The Environmentally Responsible Dentist - Dental Amalgam Recycling: Principles, Pathways and Practice

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The Environmentally Responsible Dentist - Dental Amalgam Recycling: Principles, Pathways and Practice
The Environmentally Responsible Dentist
   Dental Amalgam Recycling:
   Principles, Pathways and Practice

                                          1
The Environmentally Responsible Dentist - Dental Amalgam Recycling: Principles, Pathways and Practice
Presentation Topics

• History of Amalgam

• Related Mercury Actions

• Mercury in Dental Amalgam

• Government Regulation

• Amalgam Use in the U.S.

• Environmental Fate and Transport Mechanisms

• Environmentally Responsible Practices
                                                2
The Environmentally Responsible Dentist - Dental Amalgam Recycling: Principles, Pathways and Practice
Be The Difference!
To Develop, Highlight, and Teach Environmentally
Responsible Dentistry

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The Environmentally Responsible Dentist - Dental Amalgam Recycling: Principles, Pathways and Practice
History of Amalgam
To Develop, Highlight and Teach Environmentally Responsible Dentistry

                                                                   4
The Environmentally Responsible Dentist - Dental Amalgam Recycling: Principles, Pathways and Practice
History of Amalgam

• A Chinese medical text
  mentions using a “silver
  paste”, a type of amalgam, to
  fill teeth in the 7th century.1

                                    Image courtesy of University of California Press. 5
The Environmentally Responsible Dentist - Dental Amalgam Recycling: Principles, Pathways and Practice
History of Amalgam

• Pierre Fauchard

  • b. 1678 - d. 1761.

  • The Age of Enlightenment.

  • Between 1650 and 1800, the
    science of modern dentistry
    developed.

  • Le Chirurgien Dentiste published in
    1728.

  • He advocated the use of lead
    (plombagel) to fill cavities.

                                          6
The Environmentally Responsible Dentist - Dental Amalgam Recycling: Principles, Pathways and Practice
History of Amalgam

• Joseph Fox - b. 1775 - d.
  1816.

  • One of the most highly regarded
    English dentists of his time.

  • In 1803, he created fusible metal
    (bismuth, metal, and tin).

     • This metallic filling material when
       put in the cavity form and cooled,
       would solidify and replicate the
       shape of the cavity.

     • Had a relatively high melting point -
       100°/212°- equivalent to that of        Image courtesy of the OHSU Historical Collections & Archives,
       boiling water.                          Oregon Health & Science University.

                                                                                                           7
The Environmentally Responsible Dentist - Dental Amalgam Recycling: Principles, Pathways and Practice
History of Amalgam

• “Most people may be deceived
  at the time of an operation;
  though woeful experience in a
  few months unfolds the
  deception. The impostor is
  sought for to make reparation,
  or to receive merited
  punishment; but the bird has
  flown; he is gone to practice his
  tricks and deceptions among
  those, who know not his
  character; until prudence drives
  him into another seclusion from
  revenge, into another ‘shoal of
  gudgeons.’ ”

  • Benjamin James MMSS - 1814
                                      Image courtesy of Bernard Becker Medical   8
                                      Library, Washington University School of
                                      Medicine, St. Louis.
The Environmentally Responsible Dentist - Dental Amalgam Recycling: Principles, Pathways and Practice
History of Amalgam

• Thomas Bell

  • b. 1792 – d. 1880.

  • Fox’s successor at Guy’s
    Hospital.

  • Around 1826, he invented an
    amalgam of coin silver and
    mercury which had a much
    lower melting point than
    Fox’s metal.

                                  9
The Environmentally Responsible Dentist - Dental Amalgam Recycling: Principles, Pathways and Practice
History of Amalgam
• Crawcour brothers

  • In 1833, introduced Taveau’s amalgam in New York.

  • Traveling Dentists.

  • They did a remarkable job of advertising.

     • Decay was not removed before filling the teeth.

                                                         10
History of Amalgam

• The Amalgam War

  • Local dentists organized to fight the use of this “execrable material by
    swindling villains.”

  • Crawcour brothers forced to flee America.

• In 1843, the American Society of Dental Surgeons (ASDS) began a
  crusade to fight the use of amalgam.

                                                                          11
History of Amalgam

• The Amalgam War

  • In 1845, the ASDS passed a resolution compelling every member not
    to use amalgam.

