The Environmentally Responsible Dentist - Dental Amalgam Recycling: Principles, Pathways and Practice
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The Environmentally Responsible Dentist
Dental Amalgam Recycling:
Principles, Pathways and Practice
1
Presentation Topics
• History of Amalgam
• Related Mercury Actions
• Mercury in Dental Amalgam
• Government Regulation
• Amalgam Use in the U.S.
• Environmental Fate and Transport Mechanisms
• Environmentally Responsible Practices
2
Be The Difference!
To Develop, Highlight, and Teach Environmentally
Responsible Dentistry
3
History of Amalgam
To Develop, Highlight and Teach Environmentally Responsible Dentistry
4
History of Amalgam
• A Chinese medical text
mentions using a “silver
paste”, a type of amalgam, to
fill teeth in the 7th century.1
Image courtesy of University of California Press. 5
History of Amalgam
• Pierre Fauchard
• b. 1678 - d. 1761.
• The Age of Enlightenment.
• Between 1650 and 1800, the
science of modern dentistry
developed.
• Le Chirurgien Dentiste published in
1728.
• He advocated the use of lead
(plombagel) to fill cavities.
6
History of Amalgam
• Joseph Fox - b. 1775 - d.
1816.
• One of the most highly regarded
English dentists of his time.
• In 1803, he created fusible metal
(bismuth, metal, and tin).
• This metallic filling material when
put in the cavity form and cooled,
would solidify and replicate the
shape of the cavity.
• Had a relatively high melting point -
100°/212°- equivalent to that of Image courtesy of the OHSU Historical Collections & Archives,
boiling water. Oregon Health & Science University.
7
History of Amalgam
• “Most people may be deceived
at the time of an operation;
though woeful experience in a
few months unfolds the
deception. The impostor is
sought for to make reparation,
or to receive merited
punishment; but the bird has
flown; he is gone to practice his
tricks and deceptions among
those, who know not his
character; until prudence drives
him into another seclusion from
revenge, into another ‘shoal of
gudgeons.’ ”
• Benjamin James MMSS - 1814
Image courtesy of Bernard Becker Medical 8
Library, Washington University School of
Medicine, St. Louis.
History of Amalgam
• Thomas Bell
• b. 1792 – d. 1880.
• Fox’s successor at Guy’s
Hospital.
• Around 1826, he invented an
amalgam of coin silver and
mercury which had a much
lower melting point than
Fox’s metal.
9
History of Amalgam
• Crawcour brothers
• In 1833, introduced Taveau’s amalgam in New York.
• Traveling Dentists.
• They did a remarkable job of advertising.
• Decay was not removed before filling the teeth.
10History of Amalgam
• The Amalgam War
• Local dentists organized to fight the use of this “execrable material by
swindling villains.”
• Crawcour brothers forced to flee America.
• In 1843, the American Society of Dental Surgeons (ASDS) began a
crusade to fight the use of amalgam.
11History of Amalgam
• The Amalgam War
• In 1845, the ASDS passed a resolution compelling every member not
to use amalgam.
• In 1850, the ASDS rescinds its pledge requirement.
• In 1855, the ASDS disbands.
• If you can’t beat them, join them.
12History of Amalgam
• What ended the Amalgam War?
• Professional and consumer demand.
• In 1859, the leaders of the profession regrouped to form the American
Dental Association.
• Between 1860 and 1890, many experiments were done to improve
amalgam filling materials.
• Amalgam was here to stay.
13History of Amalgam
• G.V. Black
• b. 1836 - d. 1915.
• Developed a “good and
workable” amalgam in 1895.
• He believed amalgam should
consist of 67% silver, 27%
tin, 5% copper, and 1% zinc.
• Use of amalgam gradually
won acceptance as a cost
effective way to restore teeth.
Image was reproduced from Volume VII of the History of
14
Dental Surgery, Chicago National Art Publishing Company,
1909.History of Amalgam
Amalgam Composition
• Modern Dental Amalgam
• Manufactured product
containing two nearly equal
parts by weight.
• First part:
• a powder containing silver, tin,
copper, zinc and other metals.
• Second part:
• liquid mercury (Hg).
15History of Amalgam
Amalgam Composition
Mercury
Silver
2%
Tin
0%
Copper
13%
Zinc (Trace)
Mercury
50%
Silver
35%
16Related Mercury Actions
To Develop, Highlight and Teach Environmentally Responsible Dentistry
17Related Mercury Actions-International
• January 31, 2005 - European Union (EU) launched a comprehensive
mercury strategy to reduce EU's and global emissions and use of
mercury.
