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Best Management Practices for mercury and other wastes in the dental office
Seminar on January 16th, 2003
Mercury is a major component of dental amalgam, the material most commonly used to fill cavities. The New York Academy of Science's 2002 publication "Pollution Prevention and Management Strategies for Mercury in the NY/NJ Harbor" identified the cumulative impact of 8,500 dental offices using or removing amalgam within the watershed as a major contribution of mercury to the NY/NJ Harbor.
As part of the outreach effort regarding mercury, the NY Academy of Sciences sponsored a seminar on “Best Management Practices in Dental Health Sciences” (BMPs) for dental practitioners and students of dentistry. This seminar, which was held on January 16th 2003 at CUNY's Graduate Center, was co-hosted by the Americas Center on Science and Society (CUNY) and the New York University College of Dentistry.
In introductory remarks, Dr. Brian Schwartz, Vice President for Research Affairs of CUNY's Graduate Center welcomed participants to this event. He then introduced Dr. Susan E. Boehme, Project Manager for the Harbor Project at the NY Academy of Sciences. Dr. Boehme began by thanking the co-hosts of the meeting and the funders of the Harbor Project (EPA-Region II, Port Authority of NYamp;NJ, Abby R. Mauze Trust and the AT&T Foundation. She then described the Agenda for the meeting (the presentation by Mark Stone DDS followed by a panel discussion). Dr. Boehme then introduced the speaker: Mark Stone, DDS, from the Naval Dental Research Institute in Chicago. His presentation began with background information on mercury and a review of why methyl mercury is a critical issue in dentistry. The lecture continued with an outline of BMPs, including discussion of solid waste and wastewater issues, amalgam separators, residual mercury in waste lines and line disinfectants; as well as local regulatory efforts. Dr. Stone's presentation is available at http://www.nyas.org/scitech/harbor
After the lecture Dr. Boehme invited an expert panel to come forward and answer questions from the audience. The team included: Dr. Mathew Neary (President, NY County Dental Society), Kevin McManus (Sr. Program Director, EnviroBusiness, Inc.), Christopher Pettinato (Environmental Specialist, School of Dental and Oral Surgery at Columbia University), and Mark Stone, DDS (Naval Dental Research Institute). Questions related either to BMPs, specifically, or to broad concerns regarding mercury. For example, one dentist inquired about the health effects of using mercury in occupational settings, and whether there were any studies about dentists' mercury blood levels. Mark Stone mentioned that the ADA has conducted several related studies and directed participants to review the ADA's website (http://www.ada.org) while Dr. Neary commented that, in general, dentists' mercury blood levels are elevated, but no adverse health effects have been observed.
With respect to BMPs, one dentist wanted to know how he could avoid discharging mercury amalgam during restorations while using the high-speed evacuation line (HSE). A member of the panel responded that it was virtually impossible to avoid picking up mercury amalgam while using the HSE lines, and another panelist suggested installing amalgam separators to prevent discharges to wastewater from HSE lines. In addition, and because the BMPs presentation recommended not placing extracted teeth in red bags (medical waste, usually incinerated), several dentists inquired about the best way to dispose of removed teeth containing mercury amalgam. Chris Pettinato mentioned that no specific rule exists about how best to handle extracted teeth. A recommended procedure involves placing the extracted teeth in bleach or similar disinfectant solution to remove blood or other organic material, and then discarding it with the contact mercury amalgam scrap sent for recycling. The discussion then focused on how best to dispose of these solutions, and it was suggested that recycling companies would know how to deal with them. Mr. McManus commented that due to the present regulatory structure there are different ways to deal with medical waste (extracted teeth) than with materials considered hazardous (mercury), and no specific recommendations exist for how to deal with a material that fits both categories. Therefore, many dentists are still confused about how to disposed of material that is considered both medical and hazardous waste (such as extracted teeth with mercury amalgam).
After these questions, Dr. Boehme encouraged all participants to join in the discussion on impediments to the implementation of best management practices in New York City. The main obstacles were identified as:
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The above obstacles point to challenges and opportunities, as described below:
1. |
Obstacles described under # 1 (above) point to: |
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The need to develop clear BMPs instructions on total dental amalgam handling, including how to differentiate between contact and non-contact amalgams. |
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The need for further research to determine the best method to deal with spent amalgam capsules. In his presentation, Dr. Stone discussed some studies done at the Dental Naval Research Institute where the whole spent capsule was dissolved and then appreciable amounts of mercury were measured. He showed clear differences between brands of amalgam capsules and recommended the simplest types. Chris Pettinato, another member of the panel, mentioned that Columbia had looked at whether these capsules contained residual mercury and they saw little to no mercury, albeit they only used a washing/leaching technique. |
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The need to have "one-stop" recyclers who can manage all types of waste generated at the dental office. |
2. |
Item # 2, signals: |
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The need to build up dentists and dental waste recycler relationships for Hg amalgam recycling. In particular, means for small scale recycling of dental amalgam must be encouraged. The lack of recycler engagement is likely to be a profitability issue. Recyclers are reluctant to focus on opportunities for small quantity recycling and retrieval. Dentists find it difficult to have access to one stop shopping for dental waste management services. Consolidation in the waste management sector may allow for more one stop shopping in the future.
Likely solutions include:
- Dentists could mail recycling boxes directly to recycler or retorting facilities
- Recycling companies could partner with medical waste haulers, which
already visit the dental offices on regular basis.
- Government agencies could organize a "one-stop" recycling service, such as
is done Massachusetts (mentioned by Kevin McManus).
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In addition, in order to build enduring associations between dentists who are liable for the hazardous waste they dispose and the waste recyclers, the dental community needs assurance as to the ultimate disposal of Hg amalgam in an appropriate manner. |
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Obstacles described under #3 and #4, indicate that: |
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Dentists would benefit from having integrated rules on how to handle their medical and hazardous waste (e.g., extracted teeth with Hg amalgam). The regulatory confusion stems from the fact that regulatory processes for medical waste are different from hazardous waste. The differentiation of regulatory processes is seen to impact down stream Hg amalgam management and the organization of the waste management. Regulatory integration is key to solve this dilemma. |
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Need to inform dental practitioners on how best to comply with current laws and regulations affecting dental amalgam management. Dental Associations, not just regulatory agencies, could play a role in educating the dental practitioner about Best Management Practices and complying with the law. |
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