d e n t a l m a t e r i a l s 2 9 ( 2 0 1 3 ) e85e90

Available online at www.sciencedirect.com

journal homepage: www.intl.elsevierhealth.com/journals/dema

Light curing in orthodontics; Should we be concerned?

Neil McCusker a , Siu Man Lee b , Stephen Robinson c , Naresh Patel d ,
Jonathan R. Sandy a , Anthony J. Ireland a,
a

Child Dental Health, School of Oral and Dental Science, University of Bristol, Bristol UK
Medical Physics Department, RUH NHS Trust, Bath, UK
c Queen Alexandra Hospital, Cosham, Portsmouth, UK
d Consultant orthodontist, Kings Mill Hospital, Manseld, United Kingdom
b

a r t i c l e

i n f o

a b s t r a c t

Article history:

Objectives. Light cured materials are increasingly used in orthodontic clinical practice and

Received 19 December 2011

concurrent with developments in materials have been developments in light curing unit

Received in revised form

technology. In recent years the irradiances of these units have increased. The aim of this

28 March 2013

study was to determine the safe exposure times to both direct and reected light.

Accepted 28 March 2013

Methods. The weighted irradiance and safe exposure times of 11 dental curing lights (1
plasma arc, 2 halogen and 8 LED lights) were determined at 6 distances (260 cm) from the
light guide tip using a spectroradiometer. In addition, using the single most powerful light,

Keywords:

the same two parameters were determined for reected light. This was done at a distance

Light curing

of 10 cm from the reected light, but during simulated bonding of 8 different orthodontic

Weighted irradiance

brackets of three material types, namely stainless steel, ceramic and composite.

Safe exposure times

Results. The results indicate that the LED Fusion lamp had the highest weighted irradiance and the shortest safe exposure time. With this light the maximum safe exposure time
without additional eye protection for the patient (at 10 cm), the operator (at 30 cm) and the
assistant (at 60 cm) ranged from 2.5 min, 22.1 min and 88.8 min respectively. This indicates a
relatively low short term risk during normal operation of dental curing lights. For reected
light at a distance of 10 cm the risk was even lower, but was affected by the material and
shape of the orthodontic bracket under test.
Signicance. The short term risks associated with the use of dental curing lights, halogen,
LED or plasma, appear to be low, particularly if as is the case adequate safety precautions
are employed. The same is true for reected light from orthodontic brackets during bonding.
What is still unclear is the potential long term ocular effects of prolonged exposure to the
blue light generated from dental curing lights.
2013 Academy of Dental Materials. Published by Elsevier Ltd. All rights reserved.

1.

Introduction

The use of light curing as a means of initiating the polymerization of orthodontic adhesives has gained in popularity

in recent years, having rst been described by Tavas and

Watts [1]. Indeed since its introduction over 30 years ago
there has been a progressive shift toward the use of light
cured materials in dentistry and an increase in the number
and types of light curing units available. Light cured mate-

Corresponding author at: School of Oral and Dental Science, University of Bristol, Bristol, UK. Tel.: +44 0117 342 4355.
E-mail address: tony.ireland@bristol.ac.uk (A.J. Ireland).
0109-5641/$ see front matter 2013 Academy of Dental Materials. Published by Elsevier Ltd. All rights reserved.
http://dx.doi.org/10.1016/j.dental.2013.03.023