• July 10, 2007 – EU banned the sale of thermometers and other
instruments which contain mercury.
• September 25, 2008 – EU adopted law that bans the export of elemental
mercury, effective March 2011.
• In 2008, Norway and Denmark banned the use of mercury in dental
amalgam.
• Effective June 1, 2009, Sweden banned the use of mercury in products,
including mercury in dental amalgam, for environmental reasons.
18Related Mercury Actions-U.S.
• On October 14, 2008, President Bush signed into law the
Mercury Export Ban Act of 2008.
• Prohibits the sale, distribution, or transfer of elemental mercury by
federal agencies.
• It also prohibits the export of elemental mercury - The law is effective
January 1, 2013.
• Department of Energy - responsible for the management and long-
term storage of the U.S. excess elemental mercury.
19Related Mercury Actions-U.S.
• February 16, 2009 - President Obama Shifts U.S. Policy and
Supports Global Mercury Control Treaty
• Covers reducing demand in products, processes and cutting Hg in
international trade.
• 120 countries expressed support for a legally binding agreement on Hg.
20Related Mercury Actions-U.S.
• August 2009 - the US Geological Service released study entitled:
"Mercury in Fish, Bed Sediment, and Water from Streams Across the
United States, 1998-2005."
• The study found mercury contamination in every fish sampled in
291 streams across the country.
• About a quarter of these fish were found to contain mercury at levels
exceeding EPA’s criterion for the protection of people who consume
average amounts of fish.
21Related Mercury Actions-U.S.
• October 2009 - EPA released Report to Congress on mercury compounds
as required by Congress under Section 4 of the Mercury Export Ban Act of
2008.
• The report identifies sources of mercury compounds in the U.S. and
reports quantities in imports and exports, and uses of these compounds
in products and processes. The report also assesses the potential for
key mercury compounds to be exported for regeneration into elemental
mercury.
22Related Mercury Actions
ADA/EPA/NACWA Publications and Partnerships
• In 2007, ADA updated its Best Management Practices (BMPs) to include amalgam
separators. (ADA first published its BMPs in January 2003.)
• An amalgam separator is a capture device that collects amalgam particles.
• The BMP for amalgam separators - the same as ANSI/ADA Specification #108
(American National Standards Institute) which delineates requirements and test
methods for amalgam separators.
• EPA published its "Health Services Industry Detailed Study" - August 2008. (In the
document, EPA compiled information on mercury discharges from dental offices, best
management practices, and amalgam separators.)
• The EPA, ADA, and the National Association of Clean Water Agencies (NACWA)
entered into a partnership in December 2008 to promote the ADA’s BMPs for amalgam
waste, including amalgam separators.
23Mercury in Dental Amalgam
To Develop, Highlight and Teach Environmentally Responsible Dentistry
24Mercury in Dental Amalgam
• Mercury is persistent, bio-accumulative, and toxic and is responsible for
significant environmental degradation around the world.
• Although its use in most product applications does not present a risk, the
subsequent disposal of any product containing mercury does.
• Amalgam is no different.
• Mercury poisoning affects about 5 million American women. 1 in 12 women
have mercury levels above the levels considered safe.
25Mercury in Dental Amalgam
• Three Types of Mercury:
1. Elemental Hg (Elemental Hg
Is Used in Dental Amalgam.)
• Heavy, odorless, silver-
colored liquid.
• Inhalation is the main source
of toxicity. (Mercury poisoning
can also occur from dermal
exposure.)
This image is licensed under the Creative Commons Attribution-
• Hg well absorbed by lungs. Share Alike 2.5 Generic license.
• Need long-term exposure or
26
one large exposure.Mercury in Dental Amalgam
• Three Types of Mercury:
2. Inorganic Hg
• Known as mercuric salts…i.e. mercuric chloride, mercuric iodide,
cinnabar.
• Found in many folk medicines.
• Corrosive and can damage the kidneys.
• Long-term exposure can cause skin irritation, staining, and nerve
damage.
27Mercury in Dental Amalgam
Three Types of Mercury:
3. Organic Mercury =
Methylmercury
• More potent and more
bioaccumulative than other
forms of mercury.
• Form to which humans are
primarily exposed.
• The EPA is most concerned
about methylmercury in the
environment.
