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The environmental impact of dentistry
Abstract
As dental practitioners, we must recognize that some of the materials and procedures we use to provide dental health services may present challenges to the environment. Realizing this, we can begin to take measures to minimize the production of these wastes and their potential environmental effects. This paper identifies some common wastes produced by dental offices (dental amalgam, lead, silver, biomedical and general office waste) and provides practical suggestions for reducing the impact of our profession on the environment.
... Dental waste in particular presents a considerable environmental risk due to the hazardous and toxic substances it contains. Although the amount of waste produced by an individual dentist may be insignificant, it can cumulatively have a substantial environmental impact [6,7]. ...
... With the available statistical data, it is possible to recognize that dentistry can pose a serious threat to the environment, and steps can be taken to control and reduce the production of toxic waste and its potential impact on the environment [6]. ...
... Medical waste can be classified into several categories based on the characteristics of the waste. The categories and their definitions, as proposed by the World Health Organization (WHO), were organized in Table 2. Some materials used in dental care pose a challenge to the environment [6,15]. Despite preventive measures such as amalgam separators, the waste is still released into the environment [15]. ...
Waste management is a crucial issue in the contemporary world, playing a significant role in the fight against environmental problems. Inadequate waste management leads to the pollution of air, water, and soil with toxic and harmful substances and to the emission of greenhouse gases, thereby contributing to climate change, the reduction of biodiversity, and the destruction of ecosystems, as well as to the emergence of diseases and allergies in animals. The management of waste is primarily determined by its type and source, with recycling, incineration, and landfilling being the most common methods. The healthcare sector, with limited opportunities for waste reduction, has its own unique approach to waste management. In particular, dental waste presents a considerable environmental risk due to the hazardous and toxic substances it contains. A prime example of such substances is mercury (Hg), a toxic and bioaccumulative metal that was commonly used in dental amalgam for over a century. With the available statistical data, it is possible to recognize that dentistry can pose a serious threat to the environment, and steps can be taken to control and reduce the production of toxic waste and its potential impact on the environment.
... There is much emphasis of the need for more knowledge acquisition at all levels of the profession: There are calls for the adoption of more preventive and adhesive dentistry [129] [131]; and the provision of effective training in the handling and disposal of mercury (including extracted teeth with amalgam restorations) [31,34,36,39,[41][42][43]57,59,74,81,132,133]. 3 Waste management features heavily with recommendations in two areas. a A need to avoid local 'chairside' Hg pollution risks [23,31,34,36,39,42,57,69], by means of: An overall reduction in exposure [49,74,93]; use of water-spray cooling and high-volume vacuum suction during amalgam removal in order to significantly reduce environmental mercury vapour [43,36,62,97,116]; the use of effective chairside traps, vacuum filters and amalgam separators, amalgam separators that meet ISO11143, that are 95% effective [12,23,26,28,[31][32][33]37,39,[41][42][43]45,58,59,62,63,[67][68][69][70]73,74,97,112,118,120,126,132,134]; avoid the use of hypochlorite cleaners, as they increase dissolution of mercury [43,84,[135]]. Effective and safe storage of amalgam features with the following recommendations: Have an amalgam spill-kit for spills of elemental mercury; use a dedicated special container in accordance with relevant regulations; ensure that this has a mercury suppressant; that the container is tightly sealed and; stored in a cold environment [31,36,43,62,70,74,79,81,89,94,97,113,115,116,120,132]. ...
... The US Environmental Protection Agency [137] provides detailed guidelines on the management of dental effluent and dental amalgam [26,62]. Recommendations: Recycle waste amalgam with effective collection, separation and recovery of mercury and silver through approved biological waste management companies; the establishment of mercury-free medical/dental facilities to avoid local environmental pollution should be considered [28,35,37,49,73,74,81,94,112,117,119,126,131,134]. Also, the removal of amalgam restorations from cadavers prior to cremation (similar to removal of pacemakers before cremation) has been suggested [117]. ...
... The greatest opportunity comes from the transition to digital radiography. Whilst using conventional wet-film radiography, the literature highlights the ease of recycling of lead foil and that this should be facilitated at a local level through the following actions: Segregation of the lead foil from the other components from of the film packet; and avoidance of disposal of film in domestic municipal waste that will end up as land fill and incineration [26,28,32,36,37,44,58,59,62,73,78,96,134,142]. Alternatives to lead aprons for shielding are also considered [46]. ...
Objectives:
To undertake a comprehensive scoping review of the literature to address the research question 'What is the current state of environmental sustainability in general dental practice?' To provide an effective baseline of data that will consider the drivers, opportunities and recommendations for the implementation of sustainable practice. Data & sources. The scoping review was conducted for all published literature in the English language that addresses this topic up to the 31st April 2021. The method of the PRISMA-ScR (PRISMA extension for Scoping Reviews was followed. 128 papers included in this scoping review consisted of: Commentary [Letters, editorials, communication and opinion] (n=39); Research (n=60); Literature reviews (n=25); Reports [Policy and legislation] (n=4). Each included record was analysed for emerging themes that were further classified according to their general relevance. The scoping review is considered over two manuscripts, with this second paper focusing on the opportunities, recommendations and best practice to develop and engage with sustainable practice.
Conclusions:
Drivers, opportunities and recommendations for best practice to achieve environmentally sustainable goals in oral health care: The lack of public and professional awareness is the greatest driver to engage with a positive change of behaviour and attitudes. Awareness through education is key at all levels and this should be the bedrock of future strategies. Reduction in staff and patient commuter travel through a reduction of the incidence of preventable oral diseases, improved patient care logistics and IT. Reducing waste and increase recycling opportunities, especially for SUPs. Engagement with legislation and policy makers. Engagement with key stakeholders across the dental materials/products supply chain for the management of manufacturing, distribution, procurement, clinical use and waste management.
... Dissolved mercury is the most reactive fraction and should be included when considering total mercury emissions as this causes the most severe environmental effects [116] Dental separators are designed to capture amalgam waste at the point of clinical use in the dental surgery. These are not widely used throughout much of the world and are approximately 90% effective [9,30,18,44,53,58,103,105,111,125,126,[132][133][134][135]. The amalgam waste that is not captured in a separator, will flow directly into the municipal waste water network. ...
... Mercury contamination from these routes is cited as a reason to cease the use of amalgam as a dental restorative material [94,111,116,119]. Moreover, it is difficult to control mercury waste as enters the environment in different forms as elemental vapour, amalgam sludge, amalgam scrap or amalgam waste [110,125,135]. ...
... There is a lack of consistency at an international level and across jurisdictions with regards to the availability of legislation and regulation [63,113,127,137], and limited access to collection agencies and sites for waste amalgam waste [112,113,135]. ...
Objectives:
(i) To undertake a comprehensive scoping review of the literature that addresses the research question 'What is the current state of environmental sustainability in general dental practice?' (ii) To provide an effective baseline of data that will consider general awareness, barriers and challenges for the implementation of sustainable practice. Data & sources. The scoping review was conducted for all published literature in the English language that addresses this topic up to the 31st April 2021. The method of the PRISMA-ScR (PRISMA extension for Scoping Reviews) was followed. 128 papers included in this scoping review consisted of: Commentary [Letters, editorials, communication and opinion] (n=39); Research (n=60); Literature reviews (n=25); Reports [Policy and legislation] (n=4). Each included record was analysed for emerging themes that were further classified according to their general relevance. The scoping review is considered over two manuscripts, with this first paper focusing on awareness of the problem and barriers or challenges to the implementation of sustainable care.
Conclusions:
Eight diverse but closely interlinked themes that influence the sustainability of oral health provision were identified: Environmental impacts (CO2e, air and water); Reduce, reuse, recycle and rethink; Policy and guidelines; Biomedical waste management; Plastics (SUPs); Procurement; Research & Education; Materials. Barriers to implementation were identified as: Lack of professional and public awareness; carbon emissions arising from patient and staff commute; challenges associated with the recovery and recycling of biomedical waste with a focus on SUPs; lack of knowledge and education into sustainable healthcare provision and; the challenges from the manufacturing, use and disposal of dental materials.
... During dental procedures, mercury is involved during placement, removal, and polishing of dental amalgam. [9,13,14] At the time of restoring a tooth with dental amalgam and also during its removal, potentially harmful waste is generated such as: [9,15,16] • Elemental mercury vapor -released from dental amalgam alloy • Dental amalgam scrap -those amalgam particles that have not come into contact with the patient (i.e., particles remaining the following restoration placement) • Amalgam waste -those particles that have come into contact with patient secretions (e.g., particles generated during carving and restoration removal procedures) • Amalgam sludge -the particles present in dental office wastewater (chairside traps and vacuum filters). ...
... During dental procedures, mercury is involved during placement, removal, and polishing of dental amalgam. [9,13,14] At the time of restoring a tooth with dental amalgam and also during its removal, potentially harmful waste is generated such as: [9,15,16] • Elemental mercury vapor -released from dental amalgam alloy • Dental amalgam scrap -those amalgam particles that have not come into contact with the patient (i.e., particles remaining the following restoration placement) • Amalgam waste -those particles that have come into contact with patient secretions (e.g., particles generated during carving and restoration removal procedures) • Amalgam sludge -the particles present in dental office wastewater (chairside traps and vacuum filters). ...
... Consumption of these animals can cause adverse health effects. [9] It has been estimated that dentists contribute a major portion (between 3% and 70%) of the total mercury content of wastewater treatment facilities. Numerous efforts are being made to completely stop its usage, the most recent being the initiative of the United Nations Environment Programme (2009). ...
... [2] It saves energy and have revolutionized energy-efficient lighting. [2,7,8] Wherever possible use the natural light by making large windows a part of your clinic décor. [3] 2. No Paper Dentistry: Going paperless is truly a new approach.3 ...
... [3] Digital images also require 75 to 90% less radiation than conventional images. [2,8] [3,8,9] 6. Maintain Amalgam Waste: Silver amalgam is one of the most commonly used permanent restorations for the teeth. Although dental amalgam is a durable, cost effective and long lasting restorative material, it contains mercury, silver and other metals that can enter the environment. ...
... [3] Digital images also require 75 to 90% less radiation than conventional images. [2,8] [3,8,9] 6. Maintain Amalgam Waste: Silver amalgam is one of the most commonly used permanent restorations for the teeth. Although dental amalgam is a durable, cost effective and long lasting restorative material, it contains mercury, silver and other metals that can enter the environment. ...
Eco-friendly dentistry is currently transforming the medical and dental field to decrease its affect on our natural environment and reduce the amount of waste being produced. In today's world, it is necessary to understand the importance of being eco-friendly in every facet of our lives, including dental practice which has a huge impact on the environment, which specifically emphasis the thrust to move towards 'Green dentistry'. Green dentistry is an innovative way of dental practice which is environment friendly and at the same time converses money and time by reducing waste, conserving energy and decreasing pollution with the use of latest techniques and procedures. Green dentistry therefore, protects the environment and mankind from the hazards of rapid urbanization in developing countries.
... Economics and lack of familiarity are the major professed impediments for green dentistry in developing countries that outplay the moral and ethical obligation to the environment by dentists. 2,3 Though implementation of green dentistry and its advantages are taught at graduate level, most of the graduates have no practical experience of effective implementation. The situation is further worsened in rural areas where green dentistry is negligible. ...
... There is a plethora of evidence to prove that poor oral hygiene can contribute to ischaemic heart disease, stroke and pneumonia. 1,2 Additionally, there is increasing focus on the benefits of a multidisciplinary team; however, the role of the dentist is rarely appreciated. We propose that ear, nose and throat undergraduate rotations incorporate OMFS teaching, with both specialities receiving recognition. ...
... Sir, caries rates have dropped in recent decades, possibly due to the use of fluoridated toothpaste. 1 The fluoride content of UK brands is available in the Delivering better oral health toolkit from the Department of Health. 2 Fluoride-free toothpastes remain on the market, claiming to improve general health due to their organic ingredients. ...
... Economics and lack of familiarity are the major professed impediments for green dentistry in developing countries that outplay the moral and ethical obligation to the environment by dentists. 2,3 Though implementation of green dentistry and its advantages are taught at graduate level, most of the graduates have no practical experience of effective implementation. The situation is further worsened in rural areas where green dentistry is negligible. ...