  • In 1850, the ASDS rescinds its pledge requirement.

  • In 1855, the ASDS disbands.

    • If you can’t beat them, join them.

                                                                    12
History of Amalgam

• What ended the Amalgam War?

  • Professional and consumer demand.

• In 1859, the leaders of the profession regrouped to form the American
  Dental Association.

• Between 1860 and 1890, many experiments were done to improve
  amalgam filling materials.

• Amalgam was here to stay.

                                                                          13
History of Amalgam

• G.V. Black

  • b. 1836 - d. 1915.

  • Developed a “good and
    workable” amalgam in 1895.

  • He believed amalgam should
    consist of 67% silver, 27%
    tin, 5% copper, and 1% zinc.

  • Use of amalgam gradually
    won acceptance as a cost
    effective way to restore teeth.
                                      Image was reproduced from Volume VII of the History of
                                                                                                 14
                                      Dental Surgery, Chicago National Art Publishing Company,
                                      1909.
History of Amalgam
Amalgam Composition
• Modern Dental Amalgam

  • Manufactured product
    containing two nearly equal
    parts by weight.

• First part:

  • a powder containing silver, tin,
    copper, zinc and other metals.

• Second part:

  • liquid mercury (Hg).
                                       15
History of Amalgam
Amalgam Composition

  Mercury
  Silver
                                 2%
  Tin
                                  0%
  Copper
                           13%
  Zinc (Trace)

                                       Mercury
                                        50%
                  Silver
                  35%

                                                 16
Related Mercury Actions
To Develop, Highlight and Teach Environmentally Responsible Dentistry

                                                                   17
Related Mercury Actions-International

• January 31, 2005 - European Union (EU) launched a comprehensive
  mercury strategy to reduce EU's and global emissions and use of
  mercury.

• July 10, 2007 – EU banned the sale of thermometers and other
  instruments which contain mercury.

• September 25, 2008 – EU adopted law that bans the export of elemental
  mercury, effective March 2011.

• In 2008, Norway and Denmark banned the use of mercury in dental
  amalgam.

• Effective June 1, 2009, Sweden banned the use of mercury in products,
  including mercury in dental amalgam, for environmental reasons.
                                                                      18
Related Mercury Actions-U.S.

• On October 14, 2008, President Bush signed into law the
  Mercury Export Ban Act of 2008.

  • Prohibits the sale, distribution, or transfer of elemental mercury by
    federal agencies.

  • It also prohibits the export of elemental mercury - The law is effective
    January 1, 2013.

  • Department of Energy - responsible for the management and long-
    term storage of the U.S. excess elemental mercury.

                                                                            19
Related Mercury Actions-U.S.

• February 16, 2009 - President Obama Shifts U.S. Policy and
  Supports Global Mercury Control Treaty

  • Covers reducing demand in products, processes and cutting Hg in
    international trade.

  • 120 countries expressed support for a legally binding agreement on Hg.

                                                                             20
Related Mercury Actions-U.S.

• August 2009 - the US Geological Service released study entitled:
  "Mercury in Fish, Bed Sediment, and Water from Streams Across the
  United States, 1998-2005."

  • The study found mercury contamination in every fish sampled in
   291 streams across the country.

  • About a quarter of these fish were found to contain mercury at levels
    exceeding EPA’s criterion for the protection of people who consume
    average amounts of fish.

                                                                        21
Related Mercury Actions-U.S.

• October 2009 - EPA released Report to Congress on mercury compounds
  as required by Congress under Section 4 of the Mercury Export Ban Act of
  2008.

  • The report identifies sources of mercury compounds in the U.S. and
    reports quantities in imports and exports, and uses of these compounds
    in products and processes. The report also assesses the potential for
    key mercury compounds to be exported for regeneration into elemental
    mercury.

                                                                             22
Related Mercury Actions
ADA/EPA/NACWA Publications and Partnerships

• In 2007, ADA updated its Best Management Practices (BMPs) to include amalgam
  separators. (ADA first published its BMPs in January 2003.)

  • An amalgam separator is a capture device that collects amalgam particles.

  • The BMP for amalgam separators - the same as ANSI/ADA Specification #108
    (American National Standards Institute) which delineates requirements and test
    methods for amalgam separators.