28Mercury in Dental Amalgam
• Three Types of Mercury
• Methylmercury (continued):
• Organic Hg primarily found
in fish.
• Organic concentrations in
large fish can be over a
million times higher than in
the surrounding water.
Drawing courtesy of Fishbase.
29Mercury in Dental Amalgam
• Three Types of Mercury:
• Methylmercury (continued):
• Found in fungicides and antibacterials (mercurichrome).
• The main source of Hg poisoning in humans is ingestion.
• Small ingestions rarely cause problems.
• Large ingestions or long-term ingestions can adversely impact all
body systems.
30Mercury in Dental Amalgam
• Inorganic Mercury and Methylmercury
• Inorganic Hg has a high affinity for particles. Therefore, the fate of most
inorganic mercury in aquatic systems is sedimentation.
• …...Methylmercury, in contrast, tends to be more soluble because of its
affinity for organic compounds. It is the most risky type of mercury in
the environment.
31Mercury in Dental Amalgam
• How is Methylmercury Formed?
• When dental amalgam is
released to the environment,
the mercury component is
transformed into methylmercury
by microbial action.
• Methylation is a product of very
complex processes that
transform mercury into more
reactive species.
32Mercury in Dental Amalgam - How Is
Methylmercury Formed?
33Mercury in Dental Amalgam
• The Impact of Methylmercury in
the Environment
• Once formed, this new mercury
compound is taken up more
readily by aquatic organisms
such as fish, particularly in
waters higher in acidity.
• Methylmercury uptake by fish
leads to fish advisories of
which there are 50
nationwide. As of 2008, all
50 states, one U.S. territory
and three tribes have issued
fish advisories.
34Government Regulation
To Develop, Highlight and Teach Environmentally Responsible Dentistry
35Government Regulation
• Why voluntarily act in an environmentally responsible fashion?
• Amalgam separators are effective in reducing over 95% of the amalgam from dental office
wastewater.
• The mercury can then be recycled.
• Currently, mercury releases to wastewater from dental offices are controlled through
state mandates and voluntary actions; however, EPA does have the authority to issue
regulations to control these releases.
As respected community leaders, dentists need to do their part for the environment.
36Government Regulation
• Dental amalgam - is a dental medical device regulated by the Food and Drug
Administration (FDA).
• Since the 1990s, several federal agencies (FDA, Center for Disease Control and the
U.S. Public Health Service) have reviewed the scientific literature looking for links
between dental amalgam and health problems.
• In September 2006, an FDA Advisory Council met to discuss the benefits and risks of
mercury and amalgam. Their findings:
• No evidence that amalgam use causes health problems in a majority of
population.
• Lack of knowledge regarding effects on pregnant women, children, and those who
are sensitive to mercury.
37Government Regulation
• In 2008, FDA again reviewed the best available scientific evidence to determine
whether low levels of mercury vapor associated with dental amalgam are a
concern. Based on this evidence, FDA considers dental amalgam safe for adults
and children aged six and older.
• For individuals who have an allergy to mercury or the other components of dental
amalgam (silver, tin, or copper) - FDA cautions these individuals not to get
amalgam fillings.
• On July 28, 2009, FDA issued a final regulation classifying dental amalgam and
its component parts (elemental mercury and a powder alloy) as “Class II” medical
devices.
• Specifically the Center for Devices and Radiological Health (CDRH). By
classifying a device as "Class II," the FDA can impose special controls to
provide reasonable assurance of the safety and effectiveness of the device.
The special controls contain, among other things, recommendations on
performance testing, device composition, and labeling statements.
38
• It is considered to be a stable device for most applications and uses.Government Regulation
• EPA is concerned about amalgam
discharges that enter the waste
stream.
• EPA regulates any waste
generated from amalgam
preparation and use.
• Examples of amalgam waste:
• Non-contact amalgam.
• Excess left over after
procedure.
39Government Regulation
• Examples of amalgam waste (continued):
• Contact amalgam:
• Has been in contact with human…extracted teeth, carving scrap, traps or
filters.
• Amalgam sludge:
• Mix of liquid and solid collected within vacuum pump filters and chairside traps.
• Amalgam capsules.
40Amalgam Use in the U.S.
To Develop, Highlight and Teach Environmentally Responsible Dentistry
41Amalgam Use in the U.S.
• Decline of Hg-containing products
• Between 1980 and 2004, mercury usage in products declined substantially
over the years – a decrease of roughly 95%.
