A Guide to Proper Waste Management in Dental Offices
Contents
1. BRAM spout SE h T 5 Hazardous Waste Haulets RBM secs MI ce Nii ee E aE 6 Lead Foil Recyclets cce M 6 NUTS Ral enn 10 06 c E eee I A ne ena ene ee ae eae ee eee ee eee tee renin mene E een yer 7 Occupational Satety and Health Administration OSHA J ercsi 7 Compliance Supplies and Equifiaeni Vendondih E 1 E Be 7 Regional Solid Waste Contacts 1 f A 8 E E E 7 Lake Champlain Basin New Y rk f 2 Mie e m Df Take Ciampi Pasin VAOD csini aie 7 Rental Test Equipment CompanicSeggg sguage ceggy ee OEE eo SE 8 Silver Reclamation Facilities My MMB Bc MMM MM cece T a 8 State Dental Societies E RRR Bee BB MIB ce MB cece dM Mee 8 State Departments of Environmental G ihgervaiiion Coriia cts S 5 MI 9 Dental Office Waste Management lables Located i E Introduction hbe Environmentally Responsible Dental Office A Guide to Proper Waste Manage ment in Dental Offices is intended to assist New York and Vermont dentists in dealing with mercury and other dental office waste problems in a proactive way This guide provides dentists with the information they need to properly dispose of mercury and amalgam waste and provides suggestions for managing the other wastes that result from the day to day activities of a den2. Recovery Act RCRA Section EL D If a small amount of elemental mercury is to be disposed of initiate a reaction with amalgam alloy to form scrap amalgam which can then be recycled through your amalgam recycler H Most solid waste districts Gn Vermont only offer elemental mercury recycling programs which allow dentists to safely dispose of their elemental mercury Call your regional solid waste district EL to inquire about such programs Amalgam Capsules After mixing amalgam the empty amalgam capsules containing no visible amalgam may be disposed of in the garbage D Any defective capsules that cannot be emptied should be placed with the non contact scrap amal gam so they can be recycled Be sure to check with your amalgam recycler LJ to see if they will take capsules with your scrap amalgam Scrap Amalgam D Salvage and store all contact and non contact scrap amalgam in separate appropriately labeled tightly closed containers D Recycle scrap amalgam through an amalgam recycler Follow the requirements of your amalgam recycler for the storage disinfection and shipping of scrap amalgam If contact amalgam must be disinfected before shipment to your recycler do not use any method that utilizes heat The heat will cause the mercury to volatilize and be released to the environment if you store scrap amalgam under used radio graphic fixer water or other liquid do not
3. Te cr T E EEE E F Dental Office Wastes Handling Procedures Page 6 Amaloam Containing Mercury and SUV EH 0issixssiassensrsnirdianvirionsitiorcentsntasioosaales oecienedatiroibnenedoente sin 6 Steps You Can Take Some Genetal GuidelinES sonrie ranir asii 6 ie a T aT EE 6 A A cs 1 e Scrap Amalgam E qi e Chairside Traps a N 7 e Vacuum Pump Filters HESSE TM lB ill 8 e Additional Sources of Mercuri Creal Offices aW i ili 8 e Amalgam SeparatoSS ccce ge ei Q e Plumbing Replacement and RepaitS 0 gffP cB el 9 e Office Renovations Si sss ee 9 Used X Ray Fixer Solution Conta ikm EER es 10 X Ray Developer cccccece ces PIER cep 10 Cleaners for X Ray Developer SYSURIRIRIIIIIIIF 0 00 cccere gM lr M Lead Foils Shields and Aprons EE aa BE lf 11 Chemiclave Chemical Sterilant SolMhons MEERN SE fall HMM ell dak Disinfectants Cleaners and Other Whemicals ile Bi 4 2 Office ee ee lle 12 e General Office Waste BB fmm E i2 e Fluorescent Bulbs E R E 12 Batteries pl gM pale ee E E 12 Resource Han dbook eee fi eee ee ll Located in Back Pocket Dental Amalgam Recyclers E F Bale MB lean fh 1 Dental Amalgam Separator Producti dOr HMR SIIB A 5 Hazardous Waste Program6
4. under any circumstances decant the liquid down the drain Contact your dental amalgam recycler G2 or hazardous waste hauler m for more information on how to dispose of this material properly Chairside Traps The control of waste dental amalgam includes proper management of the traps and filters used in your office vacuum system Disposable amalgam traps are preferable to reusable traps because of the difficulty in effectively removing amalgam particles from the trap without spilling them into the drain or garbage In addition consider replacing 40 mesh traps with 100 mesh traps if your suction system can function adequately with the smaller mesh Finer screens may be more effective at trapping amalgam particles However they may require cleaning and changing more often Be sure to check with your dental amalgam recycler LL to determine if they will accept disposable amalgam traps in the same container with your contact amalgam The following recommendations will help you to properly manage your trap systems Disposable and Reusable Amalgam Traps Use universal precautions when handling the chairside trap Change chairside amalgam traps as often as necessary Flush the vacuum system with disinfecting line solution before changing the chairside trap Y The best method is to flush the line at the end of the day and then change the trap the next morning before the suction is used This meth