e86

d e n t a l m a t e r i a l s 2 9 ( 2 0 1 3 ) e85e90

rials have a number of advantages over chemically cured

adhesives, including single paste application, consistent
handling characteristics, easy removal of excess material,
extended working time, command set, more accurate bracket
positioning and immediate ligation of the archwire [13].
There are currently three main types of light curing units
available, namely: halogen, plasma arc and light emitting
diodes (LED). With time the lights available have become ever
more powerful, producing higher light intensities (mW/cm2 )
with obvious advantages and potential disadvantages. The
advantages extend to both the operator and the patient and
include shorter curing times [4], saving time and money, less
chance of bracket drift, a reduced risk of moisture contamination and overall less discomfort for the patient [5]. However,
what is uncertain is whether or not these new more powerful
lights also bring with them additional risks to the eyes of the
operator, ancillary staff or patient.
In order to cure dental composites and resin modied glass
ionomer cements, light with a wavelength of 440480 nm is
required to initiate free radical addition polymerization. This
is within the spectrum of blue light. However, some adhesives
contain more than one photo initiator and these may have
slightly different peak sensitivity wavelengths, down to as low
as 370 nm [6,7], which is within the UV spectrum. In addition
to light of a specic wavelength, irradiance is also important
in the cure of resin based dental composites. It has been suggested that a minimum irradiance (power per unit area) of
300 mW/cm2 is required to produce an adequate degree of
polymerization [4,8]. While doubling the output above this
minimum increases the rate of cure by up to 22% [9], increasing
it beyond 1000 mW/cm2 is said to have no further detectable
benet to the polymerization of resin composites [10]. Nevertheless some of the newer light curing units has been reported
to have power outputs of up to 2000 mW/cm2 [11].
As a part of normal vision, when light reaches the photoreceptors of the eye, photochemical reactions take place
creating electrical neural impulses. As a by product of this process, harmful reactive oxygen species (ROS) are also produced
within the retina and in this respect blue light is potentially
100 times more damaging than orange light (590 nm) [12].
However, this oxidative damage is usually prevented by macular pigments based on carotenoids, which work by increasing
oxygenation at the arterial end of the retina [13]. With age
there is an increased risk of a condition known as Dry Age
Related Macular Degeneration, in which there is a gradual
deterioration of central vision due to a loss the photoreceptors and their supporting tissue in the macula. Although it is
thought to be a multi-factorial disease, one possible cause is
thought to be prolonged exposure to blue light [14].
What then are the exposure risks with the normal use of
dental curing lights? The maximum permissible daily exposure times for intense blue light sources can be calculated
using criteria published by the American Conference of Governmental Industrial Hygienists (ACGIH) [15]. In the exposure
standard, two viewing conditions are described: point source
conditions apply when the source is far removed from the
eye (greater than 1 m) and extended source conditions when
the source is close to the eye (less than 1 m). In normal dental use, extended source conditions apply. For exposure times
less than 2.8 h (104 s) the limit is given by the formula [16]

LB t 100 where LB is the radiance of the source weighted

by the blue light hazard function and t is the cumulated daily
exposure time in seconds. The blue light hazard function at
different wavelengths can be obtained from published data
[17]. Very recently new guidelines for the calculation of the
maximum daily exposures have been produced by the Health
and Safety Executive in the UK which has increased the maximal permissible exposure [18].
To date, a number of studies have described the potential
for retinal damage from dental light curing units. Satrom et al.
[19] found a variation in the maximum daily exposure photochemical (blue light hazard) to the retina, with different lights
ranged from 2.4 min a day up to 16 min a day. Whereas Moseley et al. [16] found the maximum permissible daily exposure
ranged from 12 min to 30 min for direct light and between 40
and 100 min for reected light. More recently Roll et al. [20]
estimated the maximal permissible exposure times of 13 dental curing lamps using data on spectral output and irradiance.
In their calculations, performed according to the exposure
limit guidelines set by the American Conference of Governmental and Industrial Hygienists [15] and the International
Commission on Non-Ionising Radiation Protection [21], they
assumed a 30% reection of the curing light radiation and at a
distance of 30 cm (the distance between the dental operation
site and the operators eye). They estimated the blue light maximum for the eye to be approximately 1 min/day for reected
light, whereas a direct (accidental) blue-light exposure with
zero distance from the eye should not exceed 1 s. This maximum was also true for the UV component of halogen lamps. It
should be remembered however that these studies were carried out in the mid 1980s when many of the more modern
higher irradiance curing lamps were not available.
The aims of the present study were therefore to calculate
the maximum permissible daily exposure times for a number
of currently available light curing units and to evaluate the
effect of reected light using different orthodontic brackets.

2.