• This reduction in use was due in large part to federal legislation and state
regulatory standards for mercury usage in batteries and to EPA’s regulatory
ban on mercury in paint.
• Mercury use in products accounted for an estimated 116 tons in 2004.
Mercury usage in the form of dental amalgam was 30.4 tons or 26% of the
total. (This is a high percentage of the total.)
42Amalgam Use in the U.S.
• Estimated 2004 U.S. mercury use in products1:
• Switches & Relays – 44%.
• Dental Amalgam – 26%.
• Measuring and Control Devices - 17%.
• Electric Lighting - 8%.
• Other - 5%.
• Among these products containing mercury, dental amalgam is a focus of concern.
Relative to other sectors, dentists use large quantities of mercury in fillings and
43
they generate large amounts of waste.Amalgam Use in the U.S.
• The use of dental amalgam has declined in the past two decades. It
continues, however, to be placed in teeth. Currently accounts for 30% of
dental fillings in the US.1
• In 1999, US dentists placed an estimated 71 million amalgam
restorations.2
• 29% reduction from 1990.3
• Reductions can be attributed to decrease in cavity rate and increased
use of mercury-free fillings.4
44Amalgam Use in the U.S.
• Data indicate that there were 163,181 individual dentists in 2004.1 In 2005, EPA
estimates that there were 122,918 dental offices that used or removed dental
amalgam that year. 2
• 340 mg of mercury used in an average placement with 9% or 30 mg resulting in
non-contact scrap and/or carving waste.3
• Estimated that 300 mg of mercury results from each removal.4
45Amalgam Use in the U.S.
• Amalgam Waste Contributions to Wastewater
• Major studies show impact on water quality from dental amalgam waste:
• A 2002 study by the New York Academy of Sciences indicated as
much as 40% of the New York Harbor mercury loadings were from
dental offices.1
• A report released in 2002 by NACWA indicated that dental clinics are
the largest single source of mercury in wastewater. NACWA estimated
that 36% of the mercury in the nation's wastewater system came from
dental offices. Mercury discharges from dental offices far exceeded
all other commercial and residential sources, each of which was
below 10 percent.2
46Amalgam Use in the U.S.
• Data Show Impact on Water Quality from Dental Amalgam Waste (Continued):
• In 2003, dental offices were found to be the source of 50% of all mercury
pollution entering Publicly Owned Treatment Works (POTWs).1
• EPA estimated in 2008 that the approximately 162,000 dentists who use or
remove dental amalgam in the U.S. discharge approximately 3.7 tons of
mercury each year to POTWs.2
47Amalgam Use in the U.S.
• With dental amalgam's associated mercury contamination problems, why is
amalgam still being used?
• Relatively easy to place and low cost.
• Good resistance to compressive forces, especially for posterior teeth.
• Insurance plans have traditionally covered placement procedures.
• No current, adequate substitute.
48Amalgam Use in the U.S.
• Past Management Practices = More Pressure on Dentists Today
• Despite its continued use, management of amalgam waste has created
substantial environmental contamination and has created more pressure on
the industry to recycle amalgam to prevent it from getting into the
environment.
49Amalgam Use in the U.S.
• Best Management Practices
• In January 2003, the American Dental
Association (ADA) released Best
Management Practices (BMPs) .
• The BMPs are a set of guidelines about
capturing and recycling dental amalgam
waste. Guidelines include use of such
items as collection boxes for excess
amalgam and chairside traps to retain
amalgam.
Noncommercial use, reproduction and distribution of all or any portion of the
American Dental Association's Best Management Practices for Amalgam
Waste is permitted solely for educational or scientific purposes, provided that
this copyright notice is prominently displayed on each copy of the work. Third
parties are expressly prohibited from creating derivatives of this work without
the prior written permission of the American Dental Association. This work is
educational only and does not constitute legal or professional advice.
50Amalgam Use in the U.S.
• Best Management Practices:
• All state and local voluntary programs
are based on or derived from the
guidance provided in the ADA's
BMPs.
• The 2003 BMPs stressed recycling of
amalgam collected in the dental
office. But no mention of installing
amalgam separators to remove
amalgam particles from wastewater.
Noncommercial use, reproduction and distribution of all or any portion of the
American Dental Association's Best Management Practices for Amalgam
Waste is permitted solely for educational or scientific purposes, provided that
this copyright notice is prominently displayed on each copy of the work. Third
parties are expressly prohibited from creating derivatives of this work without
the prior written permission of the American Dental Association. This work is
educational only and does not constitute legal or professional advice.