5. America Mercury is particularly threatening because it bioaccumulates in the food chain collecting and building up in the tissues of small fish and other species and then accumulating in ever increasing amounts as those creatures are consumed by others higher up the chain Humans as well as wildlife can suffer severe health effects from consuming mercury contaminated fish Currently fish consumption advisories are issued in many areas to warn sensitive populations such as pregnant women women of childbearing age and young chil dren to limit their intake of certain species of fish or to avoid eating these fish altogether But this approach poses problems for people who eat fish as a mainstay of their diets and for local economies that depend on the fishing industry for local jobs A far better solution is to end the contamination at its source And that s where you come in Please read this guide to learn how dental offices can limit the amount of mercury and other chemicals entering the environment by using common sense pollution prevention and waste management techniques You ll also find tips on the proper handling of other harmful chemicals present in dental offices This guide is part of the National Wildlife Federation s ongoing efforts to provide citizens with the knowledge the tools and the help they need to restore our nation s rivers and lakes and keep them free from toxic pollution That work has never been more urgent D
6. Ihe tnvironmentally Responsible Dental Office H Guide to Proper Waste Management in Dental Offices Northeast Natural Resource Center of the National Wildlife Federation and The Vermont State Dental Society June 1999 ry NATIONAL WILDLIFE FEDERATION People and Nature Our Future is in the Balance The Environmentally Responsible Dental Office Guide t may come as a surprise that dental care professionals have an extraordinary opportunity to help protect and restore the nation s rivers and lakes with simple changes in the way you dispose of waste in your office We know for example that 40 states have fish consumption advisories due to mercury contamination Mercury and other materials critical to your work can become poisons to people and wildlife if they are disposed of improperly Your choices in disposing of those materials can make a tremendous difference That s why the National Wildlife Federation created this guide to running an environmentally responsible dental office It s intended to give dentists dental assistants and office staff simple ideas for changes that can go a long way in preventing the release of mercury and other potentially harmful contaminants to our nation s streams lakes and rivers As you are well aware elemental mercury is among the most common hazardous materials in the dental office It is a toxic substance that threatens the health of humans and wildlife throughout North
7. OTW If your dental office is on a septic system do not wash the liquid that has gone through the silver recovery process down the drain The recov ery process waste may disrupt the proper function ing of the septic system Therefore recovery systems may not be a viable option for offices on septic systems n Hay Developer Do not mix X ray developer and used X ray fixer The silver laden used X ray fixer is considered hazardous waste and can not be flushed down the drain Please refer to the previous section on Used X Ray Fixer Solution for proper handling procedures D Check with your local publicly owned treatment works POTW to determine if waste X ray devel oper can be flushed down the drain Check in the phone book under your town s Public Works Department for the number of your local POTW If X ray developer is acidentally mixed with used y p y X ray fixer the mixture must be disposed of through a hazardous waste hauler LU Cleaners for Ray Developer Systems any cleaners for X ray developer systems contain chromium Chromium is consid ered a toxic substance that must be managed as a hazardous waste Dispose of chromium containing cleaners through a hazardous waste hauler LU Check the package label or the Material Safety Data Sheet MSDS to see if the cleaner you use contains chromium If it does ask your supplier to provide a non chromium cleaner Never put a cleani
8. Street Suite 18 South Burlington Vermont 05403 800 640 5099 ptaylorvt aol com H h NATIONAL WILDLIFE FEDERATION People and Nature Our Future is in the Balance
9. ace vacuum pump filters regularly as recom mended by the equipment manufacturer Use universal precautions when handling the filters D Remove the filter While holding it over a tray or other container that can catch spills decant as much liquid as possible without losing visible amalgam The decanted amalgam free liquid can be rinsed down the drain Put the lid on the filter and place it in the box in which it was originally shipped When the box is full the filters should be recycled Be sure to check with your amalgam recycler H to ensure that they will take these filters Q Do not dispose of used vacuum pump filters as medical waste Additional Sources of Mercury in Dental Offices e Any electrical equipment with switches relays or temperature controls thermostats may contain mercury and should be disposed of through a hazard ous waste hauler LW e Mercury thermometers and blood pressure units are sources of elemental mercury The following steps should be followed in the event that one of these items should become broken D Put on nitrile gloves Do not use latex gloves Clean up all visible elemental mercury using a mercury spill kit Mercury spill kits are available from a number of sources including companies that specialize in Occupational Safety and Health Administration OSHA compliance supplies and equipment HWH amalgam recyclers LL and dental product suppliers Before pur
