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While there has been considerable
public debate about the potential health effects of mercury fillings,
little attention has been focused thus far on the disposal of waste dental
mercury.
Dental clinics remain largely unregulated for mercury disposal and extracted
amalgam materials are often rinsed down the drain, usually to a municipal
wastewater system (or septic system), deposited in biomedical waste containers
destined for waste incineration, or placed in trash disposed in a municipal
waste landfill or incinerator.
By far the largest single contributor of mercury to wastewater is from
dental offices. While most other anthropogenic mercury uses-and their
subsequent releases-have declined by 80 percent or more since the 1980s,
this has not been the case in the dental sector. Today, dentists are the
third largest user of mercury in the United States, consuming over 20
percent of the estimated 200 metric tons used in 2001-or over 40 metric
tons of mercury- with most eventually released into the environment.
Mercury is a persistent, bioaccumulative toxin that poses a risk to human
health, wildlife and the environment. While mercury is a naturally occurring
metallic element, numerous human activities- including the use of dental
fillings-contribute 70 percent of emissions into the environment.
Levels of mercury in the environment have increased dramatically, with
a twenty-fold increase over the past 270 years.
Pregnant women and their developing fetuses, infants and young children
are especially susceptible to the harmful neurological effects of mercury.
A July 2000 National Academy of Sciences study found that at least 60,000
children are born at risk for adverse neurodevelopmental effects each
year due to their mothers' exposure to methyl mercury.
Further, data released from a Center for Disease Control and Prevention
study in March 2001 indicates that at least one in ten women of childbearing
age is exposed to mercury at levels above what is considered safe-translating
into nearly 400,000 children born at risk of mercury exposure each year.
The change required in dental office practices is relatively straightforward
and inexpensive.
For example, it costs less than $ 50.00 a month, slightly less than the
cost of a single filling, for dentists in the Massachusetts Dental Society
to remove and recycle mercury from amalgams. However, only a small percentage
of dentists nationwide have taken the steps necessary to reduce use and
release of this dangerous toxin. Up until recently this lack of action
may, at least in part, be a result of the general focus primarily on voluntary
mercury reduction initiatives at dental clinics by government agencies
over the past decade or so.
Another significant factor is that the influential American Dental Association
(ADA), as well as many state dental associations, has refrained from promoting,
and even opposed mercury reduction efforts. Following the lead of the
ADA, the U.S. dental establishment has consistently resisted efforts to
reduce releases of mercury and follow suit with the rest of the health
care establishment.
The ADA refuses to encourage its members to assume responsibility for
curtailing dental mercury pollution, opting instead to obstruct initiatives
at the state and local levels. Consistent with its position, the ADA is
now advocating for the Food and Drug Administration to effectively preempt
significant legislative advances made at the state level. In doing so,
the ADA relies on questionable scientific assumptions that deny the serious
impact of mercury releases and its build up in the environment.
Yet a growing number of governments
now believe that dental mercury is a serious problem that needs to be
addressed, and they are beginning to act. Many countries, especially in
Western Europe and Canada-and a small, but growing number of local and
state governments in the U.S-now recognize dental mercury waste as a serious
environmental pollutant and are enacting both voluntary guidelines and
stringent policies to curtail its release.
State and local governments are now finding that the establishment of
some enforceable requirements, in addition to voluntary incentives, is
providing the necessary impetus for dentists to change practices in the
classic "carrot and stick" approach that has proved very successful
in many other applications.
Clearly, the time has come for U.S. dental associations -as other health
care industry associations are already doing-to embrace the fundamental
credo of "first do no harm," by taking responsibility to reduce
amalgam use and mercury pollution. Environmentally responsible dental
clinics reduce the use of mercury where feasible, employ best management
practices and operate amalgam separators to get the highest capture rates
of dental mercury.
This approach protects human health and the environment while requiring
only a modest, compact, and available shift in clinical practices and
expenses.
Recommendations
1. Disposal of dental amalgam into all waste streams should be prohibited
and all dental mercury should be trapped, collected and recycled.
2. The reduced use and release of dental mercury should be fostered through
voluntary incentives, technical assistance and mandates to encourage and/or
require dentists to:
- Adhere to stringent best
management practices
- Install amalgam separators
to reduce mercury discharge by 95 percent or ore clean and replace mercury-laden
pipes and plumbing fixtures
- Manage quantities of excess
elemental mercury properly
- Submit annual reports on
dental mercury reduction initiatives, including the quantities of mercury
used and recycled.
3. An investigation should
be conducted to determine environmental impacts and potential liability
implications of dental mercury released into septic systems.
4. Mercury reduction and sampling
requirements should be phased in over time for all municipal wastewater
treatment plants.
5. The American Dental Association's
efforts to obstruct state and local initiatives to reduce dental mercury
releases should be strongly opposed, including recent efforts to convince
the Food and Drug Administration to preempt state legislation in this
area.
NoHarm.Org
June 2002
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