51Amalgam Use in the U.S.
• Best Management Practices
• In October 2007, the American Dental Association revised “Best Management
Practices for Amalgam Waste.”
• Added language on amalgam separators:
• Amalgam Separators
• Select an amalgam separator that complies with ISO 11143.
• Follow the amalgam separator manufacturer’s recommendations for
maintenance and recycling procedures.
• The BMPs recommend two important and effective "best practices": the use of
dental amalgam separators, and the recycling of captured amalgam solid waste.
52Amalgam Use in the U.S.
• Some states have mandatory dental amalgam program requirements,
including installation of amalgam separators.
• Specifics on state requirements can be found in EPA's Health Services
Industry Detailed Study: Dental Amalgam (August 2008).
• Additionally, The National Conference of State Legislatures lists state
legislature internet links, including links to information on state laws
requiring dentists to install amalgam separators.
53Amalgam Use in the U.S.
• Amalgam Separator Sales
• 2001-2009 data provide estimates on the numbers
of separators sold in regulated, partially regulated,
and non-regulated states.1
• Based on the number of sales by one manufacturer,
only 13% of separators were sold in non-regulated
states from 2004-2009.2
This photo is used for illustrative purposes only.
EPA cannot endorse any particular amalgam separator.
54Environmental Fate & Transport Mechanisms
To Develop, Highlight and Teach Environmentally Responsible Dentistry
55Environmental Fate &
Transport Mechanisms
• How Does Amalgam Waste Reach the Environment?
1. From Publicly Owned Treatment Works (POTWs) connected to dental
offices which receive amalgam through office piping and sewer
discharges….
2. From medical waste companies who pick up red bags at dental offices
containing amalgam waste and subsequently treat the medical waste in
incinerators…..
3. From landfills which receive amalgam waste from disposal companies which
take waste from dentists who place it in office municipal trash….
56Environmental Fate &
Transport Mechanisms
1. Publicly Owned Treatment
Works
• Dental Amalgam Waste
• Into vacuum line.
• Not captured by office
traps or amalgam
separators.
• Released to the sewer.
• Into POTWs.
57Environmental Fate &
Transport Mechanisms
• Publicly Owned Treatment
Works
• Not 100% efficient. (POTWs
have a roughly 90% efficiency
rate of removing amalgam from
wastewaters.)
• Thus, about 10% gets into
lakes, rivers, and streams.
58Environmental Fate & Transport Mechanisms
inm
Environmental Fate & Amalgam Waste Entry
into Ecosystem
Transport Mechanisms
Diagram is included in "ASSESSMENT OF MERCURY IN
THE FORM OF AMALGAM IN DENTAL WASTEWATER IN
THE UNITED STATES," Jay A. Vandeven and Steve L.
McGinnis, 2005.
59Environmental Fate &
Transport Mechanisms
2. Medical Waste Incinerators
• Red medical bags.
• Mercury released when:
Amalgam waste is
treated by medical waste
companies with
incinerators which are
not designed to handle
the mercury component
of amalgam..
• With precipitation, airborne
Hg gets deposited into water
bodies.
60Environmental Fate &
Transport Mechanisms
• Medical Waste Incinerators
• Dental Amalgam Waste
• In October 2009, EPA
published a regulation that
limits emissions from
medical waste incinerators.
EPA estimates that this rule
will cut mercury emissions
by 605-682 pounds annually
of Hg emitted to the
atmosphere through the
stacks.
61Environmental Fate
and Transport
Mechanisms
• Landfills
• Dental Amalgam Waste Goes:
• Into garbage.
• To landfills.
• Landfill leachate may enter
groundwater.
• Your amalgam waste could
reach groundwater if you
dispose of it in the trash.
62Environmental Fate and Transport
Mechanisms
• Sludge from POTWs
• Dental Amalgam Waste
• Sludge from POTWs may be applied to agricultural land as fertilizer.
• Some of the mercury in the fertilizer may also evaporate to the
atmosphere. Through precipitation, the airborne mercury
eventually gets deposited into water bodies, land and
vegetation.
• Sludge from POTWs may also be incinerated. Once incinerated, the
mercury may volatilize to the atmosphere. Mercury may then be
deposited into lakes and streams via precipitation.
