The Blue Light Hazard in Dentistry: What You Need to Know

When I give this presentation, I share to my attendees, I want all of you to listen up and I want you to look at all of these eye protection types that are available. And I want you to be aware that none of them are perfect. There is no perfect solution out there. And I'm really hoping that somebody who's listening to this podcast will take this all into consideration and develop that perfect solution and make that come to fruition. Welcome to Austin, Texas for the Phil Klein Dental Podcast. Today we're shedding light, quite literally, on a hidden hazard in the dental operatory, blue light exposure. From curing lights to computer screens, blue light is everywhere and its effects are cumulative. Studies link prolonged exposure to serious health concerns, including macular degeneration, insomnia, migraines, and eye strain. But here's something many don't realize. Dental curing lights have increased in intensity over the past few decades, now delivering up to a staggering 6000 milliwatts per square centimeter. While this shortens curing times, it also means clinicians are exposed to higher doses of blue light in a much shorter period of time, making it especially dangerous. Even brief exposure can cause retinal damage. And what makes blue light even more hazardous is that unlike sunlight or other bright lights, we don't instinctively squint or turn away from it. That means we're unknowingly taking in high levels of exposure without our natural protective reflexes kicking in. In addition to exploring why blue light is a growing concern in dentistry, we'll address practical steps you can take to safeguard your vision and overall health in the operatory. Our guest is Dr. Marie Fluent. Dr. Fluent's dental career spans over 35 years and includes all roles within the dental practice. She is passionate and deeply committed to improving dental infection control and patient safety, and through her writing, webinars, and invited lectures, she has educated thousands of dental professionals and students nationally and internationally. Before we bring in our guest, I do want to say that if you're enjoying these episodes and want to support the show, please follow us on Apple Podcasts or Spotify. You'll be the first to know about our new releases, and our entire production team will really appreciate it. Dr. Fluent, welcome to the show. Thanks, Phil. Thanks for having me. Delighted to be here. So many of us listening to this podcast, Dr. Fluent, are aware of blue light. We know that it can disrupt our sleep. It can cause migraines. They're even coming out with things about early dementia related to blue light. What is the blue light hazard in the dental operatory? The blue light hazard is an actual photochemical change to the retina of your eye. And if you look at a cross section of your eye, the retina is in the very rear most portion of your eyeball. And this damage is caused by short wavelength radiation in the 400 to 500 nanometer range. And I want to say 400 to 500 is the wavelength of this blue light. And the most damaging is right smack in the middle of that between like 420 and 455. This wavelength can cause damage of the light-sensing cells. Children are more susceptible to this damage, and all of us are exposed to way too much blue light, especially this day and age. So when you say this day and age, you're referring to all the blue light that we're absorbing from our digital devices. And that, in a sense, is dangerous because it's cumulative. What we're absorbing over the course of a day doesn't just go away at the end of the day, it stays with us, whatever damage obviously is caused. So this is a concern, is it not? Correct. Now, in everyday light, our ancestors 100 years ago and before that, of course, we're exposed to sunlight during the day. But now we have LED lights, fluorescent lights, electronic devices, and computers, and we're all logged on for numerous hours throughout the day. And then in dentistry, we're exposed to even more blue light than that. Our dental curing lights emit blue light right in this hazard. And one study showed that we spend 240 hours per year curing light. cured restorations. And 53% of dentists use LED headlamps for more than five hours per each workday. So we are exposed to a boatload of light. And if I have any endodontists listening, if you use a microscope, you're exposed to more blue light. And then the operatory light now is an LED light that has a higher concentration of blue light as well. So we're exposed to tons and tons of blue light and this damage. that we're exposed to, this blue light that we're exposed to, it's irreversible. The damage is like accumulative in nature. So if you're exposed to a lot of blue light over the weekend or during a dental work day, it's not like you go to bed and like a wound on your hand heals up the next day and within a couple of days it's gone. This damage keeps accumulating over and over and over again. Before we continue with our guest, a big shout out to G. A leader in dental materials, GC is all about minimally invasive dentistry, preserving natural tooth structure and helping to keep it healthy long after the restoration is placed. That's where glass