The issues of safe amalgam removal, safe disposal of mercury, and effective air filtration have all played a part in our practice design, and we have provided links below to some of the solutions we have implemented.

Safe amalgam removal: we rigorously follow the guidelines established by the International Academy of Oral Medicine and Toxicology (IAOMT).

Safe mercury disposal: CMA Ecocycle mercury filter stopping 99.5% amalgam and Mercury going down into the waterways (one gramme of mercury will contaminate to an unsafe level, one BILLION litres of water).

Air filtration: the Iqair Perfect 16 and iqair dental series air filters are Swiss made total building filtration systems designed especially for dental clinics. the filters not only clean the air to within 0.003 microns, but also removes all mercury vapour and other dental fumes at the time of your consultation.

Healthy Water: Dental Wellness strives to have the healthiest water available to our clients bringing in water from Mount Tamborine and offering water filtration systems for your whole house.

Surgery lighting: we use full spectrum lighting that emulates natural sunlight. Full spectrum lighting has proven beneficial in the treatment of seasonal affective disorder.

Non-toxic paints: the issue of out-gassing from volatile organic compounds (VOC) in paints has been frequently identified as a cause of environmental toxicity. Dental Wellness has been completely painted in Wattly Id– a low VOC paint.

Digital x rays imaging: the very latest system by Schick, allowing instant digital images with minimal radiation exposure.

Digital photography for comprehensive patient education and visual input on informed choice.

When you think about it, the dental profession should be at the forefront of ecologicallysustainable business. There are few professions that can tie the wellbeing of clients so directly to tools and processes used in treatment, and tie that to environmental impact. It took years for a pilot program aimed at getting amalgam out of the water supply to get up and running. And some dentists, like Brisbane’s Dr David Cowhig, just went ahead and created a sustainable practice anyway. And he’s attracting patients from all over the country.

“We don’t advertise as such,” he says. “Our patients come to us via complementary and mainstream practitioners’ referrals, word of mouth and internet searches.”

Admittedly, it helps that Dr Cowhig’s been practicing holistic dentistry in Brisbane for just over a decade. After training at Kings College, London, and nine years of practice in the uk, he migrated to Australia in 1998 and opened a practice called Queensland Holistic Dentist in Brisbane. “After migrating to Australia, I did a fellowship with the Australian College of Nutritional & Environmental Medicine (acnem)” he says, “which opened my eyes to the affects of environmental toxins on the body and how subtle changes in a patient’s nutrition and lifestyle had a noticeable positive change in their dental and overall wellbeing.”

Dr Cowhig saw this particular path as an obvious one for him to pursue, as “dentistry has always been at the forefront of preventative medicine”.

“This eventually led to the rebranding of Queensland Holistic Dentist as Dental Wellness™, and set-up of the surgery at a new premises in the leafy suburb of The Gap, only ten minutes out of town.”

The decision to move out of the city was driven by his desire to create a working environment in harmony with its surroundings, and one that rejected the principles and philosophy of the practice.

“It was important for the practice to be established with the health of the staff, patients and environment in mind,” he says. “This was the major design brief when we were at the pre-construction phase. We were to take an old, 1930′s brick building and repurpose it. Aside from the aesthetic considerations at the new practice, foremost was the environmental footprint of the dental surgery.”

Cowhig actively sought out information from around the world on how to achieve those ends, particularly when it came to the issue of amalgam waste disposal.

Water worries

The issue of amalgam contamination and waste disposal are possibly the most significant environmental factors facing any dental practice. Quite aside from any debates on the safety or otherwise of mercury in fillings (and it’s worth noting that the ada’s position is that amalgam fillings are not toxic) — its environmental impact alone is enough to cause concern. According to the World Health Organisation, mercury contained in dental amalgam and in laboratory and medical devices account for about 53 per cent of the total mercury emissions in the UK.