• EPA published its "Health Services Industry Detailed Study" - August 2008. (In the
  document, EPA compiled information on mercury discharges from dental offices, best
  management practices, and amalgam separators.)

• The EPA, ADA, and the National Association of Clean Water Agencies (NACWA)
  entered into a partnership in December 2008 to promote the ADA’s BMPs for amalgam
  waste, including amalgam separators.
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Mercury in Dental Amalgam
To Develop, Highlight and Teach Environmentally Responsible Dentistry

                                                                  24
Mercury in Dental Amalgam

• Mercury is persistent, bio-accumulative, and toxic and is responsible for
  significant environmental degradation around the world.

• Although its use in most product applications does not present a risk, the
  subsequent disposal of any product containing mercury does.

  • Amalgam is no different.

• Mercury poisoning affects about 5 million American women. 1 in 12 women
  have mercury levels above the levels considered safe.

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Mercury in Dental Amalgam

• Three Types of Mercury:

  1. Elemental Hg (Elemental Hg
     Is Used in Dental Amalgam.)

     • Heavy, odorless, silver-
       colored liquid.

     • Inhalation is the main source
       of toxicity. (Mercury poisoning
       can also occur from dermal
       exposure.)

                                         This image is licensed under the Creative Commons Attribution-
     • Hg well absorbed by lungs.        Share Alike 2.5 Generic license.

     • Need long-term exposure or
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       one large exposure.
Mercury in Dental Amalgam

• Three Types of Mercury:

  2.   Inorganic Hg

       • Known as mercuric salts…i.e. mercuric chloride, mercuric iodide,
         cinnabar.

       • Found in many folk medicines.

       • Corrosive and can damage the kidneys.

       • Long-term exposure can cause skin irritation, staining, and nerve
         damage.

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Mercury in Dental Amalgam

Three Types of Mercury:

3. Organic Mercury =
   Methylmercury

•   More potent and more
    bioaccumulative than other
    forms of mercury.

•   Form to which humans are
    primarily exposed.

•   The EPA is most concerned
    about methylmercury in the
    environment.
                                 28
Mercury in Dental Amalgam

• Three Types of Mercury

  • Methylmercury (continued):

     • Organic Hg primarily found
       in fish.

     • Organic concentrations in
       large fish can be over a
       million times higher than in
       the surrounding water.
                                      Drawing courtesy of Fishbase.

                                                                      29
Mercury in Dental Amalgam

 • Three Types of Mercury:

    • Methylmercury (continued):

       • Found in fungicides and antibacterials (mercurichrome).

       • The main source of Hg poisoning in humans is ingestion.

          • Small ingestions rarely cause problems.

          • Large ingestions or long-term ingestions can adversely impact all
            body systems.

                                                                            30
Mercury in Dental Amalgam

• Inorganic Mercury and Methylmercury

  • Inorganic Hg has a high affinity for particles. Therefore, the fate of most
    inorganic mercury in aquatic systems is sedimentation.

  • …...Methylmercury, in contrast, tends to be more soluble because of its
    affinity for organic compounds. It is the most risky type of mercury in
    the environment.

                                                                                  31
Mercury in Dental Amalgam

• How is Methylmercury Formed?

  • When dental amalgam is
    released to the environment,
    the mercury component is
    transformed into methylmercury
    by microbial action.

  • Methylation is a product of very
    complex processes that
    transform mercury into more
    reactive species.

                                       32
Mercury in Dental Amalgam - How Is
Methylmercury Formed?

                                     33
Mercury in Dental Amalgam

• The Impact of Methylmercury in
  the Environment

  • Once formed, this new mercury
    compound is taken up more
    readily by aquatic organisms
    such as fish, particularly in
    waters higher in acidity.

  • Methylmercury uptake by fish
    leads to fish advisories of
    which there are 50
    nationwide. As of 2008, all
    50 states, one U.S. territory
    and three tribes have issued
    fish advisories.

                                    34
Government Regulation
To Develop, Highlight and Teach Environmentally Responsible Dentistry

                                                                  35
Government Regulation
• Why voluntarily act in an environmentally responsible fashion?

   • Amalgam separators are effective in reducing over 95% of the amalgam from dental office
     wastewater.

      • The mercury can then be recycled.