onomer technology shines, and GC's new glass hybrid, Equia Forte HT, fits right in. It chemically fuses with the tooth for strong, long-lasting, aesthetic results. It's fast, packable, moisture tolerant, and requires no bonding or conditioning. Plus, it delivers continuous fluoride protection, ideal for patients of all ages, especially those that are moderate to high caries risk. So if you want the benefits of glass onomer, plus aesthetics, strength, and longevity, Equia Forte HT has got you covered. To learn more, visit gc.dental.america. Yeah, and these symptoms that are associated with blue light overdose or overload can be migraines, having trouble sleeping, There's lots of things that are now emerging health-wise that are related to excessive amounts of blue light. Even early stage dementia I've been reading about. So I suggest that everybody's on a computer all the time, either have a blue light protector on your monitor or wear blue light protection glasses of some kind. Let's talk about the curing light itself. Would you say that's the dominant source of blue light? that would be potentially damaging to the dentist? Is it the curing light? Let me go back. You mentioned a lot of the health ill effects of blue light, but the one that I really want to focus on is a symptom, a chronic exposure to blue light can really damage the photosensing cells and lead to damage similar to macular degeneration, age-related macular degeneration. And when somebody has age-related... macular degeneration, what they see is out of their central vision, the center portion is kind of gray and foggy and just plain not there. So this can very much impact your daily life and quality of life. It can impact driving, reading, and anything that you do on a day-to-day basis. And that symptom is completely irreversible. And if I may go off on a quick tangent, Phil, there have been studies to show. show the correlation between chronic blue light exposure and animal studies and these studies of course cannot be done in humans due to ethical reasons but there very much is a correlation between laboratory mice and age-related macular degeneration due to overexposure of blue lights. So that's the biggest one that I'm concerned about when you talk about all of the ill effects related to blue light. So let me ask you about the macular degeneration. Is that something that could happen to somebody during the course of their career where it could dramatically shorten their career? Absolutely. Absolutely. And could very much impact the quality of their life as well. Absolutely. So the development of macular degeneration could be accelerated to the point where someone who's only practicing, I don't know, 10 years starts to see that based on not preparing themselves properly and protecting themselves properly from blue light generated from... for instance, a curing light? Well, it could happen, but we don't have great studies on it at this point. And there are animal studies to show the direct correlation, but human studies are lacking, like I said, due to ethical reasons. Okay. So let's talk about curing lights and how blue light plays a role in that, or how curing lights plays a role in blue light emissions, which is dangerous, as we just talked about. talk about the different lights that are out there, the curing lights that have increased in intensity over the years. And what's driven this increase in intensity in these lights is the fact that dentists want their materials cured faster. And this, of course, has brought on very intense lights that... actually create quite a bit of heat and lots of blue light. Okay. So, so far, Phil, we talked about the actual wavelength of the blue light, how it's in the mid 400 to 500 range. And that is the wavelength of the light. And now we're going to talk about the intensity of that light. And what I want you to do is imagine that you're in a dining room at home that has a dimmer switch on it. And with that dimmer switch, you can crank up the light intensity. Say you need it for doing a task on your dining room table, you're doing your taxes, or say you want it really dim for a romantic dinner at home. That wavelength of light emitted is not changing, but the intensity of that light is indeed changing. So now we're talking about the intensity, how bright or dim the light might be. So when curing lights were introduced in the 1970s, they had an output of 400 to 600 That is the intensity of the light that comes out of the tip of the curing light. And then in the 1990s, it went up to 1,000. And then it went up to 1,500. And the highest output of an LED light that I can find today is 6,000 milliwatts per centimeter squared, which is intense. It's so intense that it can cause soft tissue burns and it can cause thermal damage to the pulp and like irreversible pulp damage. to the actual tooth itself during late curing procedures. And this is why when the manufacturer gives you instructions to say only cure for 10 seconds, you abide by that and you don't blast it for 20, 30, 40 seconds thinking you're having a more thorough cure. You may be actually causing damage to soft tissues or to the pulp of the tooth. So when you are increasing the output of a curing light, Is that a direct