As a dental hygienist, I never had to think about amalgam. I would mention a bluish stain along my patient’s gingival margin and ask her about her other tattoos. I would marvel at the amalgamator while dusting the unused equipment in the lab (aka “the land where time forgot”). I had requirements in hygiene school to polish them until they blinded the instructor, using Brownies and Greenies, and you know that I had a memory device for the order: “Tree trunks are Brownie, and they grow first. Greenie leaves grow last.” I certainly didn’t worry about where amalgam ended up when the dentist replaced it with composite.
You may not think about amalgam either, but your office has a deadline coming up fast! July 14, 2020 is the final date for compliance for the purchase and installation of amalgam separators, and a separator is mandatory for most general dentists. If an office removes amalgam from 9 or fewer teeth each year, an amalgam separator is not required¹. Exemptions also apply to certain specialties not limited to periodontists, oral surgeons, and orthodontists.
It has been estimated that one amalgam separator will cost the average office $800 per year¹ following initial purchase and installation. Of course, your cost can vary depending on several factors, including how often the filter needs to be exchanged, etc.
There is a one-time Compliance Report to be filed with a Control Authority. The Control Authority you consult depends on your state, and it can vary from your state agency, an EPA regional office, or your local utilities office². Unfortunately, some states do have additional guidelines to comply with, such as pretreatment programs in Ohio or separator regulations in Louisiana.
Statistics show over 5 tons of mercury are released from dental offices to the public-owned treatment works (POTW) and then continue to the environment². Containment at the source (your office) is more economical than treating the water supply later. You need to evaluate your choice of waterline cleaner: cleaners containing bleach and chlorine may be contraindicated because the chemical can dissolve the amalgam³.
Scraps of amalgam from a procedure or a trap cannot go down a drain that doesn’t lead to the separator, and you must not put pieces of amalgam in Biohazard red bags or containers, nor in the regular trash receptacle³. A recycle container should be purchased for use, but extracted teeth that contain amalgam may require special handling. Remember to check with your waste vendor BEFORE they arrive to make sure they can take amalgam in the form you have (pieces versus extracted teeth): CDC’s ‘cradle to the grave’ rule says you are responsible for the waste you’ve produced.
There are lots of companies and varieties to choose from, and your budget may limit your choices a bit. Look for 95% efficiency for removal, per the EPA³. Make sure you allow enough time for purchase of your separator AND to line up an installer. Fortunately, the expected amount of amalgam waste going into our water supply is decreasing. Unfortunately, the remaining time you have to get an amalgam separator in your practice is decreasing as well! Once you have filed your Compliance Report, you can relax, enjoy the sounds of compliance, and go back to not thinking about amalgam.
Pictures: Courtesy of Pixabay