For Dr. Pamela Maragliano-Muniz, her curing light is one of her most important pieces of equipment.

Knowing how it’s performing and how to apply it correctly in composite restorations should be top priorities for any clinician.

We sat down with Dr. Maragliano-Muniz to get her thoughts on what’s important when it comes to light curing and why it’s risky to trust an untested curing light.

In this 20-minute interview we discuss:

• Why curing lights are the most important piece of equipment for dentists

• The impact of incomplete curing on your patients, your profit margin, and your confidence as a clinician

• Why relying on a 20 second cure for every procedure won’t give you the best results

• Why it’s important to know the exact output of your curing light and its compatibility with your composites

• What to consider when choosing a curing light

• How to reduce the risk of your light failing or degrading over time

• What CheckUp can tell you about your curing lights and materials, and how it makes a dentist’s job easier

Watch the video at the top of this page!

Dr. Pamela Maragliano-Muniz uses CheckUp to check her curing lights and calculate optimal curing times for her composites. Learn more about CheckUp below or scroll down for a transcript of the interview.

Video transcript

Andrea Elliott: Hi, I'm Andrea. I'm the Director of Success at Bluelight Analytics, and I'm here with Dr. Pam today to discuss light curing and her best practices for light curing in her clinic. Hi, Dr. Pam.

Dr. Pamela Maragliano-Muniz: Hi, Andrea. How are you?

Andrea: I'm good. How are you doing today?

Pamela: I’m great. I can't wait to have this conversation. It's one of my favourite topics.

Andrea: It's so nice to discuss with someone who who's so passionate about it. And you've been working with Bluelight for a little bit now, and you've been using our device. Tell me a little bit about what you've learned, just using CheckUp in your practice.

Pamela: Well, I've learned a few things. I've learned that my curing light’s output actually changes from time to time. And so it's important to continually check your curing light. And I think what's also interesting that I never really thought about until I started using CheckUp, was that different curing lights will take either longer or shorter to cure the same material depending on the light’s output, which makes perfect sense. But unless you have a device to tell you what that actually means and how to put that into practice, you might be spending more time or not enough time to cure the same material.

Andrea: I completely agree with you. I hear from dentists all the time. You know, my favourite question is how do you cure your materials now? And a lot of times they say 20 seconds, and that 20 seconds is critical. If it needs more, what could happen?

Pamela: So many things. So on a chemical molecular level, you might not have an adequate cure of your material. Your resin might not turn over completely as it should. And what we might find clinically is our restorations don't hold up over time, that we start to see darkening around the margins or patients might call complaining of post-op sensitivity. And so there's some things that we can find clinically that will be an indicator that something went wrong. And I know prior to using CheckUp, I would blame myself. I would say maybe I didn't isolate properly. Maybe something happened. Maybe when I turned to grab my air syringe, I took my eyes off and maybe something happened in the mix. You know, and I tend to think something happened with my technique. But it's so important to make sure that all of the devices that we're using are working in tip-top shape. Otherwise we might not have the outcomes that we're hoping for.

Andrea: And how important would you say is your curing light to that restoration? In terms of your day-to-day use of all your tools, does your curing light rank in the top five?

Pamela: I'd say the curing light ranks in the top one, probably. I mean, think about your day in and day out of what we do in dentistry. And I would say I pick up my curing light, almost every appointment. It almost doesn't matter. Obviously curing composite, or if I'm making a provisional, I use Bisacrils and so I need to cure that, if there's any irregularities or I need to realign, I'm using resin for my indirect restorations, I'm using a curing light to set my resin cement. So let me think about all of the things that we want to have longevity, a curing light’s part of that equation.

Andrea: You're so right. And longevity to a patient can mean the difference between paying for a procedure to be done and not paying based on their insurance and everything like that. And you mentioned sensitivity, what kind of impact does this have on the patient when they come back?

Pamela: There’s a lot of things that can happen when a patient experiences a post-op complication. For starters, they're uncomfortable. And so obviously there's nothing that we want to do that's going to result in any sort of post-op discomfort. Obviously some things it's inevitable, but if there's things that can be avoided, obviously from a practice management standpoint, that's one of the best things we can do, is just from a patient comfort, patient experience standpoint, is to minimize the post-op complications.

