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Accreditation in Dental Practices

Accreditation is a process in which certification of competency is achieved through compliance with established standards of ethical behaviour, safety and quality assurance.

SAS Dental is currently one of a group of dental practices involved in pilot program “The Early Adopters Scheme” which will be used by the ADA and the Australian Commission on Safetyand Quality in Health Care together with The National Safety and Quality Health Service Standards to establish Practitioner Accreditation for Dental Clinics. Soon all dental practices will need to be accredited like hospitals already are.

Acid

Latin for sour

  • An acid is a substance that releases hydrogen ions when dissolved in water
  • The acid in mouthes may originate from acidic drinks and foods such as soft drinks (ph under 4), fruit juices and lemons but more commonly originates from the bacteria found in plaque.
  • Sugar found in drinks and “foods” is digested by these bacteria which release lactic acid as a waste product, basically their urine!!
  • Calcium is an element that loves to build. It builds teeth; bones; shells; caves; buildings. It even tries to build calculus around the gum. It is what clogs up pipes and arteries (see Atherosclerosis and Heart Disease)
  • Teeth and bones are made of crystals of calcium phosphate and like most substance scan be dissolved by an acid. In the biulding industry hydrochloric acid is used to dissolve and clean excess cement.
  • It is the hydrogen ions from acids that break the bond between the calcium and phosphate of teeth (and possibly those in bones, such as in osteoporosis).
  • The root surface is more vulnerable to demineralization than enamel because cementum begins to demineralize at 6.7 pH, wheras enamel's critical pH is 5.5. 
    But roots have a greater potential for reuptake of fluoride than enamel.
  • The incorporation of fluoride into the calcium phosphate molecule of teeth makes it much harder for acids to break the now stronger bond.

beverage-acidity-scale
pH of some common liquids

acidic-beverages
Some acidic drinks

 

Aesthetics

Aesthetics or esthetics is a branch of philosophy dealing with the nature of beauty, art, and taste. It is more scientifically defined as the study of sensory or sensori-emotional values, also called judgments of taste. Critical reflections on nature allow the dentist to replicate natures beauty sometimes through mathematical relationships (see Golden Rule).

Alveolar Bone

or Jaw Bone The alveolar process is the thickened ridge of bone that contains the teeth The tooth bearing bones are called the maxilla and the mandible When teeth are lost the alveolar bone shrinks or resorbs backdown (vertical direction) and usually provides a dense smooth surface for the gum to cover Bone loss is only noticeable when teeth are removed from the front of the mouth. If teeth behind the canine are removed there is little effect on the lips or cheek, especially if replaced with an implant, bridge or denture Alveolar bone also shrinks in a horizontal direction: The maxilla generally shrinks backward and the mandible towards the front. This is especially the case if teeth are lost at a young age. Early last century, parents would gift their teenagers with “lovely new full dentures” so they wouldn’t have the same troubles they had with their teeth. The alveolar process contains a region of compact bone adjacent to the periodontal ligament called lamina dura. It is this part which is attached to the cementum of the roots by the periodontal ligament. The buccinatoror cheek muscle attaches to the alveolar processes of both the maxilla and mandible.