10. an accidental mercury spill In the event of a mercury spill put on nitrile gloves and clean it up immediately Do not use latex gloves as mercury can penetrate latex Mercury spill kits are available from a number of sources including companies that specialize in Occupational Safety and Health Admin istration OSHA compliance supplies and equip ment HWH amalgam recyclers LQ and dental product suppliers Before purchasing a kit make sure it comes with complete instructions on how to perform a spill clean up Train several staff mem bers in proper spill clean up procedures If you are concerned about the possible uncontained presence of mercury in your dental office due to historical or recent mercury spills equipment is available for the detection of mercury vapor in the workplace environment and for the location of mercury spills This equipment can be rented from rental test equipment companies EL Minimize the generation of amalgam waste Don t mix a two spill capsule if a one spill capsule will do Less waste means less amalgam that needs to be recycled D Recycle as much amalgam as possible D When removing an existing amalgam attempt to remove it in chunks so that it is more likely to be caught in the chairside trap RELI A Never put scrap amalgam in the sharps container Never put scrap amalgam where it will end up in the red biohazard bag Never discard scr
11. ap amalgam in the trash Never rinse scrap amalgam down the drain Never remove excess amalgam from the amalgam well with the high speed suction the vacuum line Never clean up a mercury spill using a vacuum cleaner Never place extracted teeth with amalgam restorations in the red biohazard bag They should be placed in the CONTACT AMALGAM container Use universal precautions when handling extracted teeth glasses gloves and mask Elemental Mercury also referred to as free bulk or raw mercury Use precapsulated alloy to eliminate the possibility of an elemental mercury spill In the event that elemental mercury is present in your dental office it should be properly handled in the following way Never rinse elemental mercury down the drain 79 Never dispose of elemental mercury in the trash Never dispose of elemental mercury in the sharps container or as medical waste Recycle unused elemental mercury Many hazardous waste haulers LL and dental amalgam recyclers LI will accept elemental mercury for recycling If you have any other questions regarding the recycling of elemental mercury you can contact the following state offices in New York contact the New York Department of Conservation Bureau of Hazardous Waste Management Technical Determina tion Section LL in Vermont contact the Vermont Department of Environmental Conservation Waste Management Division Resource Conservation and
12. bags might be either incinerated or autoclaved If amalgam is present in waste that is incinerated the mercury will volatilize and enter the atmosphere The volatilized mercury then precipitates to the ground or a waterbody If amalgam is present in waste that is autoclaved the volatilized mercury will escape from the autoclave when the door is opened presenting an immedi ate health hazard to dental office staff e Garbage If amalgam scrap is discarded into ordinary trash it may eventually be incinerated see previous paragraph or placed in a landfill If discarded amalgam scrap ends up in a landfill it may lead to soil and or water contamination Most landfills are outfitted with leachate collection systems Leachate results from the normal decom position of the garbage in landfills The collected leachate is piped to the local publicly owned treatment works POTW where it can be released to the environment through ways described under wastewater above e Antiquated Techniques Older techniques that use bottles to dispense elemental also referred to as free bulk or raw mercury for amalgam production can lead to accidental spills and increase the chances that elemental mercury will end up in the wastestream In addition if the elemental mercury is poured into the drain it may settle in sink traps gradually releasing into the wastewater over time Reducing Mercury Contamination Opportunities for Dentists De
