Hamilton Square 600 Fourteenth Street, N.W. Washington, DC 20005-2004 202.220.1200 Fax 202.220.

1665

April 2, 2010

Gina McCarthy Assistant Administrator for Air and Radiation Environmental Protection Agency USEPA Headquarters Ariel Rios Building 1200 Pennsylvania Avenue, N.W. Mail Code: 6101A Washington, DC 20460 Re: The American Dental Associations Submission of Information To Assist EPA in Responding to Chairman Kucinichs Letter

Dear Ms. McCarthy: I have represented the American Dental Association (ADA) on mercury-related issues for nine years. On behalf of the ADA, I am submitting this letter to you. We have reviewed Chairman Kucinichs January 15th letter to Lisa Jackson requesting that the Environmental Protection Agency (EPA) account for the amount of mercury that may be released from the life cycle use of dental amalgam. It is my understanding that your Office is taking the lead in responding to this letter, although the Offices of Water, Resource Conservation and Recovery, and Intergovernmental Affairs are also responding to this request. Therefore, we have addressed this letter to you with copies to these other offices. The ADA is the largest dental professional association, representing over 155,000 dentists in the United States (U.S.), including 71.8% of active dentists nationwide. The ADA shares your view that EPA should base its decision-making on the best available science. The ADA believes that EPA or other authoritative sources have gathered much of the information requested by Chairman Kucinich. The ADA has been working cooperatively with EPA to reduce releases of mercury into the environment from dental offices for several years. For example, the ADA included amalgam separators as part of the ADA Best Management Practices (BMPs) in October 20071 and is working with EPA and the National Association of Clean Water Agencies to reduce further mercury levels in the environment
Philadelphia Berwyn Boston Harrisburg Washington, D.C. Orange County www.pepperlaw.com Detroit Princeton New York Pittsburgh Wilmington

Gina McCarthy Page 2 April 2, 2010

through voluntary dental amalgam wastewater reduction measures. Although much of this information was prepared by EPA, or is in the possession of one or more EPA offices, for EPAs convenience in responding, this letter shares scientific information on potential releases of mercury from amalgam-related sources into the environment and, where appropriate, provides ADAs scientific comments. We hope you find this helpful. Amalgam-Related Mercury Discharges To Surface Water Summary (In most cases, the citations for the conclusions in the bullet summaries below are provided in the text that follows the summary) Approximately 0.3 tons of amalgam-related mercury2 would be directly discharged from the nations sewage treatment plants into surface waters if no dentists used amalgam separators, but dentists complied with other aspects of the ADA BMPs. The additional deposition of mercury from the incineration of municipal sludge is discussed in the next subsection. Approximately 0.175 tons to 0.25 tons of amalgam-related mercury would be directly discharged into surface waters as part of the sewage treatment plants effluent if 100% of dentists used amalgam separators and complied with the other aspects of the ADA BMPs. A significant and growing number of dentists (estimated by EPA in 2008 at 30%) have installed separators, therefore, the amount of amalgam-related mercury directly discharged from the nations sewage treatment plants into surface waters is less than 0.3 tons, but more than the 0.175 to 0.25 tons cited above.

In 2005, ENVIRON International Corporation (ENVIRON), with funding from the ADA, prepared a scientific assessment (Scientific Assessment) that calculated the amount of mercury attributable to amalgam wastewater that is discharged in effluent from U.S. sewage treatment plants into surface water. The study was published in the prestigious, peer-reviewed journal (Water, Air, and Soil Pollution, (2005). This Scientific Assessment found that a total of approximately 0.2 tons of mercury enters surface water each year (see conceptual model provided below).3 EPAs contractor, Eastern Research Group (ERG), validated this approach and the vast majority of ENVIRONs conclusions.4

Gina McCarthy Page 3 April 2, 2010

After reviewing the ERG memorandum, ENVIRON updated portions of its prior Scientific Assessment in December 2008 (Updated Scientific Assessment)5 and added an assessment of the annual amalgam-related mercury emissions from medical incinerators and landfills to provide a sensitivity analysis on the amount of amalgam-related mercury that might enter surface water from dental offices that, contrary to the ADA BMPs, disposed of a portion of their amalgam in hospital/medical/infectious waste incinerators or solid waste landfills (discussed in more detail below). The Updated Scientific Assessment calculated that approximately 0.3 tons of amalgam-related mercury would be discharged into surface waters as part of the sewage treatment plants effluent using the following assumptions: (1) 31.25 tons of mercury used annually by dentists;6 (2) chair-side traps and filters capture 78% of mercury in amalgam discharged as dental office wastewater (therefore, 6.875 tons of amalgam-related mercury are discharged into the sewers); (3) 95% of the mercury entering the sewage treatment plant is removed prior to discharge into the surface water; and (4) and no dentists used separators.7 Given that many dentists now use separators either due to state or local mandatory separator laws or regulations or voluntary programs, this calculation has an upward bias.8 Approximately 0.25 tons of amalgam-related mercury would be discharged into surface waters as part of the sewage treatment plants effluent if 100% of dentists used separators and the sewage treatment plants do not capture any additional amalgam.9 Approximately 0.175 tons of amalgam-related mercury would be discharged into surface waters as part of the sewage treatment plants effluent if 100% of dentists used separators and the sewage treatment plants capture 30% of the amalgam leaving the separators.10 Trends indicate that the use of amalgam has decreased dramatically between the 1970s and 2005 and this trend is expected to continue.11 For example, less mercury is currently used because: (a) newer amalgams last longer than 10 years due to the improved physical qualities of amalgam; (b) there is a reduction in the amount of mercury in amalgams; (c) fewer restorations are needed due to caries reduction from fluorides; and (d) there are improved (more conservative) tooth preparation techniques, which are now generally accepted procedures (particularly in pediatric dentistry).12 As a result, the amount of amalgam-related mercury discharged to surface waters will continue to decrease over time.