Amalgam

Mercury or Silver Fillings

amalgam

  • Also called silver fillings are composed of approximately 50% inorganic mercury mixed with silver (30-35%), tin (10-15%), copper (3-7%) and zinc (upto 1%)
    Mercury “dissoves” the ingredients and allows them to amalgamate into a new putty like alloy:
    • Silver imparts strength and durability
    • Tin makes the amalgam easier to work
    • Copper increases hardness
    • Zinc increases workability, and unites with oxygen and other "impurities" to produce a clean amalgam
  •  Although amalgams are composed of 50% elemental mercury the amount released during function is extremely small and there has been no conclusive evidence of any harmful systemic effects from this according to tha ADA, the World Health Organisation (WHO) and the National Health and Medical Research Council (NHMRC) in Australia See www.nhmrc.gov.au
    The report concluded that:
    “ No pivotal study has been published over the past 5-10 years providing unequivocal evidence of any hazard from the levels of mercury presently resulting from dental amalgam restorations ”
    In 1989 the World Dental Federation (FDI) performed a meta-analysis of the literature on mercury toxicity and concluded that there is no documented scientific evidence to show adverse effects from mercury in amalgam restorations except in extremely rare cases of mercury hypersensitivity
  • It has been reported that organic mercury from fish caught in polluted waters poses greater potential for harm
    Mercury Study Report to Congress. 3. Washington, D.C.: United States Environmental Protection Agency.
  • at Sydney Aesthetic Smiles we do not use amalgam in teeth and have not for over 20 years but we also do not recommend the routine removal of amalgams
  • History: Were first rcommended for use in Dentistry in 1895 by Dr C. V. Black, one of the founders of “modern dentistry”. He developed the concept of “extension for prevention” (opposite of MID) where the decay is first removed and then healthy tooth structure is also removed to provide adequate thickness and strength for the amalgam.  Today, modern white fillings are bonded to tooth structure and do not need the removal of healthy tooth material for strength or retention.
  • In 1983-4, amalgam was used in 68% of all fillings in Australia. By the late 1990’s this had reduced to less than 30% (NHMRC 1999)
  • Pregnancy and breastfeeding. 
    The NHMRC Working Party report states: “… general public and environmental health principles dictate that where possible exposure to mercury from dental amalgams be reduced where a safe and practical alternative exists. This becomes more prudent in special populations, including children, women in pregnancy and persons with existing kidney disease.”
    So, although no evidence to suggest you or your baby will be harmed because of amalgam, general principles of public health suggest that it is prudent to avoid any dental treatment that can be deferred.
  • ADVANTAGES OF AMALGAM OVER WHITE FILLINGS
    • Amalgams are much easier to adapt into cavities and are not as technique sensitive (although in order to improve mechanical properties, particularly strength and expansion, some skill is required to remove as much excess mercury as possible).
    • Amalgams can be used in a “moisture contaminated environment” (amalgams used here must not contain zinc as this can cause excessive expansion on setting with resulting pain and fracture
    • As an amalgam restoration ages in the oral cavity, corrosion products form along the restoration-tooth interface. These compounds act as a mechanical block to micro leakage and account for the excellent clinical results obtained with silver amalgam.
    • Are quicker and cheaper.
  •  DISADVANTAGES
    • The main problem with amalgam fillings we feel lies in the potential for damage to teeth. Greater drilling of teeth is required before placing silver fillings
      • Because amalgams are not bonded to teeth the tooth is not supported and weak sections of teeth are able to flex and eventually form cracks.
      • Amalgams also expand and contract greater than teeth and modern composites in response to temperature changes and thus can contribute to tooth fracture Thermal expansion coefficients 10-6/oC :  Enamel 17^; Dentine 11^; Amalgam 40-60*; Composite 18~ ^Versluis et al Dent Mater 1996; Sep12:290. *VOCO. Scientific Documentation~ Fraunhofer Institute for Silicate Research in Wurzburg  Grandio, Der HessischeZahnarzt 2006; 1:40
      • Finally, amalgams undergo something called static creep over the years and results in their expansion and cracking of teeth (see Cracked Teeth)
    • Many people object to amalgams appearance especially when it tarnishes and appears black.
    • The possibility of a localized sensitivity reaction to the metals contained in amalgam.
    • Less likely, but still a concern for many is the potential for systemic effects such as neurological and genetic damage caused by the high levels of mercury used in the alloy.
    • Environmental effects of manufacturing, handling and disposing of mercury.
      Finally, amalgam will also conduct heat or cold readily (high thermal conductivity). If the amalgam is placed too close to the pulp, it may irritate the pulp. Therefore, an intermediate base of zinc oxide-eugenol (oil of cloves) that will not conduct heat or cold as readily (low thermal conductivity) may be placed under the amalgam.
  • The most important physical properties of amalgam are:
    • Flow and creep. Flow and creep are characteristics that deal with an amalgam undergoing deformation when stressed. The lower the creep value of an amalgam, the better the marginal integrity of the restoration. Alloys with high copper content usually have lower creep values than the conventional silver-tin alloys.
    • dimensional change and
    • Strength.  Amalgam is a strong material with good compressive strength. Sufficient strength to resist fracture is an important requirement for any restorative material. At a 50 percent mercury content, the compression strength is approximately 52,000 pounds per square inch (psi). In comparison, the compressive strength of dentin and enamel is 30,000 psi and 100,000 psi, respectively. The strength of an amalgam is determined primarily by the compositionof the alloy,the amount of residual mercury remaining after condensation, and the degree of porosity in the amalgam restoration

Antibiotics

  • Are used to treat bacterial infections (selective toxicity) have no effect on other cells including viruses and mammalian cells.
  • each class inhibits a biochemical process in bacteria but is safe for the same reactions in humans, for example, chloramphenicol and puromycin inhibit the bacterial ribosome, but not the structurally different eukaryotic ribosome.

  • Improper use has a risk of resistance development
  • Used in intensive farming to promote animal growth, where they may be contributing to the rapid development of antibiotic resistance in bacterial populations.
  • Allergy to penicillin can result in anaphylaxis
  • For resistance prevention and effectiveness must be taken according to instructions:
    1. Two to three times a day
    2. For 5 to 7 days
  • Tend to deplete probiotic organisms

Australian Dental Association Inc.

ada-logo

The Australian Dental Association Inc. is the peak national professional bodyrepresenting over 10,000 registered dentists (over 90%).

Its members agree to abide by a code of ethics and to participate in on-going SYDNEY DENTAL GLOSSARY

The ADA, NSW Branch, was established in 1927 with the active support of the Faculty of Dentistry, Sydney University and in 1928 the federal body came into being.

ADA members workin both the public and private sectors.

The primary objectives of the ADA are:

  • to encourage the improvement of the oral and general health of the public
  • toadvance and promote the ethics, art and science of dentistry, and
  • to support members of the Association in enhancing their ability to provide safe, highquality professional oral health care.

Further information on theactivities of the ADA and its Branches can be found at www.ada.org.au

Book a Consultation todayBook now or simply call (02) 9556 2000 for more information.

 

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Bankstown Dental Voucher

We are an Accredited Dental Practice.
We are one of the first dental practices in Australia to achieve Accreditation.