By: Griffin Cole, DDS, NMD
DENTAL WASTE MANAGEMENT: Recommended Best Solutions
Background of Dental Waste Management Practices
As many of us know, the issue of mercury discharges from amalgam waste impacts nearly every dental office. Research in the United States and other countries has repeatedly demonstrated that dental offices play a significant role in releasing mercury into the environment. Furthermore, the United States Environmental Protection Agency (EPA) reported that in 2003, dental offices were responsible for 50% of all mercury contamination in publicly owned treatment works. Much of the concern is due to the fact that when mercury is released into the environment, it is known to poison the ecosystem for years, thereby harming plants, animals, water, and soil.
This issue has now become an international matter as result of the 2013 Minamata Convention on Mercury from the United Nations Environment Programme (UNEP). The Minamata Convention is a legally-binding agreement to phase-down industrial uses of mercury as a means of protecting the environment and human health, and the treaty includes a section on dental amalgam. 94 countries have signed the global agreement so far, and the United States was the first to ratify it this past November.
In the United States, the EPA is also taking action against amalgam waste. In 2011, the EPA partnered with Marquette University’s School of Dentistry to teach dental students proper amalgam waste management, and in 2010, the EPA began work on creating guidelines to cut dental discharges of mercury. They are still in the process of reviewing these rules, but the EPA reports that they are examining the use of amalgam separators as a possible measure to lower dental mercury pollution.
The Royal College of Dental Surgeons in Ontario, Canada, has already passed maintenance requirements for amalgam separators, which is important since amalgam waste from separators should be recycled annually to prevent contamination.
Considering these national and international actions, it is logical to assume that more changes in dental waste management are inevitable. Since I have modified my dental practice to safely handle amalgam waste, it seems prudent to share my experience with others so that more dentists can begin making this transition. This will preserve the environment and also help dentists prepare for the impending future regulations.
Personal Reasons for Safe Amalgam Management
When I first became concerned about this issue 12 years ago, there were virtually no measures in place requiring dental offices to install amalgam separators, nor were there any regulations for recycling separator waste on a timely basis to ensure its proper function. However, as someone concerned about the effects of mercury in the environment, I considered these factors part of the “Best Management Practices” in my office.
The more I looked into this matter, the more convinced I became that it also makes good business sense to be proactive on several levels.
First, I did not want to be liable to my landlord for any potential damages to the building as a result of mercury going into their lines or the building being cited for mercury contamination.
Second, I knew my patients would be receptive to my concerns about the local environment.
Third, I saw taking these steps as a way of successfully preparing my dental practice for the possible office visit from any regulatory official wanting to inspect my environmental safeguards in terms of meeting current requirements.
It is interesting to note that while the dental industry has thus far generally avoided legal action based on mercury releases, in recent years, crematoriums have been the subject of lawsuits and citizen action campaigns opposed to the mercury emissions caused by the cremation of individuals with amalgam fillings.
Again, I want to stress my primary motive for adopting measures in waste management was simply because it was the right thing to do for the environment, but as I researched the issue, I realized that the potential liabilities were another sound reason to make these changes to my practice, which cost only a nominal fee compared to the many benefits.
Steps in Initiating Change for My Practice
When I explored the available options to improve my dental waste management practices, I learned there were basically two ways to proceed:
1. Order equipment available from my local dental supplier and handle the details of waste management and recycling monitoring myself, or
2. Consult with one of the new companies emerging on the market with proven experience in dental waste management.
The more I thought about it, the less appealing my dental dealer became in terms of providing me the best solution. This was not because I do not value my relationship with my local dental dealer. On the contrary, I value this relationship immensely, and my representative and his company play an important role in the everyday routines of my practice. However, when it came to this particular issue, the dealer clearly was not the correct solution.
I came to this conclusion because I recognized that waste management is not merely a matter of dental equipment. Waste management also requires taking into account the technology of recycling and the processing of waste. Thus, I knew that my dental dealer could sell me equipment, but I also needed expertise in recycling, processing, maintaining, complying with regulations, and the many complex perspectives of proper waste management.