The Australian Dental Association and the Australian Dental Industry Association have long been aware of the issues surrounding amalgam disposal, and began discussing ways of keeping mercury out of the water system in the mid-90s, but talks didn’t lead to any action until early 2002, when the ADA’s Victorian branch decided to get their teeth into the issue. It took a further three years for them to negotiate the maze of the state government, the EPA and water industry.

According to Ian Crawford, project coordinator of Dentists of Cleaner Water, “Fast forward to 2007, in August or September, the state government here in Victoria said ‘yes, we’re happy to run with it’. The EPA and water industry put money into a rebate, which said every private practice has to have a separator put into their waterline to prevent amalgam getting into the system.

“Two years ago, that happened, and I was approached in November 2007 to be project manager of a three-and-a-half year term to end in June 2011. My task is to make sure each practice conforms and has a separator. Dentists for Cleaner Water was officially launched in August last year by Gavin Jennings, Minister of the Environment, Climate Change and Innovation.”

Examples of amalgam separation (from left to right): Cattani Turbo SMART suction system fitted with Hydrocyclone Amalgam Retention device, and the Cattani Hydrocyclone Amalgam Retention device on its own.

Crawford says the project, which currently runs only in Victoria, has been received extremely positively by the profession, a situation helped by the rebate offered by the EPA and water industry.

“It’s been absolutely a positive response,” he says. “I don’t think I could count the negative responses on one hand. I keep a record here of what I’m doing, and I have filed over 700 phone calls from practices, and I can assure you once it’s explained there’s virtually no negativity. It’s been in Europe for a long time, in the us, and launched in New Zealand a year ago, but we’re the only place in the world that offers a rebate.”

And the early signs have been good—the initial targets set for signing practices up to Dentists for Cleaner Water have been exceeded, with more than 250 of the roughly 900 eligible practices in the state putting in amalgam separators at press time.

Mercury falling

According to David Cowhig, “Waste management, air quality, lighting and water quality are the most pressing environmental issues facing all dental practices. Amalgam waste, photographic chemicals, lead shielding of films and volatile solvents are all potentially hazardous.”

At Dental Wellness™ they installed a CMA Ecocycle mercury filtration system, trapping 99.5 per cent of mercury amalgam waste from going into the waste waterways. CMA states that one gram of amalgam waste can potentially contaminate one billion litres of water to a toxic level. Dr Cowhig also points out that the issue of mercury pollution is becoming an issue for global debate, citing the chair of the White House’s council on environmental quality, who said, “The United States will play a leading role in working with other nations to craft a global, legally binding agreement that will prevent the spread of mercury into the environment”.

As well as the mercury filtration system, Dr Cowhig has installed Swiss Iqair Perfect 16 and Iqair dental series air filters, which clean the air to within 0.003 Microns and remove potentially harmful mercury and solvent vapours while carrying out metal-free dentistry. Non-toxic paint on the walls, ?ltered water and full-spectrum lighting that emulates natural sunlight are also present for the bene?t of patients, staff and the dentist.

And the philosophy of a cleaner, more eco-friendly practice may soon be pushed in other states, according to Ian Crawford. He says there’s strong interest in Dentists for Cleaner Water in Queensland and New South Wales, although they’re generally waiting to see the outcome of the Victorian trial before going ahead. “But the water boards are different in those states, and the state adas have to get together with those funding agencies to do it,” Crawford explains. “The water boards don’t have the same budgets. There’s been very preliminary talks that have started between those state epas and water boards, but it’s in its infancy.”

The world, and indeed our own federal politics, is divided over the issue of climate change and emissions trading schemes, but perhaps on a more individual level we could do with taking a closer look at the environmental footprint of our own dental practices in regards to waste products of the industry such as mercury amalgam once it is removed from your mouth.

Just recently, our Minister for the Environment, Peter Garrett, created a National Waste Management Policy in order to prioritise waste issues and ways to address them. In light of this, over the past couple of years there have been made available many innovative and effective dental waste management options that not only collect mercury amalgam waste from our suction units, preventing it entering our waterways, but recycling it too. With these systems available it could be argued that our profession now has a duty of care to both our patients and to our environment.