Materials and methods

The maximum permissible daily exposure times and blue light

hazards of 11 curing lights (1 plasma arc, 2 halogen and 8 LED
lights) (Table 1) were determined by measuring their spectral
outputs using an integrated spectroradiometer (DMc150-MDE,
Bentham Instruments Ltd, UK) (Fig. 1). The lights under investigation, along with their wavelengths (nm) and irradiances
(mW/cm2 or power per unit area) derived from the manufacturers data, are illustrated in Table 1. The spectroradiometer
was congured to measure source irradiance over the spectral
range of 400 nm and 550 nm and at 7 predetermined distances
from the light curing tip. These distances were 2 cm, 10 cm,
20 cm, 30 cm, 40 cm, 50 cm and 60 cm and were chosen in
order to simulate direct exposure at 2 cm, through to a distance of 30 cm representing the light tip to eye distance of
the orthodontist and nally up to 60 cm, which represents
the light tip to eye distance of the assistant during normal
bonding. The 2 cm distance was chosen as it was the minimum distance at which the spectroradiometer could operate,
without saturation due to the very high irradiances from certain light curing unit models. A specially constructed jig was

e87

d e n t a l m a t e r i a l s 2 9 ( 2 0 1 3 ) e85e90

Table 1 Light units under test, type, wavelength and irradiances derived from the manufacturers information.
Light unit
Apollo 95 E
Cromalux
CU80
DEMIOrtho
Elipar Freelight 2
Fusion
Mini LED
Mini LED2
Ortholux
Smartlite
Starlight

Type

Wavelength (nm)

Irradiance mW/cm2

Plasma arc
Halogen
Halogen
LED
LED
LED
LED
LED
LED
LED
LED

460490
400500
380510
420465
430480
385430
420480
420480
430480
450490
440480

1600
650800
600
11001330
1000
1500
1250
2000
1600
950
100

used to ensure the predetermined distances were the same

for each light curing unit relative to the xed detector head of
the spectroradiometer.
The spectroradiometer itself consists of a double
monochromator based on two 150 mm focal length single monochromators in the Czerny Turner conguration, and
integrated DC detection electronics. Light is coupled from the
detector, which includes a cosine diffuser (D7H-WT), to the
monochromator via a 1 m randomized quartz optical ber
bundle. The cosine response of this diffuser was calibrated
with a less than 3% f2 error. The system was controlled using
Bentham proprietary software (Benwin + version 3.0.10.0)
and the spectroradiometer produced plots of irradiance
(w cm2 nm1 ) against wavelength (nm), as well as calculating the weighted irradiance using the blue light hazard
function.
The spectroradiometer was calibrated by a dedicated CL6
light source with calibration traceable to the National Physics
Laboratory (NPL) standard. The CL6 light source is powered by
a constant current source at 8.500 A with a tungsten halogen
lamp, providing a very stable output irradiance. The spectroradiometer was calibrated before each measurement session to
eliminate any inaccuracy within the system. The uncertainty
within the system after calibration is less than 1.5%.
Irradiance measurement for each type of curing light unit
began with a scan covering the wavelengths between 250 nm

and 800 nm in order to identify the output spectrum. Subsequence measurements were made only at the relevant
wavelengths. The combined tolerance of the measurement
was typically less than 5%, including temporal variation due
to continuous battery discharge condition. Care was taken to
ensure each of the lights was tested with a fully charged battery and a new bulb was placed in each of the quartz tungsten
halogen lights prior to testing. The ambient light was minimized during testing by closing the blinds and turning off
indoor uorescent lighting. In the second part of this study,
determining the effect of different brackets and bracket materials (metal and esthetic see Table 2) on reected light and
therefore the maximum daily exposure limits, a phantom
head unit with acrylic teeth was used, as it was felt these were
less variable than using extracted human incisor teeth. All
the measurements for reected light were performed with the
light curing unit that had been found to produce the greatest
spectral output in the rst part of the experiment, namely the
Fusion LED curing light. The spectroradiometer tip was placed
at a distance of 10 cm from the brackets and was held in place
using the custom made jig (Fig. 1). The brackets were placed
on upper canine to canine with Transbond XT (3 M) adhesive
and the light tip held at a distance of 0.5 cm from the central
incisor teeth.

3.