Therefore, I researched the newly emerging companies for a solution, and I quickly discovered a few options for pursuing their assistance. One possibility was to contact a “Mom and Pop” company who had developed a product and in turn sold their product to dental supply dealers for sales to offices like mine. Another option was to collaborate with Dental Recycling North America, Inc. (DRNA) a full-service waste management company solely dedicated to the dental profession.
Obviously, I chose DRNA, and in the past 12 years of working with them, my faith in this company has only grown. They are the largest direct supplier of amalgam separator technology and recycling services to the dental profession outside of dealer distribution.
Currently, they are also the largest institutional provider of dental care waste management services. Their list of institutional clientele includes a vast range of dental schools (such as the University of Texas Health Science Center in San Antonio, the University of Colorado, the University of Detroit, the University of Louisville, Stony Brook, and the University of Iowa), as well as hospitals and medical centers (such as Claremore Indian Hospital, Staten Island University Hospital, St. Charles Hospital, Harlem Hospital Center, Flushing Hospital Medical Center, New York Methodist Hospital, Lutheran Medical Center, North Shore Long Island Jewish Health System, and JFK Medical Center).
In my opinion, the benefits of cooperating with this company are proof of the success in changing my dental waste management practices. For example, my office is on an automatic recycling schedule managed by DRNA to make sure timely recycling and prevent the mercury contamination which can occur when maintenance is not practiced regularly. Additionally, my office has an assigned compliance consultant to answer all of my questions and interact with any regulatory official inquiring about how our office handles amalgam waste or any other waste we recycle with DRNA.
Key Considerations for Updating Your Dental Waste Practices
As you evaluate solutions to address this issue, there are several important points to take into account:
- Consider your goal. Do you want to simply buy a piece of equipment, or do you want to have a solution that addresses regulatory requirements and protects your practice and the environment?
- Remember that this issue is about risk management. Can you personally reduce risks by knowing all aspects of this issue, or would it be helpful to enlist a consultant with expertise in environmental and regulatory areas to assist you and your staff?
- Estimate the time and finances you have available to make the transition. Are you better off having one company address this issue rather than hiring a multiple vendors including other waste management services?
- Assess the long-term impacts of your decision. Will the vendor/s you select be around in the future and remain up-to-code with the most current regulations and application of technology?
- Research the customers of the vendor/s you would like to choose. Do they work with institutional clients? Institutional customers usually employ the most due diligence in selecting businesses, and their involvement assists in establishing the reliability and cost-effectiveness of a company.
In summary, it appears that within several years dental practices in the US could be mandated to purchase amalgam separators and recycle amalgam waste on an annual basis. You can wait for this to happen or be proactive and take action now. Not only will others recognize that you were progressive and dealt with this issue before it was required, but you will also be protecting the environment immediately.
As someone who has had an amalgam separator installed and recycling service in place for 12 years, the best advice I can provide is that the whole process of improving your waste management practices is seamless when the right solution is chosen.
Meanwhile, know that your efforts to preserve your local environment and the reputation of our profession by incorporating safe and updated dental waste management practices will prove to be worthwhile, respected, and a model for other dentists and businesses in the future.
Bio: E. Griffin Cole, DDS NMD
Dr. Cole received his DDS from the University of Texas Health Science Center in San Antonio in 1993. He has been practicing biological dentistry since that time in Austin. He became ozone certified in 2006 and received both his Board Certification in Naturopathic Medicine and his degree in Integrative Biological Dental Medicine in 2010 from the School of Integrative Biological Dental Medicine (ACIMD). Dr. Cole received his Fellowship in the International Academy of Oral Medicine and Toxicology in 2008 and drafted the Academy’s Fluoridation Brochure and the official Scientific Review on Ozone use in root canal therapy. He is the current President of the IAOMT. He has been featured on numerous radio and television programs including World News Tonight with Diane Sawyer. He has been published in four national publications for his restorative and cosmetic dentistry and lectures on practice management and biological dentistry.
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