The theme of environmental responsibility is continued in this edition of Smile with the promotion of a totally recyclable bamboo toothbrush. The brainchild of Brisbane dentist Dr Natalya Taylor, it’s a small change that can make a real, measurable difference to the health of the environment.

An article introducing my Dental WellnessTM concept in Brisbane also covers the issues of environmental responsibility when designing a state- of-the-art dental surgery. The Dental WellnessTM concept encompasses a holistic philosophy towards patients and staff and the environment, taking a pro-active wellness model to the dental industry as well as a business model for duplication.

Dr David Cowhig
Dental Wellness, Brisbane

Holistic dentistry has not been a field widely embraced by dental professionals. But the tide is turning, with more patients—and now dentists—recognising its healing powers.

The face of dentistry is changing. Not just because of all the snazzy new equipment on the market, but also in the practitioner’s approach to patient health. To this end, holistic dentistry is coming on strong, with a growing number of patients now seeking this kind of treatment—and, in turn, more practitioners specialising in the practice. But just how does it differ from traditional dentistry?

Dr David Cowhig, of Queensland Holistic Dental, believes it’s important not to focus on the differences, but instead recognise how the two practices complement one another. “Holistic dentistry integrates the philosophies of traditional and complementary medicine with the practice of dental excellence. It works with many traditional and complementary practitioners.”

Dr Ron Ehrlich, of Sydney’s Holistic Dental Centre, agrees, claiming the philosophy of holistic dentistry falls directly
under general medicine—and a patient’s overall health.

“Holistic dentistry relates your oral health to your general health. We started practicing along these lines in 1983, and 24 years later it really doesn’t seem like such a radical idea,” he says. “The body is all connected. The same blood that flows through an infected gum or tooth flows through the rest of the body.”

Despite the connection, mainstream and holistic dentistry is still somewhat at odds, with professionals on either side of the treatment fence approaching patients’ oral health needs differently. It’s this aspect that hits a nerve with holistic naysayers. But Ehrlich believes the negativity is unwarranted: “We are talking about the way the whole body is inter-connected. That is the essence of holistic healthcare. Most patients really don’t have trouble understanding that,” he argues. “What is there not to believe in?”

“If periodontal disease is now well documented to effect general health, infections in teeth and jaw bones also have the potential to harm. We need to be more open to this,” Ehrlich says. “We’ve also lost our way in understanding the treatment of headaches, which on the one hand involves prescription drugs, and on the other hand, orthodontic or reconstruction treatment in the guise of solving the problem.”

“In my opinion, the main hurdle holistic dentistry has to overcome is the move away from the negative aspects that ‘holistic’ represents, towards a more mainstream idea of dentistry—especially with the anti-this and anti-that groups—that allows dentists
to market themselves as representing a positive, preventative philosophy,” Cowhig says. “It’s a philosophy attracting a large percentage of the population who want better health and wellbeing. In this way, more GPs will be attracted to the field, primarily encouraged by patients’ demands.”

When it comes to their health, patients want advice on the ‘whole package’. And they’re also approaching dentists with more complex complaints than a sore tooth— there are more headaches and TMJ dysfunction, causing ear and neck pain.

While traditional dentists will look for traditional solutions, holistic dentists take a broader approach. An example is the promotion of drug-free pain management to to deal with several dental complaints such as inflammation, infection, stress, bruxism, TMD, anxiety and post-surgical recovery. “Holistic dentistry accepts the fact that the health of the mouth—soft tissue, dentition, periodontium, jaw bones—and its function has a major impact on the patient’s overall health and wellbeing,” says Cowhig.

“Clenching of the jaw muscles, for example, affects the muscles through the rest of the body—particularly those in the back of the neck and head. This kind of problem also plays a significant role in the treatment of tension headaches, neck aches and migraines,” states Ehrlich.

In fact, Cowhig says new research has strengthened the case for a holistic approach, verifying connections between oral health and illness like cardiovascular disease, diabetes or premature births. “In the future, all dentists may one day proclaim that they are holistic,” he says.