Results

The rst part of this research assessed the wavelength (nm)

and irradiance (mW/cm2 , W/m2 ) of the light emitted by 11
visible light curing units at seven distances ranging from 2
to 60 cm from the end of the light guide. A spectral analysis
between 400 nm and 550 nm was carried out at each distance.
The maximum weighted irradiance (mW/cm2 ) of each curing light was calculated at each distance (Table 3) as well as

Table 2 Bracket types used in the reected light study.

Fig. 1 Customized jig with phantom head, detector,

spectroradiometer, Fusion curing light, clamp and retort
stand.

Bracket type

Trade name

Manufacturer

Ceramic
Ceramic
Stainless steel
Stainless steel
Ceramic
Composite
Stainless steel
Stainless steel

Clarity
Clarity SL
Victory
Microarch
Encore
Tiger
Mini Ovation
TOC bracket

3M Unitek
3M Unitek
3M Unitek
GAC International
Ortho Technology
TOC
GAC International
TOC

e88

d e n t a l m a t e r i a l s 2 9 ( 2 0 1 3 ) e85e90

Table 3 Weighted intensity mW/cm2 at each distance (cm) for each of the 11 lights under test.
Weighted intensity mW/cm2 at each distance (cm)

Light unit
2 cm
Apollo95E
Cromalux
CU80
DEMIOrtho
Eipar freelight2
Fusion
MiniLED
MiniLED2
Ortholux LED
SmartLite
Starlight

9.90
26.01
27.43
181.02
42.54
266.68
62.01
36.33
55.77
22.36
44.26

10 cm

20 cm

30 cm

40 cm

50 cm

1.47
1.25
4.26
2.03
6.57
2.43
1.59
2.74
1.09
2.01

0.35
0.29
1.07
0.47
1.68
0.65
0.40
0.67
0.29
0.52

0.15
0.16
0.46
0.20
0.75
0.28
0.17
0.27
0.13
0.22

0.10
0.12
0.27
0.12
0.42
0.15
0.09
0.16
0.08
0.13

0.06
0.09
0.17
0.07
0.25
0.10
0.06
0.10
0.05
0.08

the safe exposure time of each curing light at each distance

(Table 4). Table 3 demonstrates that the Fusion LED light had
the greatest weighted irradiance at each of the measured distances. This was followed by the DEMI Ortho and the MiniLED
also both LED lights. The Apollo95E plasma arc lamp, perhaps
somewhat surprisingly, had the lowest measured weighted
irradiance of all the lights under test. However, it was difcult to assess the plasma arc lamp effectively as the internal
cooling mechanism of the light kept switching it off before a
complete spectral analysis could be undertaken. As a consequence only one measurement was carried out for this lamp.
The results demonstrate that the irradiance of each of
the lights under test decreased as the distance between the
light guide tip and detector increased. In the case of the
Fusion light this dropped from 266.68 mW/cm2 at 2 cm, to just
0.19 mW/cm2 at 60 cm. This drop in irradiance with distance
was to be expected and was shared by each of the lamps as
illustrated in Fig. 2.
Table 4 shows the maximum permissible exposure times
for each of the lights under test at each of the seven distances
(except for the plasma light) based on the guidelines published
by the International Commission on Non-Ionizing Radiation
Protection (ICNIRP) guidelines [21]. The ICNIRP guidelines are
the original and most representative publication regarding the
exposure limits and the published values are referenced by all
other national guidelines, including the ACGHI and the European Articial Optical Radiation Directive 2006/25/EC. It can be
seen that at a distance of 2 cm, these ranged from 0.19 minutes

