prescribe or refer specific aspects of treatment. Comprehensive patient oral health care cannot be achieved without coordination by the dentist. Services provided by other oral health care occupations are components of comprehensive oral health care and should not be offered in isolation.

CDA Board of Governors
September 1997

ODQ Board of Directors
November 1998

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.

Guidelines for Implant Supported Rehabilitation

Publication :	May 2000
Editor :	Ordre des dentistes du Québec
Download :	Document (PDF 146 Kb)

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

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,
Deep Sedation or General Anesthesia for a Dental
Practice Outside of a Hospital Setting

Taking into account the information actually available today and the factors relative to accessibility to care, the Ordre des dentistes du Québec, guided by its mission of protecting the public-at-large, has developed this document. Its purpose is to provide for and propose to Quebec dentists structured elements of information susceptible of supporting them in the pursuit of their therapeutic objectives.

The general purpose of these guidelines in their application relative to the choice of sedative agents or the techniques used is based on established protocol and norms. They are to be controlled by properly trained practitioners, constraints imposed by the patient or the procedure and the probability to induce an unintentional loss of consciousness.

Professional liability remains a reality. We would, therefore, like to highlight all the ethical obligations that are applicable to everyone.

This document will be reviewed on a regular basis in order to keep it up-to-date.

The members of the Board of Directors of the Ordre des dentistes du Québec would like to graciously thank Doctors Kenneth Bentley, Patrick Canonne, Norman Pierre Edger, David Kozloff and Paul-Richard Trépanier for their expertise and their most appreciated collaboration. They would also like to thank everyone who took the time to comment on the preliminary drafts of this document.

1. Definitions

1.1 Conscious Sedation

Conscious sedation is a minimally depressed level of consciousness that allows the patient to retain control of their airways and respond appropriately to physical stimulation and verbal command. It is produced by a pharmacological or nonpharmacological method or a combination thereof.

In dentistry, conscious sedation is used to allow dental treatment to be performed with minimal physiological and psychological stress and therefore enhance patient comfort. Conscious sedation techniques must be used in such a fashion that the loss of consciousness is avoided or in other words the patient can control the permeability of their airways and respond appropriately to physical stimulation and verbal command.

Conscious sedation may be pharmacologically induced by one of the following modalities:

1. nitrous oxide and oxygen inhalation;
2. oral administration of a single sedative agent or a combination of sedative agents;
3. the combination of nitrous oxide/oxygen inhalation with the oral administration of a sedative or sedatives;
4. parenteral (intravenous, intramuscular) administration of medication;
5. rectal administration of medication.

1.2 Deep Sedation

Deep sedation is a controlled state of depressed consciousness accompanied by partial loss of protective reflexes, including the inability of a patient to control their airways and the inability to respond appropriately to physical stimulation and verbal command.

1.3 General Anesthesia

General anesthesia is a controlled state of unconsciousness accompanied by partial or complete loss of protective reflexes, including the inability to control one's airways or respond spontaneously to physical stimulation or verbal command. The terms "deep sedation" and "general anesthesia" apply to all techniques that depress the state of consciousness of a patient beyond that of conscious sedation and includes neuroleptanalgesia and dissociated anesthesia.

2. General Principles

2.1 All Modalities

The following principles apply to all the modalities of sedation or general anesthesia when they are used by dentists.

