From the June 2002 Idaho Observer:
Dentist the Menace?
The Uncontrolled Release of Dental Mercury
The following is the executive summary of the above 18 page report, Dentist the Menace? The Uncontrolled Release of Dental Mercury, By Michael T. Bender, M.S., which includes 100 references from reputable sources. The report was commissioned by several generous grants from non-profit organizations. For additional information and access to the entire report, go to the following websites: www.mercurypolicy.org and www.noharm.org
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 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 users 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 to 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 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 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, are providing the necessary impetus for dentists to change practices in the classic carrot and stick approach which 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.
1. Disposal of dental amalgams 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 more
* 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 reductions 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.
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