13. chasing a kit make sure it comes with complete instructions on how to perform a spill clean up Train several staff members in proper spill clean up procedures D Place all contaminated items materials used during the clean up procedure and broken pieces of glass in a sealable plastic bag or container Label the bag or container as Mercury Waste Dispose of all contaminated materials through a hazardous waste hauler Never dispose of contaminated waste in the sharps container biohazard bag or trash Never dispose of elemental mercury down the drain or in the sharps container biohazard bag or trash Amalgam Separators Your office may wish to consider purchasing an amalgam separator The ability of amalgam separa tors to remove amalgam from the dental wastewater may be superior to filters and traps used in chairside dental units and vacuum lines These separator systems are used to capture scrap amalgam in wastewater which is too fine to be removed by a trap or a screen Amalgam separators are used in Europe and are currently being evaluated in selected areas of the United States Contact your state dental association L or an amalgam separator vendor EL for more information If you decide that you want to purchase an amalgam separator be prepared to shop around for the machine that works best for you These separa tors vary widely in sophistication and effectiveness The following criteria should hel
14. d the following dental staff members Debb Dowling Joanna Hoke Judy Jones and Dixie Vallie The NWF would like to thank the Vermont State Dental Society for its time donation of office space and expertise throughout the process of developing this guide and the project s Task Force which greatly contributed to the overall success of this undertaking Funding for this guide was provided through a grant from the Lake Champlain Basin Program to the National Wildlife Federation s Northeast Natural Resource Center NWF would also like to thank the Ward M and Mariam C Canaday Educational and Charitable Trust for their financial support The views expressed in this report are the views of the National Wildlife Federation and not those of the Task Force For additional copies of this guide or more information please contact The National Wildlife Federation Northeast Natural Resource Center _ 58 State Street NATIONAL Montpelier Vermont 05602 heer 802 229 0650 gilbert nwf org Vermont State Dental Society 100 Dorset Street Suite 18 South Burlington Vermont 05403 800 640 5099 ptaylorvt aol com lable of Contents INTTOQUCTION ccc cccecccccceesesseesessesisistiesitesisestsstisissessese Page 4 Bd ch gee o ig aS 610 AA E A nee ne nee ree E oer ee teeta eter 4 Reducing Mercury Contamination Opportunities for Dentists sssssseeesseeerrerrree reee 5 a POTON TEV A E ent E i E E iE OEA TE EA ETASAN 5
15. ental Conserva tion Bureau of Hazardous Waste Management Technical Determination Section EH In Vermont contact the Vermont Department of Environmental Conservation Waste Management Division Solid Waste Program EL Used n Ray Fixer Solution Containing Silver sed fixer is the solution left over from X ray processing The used fixer is consid ered a hazardous waste because of its high silver content Used fixer should be reclaimed off site by another company handled by a hazardous waste manage ment firm or reclaimed in house Reclaiming the silver in used fixer conserves a valuable resource and reduces your business liability Many reclaimers will pay to take your silver Suitable recycling methods for used fixer include Reclamation Facility Hazardous Waste Management Firm Used fixer can be taken to a silver reclamation facility H that is licensed to accept hazardous waste or disposed of through a hazardous waste hauler H In either case make sure you get a receipt or certificate of reclamation 10 Purchase your own silver recovery unit Please check with your local publicly owned treatment works POTW prior to purchasing a silver recovery unit to ensure that the level of silver removal meets the POTW s discharge standards If it does you may rinse the recovery process waste down the drain Check in the phone book under your town s Public Works Department for the number of your local P
16. espite incredible progress in addressing some of the most visible sources of pollution others like mercury remain a significant threat Addressing such threats and ensuring a healthier world for humans and wildlife begins with knowledge and understanding followed by the action of people who care We hope you will use the information provided by this guide to act on your own desire to help Together we can make a difference S ve N Mark Van Putten President and CEO National Wildlife Federation The Environmentally Responsible Dental Office A Guide to Proper Waste Management in Dental Offices he following guide was created by the National Wildlife Federation NWF and the Vermont State Dental Society VSDS in collaboration with the following project Task Force Members Dr Jerome DeSnyder DDS Plattsburgh New York Dr Daniel Ferraris DMD South Burlington Vermont Doug Kievit Kylar Pollution Prevention Planner Vermont Agency of Natural Resources Waterbury Vermont Tom Moreau District Manager Chittenden Solid Waste District Williston Vermont Mark Moroukian PE Environmental Engineer Pollution Prevention Unit New York State Department of Environmental Conservation Albany New York Hollie Shaner RN MSA Environmental Health Coordinator Fletcher Allen Healthcare Burlington Vermont Peter Taylor Executive Director Vermont State Dental Society South Burlington Vermont The National Wi
