P2: Dental Practices Operations

Outlining the inputs (operations) and outputs (waste) from dental procedures, dental office operations and building management can help get a broad idea of where opportunities for improvement can be found. Below is a general overview, along with detailed information on amalgam management.

• Dental Procedures and Services
  
• Office Building and Management
  
• Dental Amalgam Fillings

Dental Procedures and Services

Inputs	Outputs	"Green" Opportunities*
Bridges Crowns Dentures Extractions Fillings (see section on Dental Amalgam Fillings) Root Canals Teeth Cleaning etc.	Waste is generated from the use of disposable products	Reusable products such as cloth patient bibs, cloth chair and tray barriers, cloth lab coats and glass or ceramic cups and mugs can reduce purchase and disposal costs
	Toxins are released during sterilization of tools	Steam sterilization is better for the environment than chemical sterilizers

*For more information, see the P2 Opportunities section.

Office Building and Management

Inputs	Outputs	"Green" Opportunities*
Lights	Energy is consumed	Compact Fluorescent Lights (CFLs) or Light Emitting Diode (LED) lights save energy and reduce heat produced from lighting
Dental Equipment		Turning off equipment at night and when not in use saves money and costs nothing to implement; use ENERGY STAR equipment and appliances whenever possible
HVAC System		Use a programmable thermostat to turn heat and air down at night and on weekends
Computers		Use a Liquid Crystal Display (LCD) monitor to save energy and reduce heavy metal waste from cathode ray tube screens
Sinks/Faucets	Water is consumed	Use low-flow faucet aerators to reduce water use without losing pressure
Toilets		Install low-flush toilets to save on water and sewer bills
Landscaping	Energy and Water are consumed	Plant protective windbreaks to the north and northwest of the building to reduce winter fuel consumption. Plant deciduous trees to the south and southwest of the building to create needed shade in the summer.
		Do not over-water for healthier lawn and lower water bills; use water saving sprinklers and water at the optimum time between 6 and 8 am.
Office Cleaning	Waste is produced	Use non-hazardous cleaning agents; use reusable cloth rags
Paper		Go paperless with patient billing, charting and scheduling

*For more information, see the P2 Opportunities section.

Dental Amalgam Fillings

Inputs

Dental amalgam contains 50 percent elemental liquid mercury and 20 to 35 percent powdered silver. The other 15 to 30 percent of the mixture is a combination of powdered metals, such as tin, copper, and zinc, etc.

Amalgam is almost always supplied to dental offices in capsules, with the liquid mercury and metal powders kept separately. The dentist mixes the two together to create a filling.

The Center for Disease Control and Prevention (CDC) outlines how dentists use amalgam:

1. The dentist removes decay and prepares the tooth for filling.
2. The dentist mixes the mercury and metal powders together to form a putty-like substance.
3. The dentist places the substance into the tooth and carves it to replace the part of the tooth destroyed by decay.
4. The matter hardens fast and typically provides many years of normal function.

Outputs

Dental amalgam waste is generated when new fillings are placed, or when old amalgam fillings or teeth containing fillings are removed. This waste contains mercury that can negatively impact the environment. Therefore, it is important to recognize and properly manage the types of waste produced by dental offices.

All amalgam waste should be carefully handled and stored before being properly recycled by a licensed amalgam recycling company.  The recycler should provide the proper container (plastic bucket with tight-fitting lid and required labeling) for collecting and storing waste amalgam until it is sent for recycling.  For more information on storing and recycling amalgam, amalgam best management practices, or selecting an amalgam recycler, refer to the P2 Opportunities section. 

The types of amalgam waste are outlined below:

Contact amalgam has been in contact with the patient and includes carving scrap from filling installations.  All contact waste should be recycled.  Some recyclers may require disinfection prior to acceptance, but temperatures used to melt and recover the metals are hot enough to destroy any bacteria or viruses.

Extracted teeth (with amalgam fillings) are a type of contact amalgam.  Some amalgam recyclers may require disinfection prior to acceptance.  Check with the recycling company for a proper disinfection method.  Because they have been in contact with blood, the Center for Disease Control and Prevention (CDC) states that "extracted teeth… are subject to the containerization and labeling provisions of the Occupational Safety and Health Administration (OSHA) Bloodborne Pathogen Standard."  However extracted teeth with amalgam should never be placed in a medical waste container that uses an incinerator.  Instead, extracted teeth with amalgam fillings should be sent to an amalgam recycler. 

Non-contact amalgam is amalgam that did not come in contact with the patient.  It is the excess mix left over at the end of the procedure.  Whenever possible, it should be salvaged.  Otherwise, it should be placed in a proper container (discussed above) and recycled by a licensed amalgam recycler.

Amalgam sludge is bits of amalgam rinsed out during installation or removal that is collected from filters, traps, separators and other devices.  This solid-liquid mixture sludge must be handled carefully and properly recycled.  The following are frequently used amalgam capture devices:

• Vacuum pump filters
• Filters should be changed per the manual's instructions and should never be rinsed.  Contents of the filter should be recycled.  Filters can usually be placed in the same container as other amalgam waste and should be recycled by a licensed amalgam recycling company. 
• Chair-side traps
• Either disposable or reusable chair-side traps may be used to collect amalgam.  Disposable traps can be placed into containers with other amalgam waste.  Reusable traps should be emptied into buckets, but not rinsed.  Contents should be recycled.
• Amalgam separators
• In 2007, amalgam separators were added to the ADA's Best Management Practices and today, many states require their use.  They are very effective; some can remove 99 percent of amalgam.  At a minimum, amalgam separators should comply with and be properly maintained, per the manual's instructions.  Refer to the P2 Opportunities section for information.

Empty amalgam capsules are a type of non-contact amalgam; they are the containers left over after mixing pre-capsulated dental amalgam.  Capsules should be stocked in several sizes to avoid excess waste.  Once the amalgam has been mixed, capsules should be placed in the same container as other amalgam wastes for recycling.

Amalgam waste do's and don'ts:

Do's:

• Do contact a licensed amalgam waste recycling company to request details for storage and transportation of amalgam waste.
• Do place waste in an air-tight, wide-mouth, labeled container provided by recycling company in a convenient but secure place.
• Do keep container tightly closed unless adding or removing amalgam waste.
• Do mark container with the date amalgam was initially placed in the container.
• Do label container "Amalgam Waste for Recycling," or as directed by recycling company.
• Do send containers for recycling when they are full.
• Do keep a record of which recycling company was used and when amalgam waste was sent.

Don’ts:

• Do not place amalgam waste in infectious waste containers (red bags) or with regular garbage.
• Do not keep container at the dentist's office for longer than one year from the date amalgam was initially placed in it.
• Do not flush waste down the drain or toilet.
• Do not disinfect amalgam using heat.

continue to Dental Practices Reasons for Change

Other Dental Practices sections:

 

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