Amalgam waste disposal in dental hospitals of Peshawar
Kefi Iqbal
Saqib Alivisibility
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The study was done to find out the methods for dispensing the dental amalgam and its disposal in three dental teaching hospitals of Peshawar according to American Dental Association (ADA) Standard and International Standard Organization Standard (ISO). A specially designed questionnaire was sent for this study. The results showed that none of the dental teaching hospital in Peshawar follows the ADA and ISO standard for the disposal and recycling the amalgam waste. Only 9 % claimed using the chair side traps and install amalgam separator at chair side, 64% used the hand mixing alloy/mercury procedure. Number of amalgam fillings done and removed by three dental hospitals per month were 2027 and 267 respectively. It was concluded that total amalgam waste was 3.204 kg in three dental hospitals in one year, and proper measures should be taken for the dispensing and disposal of amalgam.
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Amalgam Waste Disposal
ORIGINAL ARTICLE
AMALGAM WASTE DISPOSAL IN DENTAL HOSPITALS OF PESHAWAR
1
KEFI IQBAL, BDS, MSC, PhD
2
SAQIB ALI, BDS, MSC
3
FAREED MOHSIN, BDS, MSC, MFDS
ABSTARCT
The study was done to find out the methods for dispensing the dental amalgam and its disposal
in three dental teaching hospitals of Peshawar according to American Dental Association (ADA)
Standard and International Standard Organization Standard (ISO).
A specially designed questionnaire was sent for this study.
The results showed that none of the dental teaching hospital in Peshawar follows the ADA and
ISO standard for the disposal and recycling the amalgam waste. Only 9 % claimed using the chair side
traps and install amalgam separator at chair side, 64% used the hand mixing alloy/mercury
procedure. Number of amalgam fillings done and removed by three dental hospitals per month were
2027 and 267 respectively. It was concluded that total amalgam waste was 3.204 kg in three dental
hospitals in one year, and proper measures should be taken for the dispensing and disposal of
amalgam.
Key Words: Amalgam Waste, Disposal.
INTRODUCTION
Silver amalgam is one of the oldest filling materials used in dentistry and mercury (Hg) as component
of amalgam has been used for more than 15 decades.1,2
By definition amalgam is a special type of alloy of two
or more metals having mercury as an essential component 3 which may exposed either through incinerators
or Hg in waste water from the different sources which
could be either from households or dental clinics.4 The
dental amalgam particles are released from different
sources and the waste of amalgam from dental clinic is
one of them.5 Mercury and its compounds are everywhere in our environment; between 2700 and 6000
tons of mercury is released annually from the oceans
and the earth’s crust. 6 These releases make the environment polluted through direct wastewater, incineration, land-filling and sewage sludge incineration.
Less than 1% mercury is released from dental clinics of
the total mercury discharged annually into the envi1
2
3
ronment as a result of human activities.7 A study
conducted in 1973 showed that out of the 10,000 tons
of mercury released by industry, approximately 300
tons came from dentistry from all over the world.8
According to the environmental agency, the discharge
of mercury by dental clinics is one of the factor that
make environment unhealthy.9-12 The International
Dental Federation (FDI) and World Health Organization (WHO) in 1997 stated that dental amalgam 13 if
not properly handled and regulated could be responsible for environmental pollution as well as occupational exposure.14-20 For the best management of amalgam wastage American Dental Association (ADA) recommends the following;21
DO
•
Use per-capsulated alloys and stocks a variety of
capsules sizes.
Associate Professor and Head Department of Dental Material Sciences, Baqai Dental College, Baqai Medical University 51, Deh Tor,
Gadap Road near toll plaza, Super Highway, Karachi
Assistant Professor Department of Oral Biology, Sardar Begum Dental College, Gandhara University, Canal Road University Town,
Peshawar.