63Environmentally Responsible Practices
To Develop, Highlight and Teach Environmentally Responsible Dentistry
64Environmentally Responsible
Practices
• Strategies for Proper Amalgam Waste Management in Your Office
• The EPA recommends four specific actions to manage your amalgam waste.
• The first letters of each action form the acronym...G.R.I.T.
• Gray Bag It.
• Recycle It.
• Install It.
• Teach It.
65Environmentally Responsible
Practices
• Strategies for Proper Amalgam Waste Management in Your Office
• Gray Bag It - Discard excess amalgam wastes into a gray bag. Never dispose of dental amalgam
wastes in medical red bags or in your office trash containers.
• Recycle It - Select a responsible dental amalgam recycler - who will manage your waste amalgam
safely to limit the amount of mercury which can go back into the environment.
List of Recyclers
• Install It - Install an amalgam separator in the office to capture up to 95% of the mercury leaving a
dental office through drains. This is the KEY to success.
• Important to note - A very small amount of dental amalgam waste will be released to waterways
given the high capture rate of amalgam separators (95%), coupled with the approximate 90%
efficiency rate of POTWs.
• Teach It - Educate and train staff about the proper management of dental amalgam in the office.
66Environmentally Responsible
Practices
• Gray Bag It
• Environmentally responsible
amalgam waste control begins in
the dental office.
• In September 2006, EPA and the
ADA developed a voluntary
standard for storing (and shipping
to recyclers) excess dental
amalgam not needed by dentists
during filling placement and/or
removal procedures. Standard was
developed through ANSI (American
National Standards Institute.)
• The EPA refers to this as “Gray This photo is used for illustrative purposes only.
Bag” collection. (The containers EPA cannot endorse any particular gray bag.
are gray in color.)
67Environmentally Responsible
Practices
• Recycle It
• Most important step:
• Selection of a responsible company to manage your waste once you
have properly controlled it in your office.
List of Recyclers
• It makes no sense to handle your waste properly yourself and then turn it
over to someone who can't properly manage Hg waste.
• It is important to recycle both the amalgam waste captured by amalgam
waste separators and the amalgam discarded in "gray bags."
• Gray bags serve a dual purpose: to both hold excess amalgam and as a
container to send to recyclers. 68Environmentally Responsible
Practices
• Recycle It
• Mercury cannot be destroyed, so waste managers must rely on
various methods to treat or recover it, depending on:
• the mercury species present.
• its concentration.
• the waste matrix or media involved.
69Environmentally Responsible
Practices
• Recycle It
• One of the most effective processes to handle mercury wastes is called “retorting.”
• Process especially designed to capture the mercury from mercury-containing items,
such as dental amalgam.
• Retorting operations separate the mercury from the rest of the waste stream and
condense it for recovery.
• Select a retorting company which is subject to regulatory oversight under the Resource
Conservation and Recovery Act (RCRA). Such companies are classified as hazardous
waste treatment, storage and disposal facilities that require a RCRA hazardous waste
permit during the active stage (including the closure period) of waste management at the
facility. A RCRA permit needs to be approved by state or federal officials and ensures that
specific requirements are met, such as monitoring the groundwater under the facility to
ensure that this valuable resource is not getting contaminated.
70Environmentally Responsible
Practices
• Recycle It
• Bottom Line:
• The end point to responsible waste management is ensuring that
mercury is collected and recycled and not released to the
environment during or after treatment.
71Environmentally Responsible
Practices
• Install It
• Installing an Amalgam
Separator
• Removes amalgam from dental
wastewater discharges prior to
it leaving the office.
• Over 95% effective!1
• In 2003, it was estimated that
dental offices were the source
of 50% of all mercury pollution This photo is used for illustrative purposes
entering POTWs.2 only. EPA cannot endorse any particular
amalgam separator.
72Environmentally Responsible
Practices
• Install It
• Installing an Amalgam Separator
• Separators vary in complexity, cost and efficiency.
• Even “low tech” systems appear to be
effective….
• Select one which will provide adequate removal
based on the number of operatories in your practice.
73Environmentally Responsible
Practices
• Teach It
• Educate and train your staff.
• You can know everything about
proper amalgam
management….but does your
staff?
• It is the responsibility of
everyone to manage amalgam
properly.
74Environmentally Responsible
Practices
• The Environmentally Aware Dentist Knows....
• ...why
• dental amalgam (Hg) is a hazard to the environment.
• ...how
• dental amalgam waste reaches the environment.
• ...what
• you can do to minimize its release to the environment.
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