... There is a plethora of evidence to prove that poor oral hygiene can contribute to ischaemic heart disease, stroke and pneumonia. 1,2 Additionally, there is increasing focus on the benefits of a multidisciplinary team; however, the role of the dentist is rarely appreciated. We propose that ear, nose and throat undergraduate rotations incorporate OMFS teaching, with both specialities receiving recognition. ...
... Sir, caries rates have dropped in recent decades, possibly due to the use of fluoridated toothpaste. 1 The fluoride content of UK brands is available in the Delivering better oral health toolkit from the Department of Health. 2 Fluoride-free toothpastes remain on the market, claiming to improve general health due to their organic ingredients. ...
... 3 With these facts, it is established that dentistry has a great impact on the environment and changing these principles and practices toward a greener environment is the need of the hour. Though the profession of dentistry has seen many recent advances, unfortunately, some of the materials that are currently in use including heavy metals and biomedical waste still pose potential challenges to the environment (Hiltz 2007). In the desire to maintain asepsis and reduce contamination, dental health professionals along with their medical counterparts have turned to a multitude of singleuse and disposable plastic equipment. ...
... Undeveloped X-ray films also contain a high level of silver. These silver containing chemicals must be considered hazardous waste that can contaminate the soil and groundwater (Hiltz 2007;Chopra and Raju 2017;Anderson 1999;Abraham et al. (2016)). Individual X-ray film packets are used in traditional radiographic techniques. ...
... Amalgams are typically 50% mercury with silver, tin and other metals, and this mercury is released into the environment when amalgam waste is disposed inappropriately (Kao et al. 2004;Chilibeck 2000). Ideally, it is advised to follow amalgam-free dentistry, but when that is not possible, practitioners are encouraged to follow "best management practices" in the handling and disposal of dental amalgam (Hiltz 2007). The variety of amalgam wastes generated in the dental office include elemental mercury vapors that are released primarily during the trituration of dental amalgam alloy, dental amalgam scrap, which is amalgam particles that have not come in contact with the patient, possibly as excess restorative material, amalgam waste that constitute the particles that have come in contact with secretions of patients as the ones removed after carving or on instruments and finally amalgam sludge which is made up of the finer particles that enter the wastewater through removal of old amalgam restorations. ...
As climate changes become more evident, humans have become more ecologically conscious. The focus has shifted from merely development, to reducing our footprint on the environment and bringing about sustainable development. The concept of “sustainable development” emphasizes on development along with conservation of natural resources to meet the needs of the future generations. This principle can be successfully incorporated in the healing profession of dentistry. A comprehensive electronic data search was conducted in Google Scholar and PubMed search engines to identify articles instilling the concept of sustainability in dentistry. Only original studies and review articles published in English were considered for the following systematic review. Five hundred and ninety-eight results were obtained from the electronic database search, of which 66 fulfilled the eligibility criteria and were included in the study. Forty-seven of these were review articles and 19 were original studies. A number of organizations offer knowledge, membership, standards and best practices to dentists willing to adopt and practice eco-friendly dentistry. The concept of “Green Dentistry” incorporates the 4 R’s: Reduce, Reuse, Recycle and Rethink. While on one the hand simple substitutions and changes can curb wastage, in some other cases it may take a little extra effort or money to adopt sustainable development in dentistry. Dental professionals throughout the world are collectively working to reduce the environmental impact of dental practice. The efforts of every green dental surgeon and green dental practice are transforming the dental industry by adopting the model of green dentistry.
... A atividade odontológica individual gera pequenas quantidades de resíduos prejudiciais ao meio ambiente, no entanto, os resíduos acumulados produzidos pela prática profissional são capazes de causar impacto ambiental significativo. Este processo tem causado preocupação aos ambientalistas devido a contaminação dos sistemas de água por metais pesados, considerando a produção de resíduos de amálgama dentário com fator primordial (HILTZ, 2007). Campos et al (2012) afirmam que, durante o preparo do amálgama para uma restauração em seres humanos, há sobra estimada em 30%. ...
... A inserção e remoção de restaurações de amálgama geram resíduos sólidos e de partículas que podem entrar em contado com o meio ambiente se não forem devidamente capturados e gerenciados mediante as normas de descarte de resíduos sólidos. Hiltz (2007), descreve que, não havendo descarte em conformidade com a legislação, este material irá ter contanto direto com o ambiente provocando alterações em seu estado físico, favorecendo ações de abrasão e corrosão, faciliando, assim, o despreendimento do mercúrio presente nos amálgamas, cuja ação de seres decompositores transformará o mercúrio em metil-mercúrio-orgânico altamente tóxico e nocivo ao meio ambiente. Jones, (1998Jones, ( ,1999 não consegue identificar uma relação causal entre o amálgama dentária e efeitos adversos à saúde, provavelmente porque as formas de mercúrio associados aos amálgamas dentários são elementares e inorgânicos, que são menos tóxicos do que o mercúrio orgânico. ...
... Nas práticas odontológicas também encontramos com bastante frequência o uso do tiossulfato de prata, que é um oxianião presente no fixador radiográfico, utilizado no processamento de radiografias odontológicas, fator esse causador também de riscos ao meio ambiente. Hiltz (2007) afirma que algumas formas do metal prata são mais tóxicos do que os outros, consequentemente há uma variação de agressão ao meio ambiente, dependendo do tipo do metal usado. ...
... A atividade odontológica individual gera pequenas quantidades de resíduos prejudiciais ao meio ambiente, no entanto, os resíduos acumulados produzidos pela prática profissional são capazes de causar impacto ambiental significativo. Este processo tem causado preocupação aos ambientalistas devido a contaminação dos sistemas de água por metais pesados, considerando a produção de resíduos de amálgama dentário com fator primordial (HILTZ, 2007). Campos et al (2012) afirmam que, durante o preparo do amálgama para uma restauração em seres humanos, há sobra estimada em 30%. ...
... A inserção e remoção de restaurações de amálgama geram resíduos sólidos e de partículas que podem entrar em contado com o meio ambiente se não forem devidamente capturados e gerenciados mediante as normas de descarte de resíduos sólidos. Hiltz, (2007) descreve que, não havendo descarte em conformidade com a legislação, este material irá ter contanto direto com o ambiente provocando alterações em seu estado físico, favorecendo ações de abrasão e corrosão, faciliando, assim, o despreendimento do mercúrio presente nos amálgamas, cuja ação de seres decompositores transformará o mercúrio em metil-mercúrio-orgânico altamente tóxico e nocivo ao meio ambiente. Jones, (1998Jones, ( ,1999 não consegue identificar uma relação causal entre o amálgama dentária e efeitos adversos à saúde, provavelmente porque as formas de mercúrio associados aos amálgamas dentários são elementares e inorgânicos, que são menos tóxicos do que o mercúrio orgânico. ...
... Nas práticas odontológicas também encontramos com bastante frequência o uso do tiossulfato de prata, que é um oxianião presente no fixador radiográfico, utilizado no processamento de radiografias odontológicas, fator esse causador também de riscos ao meio ambiente. Hiltz (2007) afirma que algumas formas do metal prata são mais tóxicos do que os outros, consequentemente há uma variação de agressão ao meio ambiente, dependendo do tipo do metal usado. ...
O Encontro Sergipano de Educação Ambiental (ESEA) teve início
em 2008 através das ações promovidas pelo Grupo de Estudos e Pesquisa em Educação Ambiental de Sergipe (GEPEASE) e pelo Projeto
Sala Verde na UFS, a fim de proporcionar um momento de reflexão
coletiva na perspectiva de construção de novos rumos à atuação na
Educação Ambiental no estado de Sergipe. Em 2015, em parceria com
a Sociedade SEMEAR, o GEPEASE e a Sala Verde na UFS realizaram a
5º edição do evento com o tema: “FORMAÇÃO DE EDUCADORES
AMBIENTAIS: CAMINHOS PARA A PRÁXIS”, tendo como objetivo
fomentar o debate sobre quais caminhos os educadores vêm buscando para desenvolver sua práxis, considerando o modelo de
desenvolvimento adotado pela nossa sociedade em que a técnica, a
fragmentação e a exploração do ser humano por outros seres humanos estão cada vez mais presentes e precisam ser superados. O ESEA
trouxe à tona, nesta edição, a inquietação pela busca da compreensão entre o distanciamento que se faz presente entre os avanços na
teoria e na prática em Educação Ambiental.
A fim de fomentar a construção da práxis na formação dos educadores ambientais, o evento promoveu conferências, mesas-redondas,
grupos de trabalhos – GT, oficinas e mostra audiovisual. Em todos os
momentos, a perspectiva crítica fez-se presente em torno dos eixos
norteadores do evento nos campos da educação formal, não-formal, da
pesquisa, da formação de professores, das metodologias e das diversi-
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dades, que se encontram materializados neste livro, a fim de socializar e
divulgar as experiências vivenciadas no encontro.
O livro está dividido em três partes: Da Teoria; Da Prática; Da Construção do Conhecimento. Na primeira, foram reunidos os trabalhos
referentes às discussões promovidas durante as mesas redondas e conferências do evento. Na segunda, estão presentes os artigos referentes
às oficinas e mostra audiovisual. Por fim, na terceira, encontram-se os
artigos selecionados que foram apresentados e debatidos nos grupos
de trabalho do evento.
O livro se inicia com o capítulo “Limites da Mudança e Propostas
Vagabundas: Perspectivas Práxicas da Educação Ambiental” no qual
Cae Rodrigues fala sobre uma nova metodologia para a pesquisa em
Educação Ambiental por meio da abordagem “vagabonding”, que
busca desconstruir o distanciamento entre sujeito de pesquisa e o
fenômeno pesquisado.
Na sequência temos “A Perspectiva das Pedras: Considerações sobre
os Novos Materialismos e as Epistemologias Ecológicas”. O artigo subsidiou a fala de Isabel Cristina Moura Carvalho durante a conferência de
encerramento do ESEA e aborda as bases para a compreensão do conceito de epistemologias ecológicas.
O capítulo “Educação Ambiental Emancipatória pelo Ecoturismo
Marinho de Base Comunitária: Uma Proposta Metodológica com Sustentabilidade Socioambiental”, de autoria de Alexandre Pedrini, Marta
Rhormens e Daniel Brotto. O artigo subsidiou a fala de Pedrini durantea
palestra proferida no evento e aborda as possibilidades de desenvolvimento de uma Educação Ambiental que promova a sustentabilidade em
áreas de ecoturismo marinho.
Finaliza-se a primeira parte do livro com o artigo de Cristyano Ayres
Machado, nomeado “Mitos e Realidades: Do Cenário Nacional, Internacional ao Local, Uma Reflexão sobre a Bacia Hidrográfica do Rio São
Francisco”, o qual traz um apanhado geral sobre os recursos hídricos no
Brasil, ampliando o debate sobre a gestão e os problemas presentes nos
cursos d’água da região Nordeste, em especial do Rio São Francisco.
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A segunda parte traz inicialmente o trabalho de Nayara Siqueira
Melo, “Recursos Metodológicos para o Ensino de Ciências com Ênfase na
Educação Ambiental”, tratando da importância acerca da utilização dos
recursos audiovisuais como metodologia para a Educação Ambiental
realizada através do ensino de ciências.
O artigo de Daniele Santana de Melo, Mônica Andrade Modesto e
Tatiana Ferreira dos Santos, intitulado “Stop Motion: Uma Proposta Metodológica Interativa e Dialógica para a Educação Ambiental” aborda a técnica de Stop Motion como uma ferramenta metodológica diferenciada
que integra teorias, conceitos e representações da Educação Ambiental
ao universo das tecnologias da informação e da comunicação (TIC).
Em sequência temos o capítulo “Legislação Ambiental como Ferramenta de Educação Ambiental”, de Cristiano Cunha Costa, o qual relaciona
o diagnóstico ambiental aos aspectos legais e alternativas mitigadoras às
ações antrópicas no campus da Universidade Federal de Sergipe.
No capítulo seguinte, “Ferramentas para o Trabalho Socioambiental”,
Juliana Oliveira Barreto Silva Araújoe Paula Ellen Silva Oliveira abordam
novas metodologias participativas voltadas para a temática socioambiental em todos os espaços de trabalho no intuito de proporcionar o
reconhecimento dos problemas, a sensibilização e a busca de soluções.
