CONSERVATIVE OPERATIVE DENTISTRY Page 1

Lecture: "Hg: Environmental Issues" (see Art and Science of Operative Dentistry, p165-168)

ENVIRONMENTAL CONCERNS:

A. Recycling:

RECYCLING and DENTISTRY

Cell Phones,…
Computers….
Fluorescents,…

5 lbs / person / day “ZERO WASTE”

US 2001 Total Waste Solid Waste
(229 Million Tons) Management
Paper 35.7 %
Yard Trimmings 12.2 % Source Reduction MOST
Food Scraps 11.4 % and Reuse PREFERRED
Plastics 11.1 %
Metals 7.9 % Recycling /
Rubber, Leather, .. 7.1 % Composting
Glass 5.5 % Incineration LEAST
Wood 5.7 % and Landfilling DESIRABLE
Other 3.4 %

B. Mercury in the News:

1. Major focus on Hg:

a. National Academy of Science’s “Report of World Pollution” (Hg is #1)
b. Great Lakes Pollution Prevention and Toxics Reduction Act
2. US Scientific Research Efforts for Dentistry
a. NIDCR contract for LSRO report vs “Consumers for Dental Choice:
b. …..
3. Examples of heavy metal contamination of environment in US
a. Mercury Modified Latex Paints (Agocs, et al., 1990)
b. Contamination of Everglades (1991, TV News Programs)
c. Acid rain contamination of lakes in North Carolina
Dental Materials "Amalgam: Environmental Issues" Page 2

C. Life Cycle of Mercury in Dentistry

Safety, BMP’s
Efficacy CITY / EPA
• Purchase • Leach Field
• Patients
• Personnel
•
•
Storage
Usage
Hg • Stream Dumping
• Non-Contact
FDA •
•
Filters
Training, Spills
• Burning
OSHA / ADA • Land Spreading
WASTE-
WATER
TREATMENT
PLANT
TRASH

Incinerator
(audits) OFFICE
Sanitary
PLUMBING
Landfill • [Chairside Filter]
(audits) RECYCLING
PLANT • [Vacuum System and Trap]
(audits) • Separators
EPA / NCDENR • Flushing Plumbing Lines

D. Environmental Problem for Dentistry:

1. Contamination of sewer system and WWT system

a. All contributions collect down stream at the WWT plant
b. Incineration and land spreading allow recycling into the food supply
c. Treated WWT plant water is clean
d. Local communities want “zero-effluent” from dental offices
2. Sewer system: heavily contaminated (natural flushing would take 20-35 years)
3. Sewage Disposal Options: WWTP, Septic Tank, Uncontrolled discharge

4% Hg in Cotton Rolls / Capsules

15% Trituration Surplus
33% HVAC to Sewer
48% Amalgam Restoration INCINERATION

DENTAL Trap
OFFICE
Feeder
Local Sewer
Sewer Line
Waste Water
0.0001 mg/l = 0.1 µg/l = 0.1 ppb TREATMENT
MAIN PLANT
Sewer Line SLUDGE =
Heavy Metals;
Nitrogen; Phosphate
Hg Contributions to a WWTP
• COMMERCIAL (76%)
-- Dental Offices (90% / year)
-- Industries
• RESIDENTIAL (24%)
-- Human wastes (33%)
LAND
SPREADING
Dental Materials "Amalgam: Environmental Issues" Page 3

GOVERNMENT REGULATIONS:

A. Political versus regulatory landscape:

F, Sealants, High-Cu Amalgam, Composites, Replacement Criteria AMALGAM

DIS-USE
n=150 per100 patients n= 95 n=55
in United States

Hal 60 Minutes Stone

Huggins Program Phillips Hg
Anti- CONTROVERSY
Amalgamists
?
1980 1990 2000 2010
Precapsulated Dental Amalgams
OFFICE
ADA Hg Hygiene Chairside ISSUES
Statement Filters Separators