The future of holistic dentistry does look bright, as the benefits become more evident both within the dental industry and with the general public. “Healthcare during the last century has been characterised by compartmentalising specialities, which has yielded some great advances in our understanding. But healthcare in the 21st Century will be characterised by putting that knowledge together in a holistic approach. I imagine dentistry will find another word for it in the next 10 years, but we are all moving in that direction,” Ehrlich says.

“The future direction of dentistry is developing at a rapid rate, and any dentist —either traditional or holistic— needs to keep up to date with these scientific advances. The field avoids the use of metals in the mouth, and now with the inception of all ceramic zirconia crowns and bridges, as well as future ceramic implants, it is very exciting,” says Cowhig.

But for now, holistic dentists still face some significant obstacles. “Healthcare delivery is a great challenge for us all. Learning more about the body and how best to promote its ability towards homeostasis and general good health is a challenge for all of us—both practitioners and patients alike.

Both Ehrlich and Cowhig are ready to face the challenges and focus on healing patients with the best treatments available. “As a holistic dentist, I find this to be an exciting time. I hope the rest of the profession agrees.”

Dentists are moving towards more environmentally friendly methods and materials with programs like Dentists for Cleaner Water. But some are taking their own steps towards a more sustainable practice.

When you think about it, the dental profession should be at the forefront of ecologically-sustainable business. There are few professions that can tie the wellbeing of clients so directly to tools and processes used in treatment, and tie that to environmental impact. It took years for a pilot program aimed at getting amalgam out of the water supply to get up and running. And some dentists, like Brisbane’s Dr David Cowhig, just went ahead and created a sustainable practice anyway. And he’s attracting patients from all over the country.

“We don’t advertise as such,” he says. “Our patients come to us via complementary and mainstream practitioners’ referrals, word of mouth and internet searches.”

Admittedly, it helps that Dr Cowhig’s been practicing holistic dentistry in Brisbane for just over a decade. After training at Kings College, London, and nine years of practice in the UK, he migrated to Australia in 1998 and opened a practice called Queensland Holistic Dentist in Brisbane. “After migrat- ing to Australia, I did a fellowship with the Australian College of Nutritional & Environmental Medicine (ACNEM),” he says, “which opened my eyes to the affects of environmental toxins on the body and how subtle changes in a patient’s nutrition and lifestyle had a noticeable positive change in their dental and overall wellbeing.”

Dr Cowhig saw this particular path as an obvious one for him to pursue, as “dentistry has always been at the forefront of preventative medicine”.

“This eventually led to the rebranding of Queensland Ho- listic Dentist as Dental Wellness, and set-up of the surgery at a new premises in the leafy suburb of The Gap, only ten minutes out of town.” The decision to move out of the city was driven by his desire to create a working environment in harmony with its surroundings, and one that reflected the principles and philosophy of the practice.

“It was important for the practice to be established with the health of the staff, patients and environment in mind,” he says. “This was the major design brief when we were at the pre-construction phase. Aside from the aesthetic considerations at the new practice, foremost was the environmental footprint of the dental surgery.”

Cowhig actively sought out information from around the world on how to achieve those ends, particularly when it came to the issue of amalgam waste disposal.

Water worries

The issue of amalgam contamination and waste disposal are possibly the most significant environmental factors facing any dental practice. Quite aside from any debates on the safety or otherwise of mercury in fillings (see the box on page 13 for the ADA’s posi- tion on amalgam fillings)—its environmental impact alone is enough to cause concern. According to the World Health Organisation, mercury in dental amalgam and in laboratory and medical devices account for about 53 per cent of the total mercury emissions in the UK.

The Australian Dental Association and the Australian Dental Industry Association have long been aware of the issues surrounding amalgam disposal, and began discussing ways of keeping mercury out of the water system in the mid-90s, but talks didn’t lead to any ac-
tion until early 2002, when the ADA’s Victorian branch decided to get their teeth into the issue. It took a further three years for them to negotiate the maze of the state government, the EPA and water industry.