Para finalizar a segunda parte deste livro, no artigo “Contribuições
do Circuito Tela Verde (CTV) para a Formação de Futuros Educadores Ambientais”, as autoras Daiane Gomes Silva, Francielly Silva Goes,
Mariana Reis Fonseca, Thamires Guimarães Santa Rosa e Aline Lima de
Oliveira Nepomuceno relatam a experiência de apresentação do CTV
durante o V ESEA e expõem a importância de utilização deste recurso
didático como proposta de discutir e dialogar sobre a EA de forma
lúdica, reflexiva e participativa.
A terceira parte do livro inicia com o capítulo “Guia de Campo para a
Prática da Educação Ambiental na Trilha da Mata Boa Vista, Nossa Senhora
das Dores – Sergipe”. Os autores Gealisson Santos Silva e Claudio Sérgio
Lisi relatam a elaboração e validação de um guia de campo para a trilha da
Mata Boa Vista localizada no município de Nossa Senhora das Dores/SE.
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Em seguida encontra-se o trabalho de Danilo Mota de Jesus e Anderson de Araújo Reis, sob o título “O Impacto Ambiental da Odontologia”
que se trata de uma revisão de literatura com objetivo de entender o
impacto ambiental da odontologia e descrever as medidas que podem
ser adotadas pela equipe odontológica para diminuir a produção de
resíduos potencialmente prejudiciais ao meio ambiente.
O texto seguinte “A Política Municipal de Educação Ambiental de Aracaju (Lei N° 3.309/2005) no Contexto das Políticas Nacional e Estadual:
Um Diploma Legal para o Desenvolvimento da Educação Ambiental em
Âmbito Local”, dos autores Cleverton Costa Silva e Alana Danielly Vasconcelos, trata da tríade das leis que refletem as políticas de Educação
Ambiental da União, do Estado de Sergipe e do Município de Aracaju.
O capítulo “Visões de Desenvolvimento Sustentável por Professores
de Química do Ensino Superior”, escrito por Ângelo Francklin Pitanga e
Maria Inêz Oliveira Araújo apresenta as concepções sobre desenvolvimento sustentável de professores do curso de licenciatura em Química
da Universidade Federal de Sergipe - UFS.
Dando sequência temos o trabalho dos autores José Wlamir Barreto
Soares, Silvio Santos Sandes, Ingrid Maria Oliveira de Almeida e Tiffany
Brunelly Fontes Sacramento, intitulado “O Professor de Edificações do
IFS-Campus Lagarto e a Questão da Sustentabilidade”, o qual relata de
que forma os técnicos em edificações do Instituto Federal - Campus
Lagarto são formados sob a égide da sustentabilidade, observando
ainda como o corpo docente da instituição aborda questões dessa natureza em seus conteúdos programáticos.
No capítulo seguinte, nomeado “Coleta Seletiva do Óleo de Cozinha
no Bairro Jabutiana”, os autores Flávia Dantas Moreira, Maria Helena
Andrade Santos e Lucas Santos da Silva discutem acerca do registro da
primeira coleta seletiva do óleo de cozinha saturado em uma área residencial situada o bairro Jabutiana, na cidade de Aracaju.
Por fim, temos Micaele Karolaine Pereira dos Santos e Daniela
Teodoro Sampaio, analisando estudos publicados referentes à caça de
animais silvestres que indicam a Educação Ambiental como ferramenta
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para o combate a essa prática no capítulo “A Educação Ambiental como
Ferramenta Contra a Caça e o Tráfico de Animais Silvestres”.
Esperamos que a socialização de nossas experiências imbrincadas
em cada um dos capítulos desse livro renove a confiança depositada no
grupo e propicie maior visibilidade à produção no campo da Educação
Ambiental, a fim de contribuir para a formação crítica de educadores
ambientais preocupados em unir a teoria e a prática da Dimensão Ambiental. Boa leitura!
... Disadvantages are a compromised esthetic appearance due to an argentic to black color and especially biocompatibility concerns [7, [16][17][18][19][20][21][22][23][24] . Dental silver amalgam consists of 50% mercury (in a complex mixture of copper, tin, silver, and zinc) and therefore this material was always suspected to be a considerable hazard for both patient and environment [25][26][27][28][29][30][31][32][33][34][35] . ...
... Extracted teeth with preexisting amalgams, amalgam-contaminated capsules and cotton rolls are discharged with the solid waste. However, dental mercury contamination makes only 3%-4% of global mercury being insignificant compared with industrial pollution [30,80,88,89] . With proper amalgam separators it could be even more reduced [30,80,88,89] . ...
... However, dental mercury contamination makes only 3%-4% of global mercury being insignificant compared with industrial pollution [30,80,88,89] . With proper amalgam separators it could be even more reduced [30,80,88,89] . ...
... The management of health care waste as a complicated issue requires training, awareness, and financial resources [4, 5]. Dentistry is a part of health care services and dental waste management is a category that needs to be organized [6]. Although dental centers are considered as a minor source of health care waste, but they generate a certain amount of hazardous waste. ...
... Dental offices produce a variety of wastes such as domestic-type, infectious, toxic, chemical and pharmaceutical wastes. Each fraction would require a specific approach for collection, treatment and disposal [6, 7]. Domestic-type or general waste comprises components such as paper, cardboard and plastics that is not endanger for human and animal health or the environment . ...
... Since the infectious waste is classified as hazardous, its safe management is necessary to avoid environmental and public health problems [11, 12]. Dental centers also produce certain amount of metals and chemical compounds that have health hazards to the human and environment [6]. The common sources of such hazardous waste at dental clinics include dental amalgam, chemical disinfectants and fixer solutions [13, 14]. ...
... Bu yüzden hem su tüketimini hem de atık su oluşumunu azaltmak için önlemler alınmalıdır. 14,32 Bu önlemler arasında su tüketimini kontrol etmek için sayaç takmak, kullanılmadıkları zamanlarda su kullanan ekipmanı kapatmak ve su sızıntıları düzenli olarak takip etmek sayılabilir. Yeni bir ekipman satın alırken düşük su tüketimi olan ekipmanlar tercih edilmelidir. ...
... Diş hekimliği kliniklerinde enerji ve su tasarrufu için şu adımları izleyebiliriz: 32,34 1.Enerji yıldız derecelendirmeli ekipmanlar (bilgisayar gibi) kullanılmalıdır. 2.LED ve yüksek verimli floresan ampuller kullanılmalıdır. ...
... In this context, the concept of eco-friendly dental practice was evolved, focusing on environmentally amicable dental practice. [1] Despite the many benefits offered by the eco-friendly approach, one of the main hurdles is the unawareness among the profession itself. To switch from conventional and established dental practice to the concept, design and implementation of green dentistry to promote eco-friendly dentistry is time consuming process with cost implications. ...
... Creating awareness among the fellow dentists, ensuring the implementation, and promotion of eco-friendly dental practice through the use of recycled products; reduced number of appointments for treatment to prevent commute-related air pollution, limited use of water or use of dry vacuum systems, complete digital radiography, limited use of amalgam or if not achievable, at least proper handling and its disposal, conservation of energy with the use of latest techniques, and reduction in wastes and pollution are some of the measures to stand up to achieve this goal. [1] It is worth mentioning about the recent Saudi Green initiative, Youth Green Summit, and the Middle East Green Initiative conducted in Riyadh from October 23, 2021, to October 25, 2021, which was the launch of the contribution of the Kingdom of Saudi Arabia toward protecting our environment, energy transformation, and programs for sustainability toward a green future. [2] Furthermore, programs such as "Green Impact Dentistry," launched in the UK, recognized by EDITORIAL UNESCO, provide audit elements and awards designed in particular for dentistry to promote sustainable dental practices with access to Green Impact Dentistry toolkit for eco-friendly practice. ...
... A geração e destinação dos resíduos de amálgama também é uma preocupação na prática odontológica, pois seus componentes podem contaminar o meio ambiente e prejudicar a saúde humana 6 . Se não forem contidos e gerenciados adequadamente, os resíduos de amálgama podem entrar em contato com o meio ambiente 5,14,31 . A principal forma de contaminação ambiental é o descarte nos sistemas de água, sendo a Odontologia responsável por aproximadamente 3% a 70% da carga do mercúrio presente nas instalações de tratamento de águas residuais 1,32 . ...
... A conduta adequada promove redução do impacto gerado por esse material. Também é recomendável a instalação de separadores e filtros de amálgama e a utilização ligas pré-capsuladas ou sem mercúrio em sua composição 14,31,34,35 . ...
O objetivo do estudo foi avaliar o conhecimento e a adoção de estratégias da Odontologia sustentável pelos estudantes de uma instituição de ensino superior privada de Belo Horizonte. A amostra foi composta por acadêmicos matriculados no 4º ao 9º período no ano de 2018 (n=287). Os dados foram coletados por meio de questionário autoaplicável em língua portuguesa, tabulados e analisados por meio de análise descritiva. Observou-se que cerca de um terço dos participantes (93, 32,39%) adotam as estratégias ecológicas que podem ser implementadas nas práticas odontológicas diárias. Aproximadamente a metade dos estudantes (152, 53,0%) relataram que pensam às vezes nas questões ambientais e de sustentabilidade e 252 (87,8%) responderam que nunca ouviram falar sobre Odontologia Verde. No entanto, 268 (93,4%) demonstraram interesse em conhecê-la e 230 estudantes (80,1%) consideraram importante a implementação de programas de educação ambiental no currículo dos cursos de Odontologia. Grande parte dos estudantes desconhece a Odontologia Verde e não adota condutas que refletem preocupação com as questões ambientais. Apenas uma parcela dos entrevistados utiliza estratégias ecológicas na sua rotina clínica, mas não necessariamente em seus hábitos cotidianos. A inserção da educação ambiental nas universidades faz-se urgente e foi apoiada pelos estudantes do presente estudo.
... The study was conducted using pre-designed, pre-tested, semi-structured, interview schedule, self-administered, and open-ended (27) close-ended (24) questionnaire with a letter explaining, the purpose of the study was distributed by the researcher. It was handed to the participants during evening clinics hours. ...
... All the surveyed setups were found discharging their dangerous waste directly down the drainage waste and also thrown in the garbage. [25][26][27] These results are in comparison to other studies conducted were similar to the present study. ...
... Amalgam separation technology is based on sedimentation, filtration, or centrifugation of the dental amalgam particles from the wastewater. [6] ElEctronIc WastEs ...
... Furthermore, X-ray cleaners contain chromium. [6] Digital radiography requires 70%-90% radiation as compared to conventional radiography. Thus, the use of digital radiographs not only reduces the radiation exposure but also eliminates the use of biohazardous materials. ...
In today's world, it is very necessary to understand the importance of being eco-friendly in every facet of our lives. The color “green” has healing power and denotes renewal, growth, and hope. “Eco-friendly dentistry” attempts to reduce the detrimental impact of dental practices on the environment and promote environmental awareness and sustainability to patients. This paper attempts to cover all possible aspects of making a dental practice eco-friendly, both in a dental perspective as well as a general perspective. While establishing an eco-friendly dental workplace, the dentist needs to assess his choices in planning the infrastructure and purchasing of equipment and dental materials. Eco-friendly dentistry is a newly evolving practice of dentistry, which encompasses a simultaneous devotion to sustainability, prevention, precaution, and a minimally invasive patient-centric, as well as global-centric treatment. There are two main avenues for implementing eco-friendly dentistry: (1) appropriate policy development and implementation and (2) dentists taking responsibility/ownership in the absence of policies and regulations. Although in some cases, it may take a little extra effort or money; dentists throughout the world are doing their best to reduce the environmental impact of the dental practice. Although the commitment of one small dental office cannot save the planet, certainly, the collective efforts of many small offices as well as large dental hospitals/colleges can ensure that dentists, at least, will not be responsible for destroying it. This article discusses various factors that can be incorporated into dental practice that can help make dentistry eco-friendly.
... 21,22 Radiography management: Conventional radiographs use x-ray fixer, developer and dental film, which contain hazardous chemicals and should not be disposed of in regular trash. 8,23 Dental practitioners must be aware of hazardous components and proper disposal of conventional x-rays. Green dentistry recommends digital radiographic techniques to minimize harmful chemical, paper, and plastic waste. ...
