ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Chlorine Containing Water Line Disinfectants/Cleaners Used in Dental Offices Release Mercury
Clinical Question Do chlorine-containing water line disinfectants/cleaners used in dental offices release more mercury when compared with non-chlorinated solutions?
Clinical Bottom Line Chlorine containing water line disinfectants/cleaners used in dental offices release more mercury when compared with non-chlorinated solutions; therefore, any dental offices using chlorine containing line disinfectants/cleaners, like sodium hypochlorite, should switch to a non chlorine disinfectant/cleaner. (See Comments on the CAT below)
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 17012722Batchu/2006Tested 47 disinfectants or line cleaners prepared to manufacturer's recommendationsLaboratory Study
Key resultsWater-line cleaners containing sodium hypochlorite, sodium dichloroisocyanate, and ethylenediaminetetraacetic acid release significantly more mercury from amalgam than deionized water (P<.001).
#2) 18973926Stone/2009Twenty-five amalgam samples.Laboratory Study
Key resultsDental Amalgam treated with chloramines released much less mercury than dental amalgam treated with chlorine with significant differences between 10 mg/L chlorine compared to those of 1 mg/L and 10 mg/L chloramine.
#3) 16060472Roberts/2005Nine disinfectant solutions tested on samples of high copper spherical amalgam in dental amalgamatorLaboratory study
Key resultsChlorine disinfectant solutions discharged the most mercury ions when compared to bromide, iodophor, peroxide/peracetic acid, phenolic, and quaternary ammonium compounds.
Evidence Search Search (("Dental Amalgam"[Mesh] AND "Dental Amalgam"[Mesh]) AND "Mercury"[Mesh]) AND "Chlorine"[Mesh]Search ("Dental Amalgam"[Mesh] AND "Dental Amalgam"[Mesh]) AND "Mercury"[Mesh], Search "Dental Amalgam"[Mesh] AND "Disinfectants"[Mesh]
Comments on
The Evidence
For the Batchu study, the abstract did not include the any statistical methods of analysis, number of trials, confidence interval, and t value. Thus it was not completely effective in determining the value of data. There was also "potential" competing interests involved since this study was sponsored by Septodont, which was not mentioned in the abstract. For the Stone study, the abstract did not include p values and confidence interval. Thus it was not completely effective in determining the value of data. For the Robert’s study, the abstract did not include the number of trials, sample size, confidence interval, and p value. Thus it was ineffective in determining the value of data. There was also "potential" competing interests involved since this study was sponsored by Septodont, which was not mentioned in the abstract. Even though these studies did use data from other studies for reference, there was no evidence of the data from these references being validated.
Applicability The information can be useful for a dental practice, but does require more data. A more applicable control, other than water, should be used for better comparison in a clinical setting.
Specialty/Discipline (Public Health) (Oral Medicine/Pathology/Radiology) (Endodontics) (General Dentistry) (Pediatric Dentistry) (Prosthodontics) (Restorative Dentistry)
Keywords Amalgam; mercury; disinfectants; amalgam disposal; amalgam disinfection; line cleaners; dental unit water lines; amalgam waste water; mercury.
ID# 604
Date of submission: 05/12/2010spacer
E-mail samuelt@livemail.uthscsa.ed
Author Tom A. Samuel
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Irene Bober-Moken, DMD, MPH
Faculty mentor/Co-author e-mail bobermoken@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
post a rationale
None available
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Comments on the CAT
(FOR PRACTICING DENTISTS' and/or FACULTY COMMENTS ON PUBLISHED CATs)
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by Shingmei Chang, Nicoleta Ene, Adam Pfeifer (San Antonio, TX) on 01/07/2013
A PudMed search conducted in January 2013 showed no new research regarding this topic. The CAT presented included the most recent research that proved chlorine disinfectants used in dental offices release more mercury than other comparable disinfectants.
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