1. A dentist must have successfully completed a recognized training program designed according to requirements detailed in Section 3 to attain the competency required with regard to the administration of conscious sedation, deep sedation and general anesthesia techniques.
2. There must be sufficient personnel in the practice facility. The armamentarium (equipment) necessary for the procedures dispensed must be available on site and must conform to the standards of the Canadian Standards Association (CSA). The equipment (see Annex 1) should be maintained in a manner in which to assure they function properly and in conformity with the original norms of the manufacturer and installation.
3. Pertinent medical and dental history must be clearly documented and annotated. This should include: the description of present and past diseases, hospitalizations, actual medication and their dosage and the history of allergies (especially to medication). An appropriate functional investigation and physical examination must be completed for each patient before the administration of all forms of conscious sedation or general anesthesia. The physical status of the patient should be determined according to the classification of the American Society of Anesthesiologists (ASA). All forms of conscious sedation and general anesthesia should be limited to patients of ASA-I or ASA-II status.
4. Only a dentist having successfully completed a recognized training program or a physician licensed in Quebec, a nurse licensed in Quebec working under the direct supervision and control of a physician, can administer a sedative or a general anesthesia agent.
5. A dentist and his personnel must be prepared to recognize and to treat any inadequate reaction to medication administered. They must use appropriate emergency methods and equipment and make sure that they maintain their level of competency with regard to their respective employment. A dentist and all clinical personnel must have a current cardiopulmonary resuscitation certificate and be able to provide basic cardiopulmonary resuscitation techniques. A dentist must establish the pertinent protocol for emergency procedures. He must inform his personnel and review the protocol with them on a regular basis.

2.2 Conscious Sedation

1. A dentist who administers conscious sedation techniques must be recognized by the Ordre des dentistes du Québec as having the necessary requirements and must be registered in this regard with the O.D.Q.
2. The successful completion of a training program recognized by the O.D.Q. and developed to achieve a level of competency required for a specific modality of conscious sedation is mandatory. Such a program can be offered by dental faculties or within the framework of a continuing education program. It should be:
   • organized and taught by dentists recognized by the O.D.Q. as having the competency to administer general anesthesia and conscious sedation as they apply to dentistry. They would be assisted, as necessary, by other professionals recognized in relation to the techniques that are taught;
   • understood that this teaching would be provided in an adequate environment which allows the candidate to apply the techniques taught, on patients during dental treatment;
   • mandatory that the candidate be given a written evaluation attesting to the level of competency attained with regard to a specific type of conscious sedation administration.
3. Preoperative and postoperative instructions must be given in writing to the patient or a responsible adult who accompanies the patient during the visit prior to treatment.
4. If a dentist administers parenteral conscious sedation and concurrently acts as the provider of dental services, he must be assisted by the necessary personnel (see Section 4).
5. Written consent from the patient or from a responsible adult accompanying the patient must be obtained prior to the administration of conscious sedation.
6. During any intervention where the patient's level of consciousness is altered, the presence of a third person (e.g.: assistant) is required.
7. A dentist who is responsible for the administration of conscious sedation must never leave his patient unattended.
8. The professional who administers the sedative technique must evaluate the physical status of the patient before signing for the discharge of the patient. He must never leave the premises before the patient is deemed to be able to leave.
9. With the exception of nitrous oxide and oxygen used as a separate entity, all conscious sedation techniques require, that when the patient is discharged, that the patient be entrusted to a responsible adult. The patient must be informed that they not drive a car, that they not operate hazardous machinery, that they not make important decisions and that they avoid drinking alcohol for a minimal period of 18 hours or more if drowsiness or dizziness persists.

3. Specific Principles

3.1 Oral administration of a single sedative agent

A medication can be used to induce conscious sedation. Preferably it should be administered in the dental office. The patient's level of consciousness must be controlled by clinical observation and the assessment of vital signs. When the patient is discharged, the patient must be entrusted to a responsible adult. The dentist must have a cardiopulmonary resuscitation certificate.

3.2 The use of nitrous oxide with or without one or more oral sedative agent(s) and the use of multiple oral sedative agents

The use of nitrous oxide alone or in combination with an oral sedative agent or oral sedative agents can be administered by:

1. a qualified dentist having completed specialized training in conscious sedation (parenteral pathway) in a university or hospital setting.
2. a specialist in oral and maxillofacial surgery with adequate training in sedation and general anesthesia.
3. a dentist having successfully completed specific training in this modality of sedation.