      • Currently, mercury releases to wastewater from dental offices are controlled through
        state mandates and voluntary actions; however, EPA does have the authority to issue
        regulations to control these releases.

      As respected community leaders, dentists need to do their part for the environment.

                                                                                               36
Government Regulation

• Dental amalgam - is a dental medical device regulated by the Food and Drug
  Administration (FDA).

• Since the 1990s, several federal agencies (FDA, Center for Disease Control and the
  U.S. Public Health Service) have reviewed the scientific literature looking for links
  between dental amalgam and health problems.

• In September 2006, an FDA Advisory Council met to discuss the benefits and risks of
  mercury and amalgam. Their findings:

  • No evidence that amalgam use causes health problems in a majority of
    population.

  • Lack of knowledge regarding effects on pregnant women, children, and those who
    are sensitive to mercury.

                                                                                     37
Government Regulation
 • In 2008, FDA again reviewed the best available scientific evidence to determine
   whether low levels of mercury vapor associated with dental amalgam are a
   concern. Based on this evidence, FDA considers dental amalgam safe for adults
   and children aged six and older.

 • For individuals who have an allergy to mercury or the other components of dental
   amalgam (silver, tin, or copper) - FDA cautions these individuals not to get
   amalgam fillings.

 • On July 28, 2009, FDA issued a final regulation classifying dental amalgam and
   its component parts (elemental mercury and a powder alloy) as “Class II” medical
   devices.

    • Specifically the Center for Devices and Radiological Health (CDRH). By
      classifying a device as "Class II," the FDA can impose special controls to
      provide reasonable assurance of the safety and effectiveness of the device.
      The special controls contain, among other things, recommendations on
      performance testing, device composition, and labeling statements.
                                                                                    38
    • It is considered to be a stable device for most applications and uses.
Government Regulation

• EPA is concerned about amalgam
  discharges that enter the waste
  stream.

• EPA regulates any waste
  generated from amalgam
  preparation and use.

• Examples of amalgam waste:

  • Non-contact amalgam.

     • Excess left over after
       procedure.

                                    39
Government Regulation

• Examples of amalgam waste (continued):

• Contact amalgam:

  • Has been in contact with human…extracted teeth, carving scrap, traps or
    filters.

• Amalgam sludge:

  • Mix of liquid and solid collected within vacuum pump filters and chairside traps.

• Amalgam capsules.

                                                                                        40
Amalgam Use in the U.S.
To Develop, Highlight and Teach Environmentally Responsible Dentistry

                                                                  41
Amalgam Use in the U.S.

• Decline of Hg-containing products

  • Between 1980 and 2004, mercury usage in products declined substantially
    over the years – a decrease of roughly 95%.

  • This reduction in use was due in large part to federal legislation and state
    regulatory standards for mercury usage in batteries and to EPA’s regulatory
    ban on mercury in paint.

  • Mercury use in products accounted for an estimated 116 tons in 2004.
    Mercury usage in the form of dental amalgam was 30.4 tons or 26% of the
    total. (This is a high percentage of the total.)

                                                                              42
Amalgam Use in the U.S.

•    Estimated 2004 U.S. mercury use in products1:

    • Switches & Relays – 44%.

    • Dental Amalgam – 26%.

    • Measuring and Control Devices - 17%.

    • Electric Lighting - 8%.

    • Other - 5%.

    • Among these products containing mercury, dental amalgam is a focus of concern.
      Relative to other sectors, dentists use large quantities of mercury in fillings and
                                                                                          43
      they generate large amounts of waste.
Amalgam Use in the U.S.

• The use of dental amalgam has declined in the past two decades. It
  continues, however, to be placed in teeth. Currently accounts for 30% of
  dental fillings in the US.1

• In 1999, US dentists placed an estimated 71 million amalgam
  restorations.2

  • 29% reduction from 1990.3

  • Reductions can be attributed to decrease in cavity rate and increased
    use of mercury-free fillings.4

                                                                        44
Amalgam Use in the U.S.

• Data indicate that there were 163,181 individual dentists in 2004.1 In 2005, EPA
  estimates that there were 122,918 dental offices that used or removed dental
  amalgam that year. 2

• 340 mg of mercury used in an average placement with 9% or 30 mg resulting in
  non-contact scrap and/or carving waste.3