Objective: Green dentistry is an emerging concept necessary to address the worsening climatic changes. It is essential to compile the existing literature on knowledge, attitude, and practice on green dentistry that can be accomplished by conducting a literature review. The objective of this literature review was to summarize and present the existing knowledge that dentists have regarding green dental practices, their attitude about this shift towards sustainability, and steps that they have taken in their personal practice to adhere towards an eco-friendlier dental approach. Methods: Three months of effective research and review development from March 2022 to June 2022. Design using keywords, a literature search was performed in PubMed, Google scholar and Web of Science databases. A total of 13 articles of 45, fulfilling the inclusion criteria were selected, of which two were excluded as these were not in English. Results: Dental practitioners have good knowledge about green dentistry and positive attitudes towards environment conservation, but implementation in their practice is not adequate. Most common themes of knowledge, attitude and practice assessment in green dentistry are amalgam management, radiographic management, infection control, waste management, water, and electricity management. Conclusion: The absence of adequate literature on eco-friendly practices in dentistry makes it difficult to validate the findings of most of these studies. Dental professionals are familiar with environmentally friendly dental practices and have a positive outlook on their role in environmental protection, but its application in practice is far from adequate. doi: https://doi.org/10.12669/pjms.40.1.7606 How to cite this: Zia N, Doss JG, John J, Panezai J. Sustainability in Dentistry: Assessing knowledge, attitude, and practices of dental practitioners about green dentistry. Pak J Med Sci. 2024;40(1):---------. doi: https://doi.org/10.12669/pjms.40.1.7606 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
... Outro ponto importante é que a maioria dos pesquisados relata não gerar resíduos radiográficos físicos (filmes e películas), nem líquidos (fixadores e reveladores). Isso pode ter relação com o avanço tecnológico nesta área, em que cada vez mais são utilizados aparelhos radiográficos digitais para o desempenho desta função, diminuindo assim a necessidade do processo manual e contaminante (GOSHIMA; HORI; YAMAMOTO, 1994;TESCHKE et al., 2002;HILTZ, 2007). ...
O objetivo foi avaliar o gerenciamento de resíduos de serviços de saúde por cirurgiões-dentistas que atuam no setor público e no setor privado. O estudo foi de campo, quantitativo e descritivo, com 48 profissionais do setor público e privado. A coleta de dados ocorreu entre os meses de dezembro de 2020 e março de 2021, pela aplicação de questionário com 40 questões, o qual foi divulgado nas redes sociais e aplicado via Formulários Google, após aprovação pelo Comitê de Ética em Pesquisa. Os dados foram submetidos à estatística descritiva e ao teste de associação entre as variáveis (qui-quadrado). Observou-se que 29,17% dos participantes não têm conhecimento sobre o descarte de Resíduos de Serviço de Saúde (RSS), 39,58% desconhecem os procedimentos de descarte sobre medicamentos vencidos e suas sobras; 47,92% desconhecem o Plano de Gerenciamento de Resíduos de Serviço de Saúde (PGRSS); 45,83% desconhecem há quanto tempo este foi implementado; e 77,08% afirmaram falta de capacitação sobre gerenciamento de RSS, sendo a principal dificuldade apontada para o adequado gerenciamento de resíduos. É imprescindível fomentar práticas de educação permanente que contribuam na formação e na atuação profissional sobre gestão dos RSS e instigar a implementação e o funcionamento do plano municipal de gestão de resíduos.
... Although using reusable covers and suction tips could be a solution to this problem, it does not seem feasible due to the patients' preference for single-use items. 2. Energy and water consumption (a) The Eco-Dentistry Association (EDA) estimates 360 gallons of water usage per day just by the dental vacuum system in dental practices, which adds up to 9 billion gallons in the United States without considering the usage of water in laboratories in pouring moles and cooling and cleaning the equipment (Hiltz 2007). ...
Green dentistry involves the integration of new technologies, reducing waste, reducing pollution, and increasing productivity by properly managing currently used nonbiodegradable material and advancing research and progress in the production and successful clinical application of green material. Ultimately, the goal would be a quality treatment for the patient with less toxicity and pollution for the environment.
... Unfortunately, some of the materials that are currently in use -including heavy metals and biomedical waste -present potential challenges to the environment. [20] Dental amalgam has been used for over 150 years for the treatment of dental cavities and is still used in large cavities because it is a long-lasting, cost-effective, and resilient restorative material. It however contains silver, mercury, copper, tin and zinc, with mercury constituting up to 50% by weight of dental amalgam, while dentists contribute between 3% and 70% of the entire mercury load entering wastewater treatment facilities. ...
... Nowadays, some countries limit the use of amalgam. [11][12][13][14] There are some drawbacks of amalgam due to its mercury content, and whether it has an adverse effect or not and the esthetics, is controversial. Gradually, resin composites have come into the market as an alternative to amalgam. ...
Background:
Many dental restorative materials are used in dental clinics, while in a new practice, many countries are trying to ban dental amalgam for many reasons. Dental mercury is the main issue for suspending the use of dental amalgam. Another restoration method, the composite restoration for posterior and anterior teeth for esthetic porous, became the alternative to amalgam.
Aim:
To measure patient satisfaction with two different materials based on multiple criteria using an oral health impact profile (OHIP) form.
Method:
This is a prospective study on two groups. The patients visiting the clinic with a vital posterior tooth indicated for restoration were requested to participate in the study. The first group received composite restoration of the posterior teeth. Contrarily, the second group underwent an amalgam restoration application. Patient satisfaction was assessed using the OHIP5 to assess different aspects of patient satisfaction. The patients were asked to fill out a form before starting the procedure, and after 4 weeks, the procedure was reported. The operators were requested to fill out their forms based on the procedure done to determine the participant eligibility criteria.
Results:
Overall 64 subjects were involved in the study among them 35 participants who received composite restoration, 48.5% were female, whereas 51.5% were male. Under other conditions, the patients who underwent amalgam application were 29, and 41.4% were female. Based on the study results, the participants underwent before and after assessment and showed no demands for different aspects with the two different materials.
Conclusion:
No significant differences using amalgam or composite restoration regarding appearance, functional, and psychological factors in the posterior teeth were noted.
... Gümüş amalgam dişler için en sık kullanılan kalıcı restorasyonlardan biridir. Dental amalgam dayanıklı, uygun maliyetli ve uzun ömürlü bir restoratif materyal olmasına rağmen cıva, gümüş ve çevreye girebilen diğer metalleri içerir (Chin et al., 2000;Hiltz, 2007;Kao, Dault, & Pichay, 2004). Civa biyouyumludur ve bitkiler, hayvanlar ve insanlarda toksik etkileri olduğu bilinmektedir (Barron, 2004;Cailas, Drummond, Tung-Yi, & Ovsey, 2002;Kao et al., 2004). ...
Sürdürülebilirlik, mevcut sistemlerin verimlilik ve çeşitliliğinin sürekliliğini sağlamaktır. Sürdürülebilirlik ile sahip olunan doğal kaynakların gelecek nesillere aktarılması hedeflenmektedir. Artan maliyetler, artan talep ve yüksek çevresel yük nedeniyle, gelecekteki sağlık hizmetleri imkanlarının sürdürülememe tehlikesi söz konusudur. Diş hekimliği sürekli gelişen ve yeniliklere açık olan bir tıp dalıdır. Günümüzde gelişen teknolojik yeniliklerle birlikte diş hekimliğini yeşil bir geçişe taşımak ilk hedeftir.Her diş hekimi gelecekte de aynı imkanları
hastalarına sunabilmek için, uygulamalarında Genel Diş Hekimliği Konseyi yönergelerini, gezegen ve insan sağlığı arasındaki ilişkiyi anlamalıdır. Ekolojik olarak sürdürülebilir bir sağlık hizmeti sisteminde ilerleme diş hekimliği uygulamalarının çevresel etkisini azaltmayı amaçlayan bir yaklaşım izlenmelidir. Çevre dostu diş hekimliği, hastaların gereksinimlerini karşılayan ve diş hekimlerine yaptıkları uygulamaları mali olarak destekleyen, gezegeni ve toplumsal refahı korumalarına yardımcı olan bir yaklaşımdır. Diş hekimliği alanında atıkların
oluşumunun çoğundan sorumlu prosedürler; amalgam, konvansiyonel X-ray sistemleri, tek kullanımlık materyaller, sterilizasyon malzemeleri gibi enfeksiyon kontrol yöntemleri ve geleneksel vakumlu sakşın sistemleridir. Ayrıca diş hekimliğinde kullanılan birçok ekipman ve materyal karbon ayak izi oluşumuna neden olmakta ve bu şekilde doğal kaynaklara zarar vermektedir. Diş hekimliği alanında yer alan ve azımsanmayacak düzeyde olan bu atık kaynakları değerlendirilmeli ve sürdürülebilir forma dönüştürülmelidir. Diş hekimleri tüm
insanlar için en iyi ağız sağlığını teşvik ederken ve hasta güvenliğini korurken, bu uygulamaların doğal kaynaklar üzerindeki olumsuz etkilerini de azaltmalıdır. Diş hekimliğini çevresel açıdan daha sürdürülebilir kılmak için ürün seçimine, politikalara, sürdürülebilirlik eğitimine ve öncelikli araştırma alanlarına önem verilmelidir. Sürdürülebilir bir dünya, gelecek nesillerin kendi ihtiyaçlarını karşılama yeteneğinden ödün vermeden bugünün ihtiyaçlarını karşılamalıdır. Bu çalışmanın amacı; diş hekimliği mesleğinde ortaya çıkan atık kaynaklarına değinmek ve bunların sürdürülebilirlik sistemi içerisinde nasıl değerlendirebileceğinin açıklamaktır.
... Therefore, a scientific study addresses the environmental impact of dental materials and describes measures that should be taken to reduce the harm caused by this potential waste. [34] To sum up, it can be said that there is a strong belief, based on accurate statistics in the field of dentistry, that air pollution has a detrimental allot of harmful effects on our health. Hence, all these harmful issues resulting from air pollution have a direct negative impact on the public health of humans. ...
... The truth is that even before the pandemic and over the decades, the growth of the medical and dental sector around the globe, combined with an increase in the use of disposable and single-use products, has contributed to a large amount of medical and dental waste generated. The management of these specific types of dental waste (DW) can be considered by many as a complicated holistic issue [14][15][16][17]. ...
In this review, life cycle assessment (LCA) principles are coupled with circular economy (CE) in order to address LCA examples in the biomedical sector worldwide. The objectives were (1) to explore the application of LCA in the medical, pharmaceutical, and dental fields; (2) to describe the ways of biomedical waste management; (3) to emphasize on the problem of dental waste in private and public dental sectors; and (4) to propose ways of "green circulation" of the dental waste. A literature search was performed using the Google Scholar, PubMed, and Scopus search engines covering the period from January 2000 until May 2020, corresponding to articles investigating the LCA and circular economy principles and legislation for biomedical and dental waste, their management options, and modern ways of recycling. The results showed that incineration seems to be the best management way option involved despite the mentioned drawbacks in this technology. Different adopted models are well defined for the dental field based on the 3Rs' module (reduce, reuse, recycle). Replacing disposable products with reusable ones seems to be a good way to tackle the problem of waste in medical and dental sectors. Interventions on the selection and better biomedical and dental waste management will ensure eco-medicine and eco-dentistry of the future. These new terms should be the new philosophies that will change the way these fields operate in the future for the benefit of the professionals/patients and the community.
Supplementary information:
The online version contains supplementary material available at 10.1007/s43615-020-00001-0.
... The disposed materials from healthcare activities have the potential of transmitting infection to humans [4,5]. Dental office is a source of generation of biomedical waste, radiological waste from the dental materials, general office waste, etc. Radiological waste like radiographic films, developer, fixer solutions, radiographic water, used/ unused dental films, lead foil and processor system cleaners [6][7][8][9][10]. Fixer solution contain silver, it should be recycled. ...