Assistant Professor Department of Oral Pathology and Oral Medicine, Baqai Dental College, Baqai Medical University, Karachi
Pakistan Oral & Dental Journal Vol 32, No. 3 (December 2012)
540
Amalgam Waste Disposal
•
Recycle the disposable capsules after use.
RESULTS
•
Recycle salvage, non-contact and store amalgam
(scarp amalgam).
•
Recycle amalgam waste and the remaining amalgam pieces from restorations after removal.
•
For retaining the amalgam use vacuum pump
filters, chair-side traps, and amalgam separators
procedure and recycling their contents as well.
•
Recycle teeth which contain dental amalgam fillings. (Notes: Ask your recycler for disinfection).
The overall response rate was 100%. According to
the present study, 64% claimed using hand mixing
dispensing method and only 1% showed their interest
of using both forms of dispensing (Fig. 1). Number of
amalgam fillings performed and removed by three
dental hospitals per month are 2027 and 267 respectively (Fig.2). Method of disposing amalgam waste by
bin has the highest percentage that is 67% (Table.1)
and none of ISO standard procedure for controlling
amalgam waste at chair side is used by any of the
dental teaching hospitals (Table. 2).
•
Recycling the amalgam waste as much as possible.
•
For minimizing the dissolution of amalgam use
line cleaners.
DONT
•
Use mercury in bulk.
•
Throw the capsules in biohazard containers (red
bags) or garbage.
•
Put non contact and contact amalgam waste in
infections waste containers (red bags), biohazard
containers, or regular garbage.
•
Use drains or sinks for rinsing the devices containing amalgam.
•
Dispose of the restorations in sharp containers or
regular garbage.
•
Flush the amalgam waste or its product down the
drain or toilet.
•
Use chlorine or bleach–containing cleaners to flush
wastewater lines.
Fig 1: Percentage of dispensing methods
Fig 2: Number of fillings done and removed
METHODOLOGY
A questionnaire was sent to three teaching dental
hospitals in Peshawar, (Sardar Begum Dental College, Khyber College of Dentistry and Peshawar Dental College). The response was 100%. They were asked
to inform which form of dispensing (Hand Mixing or
Encapsulated), methods of disposing for amalgam
waste and number of restorations performed and removed by the dental practitioners.
Pakistan Oral & Dental Journal Vol 32, No. 3 (December 2012)
TABLE 1: METHODS OF DISPOSING AMALGAM
WASTE USED IN THREE DENTAL HOSPITALS
S.
Methods of disposing of amalgam
No. waste
%
1.
Sink
29
2.
Photographic fix solution
1
3.
Bin
67
4.
Proper recycling method
5
541
Amalgam Waste Disposal
TABLE 2: ISO PROCEDURE TO CONTROL
AMALGAM WASTE AT CHAIR SIDE IN THREE
DENTAL HOSPITALS
S. ISO procedure to control amalgam
No. waste at chair side
%
1
Amalgam separator
5
2
Chair side traps
9
3
Vacuum pump filters
7
4
None
77
Co. The curtis centre; Independence square west, Philadalphia,
PA 19106. 1991; 303-26.
4
Lars DH, Anders L, Lars G. High mercury emissions from
dental clinics despite amalgam separators. Sci Total Enviro.
2006; 362: 74-84.
5
Jokstad A, Fan PL. Amalgam waste management.Int Dent J.
2006: 1-7.
6
Foulke JE. Mercury in flash; cause for concern? FDA consumer
report. 1994; 6-9.
7
Arenholt B D, Dental Amalgam –enivornmental aspects. Adv
Dent Res. 1992; 6: 25-3.
8
Amjad S, Awadh A, Jalal T,Al-Thakafy . Dental clinics: A point
pollution source, not only of mercury but also of other amalgam
constituents. Chemosphere. 2011; 84: 1133-1139.
9
Kummerer K, Wallenhorst T, Kielbassa AM. Mercury emissions from dental chairs by disinfection. Chemosphere .1997;
35: 827-33.