Gina McCarthy Page 4 April 2, 2010

(Taken from the 2005 Assessment, see note 3, at 358. ENVIRONs Limited Update of the Scientific Assessment, see note 4, also uses the same conceptual model, but the numbers are slightly different.)

Amalgam-Related Mercury Emissions From Sludge Incinerators Summary Approximately 0.1 tons of amalgam-related mercury will be deposited into surface waters as a result of emissions from sludge incinerators if no dentists used amalgam separators using EPAs emission factor (i.e., a capture rate of 79%). The 2005 Assessment concluded that discharges from amalgam separators into sewage treatment plants may not be collected by the sewage treatment plant (because the same small size particles not collected by the separator are unlikely to be collected by the sewage treatment plant and some studies measured no decrease in mercury in sewage treatment plant effluent after installation of amalgam separators). If no amalgam particles discharged by amalgam separators are collected by the sewage treatment plant, there will be no amalgam-related mercury in the sewage sludge and, therefore, none emitted by sewage sludge incinerator. Approximately 0.001 to 0.005 tons per year of amalgam-related mercury is deposited in surface water if 100% of dentists used amalgam separators, the sewage treatment plant collects 30%

Gina McCarthy Page 5 April 2, 2010

of the amalgam discharged from the separators, and the sewage sludge incinerator pollution controls capture 0% to 79% of the mercury emitted. Therefore, the amount of amalgam-related mercury deposited into surface waters as a result of emissions from sludge incinerators is less than 0.1 ton, but probably more than 0.001 to 0.005 tons per year. The amount deposited into surface water could be zero if the sewage treatment plant does not remove any of the very small, residual amalgam particles from the amalgam separator discharge. Current concentrations of mercury in sewage sludge are generally below 3 mg/kg (in fact, 62% were below 1 mg/kg in a recent EPA study) and are decreasing over time.13 These concentrations are well below the lowest regulatory limit of 17 mg/kg. EPAs position is that application of biosolids that meet EPA sludge standards should not result in the accumulation of metals to harmful levels.14 The NAS, after an extensive review of EPA sludge standards, made an overarching finding that [t]here is no documented scientific evidence that the Part 503 rule has failed to protect health.15

The amount of mercury attributable to amalgam wastewater that is deposited into surface water from emissions from municipal sewage sludge incinerators (SSI) was calculated in the Scientific Assessment and the Updated Scientific Assessment, described above (see conceptual model provided above).16 The amount of amalgam-related mercury annually emitted from sludge incinerators and deposited into surface waters is approximately 0.1 tons per year assuming EPAs emission factor (i.e., a capture rate of 79%) and no amalgam separators are used by dentists.17 At worst, assuming the capture rate of municipal sludge incinerators is 0%, the amount of dental amalgam-related mercury annually emitted from sludge incinerators and deposited into surface waters would be approximately 0.35 tons per year.18 If no amalgam-related mercury is captured by the sewage treatment plant, there are no emissions and, therefore, no deposition of amalgam-related mercury from sludge incineration. The amount of amalgam-related mercury annually emitted from sludge incinerators and deposited into surface waters is approximately 0.001 to 0.005 tons per year, assuming EPAs emission factor (i.e., a capture rate of 0% to 79%) and 30% of amalgam-related mercury is captured by the sewage treatment plant.19

Gina McCarthy Page 6 April 2, 2010

Emissions From Hospital/Medical/Infectious Waste Incinerators Summary Approximately 0.04 tons of mercury is emitted per year from hospital/medical/infectious waste incinerators (HMIWI), based on EPA sampling and the new Clean Air Act mercury limits. Approximately 0.002 tons per year of mercury from all sources are emitted from new HMIWIs. These estimates are emission estimates. Generally, EPA has estimated that only a third of the mercury emitted is deposited in surface waters within the United States. Since this point applies to the remainder of the emission estimates, it will not be repeated for each potential source. Amalgam-related mercury deposition is even lower than 0.04 tons per year because not all mercury emitted by HMIWIs are related to amalgam.