Knowledge and Perception of Dental Clinicians Toward Radiological Waste Management in Dentistry
... However, strict norms and self-consciousness along with programs to remind and enhance the education of the healthcare sector has greatly helped and kept the generation and disposal of biomedical waste in control. Dentistry is a part of the healthcare sector which serves to promote and enhance oral health by use of a variety of materials and equipment [2,4]. ...
... 10 The placement or removal of amalgam fillings produces amalgam debris, which can be introduced into the environment through waste water from dental offices. 11 While waste management initiatives and requirements introduced in recent years for Canadian dental facilities have contributed to a significant reduction of amalgam waste discharge into the environment, 12 on the international front, the United Nations Environment Programme has established the Minamata Convention on Mercury, which aims "to protect the human health and the environment from anthropogenic emissions and releases of mercury and mercury compounds." 13 In addition to the use of mercury in general, the Minamata Convention addresses the use of amalgam in dentistry by recommending a phase-down of its use; specifically, parties who have ratified the Convention commit to the adoption of at least two of nine proposed measures. ...
Executive Summary
Issue
Amalgam is a restorative material that has been widely used to treat dental caries for more
than 150 years. But because dental amalgam is partly composed of mercury (Hg), its use
has fuelled concern for decades about risks to human health. Composite resin is the most
common alternative to dental amalgam; although data indicate that rates of restoration
failure and secondary caries — as well as costs — are higher compared with amalgam. As
well, the potential for toxicity to human health from composite resin restorations vis-à-vis
compounds such as bisphenol A, for instance, remain uncertain.
Given longstanding debate around the use of dental amalgam, alongside a global impetus
to phase down its use, a comprehensive evaluation of its benefits, harms, and other
consequences is necessary to inform Canadian decision-makers. Specifically, this health
technology assessment (HTA) sought to inform the following policy question:
Should dental amalgam continue to be used in Canada?
Objectives and Research Questions
Clinical Review 1.
2.
Economic Review 3.
Patient Perspectives and Experience 4.
Implementation Issues 5.
6.
This HTA aims to inform the policy question through a comparative assessment of dental
amalgam and composite resin restorations, including investigation into the efficacy, safety,
cost-consequence, patient perspectives and experiences, implementation issues,
environmental impact, and ethical considerations.
What is the comparative efficacy of direct dental restorations made of composite resin
versus amalgam for the treatment of dental caries in permanent posterior teeth?
What is the comparative safety of dental restorations made of composite resin versus
amalgam in children and adults?
What are the comparative consequences and costs of using dental restorations made
of composite resin or amalgam for permanent teeth in Canada?
What are the perspectives and experiences of patients (adults or children), parents of
children patients, or caregivers around dental amalgam and composite resin
restorations?
What is the current use of amalgam restorations in Canadian dental practices or
programs?
What is the current use of composite resin restorations in Canadian dental practices or
programs?
HEALTH TECHNOLOGY ASSESSMENT REPORT Composite Resin Versus Amalgam for Dental Restorations: A Health Technology Assessment 12
7.
Environmental Assessment 8.
Ethics 9.
... Estimated 680 million plastic and paper chair barriers and 1.7 billion instrument and sterilization pouches are dumped into landfills yearly 4,5 . ...
Aim: The survey aims to assess the knowledge, attitude and practices regarding eco -friendly dentistry among dental practitioners.Material and Methods: The cross sectional study was conducted among 800 dental practitioners selected through a systematic random sampling. Data was collected using the pretested structured closed ended questionnaire. The first part of the questionnaire consisted of the demographic details and the second part awareness on eco-friendly dentistry, its associations and implemented strategies in their practice, their support and opinion towards this concept.Results: Among the total sample only 13.1% were aware of EFD Association. 76% (608) of the total sample reported that they were aware of harm done to the environment by dental practice. Among the total participants, majority 57.9% reported that they implement the strategy of proper protocol for waste disposal. Among the total sample 91.9% (735) of them gave positive opinion on emphasis to be made on implementing these strategies.Conclusions: Significant difference was found in gender, specialty, place of practice and type of practice related with knowledge attitude and practice on eco friendly dentistry. Significant difference was found in study subjects related with awareness on eco friendly dentistry concept, following the concept, awareness on the harm done by dental practice, opinion on emphasis to be made on implementing these strategies.
... A questão da sustentabilidade ambiental está diretamente relacionada com a Odontologia, uma vez que ela apresenta uma variedade de resíduos de serviços de saúde que se assemelham com os resíduos da área médica, como resultado do contato com fluidos biológicos (sangue, saliva). Adicionalmente, os procedimentos odontológicos envolvem certos materiais que não são utilizados na Medicina geral, dentre os quais, alguns extremamente tóxicos, constituídos de metais pesados e combinações químicas, apresentando riscos graves para a saúde dos cidadãos, bem como causando impactos ambientais mais amplos (HILTZ, 2007). ...
p> Introdução : São enormes os desafios da sociedade moderna frente ao diagnóstico ambiental sombrio e seus efeitos para a saúde das populações. Destaca-se o papel dos profissionais da Odontologia na construção de um mundo ecologicamente sustentável. Objetivo : o estudo, de natureza qualitativa, teve por objetivo identificar o nível de conscientização e atuação de estudantes de Odontologia acerca da biossegurança e dos riscos provocados pelo descarte inadequado de resíduos sólidos. Metodologia : A amostra se constituiu de estudantes matriculados nos 5º e 10º períodos do curso de Odontologia da UFPE. Resultado : A análise dos dados identificou que os alunos apresentam conhecimentos básicos, porém com nível de reflexão bastante simplificado, apesar de os estudantes do 5º período terem cursado disciplinas que abordam a questão. Para eles, a Biossegurança está associada apenas aos procedimentos que evitam a contaminação de pessoas em decorrência do descarte inadequado dos resíduos. Para ambos os períodos, a maioria dos profissionais exercem atividades clínicas sem adotar medidas de Biossegurança. Segundo eles, a responsabilidade pelo gerenciamento desses materiais é das empresas especializadas. Conclusão : Os autores concluem que, apesar da mudança curricular, esforços devem continuar a ser feitos para que docentes e discentes desenvolvam maior sensibilidade para as questões ambientais, a fim de poderem atuar de modo ecologicamente sustentável.</p
... Hence, a reconsideration of the medical practices in this regard is required. (Hiltz Margot, 2007, p. 59-62) The Teleosis Institute (2006) finds that " at the level of the green health care, the use of some non-toxic buildings, promoting the notions about local issues regarding the environment and the use of some safe medical methods, efficient and cautious, are intrinsic elements of the new health care system which is beneficial for people and the environment. " (http://www.teleosis.org/) ...
Sustainable development has come into prominence in recent years as a concept that determines implications in all areas of human activity. Modern medical services are distinguished by a special position regarding application of the specific principles of sustainable development. This is because they are not only a necessary and useful tool to implement the concept of sustainable development at the scale of the entire human civilization but also an area of activity where sustainability is experiencing a complex application. In this context, health care consumer behaviour has also suffered substantial changes determined both by the technological evolution from the medical field and the large scale which phenomena such as social networks and communication technology has in the present. This article proposes a review of the evolution of the concept of sustainable development, its application in the medical field, with an emphasis on dental health services and final considerations on how consumer behaviour is influenced by the implementation, at the level of the medical organisations, of the principles of sustainable development.
... Unfortunately, some of the materials that are currently in use -including heavy metals and biomedical waste -present potential challenges to the environment. [20] Dental amalgam has been used for over 150 years for the treatment of dental cavities and is still used in large cavities because it is a long-lasting, cost-effective, and resilient restorative material. It however contains silver, mercury, copper, tin and zinc, with mercury constituting up to 50% by weight of dental amalgam, while dentists contribute between 3% and 70% of the entire mercury load entering wastewater treatment facilities. ...
Background: Occupational exposure to elemental mercury vapor in a dental setting is mainly through inhalation exposure during preparation, insertion, polishing, and removal of amalgam fillings including storage of amalgam waste before disposal. This study aims to determine the indoor air levels of elemental mercury vapor in the dental operatories and ancillary sites at the Lagos State University Teaching Hospital (LASUTH). Materials and Methods: Samples of the ambient air were taken at seven locations the Dental Center of LASUTH by a trained technician between 9:00 and 11:00 a.m. This was done at a predetermined height (41/2feet) above the floor for mercury vapor concentration using Lumex 915 light data logger mercury vapor analyzer manufactured by Ohio Lumex Company Incorporation, USA®. Results: The highest level of 1434 ng/m3 of mercury vapor in the air was found in the restorative clinic while the lowest of 23 ng Hg/m3 was found in the ambient air at the entrance of the dental Center. The Oral Surgery clinic had mercury vapor level of 318 ng/m3 which was slightly higher than Environmental Protection Agency recommended value of 0.3 μg/m3. Conclusion: An unacceptably high level of mercury vapor was detected, especially in the restorative clinic. Every dental clinic should have its ambient air evaluated for mercury vapor level for the purpose of forming a baseline data for monitoring purposes during the period of phase down of amalgam use. Best practices should also be instituted to reduce the level of exposure of patients and dental care workers to mercury vapor.
... Journal of Operative Dentistry and Endodontics, January-June 2017;2(1):[19][20][21][22][23][24] ...
Dentistry is an extremely important and foremost healing profession. In today's world, with the increasing ecological disasters, it is highly obligatory to understand the paramount importance of being eco-friendly in every facet of our lives, including in dental practice, which has a huge impact on the environment. Eco-friendly dentistry is a term legally accepted by the Eco Dentistry Association, which is an emerging concept in dentistry. It is an approach to minimize the environmental hazards of dental practice and provide dental care in an environmentally friendly way. With the widespread introduction of beryllium into the dental industry, a large number of these workers are at risk for the development of chronic beryllium disease. Proper handling of biomedical and dental waste is indispensable for the dental profession. People have become much more cognizant of potentially harmful chemicals contained in plastic products, especially, bisphenol-A. This can be achieved by reducing waste and lowering pollution. Dental offices can use reusable towels, high-efficiency machines, and paperless records. A small change can make the overall impact of the dental office less damaging to the environment.
The purpose of this review is to discuss various ways that a dentist can choose to make the dental office “Green” and conserve precious resources with all the options available today. Eco-friendly dentistry is soon becoming the standard.
How to cite this article
Sawant PH, Vimala N, Padhye L. “Let's go Green to get Our Globe Clean”: Green Dentistry. J Oper Dent Endod 2017;2(1):19-24.
... 1. Capture and recycle: Dentists can collect and store all contact and noncontact scrap amalgam for recycling. This waste must be sent to an approved recycler that is able to reprocess the mercury [8,9] 2. Installing an amalgam separator not only keeps this mercury-containing material out of the water system, but recycling waste amalgam means that more of the material does not have to be created [10,11] 3. If using traditional x-rays, recycle fixer and developer solutions and recycle lead foil from x-rays [8] 4. In the office rest room, discontinue the use of disposal kitchenware or make sure to only use biodegradable plastic ware. ...
... To accomplish these goals, dentists use a variety of materials and equipment. Unfortunately, some of the materials that are currently in useincluding heavy metals and biomedical wastepresent potential challenges to the environment [8]. ...
... A Odontologia apresenta uma variedade de Resíduos de Serviços de Saúde (RSS) que se assemelham com os resíduos da área médica, como resultado do contato com fluidos biológicos (sangue, saliva). Entretanto, os procedimentos odontológicos envolvem certos materiais que não são utilizados na Medicina geral, dentre os quais, alguns extremamente tóxicos, constituídos de metais pesados e combinações químicas, apresentando riscos graves para a saúde dos cidadãos, bem como causando impactos ambientais mais amplos [2][3][4] . ...