Now, what that also means is if the patient does have a post-op complication, now there might be diminished trust. The patient might think, well, maybe this isn't a good dentist. You know, my last dentist, when I had a filling, nothing went wrong and now I have a sensitive tooth and the patient's not going to think, well, this is probably a deeper restoration or maybe something happened. They're going to think that dentist didn't do as good a job as the other dentist where I didn't have a negative outcome. And so that's obviously something we all would like to avoid.

But another thing that we need to avoid, and this is obviously, you know, strictly from a, we do run a business standpoint, is having that patient back to reassess or possibly redo that restoration. I actually, gosh, it must be two years ago now, kind of just like played around with the math and thought, okay, so the patient comes in, you know, you charge X amount of dollars for your restoration for X amount of time. And if that patient comes back and you have to redo that restoration for free, you still have all of your underlying costs. You're still paying your assistant twice. You still have your lights on, all of the things that are underlying costs. It's not like, oh, I just did this and it's no big deal. It actually, when you do the math, at least in my office, I found out I'm probably better off giving my patient at least $20 and sending them somewhere else in the first place. That's obviously not a great way to run your practice, but inevitably, if we have to redo a restoration, that's kind of what we're doing.

Andrea: I completely agree with you. You know, I've heard people say, oh yeah, my curing light is the last place I look when my patient comes back with sensitivity. In my world it's the first place you look. It shocks me sometimes that clinicians don't know how their curing light is working. And, and how important would you say that it is to know the output, like the exact output of your curing light day to day?

Pamela: I think it's important. Now, do you have to know the exact number and you have to keep that in your mind? No, but the question is, is your curing light working acceptably? Is it working above the standard? Is it at the standard? Is it below the standard or is it just off the charts? Not on the standard. Those pieces of information are important. Just because the light turns on and the light looks blue, it doesn't mean that you're going to get an adequate cure of your materials.

Now it's not even just the cure of your materials, which is important. It's also the technique that we're using. Are you curing at the right increment? What if it's a deeper preparation? Do you cure the same amount of time as you would for say a sealant? You know, if you're not taking all of these things into account, you might not be using your curing light properly, or you might unfortunately be experiencing an inadequate cure in some areas.

Andrea: I find that oftentimes the curing light is something that, you know, you just hit the button, you turn it on, but some of them it’s complicated to change the mode, to change the curing light cycle. Then you've got your three second cures. There's so many options out there for lights, not even to mention the many options for materials. And I'd love to know for you. How did you keep track of all of these things pre-CheckUp? I know CheckUp gives you the, the ins and outs of that without you having to do the work, but you know, how did you keep track of that in your clinic pre-CheckUp?

Pamela: I would say, what I used to do prior to CheckUp is I would use a radiometer periodically. And I did, I can tell you honestly, that I didn't do it all the time. It wasn't something I did on a consistent basis. I'd sorta think about it and be like, oh, let's check the curing lights. What I would get is a number. And I'd be like, okay, if it's over a thousand, I'm probably pretty good. And I would just sort of move on with my day and not really give it a thought until the next time I give it a thought. I can tell you from my own experience, I need a little more help than that.

And so, you know, just to read a number is I guess, okay. And it's great that you're taking those measures to do that. But the information that you get from CheckUp is so much more valuable and it's so much more practical. So not everybody thinks like, oh, what's this number and what does it mean? And if I forgot, I'm going to go look it up. I mean, that's all of those steps that, you know, not many of us have time to do in our day. With CheckUp, it's just all right there for you. It takes 10, 20 seconds, whatever you're carrying your light for. And all of a sudden, all of this information pops up and not only tells you the energy output. It tells you the amount of time in which your light becomes too hot on a surface. So you have to keep that in mind when you're curing a tooth and curing around the gingival margin. It also tells you, you can input all of the materials that you use. And it will tell you how much time your specific curing light will take to use that specific material. And the other thing I love about it is it tells you the increment in which you're supposed to be placing that material. So pretty much all of the information that you need to properly handle your composite and your curing light is right there on the app. And so I feel like, gosh, if I mess up after using this, then I just wasn't looking, or I just didn't refer to it. Or I just, I don't know, something went wrong.

Andrea: So having a patient come back after having sensitivity or debonding or something like that, can, I'm sure affect your confidence as a clinician. You know, how does it make you feel when they come back and you have to look at your work, and you have to look back and say, hey, what did I do there that caused this to happen?