EPA issued new, more stringent Clean Air Act emission standards for HMIWI that were fully implemented by September 2002.20 On October 6, 2009, EPA issued its first 5year review of the HMIWI standards required by the Clean Air Act (i.e., the HMIWI Clean Air Act Maximum Achievable Control Technology standard). For this five year review, EPA measured annual baseline emissions from all 57 existing HMIWI prior to the imposition of the Clean Air Act MACT standard and 0.341 tons of mercury (from all sources in the HMIWI) per year was emitted.21 EPA estimated that the MACT standard (i.e., the so called floor for emission limits) reduced these emissions by an additional 88.7% (i.e., current emissions are 77 pounds per year or 0.04 tons per year).22 New HMIWI were estimated to emit 3.12 lbs per year or 0.002 tons per year.23 Amalgam waste should account for only a small portion of hospital medical infectious waste (however, the ADA does not have any specific information on the quantitative proportion). EPA may have data from its HMIWI MACT standard. The ADA BMPs specifically cautions that amalgam not be included in medical waste stream. Generally, federal law recommends segregation of mercury containing wastes. In fact, EPAs survey of nine representative HMIWI operators found that all

Gina McCarthy Page 7 April 2, 2010

survey respondents, except for the commercial company, practice onsite waste segregation to reduce the volume of waste being incinerated. The commercial company encourages waste segregation from its waste generator clients through a number of efforts, including a waste management plan, contract requirements and waste acceptance protocols, a dental waste management program, and educational programs and supporting posters. Other materials that are separated from the HMI waste stream include metals containing materials (e.g., aluminum, copper, lead, mercury, steel, and electronics).24 As a result, the amalgam-related mercury emissions from HMIWI should be considerably lower than 0.04 tons per year, the measured and estimated values provided by EPA. Over time, as new incinerators replace the existing incinerators, the emissions related to amalgam will decrease towards 0.002 tons per year nationwide. Emissions From Landfilled Hospital/Medical/Infectious Waste Summary Approximately 0.00165 tons of mercury per year would be emitted from hospital/medical/infectious (HMI) waste if all of HMI waste containing mercury (from all sources) was landfilled according to EPAs 2009 evaluation for the HMIWI Clean Air Act regulations. The contribution of these emissions from amalgamrelated mercury is less than 0.00165 tons of mercury per year.

The hospital/medical/infectious waste incinerator Clean Air Act regulation is reviewed every five years. In 2009, EPAs review estimated that mercury air emissions would be 0.0330 lbs of mercury per year or 0.00165 tons per year, if all of the hospital/medical/infectious waste was landfilled.25 Again, amalgam waste only accounts for a small portion of these wastes and ADA BMPs recommend that amalgam not be included in the medical waste stream. Generally, federal law recommends segregation of mercury containing wastes. So the dental related mercury emissions from hospital/medical/infectious waste should be considerably lower than the measured and estimated values provided by EPA.

Gina McCarthy Page 8 April 2, 2010

Emissions of Mercury Attributable To Amalgam From Solid Waste Landfills Summary EPA has calculated that emissions of mercury from all sources in solid waste landfills were approximately 0.1 tons per year in 1994 1995 and 0.2 tons per year in 1996.26 The amount of mercury disposed of in landfills is likely to have decreased since then. This estimate is consistent with other government estimates of total mercury emissions from landfills.27 Amalgam waste was estimated to contribute 1.45% of the mercury in municipal landfills.28 Thus, the emission of amalgam-related mercury is probably less than 0.003 tons per year.29 Mercury in amalgam is physically bound with other metals to form a solid. Therefore, the estimate of how much mercury reaches surface water overstates the impact of dental amalgam. The ADA Best Management Practices (BMPs) recommend that amalgam be recycled not disposed of in solid waste landfills.

Emissions From Landfilled Sludge Summary As noted above, EPA has found that land disposal of sludge was safe and the levels are decreasing. EPA itself has concluded that releases of mercury to land (such as application of biosolids) are generally not considered to be as environmentally harmful as releases to air because the mercury may be less mobile and less likely to reach surface waters and fish.30 As a general rule, mercury emissions from other landfills should also be relatively low.

Gina McCarthy Page 9 April 2, 2010

Emissions From Grit Removal At Wastewater Treatment Plants Summary The ADA has no specific information on emissions of mercury from grit land disposal facilities. However, as noted above, emissions from landfills containing mercury are very low and we are not aware of any reason that emissions from land disposal facilities containing grit from sewage treatment plants should not also be very low. As noted above, our estimate of how much mercury reaches surface water from landfills overstates the impact of dental amalgam because of the nature of dental amalgam. Emissions Of Mercury Attributable To Amalgam From Hazardous Waste Incinerators Summary The emissions of mercury attributable to amalgam from hazardous waste incinerators are calculated to be less than 0.0116 tons per year based on EPA regulations.31 EPA may have data on actual emissions from all commercial hazardous waste incinerators. Amalgam waste should not be entering hazard waste incinerators. The ADA BMPs recommend that amalgam be recycled, not disposed of in hazardous waste incinerators. Emissions Of Mercury Attributable To Amalgam From Solid Waste Incinerators Summary These emissions are estimated at approximately 0.03 tons per year.32 Emissions From Crematoria Summary The only information that the ADA possesses is EPA emissions estimates. EPA estimates than less than 0.1 tons of mercury is emitted by crematoria per year.33 There are other sources of mercury (e.g., batteries used in implants) so the portion of these emissions from amalgam waste is less than 0.1 tons per year. The calculations assume rates of cremation, the amount of amalgams per person cremated, and 100% release into the air. None of these values seem to be scientifically determined. In general, the analyses do not take into account the distribution of amalgam with age, the likelihood that a significant number of older persons being cremated may have false teeth, and that a significant number of younger persons cremated may have no amalgam fillings.

