The American Dental Association (ADA) lists the sources of mercury exposure at the dental office, including removing amalgam fillings and polishing them. It also recommends that all personnel involved in the handling of mercury and dental amalgam be trained in the potential hazards of mercury vapor and the necessity of observing good mercury hygiene (Occupational Mercury Safe). This article proves that the ADA strongly promotes Mercury Safe dentistry. We want our patients to know that as an Occupationally Mercury Safe Dental Office we follow the ADA recommendations, even going behind what they suggest we do to protect the patient.
The American Dental Association has long recognized the importance of observing proper mercury hygiene practices for the safety of dental health care workers. The following recommendations were developed as an update of the ADA Council on Scientific Affairs’ 1999 recommendations1 to provide guidance to dentists in adopting an appropriate mercury hygiene program, ensuring the safety of all dental personnel involved in the handling of mercury or dental amalgam and minimizing the release of mercury into the environment. They are not intended to establish a standard of care or to set requirements that must be followed in all cases.
The current update
In February 2003, the ADA published Best Management Practices for Amalgam Waste.2 Dentists are strongly urged to follow the ADA Best Management Practices, or BMPs, and any that may have been adopted by their state or local dental associations. The ADA BMPs are available online in the members-only portion of the ADA Web site (“www.ada.org”); interested readers also can obtain a copy of the ADA BMPs by calling the ADA toll-free number, Ext. 2878, or 1-312-440-2878. Dentists are urged to include the ADA BMPs in their mercury hygiene training programs.
Background. The ADA has long recognized the importance of observing proper mercury hygiene practices for the safety of dental professionals. In 1999, the ADA Council on Scientific Affairs adopted mercury hygiene recommendations to provide guidance to dentists and their staff members for safe handling of mercury and dental amalgam. These mercury hygiene recommendations have been developed to update those previously adopted by the Council.
Overview. In addition to discussing sources of mercury in the dental office, this Council report describes office engineering considerations and hygiene recommendations to be used during preparation and placement of dental amalgam restorations. New information included in this report covers the management of mercury spills.
Practice Implications. These recommendations are intended to provide guidance to the dental practitioner in ensuring the safety of personnel who handle dental amalgam and in minimizing the release of mercury into the dental office environment.
Dental personnel potentially can be exposed to mercury through direct skin contact with mercury (or freshly mixed dental amalgam) or through exposure to the following potential sources of mercury vapors: accidental mercury spills; malfunctioning amalgamators, leaky amalgam capsules or malfunctioning bulk mercury dispensers. (although the ADA recommends against the use of bulk elemental mercury); trituration, placement and condensation of amalgam;
polishing or removal of amalgam; vaporization of mercury from contaminated instruments; and open storage of amalgam scrap or used capsules.
In case of an accidental mercury spill (regardless of size), the Council endorses the following recommendations5 :
A spill is considered small if there are less than 10 grams of mercury present (a pool no larger than the size of a quarter).6,7 Small spills can be cleaned safely using commercially available mercury cleanup kits and by observing the steps listed in the Michigan Department of Environmental Quality’s table entitled “Management of Mercury Spills.”8
A mercury spill is considered large if there are more than 10 g of mercury present (a pool larger than the size of a quarter).6,7 Cleanup of large mercury spills requires the use of an experienced environmental contractor who specializes in toxic spill cleanup. Contact your state or local Environmental Protection Agency office for a list of contractors who clean up toxic spills.
This report was prepared on behalf of the ADA Council on Scientific Affairs by Division of Science staff members Dr. Yasser Elseweifi; P.L. Fan, Ph.D.; Kathleen Todd; and Roger Connolly.
Address reprint requests to American Dental Association, Council on Scientific Affairs, 211 E. Chicago Ave., Chicago, Ill. 60611.
Copyright ©2003 American Dental Association. All rights reserved.
JADA, Vol. 134, November 2003 1499