Pamela: Well, I would think a lot of clinicians are like me and I tend to blame myself. I think something had to have gone wrong. What did I do that resulted in this not optimal outcome? And so I'm always thinking, is it maybe isolation was a problem. Maybe there was just something that didn't go right. And I think about it, you know, even though I'm the same person trying to do the same thing every single time and be consistent. At the end of the day, we're all human. And so we might have a situation where we're rushed or, you know, our patient can't tolerate our isolation protocols, or whatever it is, you know, that may contribute to that negative outcome. It might not be our fault, but I always tend to blame myself. And one thing, if we are overlooking the output of our curing lights, unfortunately these negative outcomes will not only be this one instance. Over time, days, weeks, months, those negative outcomes can become cumulative and it can really impact your reputation, your practice and your outcomes. And I would think also your confidence as a clinician. So it's really a good idea to just take that out of the equation, make sure you're curing lights are functioning properly, make sure the materials that you're using are compatible with the light that you have, and make sure that you're using those materials at the recommended increments.

Andrea: I completely agree with you. I think, you know, you do so much work in dentistry to make sure that that restoration is going to go right. And a lot of time goes into that. And then your curing light changes hands and moves operatories. And you know, someone might hit a button and you're doing it different than you would have been. And it's just to me, very, very important that you just make sure it's working because then you don't have to worry about it. That’s the tool that could ruin 40 minutes of work, if you're not sure what the output is. So if you check it at the beginning of every day, if you check it every week, just having that confidence that it's gonna work for you, then it saves you money, it saves you time, and it increases your patient confidence. Because the patient coming back can have a negative impact, like you said, on your reputation in your clinic.

So I get this question a lot and I'm going to ask you your opinion on it. People ask me what's the best curing light on the market. And in my opinion, that really depends on the clinician. And how they like to use their curing light. What do you look for in a curing light when you go to choose it?

Pamela: I look for a lot of different things and I agree with you. There's a lot of really great curing lights out there. So the curing light I use in my hands that I really like, you know, a friend of mine down the street might say, no, no, no, I love this one. And at the end of the day, they're both really great lights. Now I would say working with a, you know, a reputable light, making sure that the light is from a reputable company, is very important. Making sure that there's a wide range of wavelength that's covered and also making sure that the materials that you're using fit within that range. And I also like looking at the diameter of the tip of the curing light. So if you have kind of a wider diameter that can cure a greater surface area, you might be able to cut down some of your curing times.

Also having a light that has a little bit of flexibility. The light that I use has a pre-cure setting, which I love for my resin cements. So it actually, it takes like two or three seconds at a lower energy output, just so we can get that initial cure, so that I'm no longer counting at full energy, like, okay, one, two, three. And if I counted wrong and now all of a sudden my materials cured too much, then I know that, okay, I just like having things that work consistently for me. So I think looking into the technology, making sure that your light is from a reputable source, making sure that, you know, your materials are compatible with your light, making sure it's comfortable in your hands. I personally like a sleek design that can be disinfected well. You know, something that you're not going to destroy the light if it comes in contact with disinfectant. The simple thing that I like that is, you know, really has nothing to do with technology, but I like having a little cradle for it to sit on the countertop, having a place that it can sit safely because obviously we'd like to avoid our lights from hitting the ground.

So I think, you know, having different safety measures in place are really important for a curing light as well. So, I'm sure there's plenty of other features that I overlooked at this point in this conversation. But for me, I would say, a quality light, good at a range of wavelengths, comfortable in my hands, ergonomic, something that supports infection control, and also something that's been tested to offer some longevity.

Andrea: I think you covered all great points there. You know, there are, I think there's an article out there from the CDA that says, here are the things you should look for in a curing light, but in terms of guidance on what it should have and what it shouldn't have and any kind of specifications, there isn't a whole lot out there. You mentioned curing lights being compatible with your materials. What did you mean by that?

Pamela: Basically each curing light, even though it all looks blue, there's a range of light that's output from the top of the curing light. And so there's some curing lights that offer a shorter, more narrow range. And then there's other curing lights that offer a wider range. And the other thing that we may not always think about with all of our resin materials, there's a specific range of light that will cure that specific material. Not every material is compatible with every single light. And so say if you're using a light with a very narrow wavelength range and the composite that you're curing is outside that range, you'll never get a complete cure because these materials are not compatible. So, when you're selecting a light, I would think that one of the best choices is to select a light that offers kind of a wider spectrum of light that it'll cover, so that therefore it will cover virtually every material that you have in the office.