This training will satisfy the following requirements:

Didactic requirements : 20 hours of courses given by a dentist formally trained for sedation and anesthesia as it applies to dentistry or by a physician formally trained in anesthesia

Clinical requirements : Active and supervised application of these modalities in the treatment of a minimum of 10 patients; and the equivalent of a 2 week rotation in the anesthesia department of a universityhospital with active participation in the administration of general anesthesia including venipuncture, endotracheal intubation and airway maintenance; or the successful completion of training in advanced cardiopulmonary resuscitation (Advanced Cardiac Life Support - ACLS) or its equivalent.

In the three above-mentioned cases, the dentist should have a valid cardiopulmonary resuscitation certificate.

3.3 Parenteral Conscious Sedation

The use of parenteral conscious sedation with one or more sedative agents can be administered by:

1. a specialist in oral or maxillofacial surgery having specific training for the administration of conscious sedation and general anesthesia; or
2. a dentist having successfully completed specialized training in a university or hospital setting for the use of sedation and general anesthesia. Such a course must be approved by the O.D.Q. and be given by an accredited dental institution. It must also meet the following clinical and theoretical requirements:

   Didactic Requirements

   • Training consists of a minimum of 12 months of specialized study in a university or hospital setting.

   Clinical Requirements

   • Clinical training consists of the supervised administration of parenteral conscious sedation techniques concurrent with dental treatment, as well as, training in general anesthesia.

   • The successful completion of an advanced cardiopulmonary resuscitation course (ACLS) or its equivalent is recommended.

3.4 Deep Sedation and General Anesthesia

1. A dentist who administers deep sedation or general anesthesia must be recognized by the O.D.Q. as having the required qualifications and be registered as such with the Order.
2. All private dental offices that offer deep sedation or general anesthesia services must be registered with the O.D.Q. A permit in this regard will be issued by the Order if it is found that the personnel have had adequate training and if conformance with these guidelines is found to be satisfactory. The permit issued is valid for three years.
3. Deep sedation or general anesthesia must only be administered to patients of ASA-I or ASA-II status (according to the classification of the American Society of Anesthesiologists (ASA), by a qualified professional according to the following principles:
   • a dentist who has an O.D.Q. specialist's certificate in oral and maxillofacial surgery where specific training in sedation and general anesthesia has been evaluated through the program.
   • a dentist who has successfully completed a postgraduate program in deep sedation and general anesthesia in a university and/or teaching hospital setting.
   • a licensed physician in Quebec able and competent to administer deep sedation or general anesthesia.
4. A dentist cannot administer deep sedation or general anesthesia and provide dental services at the same time.
5. Preoperative and postoperative instructions must be given in writing to the patient or a responsible adult who accompanies the patient during the visit prior to treatment.
6. Written consent from the patient or from a responsible adult accompanying the patient must be obtained before the administration of deep sedation or general anesthesia.
7. During any intervention where the patient's level of consciousness is altered, the presence of a third person (e.g.: assistant) is required.
8. The patient must never be left unattended by the dentist responsible for the administration of deep sedation or general anesthesia.
9. The professional who administers the sedative technique must evaluate the physical status of the patient before signing for the discharge of the patient. He must never leave the premises before the patient is deemed able to leave.
10. Deep sedation and general anesthesia techniques require that the patient be entrusted to a responsible adult when discharged.

4. Teams

4.1 Conscious Sedation Team (oral pathway and parenteral pathway)

The administration of nitrous oxide itself or in combination with one or more sedative agent(s) by the oral pathway and parenteral conscious sedation administered to ambulatory dental patients must be provided by a conscious sedation team. The conscious sedation team shall consist of the following individuals:

1. A DENTIST, duly qualified, responsible for the conscious sedation team and the dental procedures and having a cardiopulmonary resuscitation certificate.
2. AN ASSISTANT who under the supervision and responsibility of a dentist assures that the operative field is free of blood, mucous and debris. Once the operative procedure is over, an assistant supervises and monitors the patient while they awaken (recovery). This person must have a cardiopulmonary resuscitation certificate. A third person can also be responsible for recovery. One cannot fulfill the two duties (assistant and recovery supervisor) simultaneously when more than one patient is in the process of treatment.
3. ADMINISTRATIVE SUPPORT STAFF do the necessary clerical duties in order to not disturb the conscious sedation team.