17. ldlife Federation s Northeast Natural Resource Center NNRC based in Montpe lier Vermont is one of ten field offices of NWF NWF is a non profit conservation and education organization with headquarters in Vienna Virginia Founded in 1936 NWF its members and supporters and a national network of affiliated organizations works to educate citizens about the need for sustain able use and proper management of our natural resources NWF s mission is to educate inspire and assist individuals and organizations of diverse cultures to conserve Wildlife and other natural resources while protecting the Earth s environment to promote a peaceful equitable and sustainable future The NWF s NNRC has three overall purposes to represent NWF on a local and regional basis among the New England states to work with state affiliate organizations within the region and to conduct research education and advocacy programs on conservation issues of regional significance in the Northeast The principal authors of this report are Monique Gilbert and Wendy Houston Anderson Water Resources Project Associates at NWF The authors would like to thank the following people for their editorial support Kari Dolan NNRC Water Resources Project Manager Eric Palola NNRC Director Guy Williams NWF Pollution Prevention Specialist Terri Goldberg Pollution Prevention Program Manager Northeast Waste Management Official s Association an
18. ng solution disinfectant or any other process waste into a septic system regardless of its concentration It may disrupt the proper functioning of the septic system lead Foils Shields amp Aprons Do not put the lead foil that shields X ray film protective lead shields and lead aprons into the trash or into biohazard bags The lead content of these items makes them hazardous waste even if they are recycled for their scrap metal content D Dispose of lead foils shields and aprons through a hazardous waste hauler H Check with the manufacturer for recycling possibilities for lead aprons that become worn out or damaged D Remember to always get documentation from the company handling your lead waste confirming that the waste has been disposed of properly Chemiclave Chemical sterilant Solutions pent chemiclave solution is the liquid left over from the chemical sterilization of dental instruments This used solution is an ignitable waste because it contains more than 24 alcohol and has a flashpoint below 140 F Dilute the spent chemiclave solution with at least 4 parts of water 4 parts water to one part chemiclave solution or more before discharging down the drain Do not wash the chemiclave solution down the drain undiluted or put in the garbage Never put a cleaning solution disinfectant or any other process waste into a septic system regardless of its concentration It may disr
19. ntists have many options available to them to reduce the amount of amalgam inadvertently leaving their office The information presented in this guide falls into two categories of waste management strategies pollution prevention actions and control actions also called best management practices Pollution Prevention The goal of pollution prevention is to reduce or eliminate the use of toxic or polluting substances at the source Pollution prevention activities and recycling in dental offices are essential in order to minimize releases of polluting substances into the sewer system medical waste or ordinary trash An effective pollution prevention strategy is to use products that are less harmful to the environ ment For dentistry this strategy includes the development and use of amalgam substitutes as appropriate and the use of less hazardous cleaning products Pollution prevention programs can also include education and training good housekeeping prac tices chemical inventory control and recycling Elements of a successful pollution prevention program are a a written statement of policies and goals tailored to each dental practice b a commit ment to consistent administration of the program and c continuous monitoring of pollution preven tion policies and goals by the dentists and their staff members You should consider implementing a pollution prevention program for your dental office using the follo
20. od will allow the particles in the trap to dry An alternative method is to flush the system with a cleaning solution according to the product s directions then remove the lid from the trap and allow air to pass through the trap until the contents are dry usually not more than five minutes Follow the steps below that apply to the type of trap you have Disposable Amalgam Traps Open the chairside dental unit to expose the amalgam trap Remove the amalgam trap and place it directly into the contact amalgam recycling container You may need to have a contact amalgam container that is large enough to accommodate the disposable chairside traps If the trap is visually clean it can be put in the trash or re used Visually clean traps have been determined to be nonhazardous A heavily contaminated trap should always be recycled Store contaminated traps in the contact amalgam container Reusable Amalgam Traps Remove non amalgam fragments such as cement from the trap with cotton forceps and discard in the garbage Remove all visible amalgam by tapping the contents into the container labeled CONTACT AMALGAM Close the cover tightly Do not clean reusable traps under running water or discharge the trapped amalgam into the wastewater system Do not discharge the trapped amalgam into the sharps container biohazard bag or trash Vacuum Pump Filters by the central suction pump D Repl