• Estimated that 300 mg of mercury results from each removal.4

                                                                                45
Amalgam Use in the U.S.

 • Amalgam Waste Contributions to Wastewater

   • Major studies show impact on water quality from dental amalgam waste:

     • A 2002 study by the New York Academy of Sciences indicated as
       much as 40% of the New York Harbor mercury loadings were from
       dental offices.1

     • A report released in 2002 by NACWA indicated that dental clinics are
       the largest single source of mercury in wastewater. NACWA estimated
       that 36% of the mercury in the nation's wastewater system came from
       dental offices. Mercury discharges from dental offices far exceeded
       all other commercial and residential sources, each of which was
       below 10 percent.2

                                                                         46
Amalgam Use in the U.S.

• Data Show Impact on Water Quality from Dental Amalgam Waste (Continued):

  • In 2003, dental offices were found to be the source of 50% of all mercury
    pollution entering Publicly Owned Treatment Works (POTWs).1

  • EPA estimated in 2008 that the approximately 162,000 dentists who use or
    remove dental amalgam in the U.S. discharge approximately 3.7 tons of
    mercury each year to POTWs.2

                                                                                47
Amalgam Use in the U.S.

• With dental amalgam's associated mercury contamination problems, why is
  amalgam still being used?

•   Relatively easy to place and low cost.

•   Good resistance to compressive forces, especially for posterior teeth.

•   Insurance plans have traditionally covered placement procedures.

•   No current, adequate substitute.

                                                                             48
Amalgam Use in the U.S.

• Past Management Practices = More Pressure on Dentists Today

  • Despite its continued use, management of amalgam waste has created
    substantial environmental contamination and has created more pressure on
    the industry to recycle amalgam to prevent it from getting into the
    environment.

                                                                          49
Amalgam Use in the U.S.

• Best Management Practices

  • In January 2003, the American Dental
    Association (ADA) released Best
    Management Practices (BMPs) .

  • The BMPs are a set of guidelines about
    capturing and recycling dental amalgam
    waste. Guidelines include use of such
    items as collection boxes for excess
    amalgam and chairside traps to retain
    amalgam.

                                    Noncommercial use, reproduction and distribution of all or any portion of the
                                    American Dental Association's Best Management Practices for Amalgam
                                    Waste is permitted solely for educational or scientific purposes, provided that
                                    this copyright notice is prominently displayed on each copy of the work. Third
                                    parties are expressly prohibited from creating derivatives of this work without
                                    the prior written permission of the American Dental Association. This work is
                                    educational only and does not constitute legal or professional advice.
                                                                                                                50
Amalgam Use in the U.S.

• Best Management Practices:

  • All state and local voluntary programs
    are based on or derived from the
    guidance provided in the ADA's
    BMPs.

  • The 2003 BMPs stressed recycling of
    amalgam collected in the dental
    office. But no mention of installing
    amalgam separators to remove
    amalgam particles from wastewater.

                                   Noncommercial use, reproduction and distribution of all or any portion of the
                                   American Dental Association's Best Management Practices for Amalgam
                                   Waste is permitted solely for educational or scientific purposes, provided that
                                   this copyright notice is prominently displayed on each copy of the work. Third
                                   parties are expressly prohibited from creating derivatives of this work without
                                   the prior written permission of the American Dental Association. This work is
                                   educational only and does not constitute legal or professional advice.
                                                                                                               51
Amalgam Use in the U.S.
• Best Management Practices

  • In October 2007, the American Dental Association revised “Best Management
    Practices for Amalgam Waste.”

  • Added language on amalgam separators:

     • Amalgam Separators

        • Select an amalgam separator that complies with ISO 11143.

        • Follow the amalgam separator manufacturer’s recommendations for
          maintenance and recycling procedures.

  • The BMPs recommend two important and effective "best practices": the use of
    dental amalgam separators, and the recycling of captured amalgam solid waste.
                                                                                    52
Amalgam Use in the U.S.

• Some states have mandatory dental amalgam program requirements,
  including installation of amalgam separators.

  • Specifics on state requirements can be found in EPA's Health Services
    Industry Detailed Study: Dental Amalgam (August 2008).

  • Additionally, The National Conference of State Legislatures lists state
    legislature internet links, including links to information on state laws
    requiring dentists to install amalgam separators.