Air, Water, Land, Food ENVIRONMENTAL

ISSUES
US-EPA OSHA FDA NAS

B. Regulations for Hg/amalgam (products and wastes) in dentistry:

1. Dental product “safety and efficacy” (FDA)

2. In-office storage, use, and containment (OSHA)
3. Disposal and/or recycling (EPA and State/County/City)
a. Air (US-EPA) =
b. Ground water (US-EPA) =
c. Sanitary landfills (US-EPA) =
d. Sanitary sewers (State/County/City)
> Raleigh, NC = 0.1 µg/L
> Whiteville, NC = 0.1 µg/L

(Reference: 0.0001 mg/L = 0.1 µg/L = 0.1 ppb)

(Detection Limit = 0.02 µg/L)
Dental Materials "Amalgam: Environmental Issues" Page 4

BEST MANAGEMENT PRACTICES (BMPs):

A. Overview:

1. Definition: BMP = “best management practices”

2. Generally associated with the management of hazardous and/or toxic waste in all
industries.

3. Examples of current published BMPs for states:

(a) North Carolina (NCDS VIP Statement) = Guideline
(b) Vermont (Dept of Environmental Conservation) = Regulation
(c) Western Lake Superior Sanitary District (Duluth, MN) = Regulation
(d) Dentist’s Guide to BMPs (Oregon Dental Association) = Guidelines

B. Content of BMPs:

1. Dental Amalgam
(a) Spent Amalgam Capsules
(b) Non-Contact Amalgam (left-over from mixing procedures)
(c) Chair-side Traps (contact-amalgam trapped by coarse filter)
(d) Vacuum Pump Filter (contact-amalgam trapped by medium filter)
(e) Separator or Recapture Device (added before vacuum with fine filter)
(f) Plumbing and Sink Traps
(g) Hg Spill Kits

2. X-ray Wastes
(a) Fixer (Ag recovery or recycling processes)
(b) Developer (controlled discharge into sanitary sewer)
(c) Cleaners (Cr-containing cleaners must be recycled)
(d) Lead foil (must be recycled)
(e) Lead Shields (e.g., aprons) (must be recycled)

3. Chemical Sterilant Wastes

(a) Chemiclave/Chemical-Sterilant (dilute 4:1 with water before draining)

4. Waste Waters

5. Fluorescent Lamps and Batteries (recycle only)

C. BMP activities:

1. Training
2. Labelling / Packaging
3. Recycling (and Verification)
4. Record keeping
Dental Materials "Amalgam: Environmental Issues" Page 5

IN-OFFICE MANAGEMENT:

A. Pre-use management:

1. Storage in cabinets
2. Hg micro-spill management
3. Amalgam mixing equipment

B. Use management:

1. Avoid contact with sinks and traps

2. Vacuum Line >> Chairside Filter >> Pre-Vacuum Separator (see below)

HG HYGIENE PLUMBING

Amalgam Sink Traps

Mixing and Plumbing

Suction Mini-Trap
Amalgam
Storage Chairside Filter

Hg-Spill

Separator
Vacuum Pump
Filter or Trap
Vacuum Pump

SEPARATORS:

A. Examples of good Hg/amalgam separators:

DRNA SOLMETEX
Dental Recycling North America, Inc. SolmeteX
P.O. Box 1069 29 Cook Street
Hackensack, NJ 07601 Billerica, MA 01821
1-800-360-1001 (TEL) TEL = 978-262-9690
FAX = 978-262-9889
1-201-489-4740 (FAX)

Air-Water Separator

Filter and Hg Absorber

$695 for installation
$150 per cartridge exchange

SEWER 99.5% recovery is typical

Dental Materials "Amalgam: Environmental Issues" Page 6

B. Test results for Hg/amalgam separators

1. Removal efficiency = chairside filter + separator

a. Chairside filter (>100 micron filter) = ~60%
b. Separator = 30-40% (10 micron filter = ~30%; soluble phase trap = 10%)

Amalgam/Hg Separators
OBJECTIVE: Remove amalgam and/or mercury
from air/water stream in HVAC system.
METHODS: ISO 11143 for Amalgam Separators.

