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Putting Into Place the BMPs for Amalgam Waste

Putting Into Place the BMPs for Amalgam Waste. Frederick Eichmiller, DDS VP & Science Officer Delta Dental of Wisconsin. Amalgam. Material A mixture of elemental mercury with powdered silver-tin-copper alloy Mercury combines with silver and tin to form stable strong intermetallic compounds.

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Putting Into Place the BMPs for Amalgam Waste

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  1. Putting Into Place the BMPsfor Amalgam Waste Frederick Eichmiller, DDS VP & Science Officer Delta Dental of Wisconsin

  2. Amalgam • Material • A mixture of elemental mercury with powdered silver-tin-copper alloy • Mercury combines with silver and tin to form stable strong intermetallic compounds Ag3Sn + Hg  Ag2Hg3 + Sn7-8 Hg Powder (~50%)Liquid (~50%) Silver 63% Mercury 100% Tin 23% Copper 13% Zinc <1%

  3. The Amalgam Revolution • Early attempts with lead, tin and bismuth • The “Amalgam War” of 1850 • Dentists manufacturing amalgam • G.V. Black formula (1890s) • The first amalgam standard (1920) • Modern alloys (1960s)

  4. Lost “most used” status between 1998 & 1999 • Utilization in North America is dropping at a constant rate • Some European are countries eliminating use • Global demand remains fairly constant

  5. Alternatives

  6. Amalgam • Most cost effective from cost-service standpoint • Still only “underwater dentistry” material • Still frequently the Tx of choice in some situations

  7. Human Toxicity • What kind of Hg is it? • What’s the route of exposure? • What’s the dose?

  8. Mercury: Man’s Deadly ServantNational GeographicOctober 1972 J. Osborne

  9. Biological Activity • 70 trace elements in human body • 35 have no biological activity Mercury has no biological activity • Carcinogen: no positive human results • Teratogens: highly positive, numerous systems J. Osborne

  10. Liquid Mercury • Very low absorption on skin • Less than 0.01% absorption J. Osborne

  11. Liquid Mercury (continued) • No toxic effect when swallowed • Less than 0.01% absorption • Miller-Abbott (bowel obstruction) tube breaks 2% to 3% • Pre-1900s drink a pound of Hg for constipation • 7 lbs. Hg ingested (1/2 pint) took 10 days to clear J. Osborne

  12. Liquid Mercury (continued) • Bizarre forms • Inject subcutaneously,intramuscular andintravenously • Cause local inflammation, abscess and gangrene • Patient does not see doctor for years • Rarely causes severe mercury toxicity

  13. Inorganic Mercury • HgCl2 mercuric chloride (corrosive sublime) • Chemical catalyst, preservative, treatment for syphilis • Hg2Cl2 mercurous chloride (calomel) • Diuretic and laxative, electrodes • HgO mercuric oxide (montroydite) • Batteries • HgS mercuric sulfate (cinnabar) • Red tattoo color, native ore of Hg • Hg(ONC)2 mercury fulminate • Contact detonators J. Osborne

  14. Organic Mercury • Alkyl • methyl - food chain, shellfish, • ethyl - preservative • Aryl • aromatic series • anti-fungal on seeds • Phenyl • prevent mildew J. Osborne

  15. Organic Mercury • Methyl mercury: Very toxic • 90-95% absorbed in gut • half-life 70-90 days • Hg enters waterway • Methylation by microorganisms • Hg concentrated as itmoves up food chain (tuna, shark, and swordfish) J. Osborne

  16. Organic Mercury • Ethyl mercury, preservative • Thimerosal (mercurochrome) • controls microbial growth 0.003-.01% used in: • Soaps • Shaving cream • Hyper allergic cosmetics • Ear flush • Multidose vaccines • Gamma-globulin shots • Ophthalmic solutions • Shampoos • Nasal sprays J. Osborne

  17. Organic Mercury • Aryl • Aromatic series anti-fungal for seeds • Highly toxic • 90-95% absorption in gut • Widely used in agriculture J. Osborne

  18. Mercury Vapor • 80% absorbed in lung • Significant toxicity when inhaled • Accounts for most occupational and home exposures • Acute toxicity is rare, but can occur • Large dose causes acute pneumonitis, renal failure, seizures and neurological dysfunction J. Osborne

  19. Mercury Vapor Sun light → UV light ← J. Osborne

  20. Hg Sources • 50% of the mercury released to the environment comes from human activity • Of that amount: • 53% is emitted from combustion of fuels for energy production and • 34% is from the combustion of waste • 13% from all other sources, including manufacturers and consumers • Dentistry contributes less than one percent EPA Data

  21. Electric Other Lighting 7% 9% Electronic Switches 42% Measuring and Control Devices Dental 28% 14% 2001 Hg Use in Products EPA Estimates

  22. Common Mercury-Added Products

  23. Hg in Products • Hg content in common products: • Toothpaste 3.8 ppb • Deodorant 1.35 ppb • Soap 25 ppb • Laundry detergent 2.4 ppb • Kool-Aid 6 ppb • Mountain Dew .158 ppb Hampton Roads Sanitation District