                                                                               53
Amalgam Use in the U.S.

• Amalgam Separator Sales

  • 2001-2009 data provide estimates on the numbers
    of separators sold in regulated, partially regulated,
    and non-regulated states.1

  • Based on the number of sales by one manufacturer,
    only 13% of separators were sold in non-regulated
    states from 2004-2009.2

                                                       This photo is used for illustrative purposes only.
                                                       EPA cannot endorse any particular amalgam separator.
                                                                                                       54
Environmental Fate & Transport Mechanisms
To Develop, Highlight and Teach Environmentally Responsible Dentistry

                                                                  55
Environmental Fate &
Transport Mechanisms

• How Does Amalgam Waste Reach the Environment?

  1. From Publicly Owned Treatment Works (POTWs) connected to dental
     offices which receive amalgam through office piping and sewer
     discharges….

  2. From medical waste companies who pick up red bags at dental offices
     containing amalgam waste and subsequently treat the medical waste in
     incinerators…..

  3. From landfills which receive amalgam waste from disposal companies which
     take waste from dentists who place it in office municipal trash….

                                                                                56
Environmental Fate &
Transport Mechanisms

1. Publicly Owned Treatment
  Works

  • Dental Amalgam Waste

       • Into vacuum line.

       • Not captured by office
         traps or amalgam
         separators.

       • Released to the sewer.

       • Into POTWs.
                                  57
Environmental Fate &
Transport Mechanisms

• Publicly Owned Treatment
  Works

  • Not 100% efficient. (POTWs
    have a roughly 90% efficiency
    rate of removing amalgam from
    wastewaters.)

  • Thus, about 10% gets into
    lakes, rivers, and streams.

                                    58
Environmental Fate & Transport Mechanisms

                        inm

 Environmental Fate &              Amalgam Waste Entry
                                   into Ecosystem
Transport Mechanisms
                              Diagram is included in "ASSESSMENT OF MERCURY IN
                              THE FORM OF AMALGAM IN DENTAL WASTEWATER IN
                              THE UNITED STATES," Jay A. Vandeven and Steve L.
                              McGinnis, 2005.
                                                                                 59
Environmental Fate &
Transport Mechanisms
2. Medical Waste Incinerators

     • Red medical bags.

     • Mercury released when:

          Amalgam waste is
          treated by medical waste
          companies with
          incinerators which are
          not designed to handle
          the mercury component
          of amalgam..

     • With precipitation, airborne
       Hg gets deposited into water
       bodies.
                                      60
Environmental Fate &
Transport Mechanisms
• Medical Waste Incinerators

  • Dental Amalgam Waste

     • In October 2009, EPA
       published a regulation that
       limits emissions from
       medical waste incinerators.
       EPA estimates that this rule
       will cut mercury emissions
       by 605-682 pounds annually
       of Hg emitted to the
       atmosphere through the
       stacks.

                                      61
Environmental Fate
and Transport
Mechanisms
• Landfills

   • Dental Amalgam Waste Goes:

      • Into garbage.

      • To landfills.

      • Landfill leachate may enter
        groundwater.

      • Your amalgam waste could
        reach groundwater if you
        dispose of it in the trash.

                                      62
Environmental Fate and Transport
Mechanisms
• Sludge from POTWs

  • Dental Amalgam Waste

     • Sludge from POTWs may be applied to agricultural land as fertilizer.

        • Some of the mercury in the fertilizer may also evaporate to the
          atmosphere. Through precipitation, the airborne mercury
          eventually gets deposited into water bodies, land and
          vegetation.

     • Sludge from POTWs may also be incinerated. Once incinerated, the
       mercury may volatilize to the atmosphere. Mercury may then be
       deposited into lakes and streams via precipitation.

                                                                              63
Environmentally Responsible Practices
To Develop, Highlight and Teach Environmentally Responsible Dentistry

                                                                  64
Environmentally Responsible
Practices

• Strategies for Proper Amalgam Waste Management in Your Office

  • The EPA recommends four specific actions to manage your amalgam waste.

  • The first letters of each action form the acronym...G.R.I.T.

     • Gray Bag It.

     • Recycle It.

     • Install It.

     • Teach It.
                                                                             65
Environmentally Responsible
Practices

• Strategies for Proper Amalgam Waste Management in Your Office

  • Gray Bag It - Discard excess amalgam wastes into a gray bag.      Never dispose of dental amalgam
    wastes in medical red bags or in your office trash containers.