60 cm

0.04
0.05
0.12
0.05
0.19
0.07
0.05
0.07
0.04
0.06

for the Fusion light, to 11.77 min for the Apollo 95E plasma arc
lamp. The maximum permissible exposure time is the theoretical time that it would take for a lesion to form on the retina.
If the distance from the light tip to the patients eye is approximately 10 cm, to the operator approximately 30 cm and to the
assistant 60 cm, then direct exposure at these distances would
cause damage to the retina in approximately 2.5 min, 22.1 min
and 88.8 min respectively. This is assuming that no protection
was being used and that the direct exposure was continuous.
The second part of this study looked at the effect of
orthodontic brackets and therefore reected light on the
weighted intensities and the safe exposure times using the
Fusion LED light at 10 cm. The initial reading was a baseline reading of the reected light from the acrylic teeth, with
no orthodontic brackets. The subsequent readings measured
the reected light with orthodontic brackets placed on upper
canine to canine, again measured at 10 cm. The results are
illustrated in Table 4. Looking at both the measured weighted
intensities and safe exposure times of reected light using
the Fusion LED with the various brackets, the stainless steel
Mini Ovation bracket gave the highest value with the Tiger
bracket second. This perhaps suggests that both bracket shape
and material are important for the reected light. However,
in all cases the measured weighted irradiances were low and
so the maximum safe daily exposures were relatively high.
As the values were so low for reected light at 10 cm it was
felt that any results measured at distances of greater than
10 cm would be too low to be of any clinical signicance and

Table 4 The calculated safe exposure times (min) using the ICNIRP guidelines at each of the distances under test and for
each of the light curing units (calculated using the formula LB t 100).
Light unit

Safe exposure time (min) at each distance (cm)

2 cm

Apollo95E
Cromalux
CU80
DEMIOrtho
Eipar freelight2
Fusion
MiniLED
MiniLED2
Ortholux LED
SmartLite
Starlight

11.77
4.49
4.25
0.64
2.74
0.19
1.88
3.21
2.09
5.22
2.64

10 cm

20 cm

30 cm

40 cm

50 cm

60 cm

11.3
13.4
3.9
8.2
2.5
6.9
10.5
6.1
15.3
8.3

47.2
57.1
15.6
35.5
9.9
25.8
42.2
25.1
57.9
32.2

113.5
104.8
36.3
81.8
22.1
60.3
100.9
61.2
123.5
76.1

175.3
144.8
62.4
144.6
40.1
114.2
176.0
105.7
211.3
126.7

301.3
194.6
97.6
229.6
66.6
173.0
265.2
166.4
326.7
202.0

432.9
312.7
138.5
322.3
88.8
248.2
365.6
226.1
450.9
301.7

e89

d e n t a l m a t e r i a l s 2 9 ( 2 0 1 3 ) e85e90

Weighted intensity of different orthodontic curing light at various distances

Cromalux
CU80
DEMIOrtho
Eipar_freelight2
Fusion
MiniLED
MiniLED2
Ortholux_LED
SmartLite
Starlight

1000000.00

Weighted intensity [mW/m ]

10000000.00

100000.00

10000.00

1000.00

100.00

10

20

30

40

50

60

70

Distance [cm]
Fig. 2 Weighted intensities (mW/cm2 ) of the different curing lights at 2, 10, 20, 30, 40, 50 and 60 cm.

so these were not carried out. The safe exposure time at 10 cm

for the reected light ranged from 61.8 min (Mini Ovation) to
90.8 min (Clarity). The gures for reected light to the eye
of the orthodontist (35 cm) and assistant (60 cm) would be
expected to be much greater than this. Direct exposures are
therefore of more concern than indirect exposures.

4.

Discussion

The rst part of this study looked at the maximal permissible daily exposure times for light curing units at a variety
of distances from the light source ranging from 2 to 60 cm,
with 2 cm being the minimum permissible distance at which
the spectroradiometer would work. It can be seen that a
direct exposure at 2 cm with the most intense light, namely
the Fusion LED, would produce a retinal lesion in just 11.4 s
(0.19 min) based on the ICNIRP guidelines [21]. This may be
related to the collimation of the light beam, which has been
shown to be greater in the case of the Fusion LED than some
other curing lights [22]. An earlier pilot study had measured
the light tip to eye distance when bonding an upper incisor
bracket and for the patient was measured as approximately
10 cm; for the orthodontist approximately 30 cm and to the
orthodontic assistant approximately 60 cm and is similar to
the distances used in previous studies [23]. Using these same
distances it can be estimated from our results that the time
taken to form a lesion on the retina with a direct exposure
would be 2.5 min for the patient, 22.1 min for the orthodontist
and 88.8 min for the assistant, depending on which guidelines
are used. Whichever guidelines are used, all of the gures
assume a direct exposure with no safety procedures in place.
If safety precautions are used, such as orange lters close
to the light guide tip, an orange paddle shield or orange spectacles, then the light produced by each of light curing units
under test is unlikely to reach the maximum daily exposures