  24. USGS/ICE CORES

  25. Dental Use of Mercury • No organic or inorganic mercury is used in dentistry or in dental amalgam • Restorations in 1999 required approximately 35 tons of elemental Hg in the U.S. • The use of amalgam and mercury in dentistry continues to drop at a fairly constant rate (58% from 1979-99)

  26. Chairside traps and vacuum filters (78% efficient) Amalgam placements and replacements Sewers & POTWs (Publicly 0wned Treatment Plants) 29.7 ton Hg 6.5 ton Hg The Dental Hg Trail VanDeven JA & McGinnis SL Water, Air, and Soil Pollution (2005) 164: 349–366

  27. Hg emissions 0.1 tons Incinerated biosolids 1.0 tons Hg POTW effluent 0.3 Tons Hg Grit solids 1.6 tons Hg The Dental Hg Trail Sewers & POTWs 6.5 tons Hg Total Bioavailable Up to 0.4 tons Hg Beneficial use biosolids 3.6 tons Hg VanDeven JA & McGinnis SL Water, Air, and Soil Pollution (2005) 164: 349–366

  28. So what’s dentistry’s relative contribution? Tons/Yr MunicipalWaste Combustors IndustrialBoilers Hazardous Waste Combustors Chlor-alkali Plants Portland Cement Kilns Geothermal Power Dental Coal Utilities

  29. Boston Seattle S.F. Minn/St Paul Cleveland Duluth Palo Alto Various Cities’ Estimates of Mercury Loads (% of Total System Loads) Coming From Dental Facilities 76 80 60 34 40 26 13 14 11 20 9 0

  30. Septage <1% Corrosion Water Supply Dental Offices <1% <1% 13% Infiltration Permitted Industries 33% 3% DITP Recycle Unknown Commercial Stream 20% 7% Residential Sewage Inflow 13% 11% Typical Mercury Influent Loadings to a POTW (Metro Boston)

  31. Why is Mercury an Issue for Municipal Sewer Systems? • Plant performance and environmental conditions at outfalls closely scrutinized • Many POTWs are committed to beneficial re-use of biosolids as fertilizer and soil amendment • Cities operating combined sewers facing new restrictions on storm water flows

  32. Why is Mercury an Issue for Municipal Sewer Systems? • Fish consumption advisories in 50 states • Discharge limits are being lowered nationwide • Mercury “Virtual Elimination Strategies” are gaining attention in NE, Great Lakes, other locations

  33. The Regulatory Process • EPA’s maximum mercury allowed in surface water is 0.001 µg /L of mercury per liter for states located along the Great Lakes and 0.05 µg /L for other states. (µg/L = parts per billion) • States may use more stringent limits than EPA regulations.

  34. Municipal Wastewater Treatment Facilities’ and Dentistry • Municipal POTWs are receiving more stringent mercury limits for their discharge • This requires them to begin to look “upstream” for additional sources of mercury • Dental offices have been identified by many cities as a significant mercury source to their systems • NACWA Position: “Pollution prevention efforts targeting sources of mercury should focus on dental offices and medical facilities (hospitals)”

  35. The Unfortunate Facts • While our overall contribution to bioavailable Hg is very small, our contribution to an individual wastewater treatment facility averages approximately 40%. • Treatment facilities have a growing problem meeting their stricter discharge requirements. They have a problem and they need our help!

  36. The Solution to Pollution is Not Dilution

  37. What about Mercury in Amalgam? • “While we recognize that dental amalgam is a safe material for filling cavities, its waste should be handled properly, recovered and recycled just as we do with other waste products.” Dr. J. Bramson, Executive Director, ADA July 2002 Press Release

  38. So what can your office do today?

  39. ADA Recommended Best Management Practices (“BMPs”) for Dentists

  40. What are the BMPs? • Use pre-capsulated alloys • Recycle used capsules • Salvage, store and recycle amalgam • Recycle extracted teeth with amalgam restorations (following disinfection) • Use disposable chair side traps to retain amalgam; they can be recycled • Install and use amalgam separators

  41. What are the BMPS? (continued) • Clean or replace screens, traps and filters regularly • Store amalgam wastes in separate airtight, labeled containers • Recycle all amalgam wastes through an amalgam recycler (including used capsules) • Use non oxidizing vacuum line cleaners

  42. BMP Video

  43. Practices to Avoid • Never use bulk mercury for amalgams • Never pour bulk elemental mercury waste in the garbage, red bag or down the drain • Never place amalgam waste of any kind (including extracted teeth with amalgams) in the biohazard (red) bag, the trash or the sharps container

  44. More Practices to Avoid • Never rinse traps, filters, or screens over or down the drain, or empty into a waste basket • Never disinfect teeth or any item containing amalgam with any method that uses heat

  45. More Practices to Avoid • Never decant liquid in which amalgam has been stored down the drain • Never rinse tools used to place or carve amalgam over the drain • Never clean spills of elemental mercury with a vacuum cleaner

  46. Proper Use/Maintenance of Existing Traps is an Important Amalgam Capture Mechanism

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