Amalgam Separator: EMPTY FULL Total Effluent Hg

(% Efficiency) (% Efficiency) (ppb, range)
A1000 96.09 ± 0.39 96.24 ± 0.46 30,200 - 34,899
Amalgam Collector 99.89 ± 0.06 99.96 ± 0.03 1,180 - 3,350
Asdex 99.10 ± 0.09 99.36 ± 0.14 9,930 - 15,750
BullfroHg 98.88 ± 0.64 99.38 ± 0.48 5,850 - 16,270
Durr 7800/7801 98.06 ± 1.08 97.66 ± 0.35 970 4,070
ECO II 98.17 ± 0.43 97.51 ± 0.74 16,310 - 26,340
HgS 99.36 ± 0.15 99.28 ± 0.10 6,430 - 9,600
Hg10 99.99 ± 0.06 (not tested) 20 - 100
MRU 99.96 ± 0.03 99.95 ± 0.04 200 - 570
MSS 2000 99.66 ± 0.30 98.94 ± 0.06 730 - 4,040
Rasch 890-4000 99.93 ± 0.03 99.90 ± 0.03 600 - 1,250
RME 2000 99.67 ± 0.13 99.66 ± 0.24 1,530 - 3,430

Fan PL, Batchu H, Chou HN, Gasparac W, Sandrik J, Meyer DM. Laboratory evaluation of amalgam
separators. J Am Dent Assoc 2002; 133: 577-589.

C. Pricing for Hg/amalgam separators:

Amalgam/Hg Separators
Cost = Separator Unit + Installation + Cartridges
Cost = Rental of unit (with free cartridges)

Amalgam Claimed % Unit Replacement

Separator: Efficiency Cost: Filter Cost:
A1000 > 95% $750 $500
Amalgam Collector > 90% $350 $350
Asdex = 97.5% $215 $ 35
BullfroHg > 95% $100/month
Durr 7800/7801 > 96% $4,000 $ 95
ECO II > 95% $29/month
HgS > 98% $500 $ 75
Hg10 (Solmetex) > 99.9+ % $696 $150
MRU (DRNA) > 95% $150/month
MSS 2000 = 98.8% $3,000 $296
Rasch 890-4000 > 95% $1,650 $750
RME 2000 = 96.9% $1,895 $395

Fan PL, Batchu H, Chou HN, Gasparac W, Sandrik J, Meyer DM. Laboratory evaluation of amalgam
separators. J Am Dent Assoc 2002; 133: 577-589.
Dental Materials "Amalgam: Environmental Issues" Page 7

MULTIPLE CHOICE STUDY QUESTIONS:

What is the typical recycling load on the environment in the US?

a. 0.2 lbs/person/year
b. 1 lb/person/year
c. 2 lbs/person/month
d. 1 lb/person/day
e. 5 lbs/person/day

Which prestigious agency has defined Hg as the #1 problem facing the world?
a. US Environmental Protection Agency
b. European Space Agency
c. US National Academy of Sciences
d. Kyoto Accords for Environmental Action
e. NIH

What is the primary method of Hg contamination resulting from dentistry?

a. Vapor release from patients
b. Sewage contamination
c. Cotton rolls in the trash
d. Hg release from corpses after burial
e. Spillage or losses in the dental office

Which agency regulates the Hg discharge into the local sewer system?
a. OSHA
b. FDA
c. US-EPA
d. State EPA/County/City
e. ADA

Which agencies have some impact on the dental use of Hg?

a. FDA, OSHA, US-EPA
b. FDA, OSHA, US-EPA, NCDENR, State-EPA/County/City, ADA
c. OSHA, US-EPA, NCDENR, State-EPA/County/City
d. US-EPA, NCDENR, State-EPA/County/City, ADA
e. ADA