  • Recycle It - Select a responsible dental amalgam recycler - who will manage your waste amalgam
    safely to limit the amount of mercury which can go back into the environment.
                                                                                 List of Recyclers

  • Install It - Install an amalgam separator in the office to capture up to 95% of the mercury leaving a
    dental office through drains. This is the KEY to success.

      • Important to note - A very small amount of dental amalgam waste will be released to waterways
        given the high capture rate of amalgam separators (95%), coupled with the approximate 90%
        efficiency rate of POTWs.

  • Teach It - Educate and train staff about the proper management of dental amalgam in the office.
                                                                                                        66
Environmentally Responsible
Practices

• Gray Bag It

  • Environmentally responsible
    amalgam waste control begins in
    the dental office.

  • In September 2006, EPA and the
    ADA developed a voluntary
    standard for storing (and shipping
    to recyclers) excess dental
    amalgam not needed by dentists
    during filling placement and/or
    removal procedures. Standard was
    developed through ANSI (American
    National Standards Institute.)

  • The EPA refers to this as “Gray      This photo is used for illustrative purposes only.
    Bag” collection. (The containers     EPA cannot endorse any particular gray bag.
    are gray in color.)
                                                                                              67
Environmentally Responsible
Practices

• Recycle It

  • Most important step:

     • Selection of a responsible company to manage your waste once you
       have properly controlled it in your office.
                                                 List of Recyclers

     • It makes no sense to handle your waste properly yourself and then turn it
       over to someone who can't properly manage Hg waste.

     • It is important to recycle both the amalgam waste captured by amalgam
       waste separators and the amalgam discarded in "gray bags."

     • Gray bags serve a dual purpose: to both hold excess amalgam and as a
       container to send to recyclers.                                    68
Environmentally Responsible
Practices

• Recycle It

  • Mercury cannot be destroyed, so waste managers must rely on
    various methods to treat or recover it, depending on:

     • the mercury species present.

     • its concentration.

     • the waste matrix or media involved.

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Environmentally Responsible
Practices

• Recycle It

  • One of the most effective processes to handle mercury wastes is called “retorting.”

     • Process especially designed to capture the mercury from mercury-containing items,
       such as dental amalgam.

     • Retorting operations separate the mercury from the rest of the waste stream and
       condense it for recovery.

  • Select a retorting company which is subject to regulatory oversight under the Resource
    Conservation and Recovery Act (RCRA). Such companies are classified as hazardous
    waste treatment, storage and disposal facilities that require a RCRA hazardous waste
    permit during the active stage (including the closure period) of waste management at the
    facility. A RCRA permit needs to be approved by state or federal officials and ensures that
    specific requirements are met, such as monitoring the groundwater under the facility to
    ensure that this valuable resource is not getting contaminated.

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Environmentally Responsible
Practices

• Recycle It

  • Bottom Line:

     • The end point to responsible waste management is ensuring that
       mercury is collected and recycled and not released to the
       environment during or after treatment.

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Environmentally Responsible
 Practices
• Install It

   • Installing an Amalgam
     Separator

       • Removes amalgam from dental
         wastewater discharges prior to
         it leaving the office.

          • Over 95% effective!1

       • In 2003, it was estimated that
         dental offices were the source
         of 50% of all mercury pollution   This photo is used for illustrative purposes
         entering POTWs.2                  only. EPA cannot endorse any particular
                                           amalgam separator.

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Environmentally Responsible
Practices

• Install It

  • Installing an Amalgam Separator

      • Separators vary in complexity, cost and efficiency.

         • Even “low tech” systems appear to be
           effective….

      • Select one which will provide adequate removal
        based on the number of operatories in your practice.

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Environmentally Responsible
Practices
• Teach It

  • Educate and train your staff.

  • You can know everything about
    proper amalgam
    management….but does your
    staff?

  • It is the responsibility of
    everyone to manage amalgam
    properly.

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Environmentally Responsible
Practices

• The Environmentally Aware Dentist Knows....

  • ...why

     • dental amalgam (Hg) is a hazard to the environment.

  • ...how

     • dental amalgam waste reaches the environment.

  • ...what

     • you can do to minimize its release to the environment.
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