Resumo Objetivo: Verificar o processo de gerenciamento dos resíduos odontológicos do serviço público de saúde em 11 municípios brasileiros. Material e método: Uma única pesquisadora realizou as visitas e as observações foram anotadas em um roteiro previamente elaborado e testado. Resultado: Foram visitadas 50 unidades de saúde, sendo que nenhuma apresentou cópia do plano de gerenciamento de resíduos. Do total de estabelecimentos, 62% realizavam a correta segregação dos resíduos no momento da sua geração. A presença de recipientes adequados a cada tipo de resíduo gerado no consultório odontológico foi observada em 74% dos estabelecimentos e, destes, 94% apresentavam capacidade adequada ao tipo de resíduo gerado. A identificação do tipo de resíduo nas embalagens plásticas bem como anotações identificando o estabelecimento gerador dos resíduos foram encontradas em 8% e 6%, respectivamente. Somente 21% dos estabelecimentos apresentavam locais apropriados, de acordo com as normas vigentes, para o armazenamento dos resíduos até que fosse feita a coleta externa. Conclusão: Constatou-se na presente pesquisa que a rotina adotada pela rede pública de saúde bucal, no que tange ao gerenciamento de resíduos de saúde, apresentou falhas. Descritores: Gerenciamento de resíduos; resíduos odontológicos; resíduos de serviços de saúde; saúde pública. Abstract Objective: was to investigate the process of waste management of dental public health service in eleven counties. Material and method: one researcher conducted the visits, and observations were recorded on a previously elaborated and tested. Result: We visited 50 health units, and none presented a copy of the waste management plan. Of the total 62% of businesses held the correct segregation of waste at the time of his generation. The presence of containers suitable for each type of waste generated at the dental office was observed in 74% and of those, 94% had adequate capacity for the type of waste generated. The identification of the type of waste in plastic containers and annotations identifying the establishment from which the waste was found in 8% and 6% respectively. Only 21% of establishments had appropriate locations, according to the current regulations for the storage of waste until collection was done outside. Conclusion: It was found in this study that the routine adopted by public oral health, regarding the management of healthcare waste had flaws. Descriptors: Waste management; dental waste; medical waste; public health. INTRODUÇÃO Segundo a Organização Mundial da Saúde (OMS), os resíduos de serviço de saúde constituem resíduos sépticos que contêm, ou potencialmente podem conter, germes patogênicos. São produzidos em serviços de saúde, tais como: hospitais, clínicas odontológicas, laboratórios, farmácias, clínicas veterinárias e postos de saúde 1. A Odontologia apresenta uma variedade de Resíduos de Serviços de Saúde (RSS) que se assemelham com os resíduos da área médica, como resultado do contato com fluidos biológicos (sangue, saliva). Entretanto, os procedimentos odontológicos envolvem certos materiais que não são utilizados na Medicina geral, dentre os quais, alguns extremamente tóxicos, constituídos
##Objectives To find out how important environmental sustainability is to the dental profession in Ireland. The extent of the dental profession’s interest in and knowledge of sustainability is unclear.
##Materials and methods A total of 735 questionnaires were distributed to dental practices and at dental conferences in Co. Dublin. The questionnaires sought information from the members of the dental team on their interest in sustainability, their understanding of it, their interest in learning more, and whether they consider sustainable energy use, travel, waste disposal, goods and services, and costs. It also sought to find out if they measure their carbon footprint and if they think sustainability should be a HSE priority.
##Results A total of 735 questionnaires were distributed. A total of 69% of the respondents stated that they are interested in sustainability, and 68% think it should be a HSE priority. However, only 31% of dental professionals consider sustainable travel and 43% consider sustainable energy use, while 58% consider sustainable waste disposal practices. Over half of the sample said they fully understand what environmental sustainability means, with 64% of people interested in learning more about it. Of the respondents, 34% think sustainable practices would decrease costs, while 20% measure their practice’s carbon footprint.
##Conclusions The dental profession in Ireland cares about environmental sustainability, but more research and policies should be introduced in Ireland to increase awareness of how sustainable practices can improve within dentistry.
Dentistry increasingly integrates artificial intelligence (AI) to help improve the current state of clinical dental practice. However, this revolutionary technological field raises various complex ethical challenges. The objective of this systematic scoping review is to document the current uses of AI in dentistry and the ethical concerns or challenges they imply. Three health care databases (MEDLINE [PubMed], SciVerse Scopus, and Cochrane Library) and 2 computer science databases (ArXiv, IEEE Xplore) were searched. After identifying 1,553 records, the documents were filtered, and a full-text screening was performed. In total, 178 studies were retained and analyzed by 8 researchers specialized in dentistry, AI, and ethics. The team used Covidence for data extraction and Dedoose for the identification of ethics-related information. PRISMA guidelines were followed. Among the included studies, 130 (73.0%) studies were published after 2016, and 93 (52.2%) were published in journals specialized in computer sciences. The technologies used were neural learning techniques for 75 (42.1%), traditional learning techniques for 76 (42.7%), or a combination of several technologies for 20 (11.2%). Overall, 7 countries contributed to 109 (61.2%) studies. A total of 53 different applications of AI in dentistry were identified, involving most dental specialties. The use of initial data sets for internal validation was reported in 152 (85.4%) studies. Forty-five ethical issues (related to the use AI in dentistry) were reported in 22 (12.4%) studies around 6 principles: prudence (10 times), equity (8), privacy (8), responsibility (6), democratic participation (4), and solidarity (4). The ratio of studies mentioning AI-related ethical issues has remained similar in the past years, showing that there is no increasing interest in the field of dentistry on this topic. This study confirms the growing presence of AI in dentistry and highlights a current lack of information on the ethical challenges surrounding its use. In addition, the scarcity of studies sharing their code could prevent future replications. The authors formulate recommendations to contribute to a more responsible use of AI technologies in dentistry.
The research intends open a gate between the dental industry and ecofriendly practices, now that the tendency to have less contamination impact in a daily basis routine has risen in the past years. The topic of carbón neutrality has come to the table since it is an important complement to have a better understanding of the damage and carbon foot print that is happening in the present. As well, big part of the study was to investigate if the dentists have had any kind of information regarding ecofriendly dental offices and it requirements, as well to see which one is the biggest difficulties dentists think are pushing them back to apply this modality in their day to day routine.
Radiographs are used by the dentists for the diagnosis, and/or treatment of patients in the majority of the cases. These radiographs have become a third eye to the dentist. Even with the advent of digital imaging there are a large number of dental offices that use conventional methods to obtain the radiographic images. Unfortunately, the conventional radiographic procedures generate certain substances that present as potential challenge to the environment. Although individual dentists generate only small amount of environmentally hazardous wastes, the accumulated waste produced by the profession may have a significant environmental impact, which in turn may pose a risk to the human health. Thus, it becomes extremely important for the proper disposal of materials originated from conventional radiographic methods, in order to minimize the negative environmental impact. This paper addresses the environmental impact of dental radiographic waste and describes measures that can be taken by dentists and their team to reduce the production of potentially harmful wastes.
This article provides an example of interprofessional collaboration for policy development regarding environmental global health vis-à-vis the Minamata Convention on Mercury. It presents an overview of mercury and mercury-related environmental health issues; public policy processes and stakeholders; and specifics including organized dentistry's efforts to create global policy to restrict environmental contamination by mercury. Dentistry must participate in interprofessional collaborations and build on such experiences to be optimally placed for ongoing interprofessional policy development. Current areas requiring dental engagement for interprofessional policy development include education, disaster response, HPV vaccination, pain management, research priorities, and antibiotic resistance.
Green dentistry is a high-tech approach that reduces the environmental impact of dental practices and encompasses a service model for dentistry that supports and maintains wellness. It is an approach of dentistry that encourages sustainable practices by reducing resource consumption and waste. Eco-friendly dentistry also tries to increase the health of patients by reducing chemical use in the clinics and using low volatile products. Eco-friendly dentist offices take into consideration patient volume, consumption of dental resources, electricity, energy, chemical and water usage and waste and try to implement environmentally friendly alternatives. By conserving water, using digital imaging and recycling the many recyclable items that pass through the office of a green dentist, a great impact is made. This article provides a series of 'green' recommendations that dentists around the world can implement as going green is need of the hour.
Mercury passes along the food chain and eventually to man as methylmercury (CH3Hg) or ethylmercury (CH 3CH 2Hg +). This article addresses the likelihood that dental materials containing mercury can be an important causal factor of systemic diseases. Materials and methods: Mercury exposure remains a major public health concern because of the natural and anthropogenic release of inorganic mercury into the aquatic environment, where it is transformed by algae and bacteria into MeHg. Results: Human exposure to mercury results in neurologic and kidney disorders. Conclusions: Several investigations showed that elemental mercury vapour can be released from dental amalgam, and its quantity is directly related to the number of filling surfaces and may contribuite to multiple sclerosis and Alzheimer's disease.
Proper management of dental waste is a crucial issue for maintaining human health and the environment. The waste generated in the dental clinics has the potential for spreading infections and causing diseases, so improper disposal of these dental wastes can cause harm to the dentist, the people in immediate vicinity of the dentist, waste handlers, general public and the environment through production of toxins or as by-products of the destruction process. Staff that provide dental healthcare ought to be aware of the proper handling and the system of management of dental waste used by different dental hospitals. The method of investigation adopted in the paper involved a desk study in which documents and records relating to dental waste handling were studied to obtain background information on existing dental waste management in Nigeria other countries of the world are also mentioned as examples. Additionally, information on generation, handling, segregation, risk associated during handling and treatment of dental medical waste were sought in order to determine the best method for safe disposal. This article provides dentists with the information they need to properly dispose of mercury and amalgam waste, and provides suggestions for managing the other wastes that result from the day-to-day activities of a dental office such as: used X-ray fixers and developers; cleaners for X-ray developer systems; lead foils, shields and aprons; chemiclave/chemical sterilant solutions; disinfectants, cleaners, and other chemicals; and, general office waste. Additionally, this study may be beneficial for authorities and researchers of developing countries to work towards improving their present Dental waste management system.
Animal studies have demonstrated that relatively low doses of lead can produce modest elevations in blood pressure. During the past 10 y, many epidemiologic studies have examined the relationship between low-level lead exposure and blood pressure in humans. These studies were reviewed in a consensus conference, which concluded that the evidence supported the existence of a causal association; however, no formal meta-analysis has been conducted. Epidemiologic studies of blood lead and systolic blood pressure in males were analyzed in the present meta-analysis. A highly significant and moderately consistent association was found, i.e., decrease of blood lead from 10 mg/dl to 5 mg/dl associated with a decrease of 1.25 mm Hg (95% CI = 0.87-1.63 mm Hg). The association was robust to deletion of the most significant study or the addition of eight additional studies showing no effect. Given the strong animal data, which also implicate a mechanism (disturbance of calcium messenger system regulation of blood pressure) present in humans, the association should be considered causal.
To determine the amount of amalgam entering the waste stream during removal of dental amalgam restorations.
Dental amalgam restorations were removed from anatomic replica teeth and natural teeth by means of a tungsten carbide bur, a high-speed handpiece and a conventional suction system. The weight of amalgam particles trapped in the primary and secondary solids separators was determined. Amalgam particles were filtered from wastewater with 15-microm filter paper and weighed. The concentration of total mercury in the effluent collected (by instantaneous flow-through) during the removal of amalgams, with and without an ISO-certified separator, was measured by means of cold-vapour atomic absorption spectrophotometry.
About 60% by weight of the amalgam removed was found in the effluent, about a third was retained in the primary solids separator and less than 10% was retained in the secondary solids separator. The ISO-compliant separator reduced the concentration of mercury in the instantaneous flow-through discharge by 99.4%, from 31.2973 mg/L to 0.1800 mg/L.
About 60% of the waste generated during the removal of amalgams escaped the primary and secondary solids collectors and was released into the wastewater. An ISO-certified amalgam particle separator was effective in removing the amalgam from the wastewater.
There is widespread concern regarding the safety of silver-mercury amalgam dental restorations, yet little evidence to support their harm or safety. We examined whether mercury dental amalgams are adversely associated with cognitive functioning in a cross-sectional sample of healthy working adults. We studied 550 adults, 30-49 years of age, who were not occupationally exposed to mercury. Participants were representative of employees at a major urban medical center. Each participant underwent a neuropsychologic test battery, a structured questionnaire, a modified dental examination, and collection of blood and urine samples. Mercury exposure was assessed using a) urinary mercury concentration (UHg); b) the total number of amalgam surfaces; and c) the number of occlusal amalgam surfaces. Linear regression analysis was used to estimate associations between each marker of mercury exposure and each neuropsychologic test, adjusting for potential confounding variables. Exposure levels were relatively low. The mean UHg was 1.7 micro g/g creatinine (range, 0.09-17.8); the mean total number of amalgam surfaces was 10.6 (range, 0-46) and the mean number of occlusal amalgam surfaces was 6.1 (range, 0-19). No measure of exposure was significantly associated with the scores on any neuropsychologic test in analyses that adjusted for the sampling design and other covariates. In a sample of healthy working adults, mercury exposure derived from dental amalgam restorations was not associated with any detectable deficits in cognitive or fine motor functioning.
