Clean teeth


recycleThere has been a lot of talk about recycling within Australian dental practices, but those at the frontline believe far more direct action is now required. By John Burfitt

The Australian Dental Association (ADA) is very clear about what constitutes appropriate amalgam waste management. In the “Appendix to Policy Statement 6.11 – Guidelines for Amalgam Waste Management”, it states: “Dental amalgam waste should be recycled … amalgam should not be disposed of in the general waste. Amalgam also should not be rinsed down the drain.”

So it came as a surprise to be told—off the record—by a number of dental practitioners contacted for this story that many have colleagues who continue to throw waste amalgam out with the rest of the garbage; one was even known to hose waste amalgam down a driveway into the gutter!

There were also tales of expired X-rays that were perfectly suitable for recycling being instead thrown into a dumpster bin.

“It’s a reality that there are a lot of people in dentistry who are still not recycling these materials, and in the work we are doing now on awareness, we are only really touching the surface of this,” says Ian Crawford, a dental industry consultant at environmental waste company CMA Ecocyle.

Dental amalgam is a mixture of metals, consisting of mercury (50 per cent), silver, zinc, tin and copper.

CMA Ecocyle estimates that the mercury from just one amalgam tooth filling is enough to pollute up to 30,000 litres of water beyond safe drinking level.

Indeed, amalgam fillings have been identified as a major source of mercury entering the waterways—a problem deemed so serious the ADA Victorian Branch, the Victorian Water Industry and the Environmental Protection Authority in Victoria together launched the Dentists for Cleaner Water (DCW) program in 2008, which ran until 2011.

The program promoted the installation and use of dental amalgam separators in private dental practices to help filter out amalgam from wastewater before it reaches our sewerage systems.

As a result of the initiative, more than 700 separators were installed in Victorian practices.

“It’s a reality that there are a lot of people in dentistry who are still not recycling these materials.”—Ian Crawford, CMA Ecocyle, Sydney

In NSW, there have similarly been positive developments. In response to the National Health and Medical Research Council’s “Recommendations in Dental Mercury Hygiene”, all public dental clinics are now equipped with systems to trap waste amalgam.

There has also been an international movement on the safe disposal of mercury since the Minamata Convention in 2013. The convention is a global binding treaty to reduce emissions and releases of mercury into air, land and water, and to phase out many products that contain the toxic metal.

Although the Australian Federal Government has signed the Convention, along with 138 other countries, it has stopped short of ratifying it.

In 2014, the Department of the Environment sought views on the impacts on Australia of meeting the obligations of the Convention. In its submission, the ADA confirmed its support of installing amalgam traps in surgeries to keep mercury out of the water supply.

Ian Crawford says that while there have been effective campaigns to raise awareness of the issue, there now needs to be a greater focus on the issue of compliance.

“What we are trying to do now is get all dentists to install amalgam separators in their practices to capture the amalgam and stop it from going into the water system or to landfill.

“It is the same with things like mercury capsules or old X-rays, which have silver content and other chemical components that can be taken away, treated and recycled, rather than being buried in the earth and left to rot,” he says.

The clinic amalgam separator acts like a gully trap and works with the suction systems. It catches all the metal particles removed from a patient’s mouth after they spit into the bowl, then collects the material in a special unit.

For the average practice, the separator needs to be emptied about every 12 months. Mercury capsules can also be collected in a special disposal bin.

These days, many dental practices avoid the costs associated with photographic X-ray systems by using digital imaging. The disposing of old X-ray images, however, remains an issue.

“X-rays have silver in them, and that can be recycled and put to good use again,” says Crawford. “When old films get to their expiry date after about seven years, they can be taken away and processed. Confidentiality is also assured as they are shredded like waste paper, so no one can be identified.”

“A lot of the big dental companies have realised they need to be environmentally friendly as much as they are business friendly.”—Dr Vas Srinivasan, Invisible Orthodontics, Sunshine Coast

The annual cost for a recycling service such as CMA Ecocyle for an average practice is around $600.

Dr Vas Srinivasan of Invisible Orthodontics on the Sunshine Coast in Queensland believes it is up to practitioners to take a proactive approach to the way their practice operates in terms of recycling. He says an important first step is to ask questions of all the suppliers.

“You need to ask the manufacturer about all the products you buy from them; if they can be recycled and if not, then why not?” Dr Srinivasan estimates that both Invisible Orthodontics clinics would go through more than 25,000 plastic liners used for the Invasaligners that are installed every year. Looking at a pile of discarded plastic one day in one of the clinics, he decided there had to be a better way of operating.

“It was a whole lot of plastic, and it really made me think. So when I encountered one of the manufacturers recently and asked directly about what can be done about recycling all that plastic, he admitted no one had ever asked him that before. I was astounded by that. I am also still waiting,” he says.

Dr Srinivasan says it is the responsibility of all practitioners to determine more effective ways of operating that do not put pressure on the environment.

“A lot of the big dental companies have realised they need to be environmentally friendly as much as they are business friendly,” he says.

“It is up to us in the industry to talk to our reps and suppliers about what we are wasting and how we all need to reduce that. We all need to be having more direct conversations with all these people. If you are not having those conversations, then you are not playing a part in helping the environment and helping our industry be far more sustainable in the long run. If you notice something is amiss, then talk about it.”

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