Gina McCarthy Page 10 April 2, 2010

Emissions From Sewer Overflows Summary The ADA has no information on this issue. In general, amalgam is less likely to be transported into surface water during a storm water overflow event because amalgam is heavy, in particulate form, and many sewer systems may have weirs to prevent the flow of particulates. Emissions From Dental Offices Summary The calculations of emissions from dental offices cited in Chairman Kucinichs letter were not based on monitoring data. Many reports simply assume that 2% of the mercury is evaporated into the air in dental offices. This assertion is derived ultimately from a 1971 EPA report, which seems to be based on an assumption, not data, and is from a time when liquid mercury was used in dental offices. Currently, dentist use encapsulated amalgam, in which the liquid mercury and powdered metals fully enclosed up to the mixing. This practice reduces the likelihood and amount of volatilization. The current information on the amount of mercury emissions from dental offices is inadequate to calculate the average mercury concentration in air leaving the office, the length of time these emissions occur, the source within the office, and the number of dentists using or handling amalgam. Were dental office emissions large, dentists would be exposed to significant levels of mercury. Biomonitoring data collected by the ADA demonstrate low levels of exposure.34 The data available concerning other sources suggest that dental offices are not a large source of mercury air emissions. If EPA deems the gathering of this additional information

Gina McCarthy Page 11 April 2, 2010

necessary, EPA can gather such data, if it deems such expenditures are necessary. The 1999 National Emission Inventory (NEI) report seems to be the basis for the information asserted in the January 15th letter from Chairman Kucinich. The National Emissions Inventory (NEI) estimated that approximately 0.7 tons of mercury is emitted from dental offices.35 The NEI estimate is not based on data and is based on practices no longer utilized by dentists. In the 1999 NEI Inventory, EPA simply multiplied the estimated 35 tons mercury used by dentists by 2% (35 tons x 0.02 = 0.70 tons mercury released).36 The 2% estimate of volatilization comes from EPAs Locating and Estimating Air Emissions from Sources of Mercury and Mercury Compounds.37 However, that report, in turn, cites a 1981 report38 for the proposition that 2% of the mercury is emitted into the air. The 1981 report again provides no data or evaluations, but simply cites a 1975 EPA report.39 The 1975 report states that if a dental office uses 1,000 pounds of mercury, 10 pounds would evaporate from open containers (a procedure no longer used in modern dental offices) and another 10 pounds would evaporate from sitting in the office after the amalgam (which is referred to as a metallic putty) is sitting prior to being used in the permanent tooth restoration.40 Thus, EPA assumed those 20 pounds out of 1,000 pounds (or 2%) of the mercury would be emitted to the air. There is no explanation of the reason that EPA chose 2%.41 Even if these estimates were ever valid, they are no longer valid because virtually all dentists use pre-mixed amalgam capsules, not liquid mercury. Thus, any airborne releases of mercury caused by physically mixing amalgam in the dental office are no longer possible. Mercury also no longer sits in open containers. The above suggests that the emissions of mercury from dental offices are considerably lower than 0.7 tons per year. If EPA desires to pursue this calculation, EPA should perform literature reviews and/or perform simple laboratory tests.42 Any evaluation of the emissions from dental offices should take into account the following factors. First, EPA should survey the literature on emissions from dental offices. This survey should distinguish between measurements from time periods when dentists mixed liquid mercury into amalgam in their offices as opposed to current practices. Amalgam comes in capsules and is never exposed to the air except in amalgam form. Second, the calculation should take into account that amalgam placement is episodic, so the calculation needs to measure the average concentration of mercury leaving the dental office over time, the number of days over which the source is emitting, as well as the air flow, to calculate the annual mercury releases.

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Third, the estimated emission rate should be compared to other rates to assess its scientific credibility. For example, an EPA report calculated: (a) 0.14 tons per year were emitted by secondary amalgam manufacturers (i.e., companies that obtain, among other mercury products, amalgam and recycle it); and (b) 0.7 tons per year (2% emitted) by dental amalgam manufacturers (neither of these emissions are uncontrolled).43 Emissions From Respiration Most of the prior calculations of emissions from respiration are based on the assumption that breathing releases 2% annually of the mercury in amalgam. It is not clear from the various calculations whether these estimates take into account that most people breathe through their nose and, therefore, may exhale little if any mercury. Again, any attempt to calculate this value should be based on representative concentrations, representative exhalation rates, and representative number of people exhaling (i.e., taking into account children without restorations and those with dentures). If 2% of the mercury in amalgam filings volatilizes each year, then the mass of amalgam restorations should be 20% less than original over the lifetime of such a filing. As noted, above, amalgam filing now last longer. Such losses have not been clinically observed. In summary, the ADA hopes that the information provided is of assistance to EPA. The ADA would be glad to provide pdf copies of any of the documents cited and summarized in this letter. Generally, the amalgam-related mercury emissions are significantly lower than assumed in the January 15th letter. Individually or collectively, these emission and deposition estimates are relatively low. If there are any questions or clarifications, the ADA will be glad to provide additional information. Yours truly,

William J. Walsh Pepper Hamilton LLP on behalf of the American Dental Association WJW/twx cc: Mary Smith (smith.maryt@epa.gov) Greg Spraul (spraul.greg@epa.gov) Matthew Hale (hale.matt@epa.gov)

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In accordance with its Best Management Practices (BMPs), the ADA believes professional dentists should operate his or her dental office in a manner that maximizes the amount of amalgam that is captured for recycling.