This paper deals with the issue of amalgam waste from dental offices. The aim is to put into perspective the very small contribution of dental mercury to the overall volume of mercury discharged into the environment each year. While the amount discharged from dental offices is very small compared to other sources, the amount discharged into the environment from amalgam fillings in people's mouths is estimated as less than 2% of the amount from dental offices. At least 50% of mercury in the environment comes from natural sources. The major source of man-made mercury pollution is the industrial burning of fossil fuels. It is important to distinguish between inorganic mercury and organic mercury in terms of the impact on the health of the population.
Mercury (Hg) release from dental offices has become an acute issue for the dental profession and has resulted in efforts by regulators to mandate both the use of Best Management Practices (BMPs) as well as the installation of amalgam separators. Concern has been expressed by some regarding the efficacy of amalgam separators in reducing the Hg loads to wastewater treatment plants (WWTPs). Data from several Publicly Owned Treatment Works (POTWs) serving areas with installed bases of separators suggest these devices can substantially reduce Hg burdens to WWTPs. The data consists of Hg levels in sewer sludge (biosolids) and in some cases includes Hg concentrations in WWTP influent and effluent. Data comes from various geographical locations, and suggest separators can have a positive effect in reducing the amount of Hg reaching WWTPs.
An audit of the waste practices of ten general dental surgeries identified problems that have occurred due to the lack of specific dental guidelines or codes of practice in this area. Occupational health and safety requirements for types and locations of sharps containers, and lack of consensus on what constitutes a sharp, were identified as areas needing attention. Cross-infection control items, such as gloves, masks, single-use cups, and protective coverings, were found to constitute up to 91 per cent of total waste. When infectious waste was reclassified by the audit team as ‘that waste which was visibly blood stained,’ a reduction in waste in this category was made, during the audit, at each practice. The practice of disposing of radiographic fixer and developer into the sewerage system occurred in three out of the ten practices, even though the Australian Dental Association Inc. has discouraged this practice.
The effect of low-level body burdens of lead on the intelligence of children, as measured by intelligence quotient (IQ), was assessed. We reviewed 35 reports from five longitudinal studies conducted in the United States and Australia. In each of these studies, infants were followed for 58 mo or less. The study populations consisted of low- and middle-socioeconomic-class infants who had low-level exposure to environmental lead. Blood-lead levels were measured in a standard fashion at various times, beginning in the prenatal period, and intelligence was first measured at 6 mo of age and was followed by subsequent assessments. Studies were assessed for quality by a review panel blinded to the identity of the investigators and their affiliations. Efforts were made to pool the data with meta-analytic techniques, but efforts were unsuccessful because the methods used to analyze and report data were inconsistent. Inconsistencies were as follows: (a) there were few instances in which IQ and blood-lead levels were measured at comparable times in different studies; (b) incompatibilities existed among the studies, including differences in independent variables, data transformations, and statistical parameters reported; (c) results conflicted when measurement intervals were comparable (i.e., heterogeneity); (d) patterns of regression and correlation coefficients were inconsistent; and (e) data were insufficient to interconvert the parameters reported. Consequently, definitive conclusions regarding the effect of low-level body burdens of lead on IQ could not be determined from the longitudinal data. Examination of the weight of the evidence from this and other studies, however, suggests an adverse relationship of lead on the intelligence of children.
We identified 24 modern studies of childhood exposures to lead in relation to IQ. From this population, 12 that employed multiple regression analysis with IQ as the dependent variable and lead as the main effect and that controlled for nonlead covariates were selected for a quantitative, integrated review or meta-analysis. The studies were grouped according to type of tissue analyzed for lead. There were 7 blood and 5 tooth lead studies. Within each group, we obtained joint P values by two different methods and average effect sizes as measured by the partial correlation coefficients. We also investigated the sensitivity of the results to any single study. The sample sizes ranged from 75 to 724. The sign of the regression coefficient for lead was negative in 11 of 12 studies. The negative partial r's for lead ranged from -.27 to -.003. The power to find an effect was limited, below 0.6 in 7 of 12 studies. The joint P values for the blood lead studies were less than .0001 for both methods of analysis (95% confidence interval for group partial r, -.15 +/- .05), while for the tooth lead studies they were .0005 and .004, respectively (95% confidence interval for group partial r, -.08 +/- .05). The hypothesis that lead impairs children's IQ at low dose is strongly supported by this quantitative review. The effect is robust to the impact of any single study.
This article presents information garnered after an investigation by the Environmental Protection Agency in 1987 of dentists and others who had sold scrap dental amalgam to refiners who had "arranged for the disposal or treatment ... of hazardous substances," and were responsible for adverse consequences associated with their subsequent management and refining. Information about the health hazard status of scrap dental amalgams was obtained by: interviews with toxicologists, review of published lists of toxic and hazardous materials, and survey of biomedical publications (1977 through 1987) concerning toxicity or health hazards associated with dental amalgams. The conclusions were that scrap dental amalgam is not: a waste substance to be disposed of, but is a product of commercial value; identified or regulated by the Environmental Protection Agency, the Occupational Safety and Health Administration, the Department of Transportation, the Food and Drug Administration, the National Institute of Occupational Safety and Health, the US Public Health Service, or the Centers for Disease Control as an environmental health hazard or toxic substance; identified by toxicologists and persons responsible for solid waste regulation as a toxic substance or environmental health hazard; nor proved by scientific study to be toxic or hazardous in the manner and form in which it is collected and stored by dentists and subsequently sold to metal refiners.
Regulations have been adopted in several countries of the European Union which prescribe that dental treatment waste water must be discharged via an amalgam separator device. Since the effectivity of the device strongly depends on the size of the amalgam waste particles, this size was evaluated in waste water samples from eight dental offices. Per sample, all solid particles were separated from the waste water by pressure filtration, then dried and divided into six fractions by being sieved over five sieves with decreasing mesh width. Of the particles in each fraction, the density was determined by picnometry, the mass by weighing, and the area and width by image analysis. For this analysis, width was defined as the dimension perpendicular to the length of the particles. By combining the density, area, and width determinations of all fractions, we obtained mass distributions per waste particle width of the samples. The proportional amalgam mass of the distributions was estimated with the measured density of the particle fractions and with a number of assumptions for the density of amalgam particles only and of other waste particles only. Each waste sample has its own characteristics with respect to the mass and density of the particle fractions. The size distribution of waste particles has a bimodal shape and consists of a distribution of small (width, 2 to 90 microns) and large particles (width, 160 to 5500 microns). For small particles with a width up to 60 microns, the influence of the assumptions on the estimation of the proportion amalgam of the waste mass distribution is minor when compared with the sampling error. By averaging the estimations over the samples, one can estimate the weight of amalgam particles with a width < 10 microns and < 50 microns, respectively, between 4 and 15% and between 15 and 30%. The smallest particles comprising 5% of the amalgam mass have an estimated width of up to 15 microns.
One of the consequences of placing amalgam restorations is that mercury is required for the trituration process. In turn, this raises the issue of the possible environmental impact of mercury. This report considers ways in which any impact can be modified and reduced by careful attention to mercury usage and hygiene in the dental practice, the use of filters and separators in waste water pipes and the appropriate disposal of waste contaminated with amalgam. The total amount of mercury discharged into the environment varies considerably in different parts of the world due to both natural and human activities. The extent to which dentistry adds to this total also varies according to local circumstances and requirements. Recommendations are given for further development of ways to reduce mercury discharge and for further research into the environmental impact of the metal.
Waste management in the dental office is not a limited issue involving only dentists from the Region of Hamilton-Wentworth. While the ODA has had the opportunity to work with the Hamilton Academy of Dentistry and has the support of this society for a two-phased project, the Metro Toronto component societies will be joining the existing MOEE/Hamilton study. The MOEE in Halton-Peel has informed us that they will be conducting a similar survey and study. The committee would like to thank the Executive of the Hamilton Academy of Dentistry who have provided needed follow-up on this project. We look forward to the cooperation of individual dentists in all communities involved in this environmental study. Dentists are encouraged to complete the survey and to consider volunteering to take part in the in-office sample study. If you have any questions, we invite you to contact members of the Health Care Committee or the staff in the Department of Professional Affairs.
This article provides a view of government reaction in Canada to public concern over the use of dental amalgam. It also addresses the basis of the irrational fears the general public may have regarding the impact of external factors on their health.
Health Canada recently lowered the recommended maximum daily exposure of mercury from all sources for women of child-bearing age and for children less than 10 years. This new exposure guideline does not seem to be based on any new scientific finding of human toxicity. The average daily intake of methylmercury (mainly from fish) that may cause demonstrable health effects in the most sensitive individual is 300 micrograms/day, or 4.3 micrograms Hg/day/kg body weight. The new, lower Health Canada limit is 95% below the level that may cause health effects. A number of studies have looked at methylmercury in human breast milk (where maternal consumption of fish is high), but no strong evidence of toxicity has been reported. The amount of mercury released from dental amalgam is minimal; a person would have to have 490 amalgam surfaces for there to be enough mercury vapour and ionic mercury given off from amalgam fillings to meet the maximum exposure guidelines. The uptake of food-related organic mercury is six times higher than the uptake of mercury from amalgam; moreover, food-related mercury is significantly more toxic. Many studies of amalgam-related mercury are flawed by confusion between exposure and absorption for the various forms of mercury, a limited selection of data, the ignoring of confounding variables or the misclassification of data.
The number of dentists providing mobile care is increasing. One of the challenges the mobile dentist faces is proper handling and disposal of infectious medical waste generated during patient care. Mobile dentists must concern themselves with meeting Federal, state, and local regulations. Federal agencies that have jurisdiction over this issue are the Environmental Protection Agency (EPA) and the Occupational Safety and Health Administration (OSHA). EPA guidelines are summarized and clarified with respect to pre-transportation and transportation issues. Compliance with OSHA standards are addressed through presentation of a sample protocol for handling infectious medical waste. It is beyond the scope of this paper to discuss in detail the policies of each municipality, and practitioners are advised to consult with state and local authorities regarding proper handling and transportation of this material. Using the information presented in this paper, the mobile dentist can approach this complex issue in an organized manner.
Dental amalgam is one of the most commonly used materials in restorative dentistry. However, one of its major components, mercury, is of particular concern due to its potential adverse effects on humans and the environment. In this review, the environmental impact of dental amalgam will be discussed, with particular reference to the effects attributed to its mercury component. Mercury commonly occurs in nature as sulfides and in a number of minerals. Globally, between 20,000-30,000 tons of mercury are discharged into the environment each year as a result of human activities. According to a recent German report, approximately 46 per cent of the freshly triturated amalgam is inserted as new amalgam restorations and the rest is waste. Depending on the presence of an amalgam separating unit, some of the generated amalgam-contaminated sludge is discharged into the sewage system. Lost or extracted teeth with amalgam fillings and amalgam-contaminated waste, such as trituration capsules and cotton rolls are discharged with the solid waste and, in most instances, are incinerated. Use of disinfectants containing oxidizing substances in dental aspirator kits may contribute to remobilization of mercury and its subsequent release into the environment. Nevertheless, dental mercury contamination is only a small proportion of terrestrial mercury (3-4 per cent), which is quite insignificant compared with industrial pollution and combustion of fossil fuels by vehicles. The environmental impact of dental mercury is mainly due to the poor management of dental amalgam waste. Proper collection of mercury-contaminated solid waste prevents the release of mercury vapour during combustion. In addition, the use of amalgam separating devices reduces the amount of amalgam-contaminated water released from dental clinics.
Dentistry and society have long recognized the benefits of using silver-based amalgams to restore and maintain the dental health of patients. However, recent studies by health and environment experts have shown that mercury is of great concern when it enters the biosphere as a contaminant. A rational approach to pollution prevention is mandatory. This article explains the relationship between mercury, particularly dental amalgam waste, and the environment and describes a new pollution prevention initiative intended to ensure that the dental community becomes part of the solution to this serious environmental health problem.