According to Ian Crawford, project coordinator of Den- tists for Cleaner Water, “Fast forward to 2007, in August or September, the state government here in Victoria said ‘yes, we’re happy to run with it’. The EPA and water industry put money into a rebate, which said every private practice has to have a separator put into their waterline to prevent amal- gam getting into the system.

“Two years ago, that happened, and I was approached in November 2007 to be project manager for a three-and-a-half year term to end in June 2011. My task is to make sure each practice conforms and has a separator. Dentists for Cleaner Water was officially launched in August last year by Gavin Jennings, Minister for the Environment, Climate Change and Innovation.”

Crawford says the project, which currently runs only in Victoria, has been received extremely positively by the profession, a situation helped by the rebate offered by the EPA and water industry.

“It’s been absolutely a positive response,” he says. “I don’t think I could count the negative responses on one hand. I keep a record here of what I’m doing, and I have filed over 700 phone calls from practices, and I can assure you once it’s explained there’s virtually no negativity. It’s been in Europe for a long time, in the US, and launched in New Zealand a year ago, but we’re the only place in the world that offers a rebate.”

And the early signs have been good—the initial targets set for signing practices up to Dentists for Cleaner Water have been exceeded, with more than 250 of the roughly 900 eligible practices in the state putting in amalgam separators at press time.

Mercury falling

According to David Cowhig, “Waste management, air quality, lighting and water quality are the most pressing environmental issues facing all dental practices. Amalgam waste, photographic chemicals, lead shielding of films and volatile solvents are all potentially hazardous.”

At Dental Wellness they installed a CMA Ecocycle mercury filtration system, trapping 99.5 per cent of mercury amalgam waste from going
into the waste waterways. One gram of amalgam waste can potentially contaminate one billion litres of water to a toxic level. Dr Cowhig also points out that the issue of mercury pol- lution is becoming an issue for global debate, citing the chair of the White House’s council on environmental quality, who said, “The United States will play a leading role in working with other nations to craft a global, legally binding agreement that will prevent the spread of mer- cury into the environment”.

The philosophy of a cleaner, more eco-friendly practice may soon be pushed in other states, according to Ian Crawford. He says there’s strong interest in Dentists for Cleaner Water in Queensland and New South Wales, although they’re generally waiting to see the outcome of the Victorian trial before going ahead. “But the water boards are different in those states, and the state ADAs have to get together with those funding agencies to do it,” Crawford explains. “The water boards don’t have the same budgets. There’s been very preliminary talks that have started between those state EPAs and water boards, but it’s in its infancy.”

Is dental amalgam safe?

The Australian Dental Association (ADA) is pleased to support the U.S. Food and Drug Administration’s reaffirmed view that dental amalgam is a safe, effective material for use in dental restorations.

The U.S. Food and Drug Administration recently issued a final regulation classifying dental amalgam and its component parts – elemental mercury and a powder alloy—used in dental fillings. The levels of elemental mercury released by dental amalgam fillings were found to be at low levels and so not cause harm in patients.

The regulation classifies dental amalgam into Class II (moderate risk). By classifying a device into Class II, the FDA can impose special controls (in addition to general controls such as good manufacturing practices that apply to all medical devices regardless of risk) to provide reasonable assurance of the safety and effectiveness of the device.

The FDA has taken several steps to assure that the classification of dental amalgam is supported by strong science and the rule reflects years of agency review on this topic.

The ADA supports the FDA’s decision on dental amalgam. Dr Hewson, ADA Federal President, said, “Although the use of dental amalgams is declining, dental amalgam products still have a firm place in dentistry. Dental amalgam remains a safe, affordable and durable cavity filling choice for dental patients.”

“Extensive studies and scientific reviews worldwide support the conclusion that the benefits associated with the use of dental amalgam products far outweigh any potential adverse health effects. The known benefits of dental amalgam products include a broad range of applicability in clinical situations, reasonable serviceability, durability, ease of use, relatively low cost, and relative insensitivity to variations in handling technique and oral conditions.”