required to produce lesions on the retina. Previous work has

shown that use of the correct ltration can limit transmission
to 0.1% of the radiation at any wavelength in the 400525 nm
range [24]. However, the same study also demonstrated that
half of the lters under test did not perform adequately and
that it is important the lters are matched to the output of the
light curing units.
If current light curing units have the potential to cause
damage during direct exposure when safety precautions are
not taken, what about reected light, which clinically is perhaps less predictable and therefore controllable? Using the
phantom head unit once again with various brackets and
bracket materials (metal and esthetic) with the Fusion LED,
the results indicate that the safe exposure time ranged from
61.08 min for the stainless steel Mini Ovation bracket up to
88.86 min for the Clarity polycrystalline ceramic bracket at
a distance of 10 cm. The maximum permissible times for
reected light to the eye of the orthodontist (30 cm) and assistant (60 cm) would be expected to be much greater than this.
The second most reective bracket was the Tiger bracket,
a composite esthetic, which highlights the fact that bracket
shape and material can both have an effect on the reected
light and therefore maximum permissible exposure. Once
again the maximum permissible exposure times were sufciently high that the risk to the operator and nurse are very
low, particularly if the correct safety goggles or paddles are
used. This is contrary to the ndings of a previous study
investigating the maximal permissible exposure during tooth
bleaching which found one of the lamps under test exceeded
the daily permissible maximum exposure even with reected
light [25].
Although the short term risks associated with the use of
modern day dental curing lights is low, there is a possible
cumulative effect of regular exposure to blue light. Taylor et al.
[26] examined the relationship between exposure to sunlight
and various eye conditions, including age-related macular

e90

d e n t a l m a t e r i a l s 2 9 ( 2 0 1 3 ) e85e90

degeneration, in 838 bay workers. They found that in agematched controls, patients with macular degeneration had
signicantly higher exposure to blue or visible light, but were
not different with respect to exposure to UVA or UVB. It was
concluded that high levels of exposure to blue or visible light
may cause ocular damage, especially later in life, and may be
related to the development of age-related macular degeneration. It should also be remembered that people who have had
cataract surgery are at greater ocular risk to blue light exposure and this may be later in life, when the risks of exposure
to blue light are already greater [27].

5.

Conclusions

The short term risks associated with the use of dental curing
lights, halogen, LED or plasma, appear to be low, particularly
if, as is the case, adequate safety precautions are employed.
The same is true for reected light from orthodontic brackets
during bonding. What is still unclear are the potential long
term ocular effects of prolonged exposure to the blue light
generated from dental curing lights.

Acknowledgements
Based on a thesis submitted to the School or Oral and Dental Science, University of Bristol, in partial fulllment of the
requirements for the DDS degree

references

[1] Tavas A, Watts DC. Bonding of orthodontic brackets by

transillumination of a light-activated composite: an in vitro
study. British Journal of Orthodontics 1979;6:2078.
[2] Read MJF. The bonding of orthodontic attachments using a
visible light-cured adhesive. British Journal of Orthodontics
1984;11:1620.
[3] Cooper RB, Goss M, Hamula W. Direct bonding with
light-cured adhesive precoated brackets. Journal of Clinical
Orthodontics 1992;26:4779.
[4] Staudt CB, Mavropoulos A, Bouillaguet S, Kiliaridis S, Krejci I.
Light curing time reduction with a new high powered
halogen lamp. American Journal of Orthodontics and
Dentofacial Orthopedics 2005;128(6):74954.
[5] Pettemerides AP, Sherriff M, Ireland AJ. An in vivo study to
compare a plasma arc light and a conventional quartz
halogen curing light in orthodontic bonding. European
Journal of Orthodontics 2004;26(6):5737.
[6] Gronberg K, Rossouw PE, Miller BH, Buschang P. Distance
and time effect on shear bond strength of brackets cured
with a second-generation light-emitting diode unit. Angle
Orthodontist 2006;76(4):6828.
[7] Park YJ, Chae KH, Rawls HR. Development of a new
photoinitiation system for dental light cure composite
resins. Dental Materials 1999;15(2):1207.
[8] Silta Dunn WJ, Peters CB. The effect of shorter
polymerisation times when using the latest generation of
light emitting diodes. American Journal of Orthodontics and
Dentofacial Orthopedics 2005;128(6):7448.