What is a typical discharge limit for a Hg contaiminated water going into a

sanitary sewer system?
a. 5.0 µg/l
b. 3.0 µg/l
c. 1.0 µg/l
d. 0.1 µg/l
e. 0.01 µg/l

What are the primary methods by which WWTP dispose of sludge?

a. Refining it into organics
b. Dumping it into streams
c. Stockpiling it
d. Incinerating or land-spreading it
e. Burying it
Dental Materials "Amalgam: Environmental Issues" Page 8

What is the primary reason that patients are concerned about Hg?
a. 60 Minutes program
b. Anti-amalgamists media
c. US-EPA
d. National Academy of Sciences
e. ADA

Which of the following is not yet a standard Hg management practice in dental

offices?
a. Use of pre-capsulated dental amalgam
b. Hg hygiene practices
c. Chairside filters
d. Recycling of non-contact amalgam
e. Amalgam separators

What is the ABBREVIATION (ACRONYM) for guidelines for management of

hazardous and/or toxic wastes within dental offices??
a. Toxic waste guidelines (TWG)
b. Environmental protection standards (EPS)
c. Best management practices (BMP)
d. Dental recycling guidelines (DRG)
e. OSHA office standards (OOS)

What is the goal of BMPs for dental offices?

a. Safe management of hazardous in-office materials
b. Elimination of Hg and amalgam from dentistry
c. Elimination of hazardous dental materials
d. Enforcement of hazardous materials training
e. Recycling of all waste materials in dental offices

Which one of the following topics is NOT covered by BMPs?

a. Dental amalgam waste
b. Sterilizer waste
c. X-ray developer waste
d. Composite restoration waste
e. Waste water

At the present time, which one of the following in-office amalgam management
measures is considered voluntary (and not yet recommended)?
a. Non-contact amalgam recycling
b. Separators (recapture devices)
c. Chair-side traps
d. Vacuum pump filters
e. Hg spill kits

At least 60% of typical amalgam debris from dental practices is characterized as:
a. Greater than 100 μm particle size solids
b. Primarily 30-100 μm particle size solids
c. Less than 30 μm particle size solids
d. Primarily liquid mercury mixed into water
e. Primarily mercury vapor dissolved in water
Dental Materials "Amalgam: Environmental Issues" Page 9

Which of the following is normally supplied as part of the dental office chair:
a. 100-500 μm chair-side filter
b. Reservoir for chair-side suction
c. Reservoir for the operatory trap
d. One-way valve to prevent out-gassing from the vacuum system
e. Fine pre-filter just before the office vacuum pump

What are currently accepted practical targets for amalgam recapture in dental
offices?
a. 30-50%
b. 50-75%
c. 75-90%
d. 90-99%
e. 100%

Identify from the following list an example of a commercially available recapture

system that would alloy up to 99.5% amalgam and mercury recovery.
a. Chair-side filter alone
b. Centrifugal trap
c. AVPROX in-line pre-pump filter
d. DRNA pre-pump filter
e. SOLMETEX ion exchange system

Assuming that all dental offices ultimately include recapture systems, what is the
time estimated for natural clean-out of the existing contaminated sewer
systems?
a. 5 years
b. 5-10 years
c. 10-20 years
d. 25-35 years
e. 50 years

Which of the following items is NOT part of the management process for in-office
hazardous waste?
a. Training
b. Record keeping
c. Monitoring of air quality
d. Packaging / Labeling
e. Recycling

DISCUSSION STUDY QUESTIONS:

As a member of your local water quality control board, how would you react when
mercury from dental offices is detected in the sewage water?

You purchase a dental office that has been in operation for 32 years. What problems
might you face in cleaning up the plumbing to meet city sewage regulations?

One of your colleagues from dental school who now practices in another state calls you
for information on BMPs. She would like to know what are they and what should
she do in response to them in her own state. What do you say?

© 2006-2007, Stephen C. Bayne, Ann Arbor, MI 48109