In reviewing U.S. dental amalgam waste management activities, one finds a wide variety of approaches, processes, and results, within which the authors have observed an inconsistency of definitions, measurements, standards, and even of clearly applied goals. As a result, outcomes have varied greatly from community to community. This manuscript attempts to deliver logical options which might prevail even within an atmosphere of differing perspectives. The authors share the belief that successful outcomes are achievable within a collaborative environment of shared learning and cooperative planning. By example, the authors attempt to demonstrate how the joint acceptance of certain definitions and goals has served as a pathway to success in one community's dental waste management project. The goal of this paper is to share tools that may contain some measure of applicability to other similar collaborations.
California has issued fish consumption advisories because of mercury in lakes, reservoirs, creeks, rivers, and bays. Mercury in these waterways leads to the formation of methylmercury, which is toxic and bioaccumulative. Dental practices and other health care settings contribute a portion of this mercury. Government agencies are implementing programs to reduce mercury pollution. Dentists can reduce their contributions by implementing best management practices. They may also consider using pretreatment technologies as more information becomes available about their use and effectiveness.
Amalgam in dental wastewater is receiving increasing scrutiny from regulators because of national, state and local initiatives to reduce or virtually eliminate the discharge of mercury and mercury-containing items into the environment. Amalgam separators are considered to be one means of reducing the amount of amalgam that dental offices discharge into sewers. The purpose of this study was to evaluate the amalgam removal efficiency of commercially available amalgam separators and the total mercury concentration in the effluent from laboratory testing.
The authors evaluated the amalgam removal efficiency of 12 amalgam separators according to International Organization for Standardization, or ISO, Standard 11143 for Amalgam Separators. Total mercury concentration in the effluent was calculated using the mass of amalgam particles larger than 1.2 micrometers and the volume of effluent, together with U.S. Environmental Protection Agency, or EPA, Method 245.1 for amalgam particles smaller than 1.2 microm. Total dissolved mercury also was determined.
The results show that all 12 amalgam separators exceeded the ISO 11143 requirement of 95 percent amalgam removal efficiency. Statistical differences were found in the efficiencies of the separators. Both the total mercury concentration and total dissolved mercury concentration in the effluent demonstrated large variations.
This laboratory evaluation shows that amalgam separators removed at least 96.09 percent of the amalgam in samples with particle-size distribution as specified in ISO 11143. Total mercury concentration and total dissolved mercury concentration in the effluent varied widely for each amalgam separator. Additional research is needed to develop test methods to evaluate the efficiency of amalgam separators in removing small amalgam particles, colloidal amalgam particles and ionic mercury in solution.
The intent of this project was to evaluate the efficiency of three commercial amalgam separators based on mercury and particle removal.
Dental wastewater samples were collected from a 54-chair dental clinic and a one chair private dental office. Atomic absorption spectrometry was used to measure mercury, and a laser diffractometer method to determine the particle size distributions.
The mercury removal efficiency of the three units ranged from 26.5 to 61.8% for the 54-chair clinic and from 80.8 to 94.7% for the one chair office. Following treatment, the particle size range of the effluent was 8.3-19.2 microm for the 54-chair office and 27.5-41.4 microm for the one-chair clinic. For particle samples based on the silver-copper and copper standards, the three amalgam separators had a particle removal efficiency ranging from 92.3 to 99.9%. The initial particle size distributions for these samples were all under 100 microm.
The efficiency of the amalgam separators is influenced by the initial concentration of the dental wastewater, the physical setup of the discharge system before the dental wastewater reaches the separators, and the addition of chemicals to the dental wastewater. In addition, it is likely that assessment of efficiency based on particle removal by weight may not be as effective as removal based on concentration.
Growing environmental concern over the accumulation of mercury in some fish has led some state and local environmental agencies to pursue stricter regulation of mercury in wastewater. Dental offices are an identifiable source of mercury in the form of dental amalgam. Although mercury in dental amalgam is not immediately bioavailable (that is, it has not been shown to contribute significantly to the problem of mercury in fish tissue), environmental agencies in some locales are asking dental offices to install amalgam separators in an effort to reduce amalgam discharges beyond those already achieved through chairside traps and vacuum filters. Field experience indicates that the configuration and operation of the dental office infrastructure can significantly affect the choice of separator, as well as the operation and maintenance of the installed equipment.
The authors review factors related to office infrastructure and operation that dentists should consider when investing in an amalgam separator. They also provide a cost-analysis worksheet and checklist that may be useful to dentists who are considering purchasing a separator.
Before purchasing or installing an amalgam separator, dentists should consider factors specific to the available models, including size and maintenance requirements. In addition, office-specific actors should be considered (such as the plumbing configuration, available space for installation and subsequent access to that space for equipment replacement and maintenance). Dentists also should research whether any local or state regulations exist that might influence product selection or installation. Dentists should consider the effect an amalgam separator could have on existing suction equipment. Finally, dentists will want to consider the short- and long-term costs (including maintenance and parts replacement) of the available options.
ercury has been used commercially and medically for cen- turies. In the past it was a common constituent of many medications. It is still used in hospitals in thermometers and blood-pressure cuffs and com- mercially in batteries, switches, and fluorescent light bulbs. Large quantities of metal- lic mercury are employed as electrodes in the electrolytic production of chlorine and sodium hydroxide from saline. These uses still give rise to accidental and occupational exposures. 1 Today, however, exposure of the general population comes from three major sourc- es: fish consumption, dental amalgams, and vaccines. Each has its own characteristic form of mercury and distinctive toxicologic profile and clinical symptoms. Dental amal- gams emit mercury vapor that is inhaled and absorbed into the bloodstream. Dentists and anyone with an amalgam filling are exposed to this form of mercury. Liquid metallic mercury (quicksilver) still finds its way into homes, causing a risk of poisoning from the vapor and creating major cleanup costs. Humans are also exposed to two distinct but related organic forms, methyl mercury (CH 3 Hg + ) and ethyl mercury (CH 3 CH 2 Hg + ). Fish are the main if not the only source of methyl mercury, since it is no longer used as a fungicide. In many countries, babies are exposed to ethyl mercury through vaccina- tion, since this form is the active ingredient of the preservative thimerosal used in vac- cines. Whereas removal of certain forms of mercury, such as that in blood-pressure cuffs, will not cause increased health risks, removal of each of the three major sources described in this article entails health risks and thus poses a dilemma to the health pro- fessional. Exposure to mercury from dental amalgams and fish consumption has been a con- cern for decades, but the possible risk associated with thimerosal is a much newer con- cern. These fears have been heightened by a recent recommendation by the Environmen- tal Protection Agency (EPA) that the allowable or safe daily intake of methyl mercury be reduced from 0.5 µg of mercury per kilogram of body weight per day, the threshold es- tablished by the World Health Organization in 1978, 2 to 0.1 µg of mercury per kilogram per day. 3 Table 1 summarizes the clinical toxicologic features of mercury vapor and methyl and ethyl mercury. It also includes data on inorganic divalent mercury, since this is believed to be the toxic species produced in tissues after inhalation of the vapor. 5 It is also re- sponsible for kidney damage after exposure to ethyl mercury, since ethyl mercury is rap- idly converted to the inorganic form. 13 Inorganic mercury as both mercuric and mercu- rous salts was also the chief cause of acrodynia, a childhood disease that is now mainly of historical interest. 14 The clinical symptoms of acrodynia consist of painful, red, swol- len fingers and toes in association with photophobia, irritability, asthenia, and hyper- tension. It is believed to be a hypersensitivity reaction. m
Research was conducted to determine the significance of the deliberate use of mercury in products in Canada and the associated releases from these sources. Through a combination of literature review and new calculations, the reservoir, flux, and releases of mercury from eight product sources were calculated, and these results compared to historical Canadian inventories. Mercury contributions from the waste sector were also assessed and compared to total Canadian mercury releases and to mercury releases from coal-fired generating stations. Results suggest the use and release of mercury associated with release of mercury associated with its use in products is 4.5 times what previous inventories indicate. Including dental amalgam and sewage sludge, the total releases of mercury to all environmental compartments in Canada totals 20 tonnes per year. This accounts for less than one-half of the 44 tonnes per year of mercury released from mercury waste disposal each year in Canada. Waste mercury contributions from hazardous waste imports, unknown product sources, and incomplete information on the use of mercury in known products may account for this discrepancy. Waste-related mercury releases and transfers for disposal and recycling are 11 times greater than that of electricity generation in Canada. Results indicate that Canadian inventories have underestimated the significance of mercury use and release associated with products, calling into question the current priorities for mercury management. This paper was developed as part of a panel session at the International Joint Commission "Mercury in the Ecosystem" workshop, February 26-27, 2003, Windsor, ON, Canada, as a complement to the information on Canadian Inventories presented by Luke Trip (Senes Consulting, Ottawa, ON, Canada).
The objective of this study was to determine the effectiveness of a liquid and a dry commercial mercury vapour suppressant system. Measurements were made in a student dental clinic, using a mercury vapour detector for periods up to 76 weeks. The two products examined were Mercon vap liquid in a stock jar and the Mercon tainer dry jar system. Amalgam scrap jars were removed from the study when the mercury vapour concentration in the jars exceeded the arbitrary cut-off criterion of 0.05 mg Hg m(-3). Results showed that the mercury vapour concentration in the liquid system exceeded the cut-off criterion in 44 weeks or less, whereas the dry system remained below the detection limit (0.01 mg Hg m(-3)) for the maximum measurement period of 76 weeks. It was concluded that the dry system is more effective and reliable than the liquid system. The reliability of the liquid system may be influenced by contact of amalgam scrap with the portion of the inner wall of the jar that is not covered by liquid. It is proposed that amalgam scrap contaminates the wall with mercury during its insertion.
Although dental amalgam has been a restorative material for more than 150 years, government regulation of its use and disposal came much later with the creation of new federal laws and agencies. None of the federal laws regulating dental amalgam today were written specifically to regulate amalgam. Instead, these new laws and agencies were created to address broad public safety concerns, where little or no regulation existed before, in the areas of medical devices and drugs and environmental pollution. It is the interpretation and implementation of environmental laws that recently have had the greatest impact on dental practices.
Mercury has been used in both medicine and dentistry for centuries. Recent media attention regarding the increased levels of mercury in dietary fish, high levels of mercury in air emissions, and conjecture that certain diseases may be caused by mercury exposure has increased public awareness of the potential adverse health effects of high doses of mercury. Dentistry has been criticized for its continued use of mercury in dental amalgam for both public health and environmental reasons. To address these concerns, dental professionals should understand the impact of the various levels and types of mercury on the environment and human health. Mercury is unique in its ability to form amalgams with other metals. Dental amalgam--consisting of silver, copper, tin, and mercury--has been used as a safe, stable, and cost-effective restorative material for more than 150 years. As a result of this use, the dental profession has been confronted by the public on two separate health issues concerning the mercury content in amalgam. The first issue is whether the mercury amalgamated with the various metals to create dental restorations poses a health issue for patients. The second is whether the scraps associated with amalgam placement and the removal of amalgam restorations poses environmental hazards which may eventually have an impact on human health. Despite the lack of scientific evidence for such hazards, there is growing pressure for the dental profession to address these health issues. In this article, the toxicology of mercury will be reviewed and the impact of amalgam on health and the environment will be examined.
Mercury is a very useful metallic element that, while not particularly abundant in nature, can play an important role in the overall health of humans and animals. This article discusses the benefits and toxicological consequences of society's use of mercury. It also will focus upon the mining, processing, and uses of mercury in the United States, and then highlight the amounts of mercury that are released as wastes. Along the way, three important questions are addressed: How much mercury is released by human activities and by natural events? Do these releases pose a risk either to humans or to the environment in general? How does this information apply to dentistry?
Final report: Inventory of uses and releases of mercury during product life cycles
- Cc Doiron
- Associates
- Charles
- Napier
- Co
- Ltd
CC Doiron & Associates, Charles E Napier Co. Ltd. Final report: Inventory of uses and releases of mercury during product life cycles. Ontario: Environment Canada ARET Secretariat; 1998
Response (to amalgam safety) [Letter]
- B Soucy
Soucy B. Response (to amalgam safety) [Letter]. J Can Dent Assoc 2000; 66(9):476–7