correlation to the blue light emission? Yes. So we are still exposed to the same wavelength of blue light, but we're exposed to more of it in a shorter period of time. So in other words, if you had a lower output of a curing light, but left it on for 40 seconds, then you had the output that was four times as high, and you left it on for 10 seconds, I assume that's an equivalent amount of blue light emitted. Before we continue, I've got to give a shout out to our sponsor, NSK. These folks are the real deal. Their air and electric handpieces are not only top tier, they're the highest rated in the industry, peer-reviewed by Dental Product Shopper. Their Timex Z99L electric handpiece actually scored the first ever perfect rating. And the Timex Z990L is the most powerful handpiece on the market. So do yourself a favor, check out everything they offer at nskdental.com and take advantage of their free trial by reaching out to your local NSK rep. I've heard this many times from many dentists. Once you start using NSK handpieces, you'll never look back. You know what? It seems like it would be to me, but I am not a physicist for light irradiation, so I can't answer that directly. And keep in mind, too, that the threshold of high-powered LED lights, curing lights, is unknown at this time. And the people who study this are physicists, of course, and industrial hygienists, and NIOSH is studying it as well to determine what level is safe for us to look at. So I don't have those numbers. And I don't think anybody does have those numbers on the level of safety and how much light is safe for us to look at. So your best bet is to not be looking at it at all. Yeah, for sure. So based on what we're dealing with in the operatory, the curing light is the most powerful emitter. of dangerous levels of blue light. So we need to do something about protecting ourselves other than looking away because we know that doesn't work. You know, we talked offline about this, Dr. Fluent, and there's really no one method, apparently, that's the silver bullet for complete protection. But list the options so we can get an idea of what's available to us. And there are a number of methods that are available, and I'll talk to you about the pros and cons of each. So the first method that I'd like to share is an orange shield that is attached to the curing light itself. And it's probably about two or three inches in diameter, and it snaps right on to the wand itself. And it can be adjusted to either protect the operator or the assistant. small surface area and generally does not protect both the operator and the assistant. It generally protects one or the other. So if you're using an orange shield, you might have to double up with another method of protection. The second protective measure is an orange paddle. And this looks like a, well, the size of a pickleball paddle. A lot of us are playing pickleball these days. Maybe it's a little smaller than that. it's a paddle that has a larger surface area and it's held in place by the dental assistant and the advantage of the paddle is that it's larger in size and it can protect both the eyes of the dentist and the dental assistant from their vantage point but the downside of this paddle is Someone's got to hold it. Dental assistants, they just do not have enough arms and hands to assist in forehanded dentistry, especially during light curing procedures. They're retracting soft tissues. They're suctioning up extra saliva and fluids from the oral field. They're passing composite placing instruments. They're passing dental materials. And this occupies an entire hand for the entire procedure. A third option would be amber colored goggles. And these are phenomenal because they give excellent coverage and side protection as well. And the downside of these is that as a dentist, I need my loops. I need the magnification and I need to be able to see what I'm doing. So what am I going to do? Put on these amber colored goggles and then take them off to... put another increment of composite into my restoration and put them back on for the curing light component and go back and forth. No, that is totally impractical. So what I like for the amber goggles for is for my dental assistant. who may not need the magnification that I might need. I think that it would be an excellent solution for the dental assistant or a hygienist who is not wearing loops. Another option are little tips. They're anti-glare cones that fit on the tip of the curing light. And these are easy to use and they allow for a hands-free protection. But the problem is, is that they can easily become dislodged and can impact the direction of your light curing tip. as they become dislodged, they can leak blue light around the perimeter as well. Then there are loops that have a little bit of a bifocal region that has the amber shade or shield in that portion. But the problem with these is that if you look at these loops, they only protect a small little fraction of your entire field of vision. And if you're looking through any other area, you're still exposed to the blue light. So that's not an ideal solution either. And you already talked about the look away method where you point the cure. tip where you want it to be, you hold it in