21. or the Health Care Industry Conference pp 131 155 Plumbing Replacement and Repairs After your office adopts its new amalgam manage ment practices it may be a good time to clean or replace sink traps Mercury from past practices often settles at low points such as sink traps and sumps The slow dissolution of the mercury in a sink trap or sump can release mercury into the wastewater for years after past disposal practices have been corrected D Whenever plumbing parts are removed or cleaned caution should be taken to avoid spilling the contents in case amalgam or mercury are present D Pour and brush out the sludge and handle it as you would handle contact amalgam D The plumbing parts can then be put back in place or recycled Office Renovations D Alert renovators to the possibility of historical mercury spills that may have resulted in the pres ence of mercury in carpets floor cracks behind moldings and other areas where elemental mercury may have been used or where amalgam capsules may have been spilled D If you suspect the presence of uncontained mercury in your dental office due to historical or recent mercury spills equipment is available to detect mercury vapor and locate mercury spills This equipment can be rented from rental test equipment companies WH Guidance is available on the proper disposal of renovation debris In New York contact the New York State Department of Environm
22. p you select the right system e The system should be effective meaning that the company should be able to prove that it can remove the amalgam from the wastewater regardless of particle size e There should be no compromise in suction power e You may want to consider a unit that is hands off meaning that the dentist or staff does not have to perform a series of manual operations or be required to handle and change filters e The captured amalgam should be recycled Make sure that the company which sold you the unit also arranges for the recycling of the captured amalgam The company needs to provide you with the appropriate information on how to recycle the captured amalgam e Simplicity of design is a plus There will be fewer chances for something to go wrong e The unit should operate quietly e The unit should come with a fail safe mechanism that protects you from a spill or back up in the event that a blockage occurs e The unit should install centrally so that the whole wastewater stream passes through it before discharging into the sewer system e The unit should be reasonably priced Obtain information from the companies on the total cost for all services including cost of the unit over a 5 10 year period before making a decision Balogh Cynthia Welland and Paul G Rubin 1998 Removal of Mercury from Dental Amalgam Wastewater A New Prescription Pollution Prevention Strategies f
23. rict EL Fluorescent bulbs are hazardous waste and a significant source of mercury They should not be placed in the trash Do not place fluorescent bulbs in the trash Batteries D Recycle all types of batteries Most if not all batteries have hazardous properties and should be recycled Contact your regional solid waste district for recycling directions W e Single Use Batteries As a result of federal and state legislation mercury is no longer added to domestically produced alkaline batteries However certain other kinds of batteries including certain button batteries some medical batteries small sealed lead acid batteries and other specialty batteries continue to contain mercury and other metals that are intentionally added Rechargeable Batteries Batteries such as nickel cadmium Ni Cd that are no longer useful are hazardous waste and should also be recycled since they contain lead and cadmium Do not place batteries in the trash biohazard bag or sharps container Printed on recycled paper with soy based inks Design Mirabile Graphics Illustrations Carolyn Shapiro For additional copies of the Resource Handbook or Dental Office Waste Management Table please contact The National Wildlife Federation Northeast Natural Resource Center _ 58 State Street NATIONAL Montpelier Vermont 05602 ae 802 229 0650 _ gilbert nwf org or Vermont State Dental Society 100 Dorset