Unless otherwise noted, amalgam-related mercury solely refers to the fate of amalgam discharged from dental offices into local sewage system. Vandeven, J.A. and McGinnis S.L. An assessment of mercury in the form of amalgam in dental wastewater in the United States. Water, Air, and Soil Pollution. 2005 June; 164 (1-4): 349366 (Scientific Assessment). Compare Memorandum from Derek Singer, ERG, to Jan Matuszko, EPA, Subject: Dental Amalgam Separators: Summary of Removal Efficiencies, Current Use and Cost Effectiveness (DCN 04851) (September 26, 2007) in the EPA Pretreatment Docket No. EPAHQOW20060771, available at http://www.regulations.gov/search/Regs/home.html#documentDetail?R=09000064802f401f (ERG Memorandum) with the Scientific Assessment. ENVIRON International Corporation (ENVIRON), Limited Update of the Scientific Assessment (SA) Published in 2005, Attachment 1 to The American Dental Associations Comments on EPAs Study Of A Pretreatment Requirement For Dental Offices at 2 (Docket ID No. EPAHQOW20060771) (December 21, 2007) (Updated Scientific Assessment). This update is consistent with the Scientific Assessment and the ERG Memorandum.
6 7 5 4 3

ERG Memorandum, supra note 4, at 7 and Updated Scientific Assessment, supra note 5, at 2.

See Scientific Assessment, supra note 3, at 355-356 and Updated Scientific Assessment, supra note 5, at 3-5. If there were no separators being used, approximately 0.42 tons per year of amalgam-related mercury will enter surface water from the effluent of sewage treatment systems and deposition of amalgam-related mercury from sludge incinerators. Id. at Table 1. In such a situation, approximately 6.875 tons enters sewer systems (31.25 tons entering the dental office drain times 22% (i.e., the amount remaining after 78% on average is collected by chairside traps and vacuum filters) = 6.875 tons). The Updated Scientific Assessment provides a sensitivity analysis of the impacts under a range of compliance options. It calculated the combined amalgam-related mercury discharges to the surface water from sewage treatment plant effluent and deposition from atmospheric emissions from sewage sludge incinerators. The amount of amalgam-related mercury that will enter surface water from the effluent of sewage treatment systems is 0.34 tons per year (6.875 tons (see calculation above) times 0.05% (i.e., the amount remaining after 95% is removed by the sewage treatment plants)). EPA, State Mercury Medical/Dental Waste Programs, available at http://www.epa.gov/osw/hazard/tsd/mercury/medical.htm. That is, 31.25 tons of mercury used annually by dentists, times 99.2% for the total amalgam capture efficiency of chair-side traps and filters, the amalgam separator, and the sewage treatment plant, equals 0.25 tons discharged in effluent from the sewage treatment plant. This removal efficiency was calculated as follows: the effective capture efficiency of chair-side traps and filters is 78%, which is weighted by the efficiencies of each and their respective usage rates. These devices capture the largest amalgam particles in dental wastewater, resulting in a downstream particle size distribution that no longer matches that of ISO 11143, but is weighted more toward smaller particles. Given that separators operate using one or more of centrifugation, sedimentation, and filtration to remove amalgam particles, the smallest are the most difficult to capture. Once the chair-side traps and filters remove the largest particles, the remaining distribution consists of smaller, more difficult to capture, particles. Therefore, the efficiency of separators downstream of traps and filters will be slightly
9 8

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lower than the efficiency in capturing particles from the ISO 11143 distribution. In this case, the total efficiency of a trap+filter+separator train is 99.2%the same efficiency as a separator alone. The incremental efficiency, EI, is calculated using the following equation: 99.2% = 78% + 22% EI. Using this equation, we calculated the incremental efficiency to be approximately 96.4%. ERG overestimated efficiency by assuming that 99.2% of amalgam particles not captured by traps and filters are captured by separators. The lack of a decrease in the mercury concentrations in effluents after separator installations has been documented in the literature. Updated Scientific Assessment, supra note 5, at 4-5. Also see Attachment 2: A Review Of The Available Data On The Effectiveness Of Amalgam Separators, attached to The American Dental Associations Comments on EPAs Study Of A Pretreatment Requirement For Dental Offices (Docket ID No. EPAHQOW20060771) (December 21, 2007). Thus, if there is no significant decrease in concentration due to removal of additional very small particles by the sewage treatment plant, then the discharge of mercury related to dental amalgam may be as high as 0.25 tons per year assuming that the other ADA BMPs are followed. The sensitivity analysis in Updated Scientific Assessment, supra note 5, at Table 1 also provides an assessment of the amount of releases if BMPs are not followed by varying percentages of dentists. If the sewage treatment plant reduces the mercury concentration in effluent by 30% (as assumed in 2005 Assessment, supra note 2, at 362), then the amount of mercury related to dental amalgam is approximately 0.175 tons per year (0.25 tons times the 70% not captured by the sewage treatment plant). Updated Scientific Assessment, supra note 5, at 5 and Table 1. This estimated discharge to surface water assumes the few remaining smallest amalgam particles being discharged from the amalgam separators are not captured by the sewage treatment plant since these sewage treatment plants are as likely as amalgam separators not to capture the smallest particles. See the Scientific Assessment, supra note 3, at 362, and Updated Scientific Assessment, supra note 5, at 5.
11 10