[9] Yearn JA. Factors affecting cure of visible light activated

composites. International Dental Journal 1985;35(3):
21825.
[10] Oesterle LJ, Newman SM, Shellhart WC. Rapid curing of
bonding composite with a xenon plasma arc light. American
Journal of Orthodontics and Dentofacial Orthopedics
2001;119:6106.
[11] Kramer N, Lohbauer U, Garca-Godoy F, Frankenberger R.
Light curing of resin-based composites in the LED era.
American Journal of Dentistry 2008;21(3):13542.
[12] Ham WT, Mueller HA, Sliney DH. Retinal sensitivity to
damage from short wavelength light. Nature 1976;260:
1535.
[13] Davies NP, Moreland AB. Pigments: their characteristics and
putative role. Progress in Retinal and Eye Research
2004;23:53359.
[14] Margrain TH, Boulton M, Marshall J, Sliney DH. Do blue light
lters confer protection against age-related macular
degeneration? Progress in Retinal and Eye Research
2004;23(5):52331.
[15] ACGIH (American Conference on Governmental and
Industrial Hygienists). Threshold limit values for chemical
substances and physical agents and biological exposure
indices. Cincinnati: ACGIH; 1999.
[16] Moseley H, Strang R, MacDonald I. Evaluation of the risk
associated with the use of blue light polymerizing sources.
Journal of Dentistry 1987;15(1):125.
[17] Sliney DH. Standards for use of visible and nonvisible
radiation on the eye. American Journal of Optometry and
Physiological Optics 1983;60(4):27886.
[18] Health and Safety Executive UK. A non-binding guide to the
Articial Optical Radiation Directive 2006/25/EC. HSE
2011.
[19] Satrom KD, Morris MA, Crigger LP. Potential retinal hazards
of visible-light photopolymerization units. Journal of Dental
Research 1987;66(3):7316.
[20] Roll EB, Dahl JE, Johnsen B, Christensen T. Watch out for the
light from the light curing units. Nor Tannlegeforen Tid
2002;102:57680.
[21] International Commission on Non-ionizing Radiation
Protection (ICNIRP). Guidelines on limits of exposure to
broad-band incoherent optical radiation (0.383 m). Health
Physics 1997;73(3):53954.
[22] Price RB, Labrie D, Whalen JM, Felix CM. Effect of distance on
irradiance and beam homogeneity from 4 light-emitting
diode curing units. Journal of Canadian Dental Association
2011;77:b9.
[23] Labrie D, Moe J, Price RB, Young ME, Felix CM. Evaluation of
ocular hazards from 4 types of curing lights. Journal of
Canadian Dental Association 2011;77:b116.
[24] Bruzell EM, Johnsen B, Aalerud TN, Christensen T.
Evaluation of eye protection lters for use with dental
curing and bleaching lamps. Journal of Occupational and
Environmental Hygiene 2007;4:4329.
[25] Bruzell EM, Johnsen B, Aalerud TN, Dahl JE, Christensen T.
In vitro efcacy and risk for adverse effects of light-assisted
tooth bleaching. Photochemical & Photobiological Sciences
2009;8:37785.

[26] Taylor HR, West S, Munoz

B, Rosenthal FS, Bressler SB,
Bressler NM. The long-term effects of visible light on the
eye. Archives of Ophthalmology 1992;110(1):99104.
[27] Sparrow JR, Miller AS, Zhou J. Blue light-absorbing
intraocular lens and retinal pigment epithelium protection
in vitro. Journal of Cataract and Refractive Surgery
2004;30:8738.