4.2 Deep Sedation Team and General Anesthesia Team

General anesthesia or deep sedation for ambulatory dental patients must be administered through the combined efforts of the general anesthesia team. The general anesthesia team shall consist of the following individuals:

1. A DENTIST responsible for the dental procedure and having a cardiopulmonary resuscitation certificate.
2. AN ANESTHESIOLOGIST OR A DULY QUALIFIED DENTIST having postdoctoral training specifically for the administration and management of the modalities of deep sedation and general anesthesia. This dentist shall also have Advanced Cardiac Life Support (ACLS) certification or its equivalent.
3. AN INHALOTHERAPIST having a valid permit to practice in Quebec. The inhalotherapist acts under the direction of a physician. The presence of an inhalotherapist is optional.
4. AN ASSISTANT who under the supervision and responsibility of a dentist assures that the operative field is free of blood, mucous and debris. Once the operative procedure is over, the assistant supervises and monitors the patient while they awaken (recovery). This person must have a cardiopulmonary resuscitation certificate. A third person can also be responsible for recovery. One cannot fulfill the two duties (assistant and recovery supervisor) simultaneously when more than one patient is in the process of treatment.
5. ADMINISTRATIVE SUPPORT STAFF do the necessary clerical duties in order to not disturb the conscious sedation team.

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

Issued: May 2000

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

L’utilisation des mesures de contention

Publication :	September 2009
Editor :	Ordre des dentistes du Québec
Download :	Document (PDF 84 Kb) (French only)

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

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.

Guide to Using a Computer System for Keeping Patient Records

Publication :	June 2006
Editor :	Ordre des dentistes du Québec
Download :	Document (PDF 148 Kb)

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 (in French)

• Information leaflet (in French)

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.

or more information on these requirements, consult the fact sheet at www.ec.gc.ca

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

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

Supplement - Early Childhood Caries

Publication:	April 2006
Editor:	Ordre des dentistes du Québec
Download:	Document (PDF 794 Kb)

Supplement of Early detection of oral cancer

Publication:	February 2004
Editor:	Ordre des dentistes du Québec
Download:	Document (PDF 1.2Mb)

Brochure

Publication:	March 2004
Editor:	Ordre des dentistes du Québec
Download:	Document (PDF 94 Kb)

Supplement – Gum Disease (French only)

Publication:	April 2007
Editor:	Ordre des dentistes du Québec
Download:	Document (PDF 403 Kb)

Brochure

Publication:	April 2007
Editor:	Ordre des dentistes du Québec
Download:	Document (PDF 264 Kb)

Counselling Patients Who Smoke

Publication:	May 2005
Editor:	Ordre des dentistes du Québec
Download:	Document (PDF 794 Kb)

Educational Tool for Quitting Smoking

Publication :	July 2009
Editor :	Ordre des dentistes du Québec
Download :	Document (PDF 794 Kb)

Brochure

Publication:	May 2005
Editor:	Ordre des dentistes du Québec
Download:	Document (PDF 794 Kb)

Continuing Dental Education Policy

Publication :	January 2009
Editor :	Ordre des dentistes du Québec
Download :	Document (PDF 148 Kb)

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

Publication :	September 2007
Editor :	Ordre des dentistes du Québec
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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

Advertisements for goods and services may be published in the inside pages of the Journal or included as inserts with the magazine. All advertisements must be approved in advance by the Editor. 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 Editor may at all times refuse to publish any advertisement or include any 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 Editor 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.