10
Stone ME, Cohen ME, Liang L, Pang P. Determination of
methyl mercury in dental-unit wastewater. Dent Mater. 2003;
19, 675-79.
11
Vandeven JA, McGinnis SL. An assessment of mercury in the
form of amalgam in dental wastewater in the United States.
Water, Air, Soil Pollut. 2005; 164, 349-66.
12
Al Kawas S, Abu-Yousef I, Kanan S, El-Kishawi1 M, Siddique
A, Abdo, N. Analysis of mercury in wastewater of some dental
clinics in United Arab Emirates. J Int Environ Appl Sci. 2008;
3, 21-28.
13
Fox DJ. Silver amalgam. DJF@DrDavid 2002; 1 of 2.
14
ZhouHY, Wong MH. Mercury accumulation in freshwater fish
with emphasis on the dietary influence. Water Res.2000; 34,
4234-42.
15
Berzas N JJ, Garcia B LF, Rodriguez M D RC. Distribution of
mercury in the aquatic environment at Almaden, Spain. Environ.
Pollut. 2003; 122, 261-71.
16
Horsted-BindslevP . Amalgam toxicity – environmental and
occupational hazards. J. Dent. 2004; 32: 359-65.
17
Hylander LD, Goodsite ME,. Environmental costs of mercury
pollution. Sci Total Environ. 2006; 368: 352-70.
18
Ismail AI. Neurotoxicity of mercury in dental amalgam. J. Am.
Med. Assoc. 2006; 296, 1461-62.
19
Needleman HL. Mercury in dental amalgam – a neurotoxic
risk? J. Am. Med. Assoc. 2006; 295, 1835-36.
20
Mumtaz RA, Ali, Noor N, Humayun S. Amalgam use and waste
management by Pakistani dentists: an environmental perspective. J East Mediterr Health. 2010; 16: 334-39.
21
Best management practices for amalgam waste. 211 East Chicago Avenue, Chicago, Illinois 60611-2678 American Dental
Association. October 2007.
22
Langworth S, Sallsten G, Barregard L, Cynkier I, Lind ML,Soderman E. Exposure to mercury vapor and impact on
health in the dental profession in Sweden. Journal of Dent Res.
1997; 76: 1397-404.
DISCUSSION
Dentists and their staff members are exposed to
mercury and its vapors daily. Mercury in elemental
form may be absorbed through skin contact but inhalation of mercury vapors may be dangerous. The vapors are produced during mixing of the material and
removal of old filling for replacement. Mercury, at
room temperature is itself volatile. The mercury vapor
has no color, odor or taste and cannot be easily detected. For mercury hygiene protocol needs to be proper
layout of the dental clinics, trituration methods, condensation, cleaning and instruments sterilization, the
removal of amalgam restorations and amalgam waste
storage are also the matter of concern.22 This study
emphasizes that the 267 grams of mercury produced
from the removal of old dental amalgam filling per
month by three dental hospitals of Peshawar. The
large number of teaching hospital preferred to use the
hand mixing dispensation because of the cost saving,
which may cause the chances of handling error. Therefore, it is not possible to achieve the proper control of
amalgam waste. It can be overcome by the encapsulated dispensation. None of the dental hospital follows
the ADA specification to control the amalgam waste.
REFERENCES
1
Michael NB. Mercury amalgam dental fillings: An epidemiologic assessment. Int. J. Hyg. Environ.-Health. 2006; 209:
309-16.
2
De’ Morais PMR, Rodrigues AL Jr and Pimenta LA. Qualitative
microleakage evaluation around amalgam restorations with
different treatments on cavity walls. J operative Dentistry.
1999; 24: 217-22.
3
Phillips RW. Skinner’s science of dental materials. 9th edi.
Dental amalgam alloys, structure and properties. W.B. Saunders
Pakistan Oral & Dental Journal Vol 32, No. 3 (December 2012)
542
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