place using a fulcrum in dentistry or dental assisting, then you activate and look away. But as you look away, you sneak peeks back to the operative field to make sure your curing light hasn't moved or switched positions. So the look away method is never, never recommended and not a good idea. So I don't even want to put this on that list other than a don't do that. So my recommendation is to practice. Have a practice role-playing session with a fictitious patient in the dental chair and practice using whatever protective mechanism that you utilize and make sure that both the dentist and the assistant's eyes are protected from their vantage point. And if they're not... Add another source of protection. And of course, your patient's eyes need to be protected against blue light as well. So those amber colored goggles would be great for your patient as well. So there's really no one solution for eyewear when it comes to... complete blue light protection and also being utilitarian for all types of services rendered in the dental practice. It sounds like we have to figure out what's best for our office and our staff and maybe use multiple methodologies to protect us from blue light. It's not one thing. When I give this presentation, I share to my attendees, I want all of you to listen up and I want you to look at all of these eye protection types that are available. And I want you to be aware that none of them are perfect. There is no perfect solution out there. And I'm really hoping that somebody who's listening to this podcast will take this all into consideration and develop that perfect solution and make that come to fruition. I think right now with the level of eye protection that's available is the amber color is the most blue light protective. And the clear glasses that also block blue light are not as protective. And a dentist can't be practicing with amber glasses the whole day. Like you mentioned, there's... dental materials that we're looking at and shade and everything else and that is just not going to work so we're not there yet but hopefully we will be soon and the other crazy thing i do want to mention phil about the blue light is that there's not a natural aversion response for instance if you're outside looking at the sunlight You immediately squint, look away, put on your sunglasses, put on a visor and squint your eyes and know your body somehow senses, this is not good for me to be looking at this. Whereas blue light is different. We have not been exposed to the pure wavelength of blue light. in our ancestry and our ancestors before us. So when we look at the blue light, it's like looking at holiday lights. It's kind of dazzling and you want to open your eyes more and wider and take it all in. So we don't have that natural, oh, this is dangerous. I better get away from this blue light and protect my eyes phenomena. And that's a scary part of blue light as well. So as we wrap up this podcast, Dr. Fluent, when people, Go to Amazon to buy goggles. What's your thought on that as far as quality and validity as far as those goggles being actually the protection that they claim to be? Well, that's kind of interesting, Phil, because you can buy very inexpensive, amber-colored eye protection goggles. from any source, whether it be Amazon or Walmart or even Home Depot or Lowe's. And they're relatively inexpensive. So is this a good option? And the answer is, I don't know. And I don't think you would know either. And I'm not sure it's a good idea to trust these. Your best option would be to use the level of eye protection that's supplied by the manufacturer of your curing light. Use it consistently and keep it updated. and, of course, have everybody in the operatory, including the dental assistant, the dentist, or the hygienist, and the patient wearing the same level of protection. Yeah, that makes total sense. One last question. What do you recommend as far as disinfecting the goggles or the glasses that the patients get? You know, when you sit down and they hand you some eye protection that was just used by another patient, obviously there's got to be some disinfection. What's your recommendation for that? Well, if they're reusable glasses, they need to be cleaned and disinfected in between. And I'm always hesitant to interject a bit about using chemicals near where your eyes are going to be. So I like good old-fashioned soap and water. And if you want to disinfect them, read your manufacturer's instructions and they will tell you what products to use and what products not to use. And in general, if you're using an alcohol-based product, number one, it's going to damage the plastic. And within time, it may remove. those protective layers on your protective eyewear. So really, really look into what the manufacturer's instructions say and do not use any unauthorized or harsh chemicals or harsh abrasive type of wiping material or cloth as well. Follow your IFU, in other words. Yeah, and that's what we should do with almost everything we do in dentistry is make sure we read the IFU. A lot of the dentists don't do that, but we should. Dr. Fluent, it's been a very good discussion. Thank you so much for your insight. Appreciate being here. Thanks for having me, Phil. Appreciate it.