The rate of amalgam placements has declined by 3.7% per year over the 12 years prior to 2005. ADA, Economic Impact of Regulating Amalgam, Public Health Reports. SeptemberOctober 2007/Volume 122, at 657 and 659-660, available at http://www.ada.org/prof/resources/topics/amalgam_economic_impact.pdf (Impact of Regulating Amalgam). If this trend has continued since 2005, all of the estimated releases to surface water provided above should be less than estimated. Personal communication with ADA staff. Smaller restorations also have a longer life expectancy, due to reduced tooth fractures. Fluoridation of community water supplies enables dentists to place smaller restorations, reduces the number of restorations placed, and increases the life expectancy of each individual restoration. Universal use of sealants in children reduces the need for amalgam restorations, thereby reducing the usage of amalgam. If Medicaid and State Childrens Health Insurance Program funded these services, it would assist in reducing amalgam usage.

12

See National Academy of Sciences, Biosolids Applied to Land: Advancing Standards and Practices. National Academy Press, 2002) at 93, 94, 209, available at http://print.nap.edu/pdf/0309084865/pdf_image/93.pdf,-94.pdf209.pdf, which summarizes results from several states and concentrations over time (NAS Sludge Study). The state-wide median concentration of mercury in sewage sludge in New Jersey decreased from a little over 3.5 mg/kg to 1 mg/kg from 1983 to 2008. New Jersey Sewage Sludge from 1983 to 2008, available at http://www.state.nj.us/dep//dwq/pdf/2008_state_median_metal_graphs.pdf. The concentration of mercury in biosolids ranges from approximately 1 to 3 mg/kg. Letter from Ken Kirk, Association of Metropolitan Sewerage Agencies to Dr. James Branson, ADA, regarding AMASS Review of American Dental Association (ADA) Scientific Assessment Evaluation of Mercury in Dental Facility Wastewater, October 2002 (December 17, 2002). EPAs 2009 national sewage sludge survey data found 81 out 84 sewage treatment plant sludge samples with mercury concentrations less than 4.0 mg/kg (96.4%) and 52 out 84 had concentrations of mercury less than 1.0

13

Gina McCarthy Page 15 April 2, 2010

(62%). EPA, Targeted National Sewage Sludge Survey Report, January 2009, Appendix A.2, at 42-43, available at http://www.epa.gov/waterscience/biosolids/appendixa.pdf.
14 15 16

EPA, Biosolids Technology Fact Sheet: Land Application of Biosolids. EPA 832-F-00-064, September 2000 a4. NAS Sludge Study, supra note 13, at 7. Scientific Assessment, supra note 3, at 357, which states: Approximately 22% of the biosolids generated in the United States are managed through incineration in SSIs (EPA, 1999). Applying this percentage, it was estimated that approximately 1 ton (0.9 metric ton) of mercury in the form of amalgam present in biosolids is annually incinerated by SSIs. The emissions from SSIs are treated by wet scrubber systems to control particulate emissions, and capture of some particulate forms of mercury. From approximately 1988 to 1995, the United States Environmental Protection Agency (USEPA) developed representative emissions factors for SSIs, commonly referred to as AP42 factors, the average of which represented a mercury capture efficiency for SSI emission controls of about 79% (USEPA, 1995) In 1997, the USEPA estimated that approximately one-third of the mercury emissions originating from the United States were deposited within the country (USEPA, 1997). This percentage was used to estimate that less than 0.1 tons (0.1 metric tons) of the mercury is annually deposited in the United States from the incineration of biosolids containing amalgam. It was conservatively estimated that all this mercury will enter surface waters.

17

4.79 tons (collected in sewage sludge) x 21% (assuming 79% is captured by the sludge incinerators pollution controls) x 22% (the percentage of sewage treatment plants that incinerate their sludge) x 33% (EPAs estimate that approximately a third of the mercury emitted into the air is deposited in the U.S. and ENVIRONs assumption that all of that mercury ends up in U.S. surface water) = 0.07 tons per year, rounded up to 0.1 tons per year. See Updated Scientific Assessment, supra note 5, at 11, and Scientific Assessment, supra note 3, at 357.

4.79 tons (collected in sewage sludge) x 100% (assuming all of the mercury is emitted) x 22% (the percentage of sewage treatment plants that incinerate their sludge) x 33% (EPAs estimate that approximately a third of the mercury emitted into the air is deposited in the U.S. and ENVIRONs assumption that all of that mercury ends up in U.S. surface water) = 0.35 tons per year.
19

18

If the sewage treatment system captures 30% of the amalgam particles discharged by the separator, 0.075 tons of amalgam-related mercury is collected in either the grit chamber or in sludge (i.e., the 0.25 tons per year times 30%). See Updated Scientific Assessment, supra note 5, at 11 and Scientific Assessment, supra note 3, at 357.