Andrea: I think that's great. That's a good explanation. You know, we do the math in the background all the time of what lights and what materials work together. And we find that usually one in five lights in a clinic needs adjustment in some form or another with the materials that they're using. That to me, that's a very high risk of having an issue, or having an issue you just don't know about. Clinicians who've come to us and say, hey, you know, I've seen this happen, I want to test my lights all the time. I'm ready for your product, have seen some of the pain. How common would you say it is that a clinician will probably see this in their lifetime, just based on the output of their curing light?

Pamela: I think as long as you're practicing, it could be happening. I can tell you that, you know, with the coronavirus and everything else, I didn't really test my lights all the time. My office was closed for three months. I wasn't really thinking about, hey, what's my curing light doing? And unfortunately, one of my lights was dying, a slow death during the pandemic, and I didn't realize, and so once I started getting back up and running, I said, oh gosh, I should really just check my lights and make sure everything's okay. I made sure they were charged and the whole bit, but there was a light that was just at the minimum of where it should be. And I thought, oh my goodness, it's time to, pull the trigger and get new lights and make sure that I update my lights because this light was probably in the ballpark of six-ish years old. And you know, it was my workhorse. I used it every day in my favourite operatory. And it was one of the lights I used all the time. And once I saw that I was kind of at that minimal threshold, I thought, oh my gosh, you know, if I don't put it on the charger after every patient, what does that mean for this light? I don't know. Am I going to test it every hour? Of course not. But if you're one of those people that you keep your curing lights in the cradle and don't charge it all the time, I would imagine on that light where it just wasn't putting out the energy like it should. I couldn't trust that by the end of the day, the quality I had in the beginning of the day was matched at the end of my day.

So I think it's really important. You know, if you hear anybody like Josh Austin speak, he talks about curing lights as well. And unfortunately he had a terrible situation happen where his assistant dropped his curing light and felt really bad about it and thought that, well, the pieces go back together, I'm going to glue it back. And so he didn't know that that had happened and all of a sudden restorations weren't going as well as they probably should. And you know, I'll let him tell you that story if you ever have a chance to talk with him. That is an extreme story about how devastating a malfunctioning curing light can be for your practice. So I found, at least in my experience, as long as nothing dramatic happens, like a crash to the floor or something like that, the curing lights should just diminish their power output over time. And you want to catch that before you were below the threshold.

Andrea: We talk about degeneration of curing lights, you know, it doesn't happen overnight. Most of the time it happens slowly. And so once you reach below a certain point, you have to double your curing times. And a lot of clinicians don't know that. They stick with the 20 seconds and then they might add another 20 seconds in there. There's, you know, concern for soft tissue if you use too much heat. So there's lots of factors that go into it. And I think you and I have a good handle on it. And I'm happy that you're here today so that we can kind of educate and have this conversation so that everyone out there knows, hey, you might be having this and you don't know. And it's really good for you to just of kind of reach out, ask the questions, talk to someone, you know about it, test your lights, we don't care what you do it with. CheckUp has great features in terms of you've got all your digital IFUs in there, you don't have to worry about guessing at your curing times or your light output. It's just easy. And it gives you that peace of mind to go into your procedure.

I appreciate you being here today. I really do. I'm glad we could chat about this. And I always love getting together with people who are passionate about light curing as I am. Do you have any advice for everybody just before we, we end the call?

Pamela: Yes, I do. And I really appreciate the conversation as well. This is always a great way to start my day. I'll be so excited the rest of my day.

I would say to be mindful during your restorations. And obviously we all strive to provide individualized care. At least the way I think about that is, oh, I want to pick a treatment plan that's specific for this patient and their needs and their goals and their caries risk and whatever. But then we also have to be mindful during the restoration. How does this material that you're choosing, how does the handling differ from say a different material. Or if you're using composites that are, you know, more heavily filled versus an enamel layer of composite, the curing time is going to be different. Or if you have a big deep prep, that's really hard for us to reach. Even with our bur, it's going to be hard for your curing light to reach it too. And so just using a 20 second rule of thumb is probably not the best approach. And so modifying your curing times based on what's happening clinically is only going to set you up for success.

Andrea: That's great advice again. Thank you for being with us today and having this conversation. Everybody go and check out Pam’s page. She's got some great information on there, on Instagram and on Facebook and if you have any questions you can reach out to either her or I, and we'd be happy to answer them. All right. Thank you so much, Pam. We'll talk to you soon.

Pamela: Looking forward to it. Bye!