24. tain ing amalgam from dental offices Mercury is a persistent toxic contaminant and it bioaccumulates in the tissue of fish High concentrations of mercury in fish pose serious health risks to people and wildlife that consume them New York and Vermont began testing for mercury in fish as early as 1969 and 1970 respectively Studies in both states illus trate that mercury levels vary by species and among waterbodies but appear to be highest in larger older piscivore fish eating species Both states currently have state wide fish consumption adviso ries in effect Populations that are particularly sensitive to the health risk of consuming contami nated fish include pregnant women women of childbearing age children and people dependent upon fish for their daily diet There are several ways that mercury from dental amalgam can get into the environment e Wastewater Amalgam that is rinsed down drains or escapes from poorly maintained chairside traps and vacuum pump filters enters the wastewater stream and eventually the wastewater treatment plant or the septic system Any mercury contained in treated wastewater will either end up in the sewage sludge which may be land applied under an appropriate permit or in the liquid effluent to be discharged into lakes or rivers e Medical Waste Scrap amalgam both contact and non contact should not be treated as medical waste Amalgam that is improperly put into red biohazard
25. tal office such as used X ray fixers and developers cleaners for X ray developer systems lead foils shields and aprons chemiclave chemical sterilant solutions disinfectants cleaners and other chemicals and general office waste Throughout the document reference will be made to the appropriate parties to contact for information on issues such as amalgam recycling silver reclamation and hazardous waste disposal At the back of this Guide in the inside cover pocket there is a separate Resource Handbook that contains lists of companies contact names and or phone numbers to assist dentists and dental office staff in obtaining the information they need to take action on the guidance provided in this document The following symbol will be used throughout the Guide to indicate when the Resource Handbook should be consulted for additional information refer to the Resource Handbook in the inside cover pocket Also located at the back of the Guide in the inside cover pocket are two Dental Office Waste Management Tables laminated tables of consoli dated dental office waste management options and restrictions organized according to the type of waste These tables are designed to be displayed on the wall in the dental office for quick and easy reference Why is Mercury a Concern One possible environmental impact from the practice of dentistry results from the unwanted release of elemental mercury and mercury con
26. upt the proper functioning of the septic system Disinfectants Cleaners and other Chemicals i Follow the label directions on the product container for guidance on the proper handling and disposal of used disinfectants and cleaners along with the residue remaining in the product containers D Recycle the empty container through your local program or dispose of it in the trash Alcohols ethers and peroxides are considered ignitable and must not be discarded down the drain because they could explode These materials are considered to be hazardous waste Unused products should be disposed of through a hazardous waste hauler LU Never put a cleaning solution disinfectant or any other process waste into a septic system regardless of its concentration It may disrupt the proper functioning of the septic system Office Waste General Office Waste Contact your trash hauler or your regional solid waste district LY for information on how to start an office waste recycling program Recycle aluminum glass plastics newspaper corrugated cardboard paperboard and office paper through your trash hauler or local recycling program Due to confidential patient information you may want to have office paper shredded prior to recycling Recycle spent toner cartridges that have been used in printers and copiers Fluorescent Bulbs Recycle fluorescent bulbs through your regional solid waste dist
27. wing pollution prevention practices Use amalgam substitutes in cases where they are appropriate ethical and economically feasible Use non hazardous or biodegradeable detergents for clean up Use non chromium containing X ray developer system cleaners Educate your staff and cleaning service on these practices so they can properly follow the program that you have established Best Management Practices While pollution prevention is the ideal solution for solving the mercury problem it is not always feasible in practice Therefore the following sections present information on best management practices for the dental office Best management practices are economically achievable measures or actions that can be used to control or reduce the entry of pollutants mercury amalgam and other dental office wastes into the environment Northeast States for Coordinated Air Use Management NESCAUM et al 1998 Northeast States and Eastern Canadian Provinces Mercury Study A Framework for Action pp IV 6 IV 7 Dental Office Wastes Handling Procedures REMINDER aa refer to the Resource Handbook in the inside cover pocket Hmalgam Containing Mercury and Silver Steps You Can Take Some General Guidelines D Use amalgam substitutes in cases where they are appropriate ethical and economically feasible Convert to single use amalgam capsules This change will help to minimize the chance of
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