0.075 tons (collected in sewage sludge if separators are utilized) x 21% (assuming 79% is captured by the sludge incinerators pollution controls) x 22% (the percentage of sewage treatment plants that incinerate their sludge) x 33% (EPAs estimate that approximately a third of the mercury emitted into the air is deposited in the U.S. and ENVIRONs assumption that all of that mercury ends up in U.S. surface water) = 0.001 tons per year. If the sewage sludge incinerators release 100% of the mercury, then the amount of amalgam-related mercury is 0.005 tons per year. This is calculated as follows: 0.075 tons (collected in sewage sludge if separators are utilized) x 100%

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(assuming 0% is captured by the sludge incinerators pollution controls) x 22% (the percentage of sewage treatment plants that incinerate their sludge) x 33% (EPAs estimate that approximately a third of the mercury emitted into the air is deposited in the U.S. and ENVIRONs assumption that all of that mercury ends up in U.S. surface water).
20

The history of this rule and its implementation is provided in EPA, Standards of Performance for New Stationary Sources and Emissions Guidelines for Existing Sources: Hospital/Medical/Infectious Waste Incinerators, 74 Federal Register at 51,397 (October 6, 2009) (Hospital/Medical/Infectious Waste Incinerators Review). The docket of the Hospital/Medical/Infectious Waste Incinerators rule includes a summary of the sampling data. See Memorandum from Thomas Holloway, RTI International to Ketan Patel, EPA at 2 (July 6, 2009) at www.regulation.gov in Docket EPAHQOAR20060534. Id. at 4. Id. at 5. Hospital/Medical/Infectious Waste Incinerators Review, supra at note 20, at 51,385. Id., at 51,397.

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22 23 24 25 26

The EPA Mercury Report to Congress estimated approximately 0.081 tons per year (rounded up to 0.1 tons), not including emissions from hazardous waste landfills. EPA, Mercury Study Report to Congress ES-6 (EPA-452/R-97004, 1997), available at http://www.epa.gov/ttn/oarpg/t3/reports/volume2.pdf. See also EPA, Locating and Estimating Air Emission from Sources of Mercury and Mercury Compounds, (EPA-454/R-97-012), Volume 3, at 71, December, 1997, http://www.epa.gov/ttn/chief/le/mercury3.pdf (Locating Sources of Mercury).

A 1999 study estimated nationwide emissions of mercury in landfill gas of 0.15 tons per year (which is rounded up to 0.2 tons per year). See Memorandum from Eastern Research Group to EPA, RE: Assessment of Potential Hazardous Air Pollutant Emissions From Wastewater Generated at Landfills (April 28, 1999, EPA Air Document Number A-98-28, Item II-B-25. Other recent evaluations have concluded that landfills are not a major source of gaseous emissions of mercury and no controls are necessary. See N. Themelis and A. Gregory, Sources and Materials Balance of Mercury in the New York-New Jersey Harbor, Report to the New York Academy of Sciences, November 31, 2001, at p. 23) and New Jersey Mercury Task Force, Report, Volume III: Sources of Mercury to New Jersey's Environment, 2002, at 157, available at http://www.state.nj.us/dep/dsr/mercury_task_force.htm. The ADA understands that EPA dropped mercury as a pollutant of interest from its landfill wastewater/leachate studies. The total amount of mercury estimated to be discarded intentionally in products in municipal solid waste is 145 tons versus 2.1 tons from dental usage (i.e., 2.1 tons divided by 145 tons or 1.45%). See United Nations Environment Program, Global Mercury Assessment, (2003) at 95, available at: http://www.chem.unep.ch/mercury/report/Final%20report/final-assessment-report-25nov02.pdf (UNEP Mercury Assessment), citing EPA Mercury Study Report to Congress (see endnote 26, supra).
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1.45% times 0.1 to 0.2 tons per year) equals 0.0015 to 0.003 tons. Conservatively, we use 0.003 tons per year.

The total mercury (from all sources, not just amalgam) directed to landfills or collected as hazardous waste was estimated to be 295 metric tons (330 U.S. tons) in 1996. UNEP Mercury Assessment, supra note 27, at 99. Therefore, we conservatively estimated the emission rate to be 0.2 tons emitted divided by 330 tons disposed = 0.0606%. In other words, 0.0606% of mercury from dental offices that is disposed in landfills is emitted to the air. As with other emissions to air, we assume that 33% of total mercury emissions from landfills reach U.S. surface water. See Updated Scientific Assessment, supra note 5, at 7-8.

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EPAs Road Map Addressing Mercury Releases (July 2006), at 28, available at http://epa.gov/mercury/pdfs/I_HgReleases.pdf. The mercury in amalgam is bound into the mixture and the mercury in the amalgam in biosolids is less likely to be released into the air. The mercury emissions from hazardous waste incinerators are 0.94 tons per year. EPA, Final NESHAPS: Final Standards for Hazardous Air Pollutants for Hazardous Waste Combustors, 64 Fed. Reg. 52,828, at 52,863, 52,841 (September 30, 1999) (final rule). In the vast majority of states, amalgam waste is not a hazardous waste or is exempt as a small quantity generator. Many types of hazardous waste contain mercury. Therefore, the amount of mercury from amalgam waste in hazardous waste incinerators should be much lower than the contribution of mercury from amalgam waste estimated for municipal landfills. EPA may have updated emission data, but it should demonstrate a decrease in mercury emissions.

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The total amount of mercury emitted from solid waste combustion is 2.3 tons per year. Memorandum from Walt Stevenson to Large MWC Docket (EPA-HQ-OAR-2005-0117), Re: Emissions from Large and Small MWC Units at MACT Compliance, August 10, 2007, available at http://www.wte.org/userfiles/file/2007_EPAemissions_memo.pdf. This memorandum summarizes the measurements at Municipal Waste Combustors. Amalgam waste contributes 1.45% of the total mercury discarded in municipal landfills. See UNEP Mercury Assessment, supra note 28, at 95. Thus, the contribution from amalgam waste is less than 0.03 tons per year (2.2 tons times 1.45% = 0.03 tons per year). EPA may have updated emission data, but it should demonstrate a decrease in mercury emissions.
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32

Locating Sources of Mercury, supra note 26, at A-6, A-10.

See H.-N. Chou, et al. 2003. Urinary Mercury Levels in Dentists, 1984-2001. Journal of Dental Research, 82 (Special Issue): #1457 (Abstract is available at http://iadr.confex.com/iadr/2003SanAnton/techprogram/abstract_26985.htm. This paper (based on 19,000 mercury levels collected from dentists attending the annual ADA Health Screening Program from 1984-2001) concluded [f]or nearly the last decade (1992-2001) dentists mean urinary mercury levels ranged from 2.9 to 5.9 g/L with a median range of 2.1 to 4.2 g/L. See also Tsuji, et al., Evaluation of Mercury in Urine as an Indicator of Exposure to Low Levels of Mercury Vapor, Vol. 111, Env. Health Persp. 623 (April 2003) reported a mean concentration of mercury in the urine of nonoccupationally exposed individuals is approximately 4 g/L.

The 2002 NEI inventory did not calculate emissions from dental offices. EPA, Documentation For The Final 2002 Nonpoint Sector (Feb 06 Version) National Emission Inventory For Criteria And Hazardous Air Pollutants, including Appendix A: Criteria and HAP Emissions Estimation Methodology. Final, July 2006. at 2-28, available at ftp://ftp.epa.gov/EmisInventory/2002finalnei/documentation/nonpoint/2002nei_final_nonpoint_documentation0206 version.pdf. The 1999 NEI calculated the 0.7 tons per year. Documentation for the Final 1999 Nonpoint Area Source, National Emission Inventory for Hazardous Air Pollutants (Version 3), Appendix A: NEI Nonpoint HAP Source Estimates - Scc: 31502500, Dental Preparation And Use, at A-30 (August 10, 2003), available at ftp://ftp.epa.gov/EmisInventory/finalnei99ver3/haps/documentation/nonpoint/nonpt99ver3_aug2003.pdf (1999 NEI Inventory).
36 37 38 39

35

1999 NEI Inventory, supra note 35, at A-30. Locating Sources of Mercury, supra note 26, at 8-2. J. Perwak et al., Exposure and Risk Assessment for Mercury (EPA-440/4-85-011), at 27 (1981).

Van Horn, Materials Balance and Technology Assessment of Mercury and Its Compounds on National and Regional Bases. (1975) (EPA-560/3-75-007 (PB 247,000) (1975 Report). Id. at 222-224.

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There is a statement that these loss figures came from a 1971 EPA internal document entitled "Mercury Pollution in the United States." The ADA has not obtained a copy of this document. As noted above, the practices involved in mixing amalgam during the time period covered by this 1971 are no longer applicable to dental office practice. Another 2001 review of research on mercury releases to air found only two references. Rubin et al, Mercury Vapor in Amalgam Waste Discharged from Dental Office Vacuum Units (Rubin et al, 1994)) and Minnesosta Pollution Control Agency data regarding mercury concentrations in dental offices collected using a hand-held Lumex monitor. Based on these two studies, a consultant estimated that the annual releases to air from dental offices in Minnesota (using a number of assumptions based on the limited data available) were 21 kg/year (44 pounds) for 2000, but then caveated this estimate by stating that it may be incorrect by a factor of ten or more due to the lack of data. Barr Engineering, Substance Flow Analysis of Mercury in Products at 77-78 (for MPCA, August 15, 2001), available at http://www.pca.state.mn.us/publications/hg-substance.pdf. Michigan calculated mercury emissions of 145 lbs of mercury to the atmosphere annual in 2002, by assuming that 6% of the amalgam is lost through volatilization, 2002 Estimates Of Anthropogenic Mercury Air Emissions In Michigan, available at http://wiki.glin.net/download/attachments/461/2002+MI+Hg+Inventory.doc at 30-31, which is also not documented.

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Locating Mercury Sources, supra note 26, at A-1 (secondary mercury manufacturing) and A-17 (from the use of dental equipment and supplies). Later in this same report, EPA refers to this 2% emission factor as applying to the Dental Alloy (Mercury Amalgam) production, which then was identical to the dental office, since amalgam was mixed in the office. Id. Table F-1 at p. F-3. Now, amalgam capsules are prepared by manufacturers.

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