Dental Office Chemicals - Environmental assistance and

Dental Office Chemicals „ Dental Industry Overview „ Dental Office Injuries „ Chemicals Used „ Wastes Generated „ Waste Management Issues Tom Barron • Civil Engineer Sushma Dhulipala • SF Environment 1

Dental Industry Overview „ General Dentistry „ Pediatrics „ Endodontics „ Periodontics „ Prosthedonics

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Dental Office Sizes 10 - 19 9%

20 - 49 2%

50 - 99 0.1%

100 - 249 0.02%

5-9 27%

Number of People

1-4 62%

Source: US Census - California (Late 1990s) 3

Dental Office Layout „ Front Office „ Operatories „ Back Office „ „ „ „

Lab Areas Break Room Storage Utility Closet

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Lab / Work Areas „ Chemical Storage „ Ultrasonic Cleaner „ Sterilizer „ X-Ray Processor „ Medical Wastes „ Amalgam & Other

Chemical Wastes

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Utility Closet „ Air Compressor „ Hot Water „ Vacuum System

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Dental Office Injuries 900 800 700 600 500

Gloves Fixtures Chemical Instruments / Other Devices Other / Multiple Instruments / Sharps

400 300 200 100 1995

1996

1997

1998

1999

2000

2001

2002

Source: State of Washington 7

Chemical Injuries Other 25%

Skin 15%

Fumes 13% Ingested 1%

Eyes 46%

Source: State of Washington 8

Health & Safety Information „ Material Safety Data Sheet (MSDS) „ Product Labels & Use Instructions „ Professional Literature (CDA, ADA, etc.) „ Vendor Training Materials „ Loss Prevention Specialists

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Chemicals Dentists Use • 1 „ Photography

„ Hydroquinone

„ Infection Control

„ Silver

„ Hygiene Work

„ Glutaraldehyde

„ Restoration Work „ Lab Work „ Pharmaceuticals

„ Potassium Hydroxide „ Potassium Sulfite „ Sodium Thiosulfate „ Acetic Acid

„ Cleaning & Maint.

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Chemicals Dentists Use • 2 „ Photography „ Infection Control „ Hygiene Work „ Restoration Work „ Lab Work „ Pharmaceuticals „ Cleaning & Maint.

„ Sanitizers „ Ethyl Alcohol „ Triclosan „ Disinfectants „ Alcohols (Ethyl, Isopropyl) „ Quat. Ammonium Chloride „ Oxidizers (Bleach, H2O2) „ Phenylphenol „ Sterilizers „ Glutaraldehyde „ Orthophthaldehyde (OPA) „ Formaldehyde

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Chemicals Dentists Use • 3 „ Photography

„ Amalgam (Hg, Ag, Cu)

„ Infection Control

„ Glass Ionomer

„ Hygiene Work „ Restoration Work

„ Resin Composite „ Gold „ Porcelain

„ Lab Work

„ Tooth Whitener

„ Pharmaceuticals

„ Adhesives

„ Cleaning & Maint.

„ Disinfectants „ Antibiotics

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Chemicals Dentists Use • 4 „ Photography „ Infection Control „ Hygiene Work

Typical Cleaners With: „ „ „

„ Restoration Work

„

„ Lab Work

„

„ Pharmaceuticals „ Cleaning & Maint.

Detergents Surfactants pH Adjusters Builders Disinfectants

Concerns About : „ „ „

Endocrine Modifiers Low & High pH Bleach

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These Chemicals Generate Wastes … Hazardous Wastes „ Photo processing wastes „ Chemical sterilants „ Line cleaners Universal Wastes „ Amalgam wastes „ Hg lamps „ Computers etc. Medical Wastes ƒ Sharps ƒ Biohazardous ƒ Pharmaceuticals

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Photo Processing Wastes

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Lead Foils & Lead Aprons Hazardous?  Yes! Contain lead Disposal: Should be recycled 

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Photo Processing Wastes - 2 X‐Ray Developer Hazardous?  May contain hydroquinone  & glutaraldehyde Disposal: Used developer can go down  the drain.  But unused developer is a  hazardous waste.  Less‐toxic tip: Switch to digital

Fixer and Developer must NOT be mixed !! 16

Photo Processing Wastes - 3 Used X‐Ray Fixer Hazardous? Yes! Contains Silver Disposal: Recycle to reclaim silver Less‐toxic tip: Switch to digital

Fixer and Developer must NOT be mixed!! 17

Photo Processing Wastes - 4 X‐Ray Cleaner

Hazardous?  May contain Chromium Disposal: Treat as hazardous waste Less‐toxic tip: Switch to digital

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Photo Processing Wastes - 5 X‐Ray Film

Hazardous? Yes! Contains Silver Disposal: Recycle to reclaim silver Less‐toxic tip: Switch to digital

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Cleaning & Sterilization Wastes Hazardous? Yes! Contains glutaraldehyde Disposal: Treat on‐site & discharge to sewer Less‐toxic tip:  Autoclave or Dry heat oven

Chemiclave ~ Chemical based Ultrasonic Cleaners ‐ ??

Autoclave ~ Steam based

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Disinfectants Hazardous?: Contain a variety of  toxics (see MSDS) Disposal: Treat as hazardous  waste Less‐toxic tip: Fully use up  product, removing need for  disposal.

Bleach must NOT be used to clean vacuum lines!! 21

Amalgam Wastes „ Scrap amalgam „ “Empty” capsules „ Extracted teeth

Cuspidor

„ Chairside traps „ Vacuum screen

____________________ „ Gloves & gauze? „ Air filters? „ Instrument cleaning? „ Carpets?

Vacuum Suction

Vacuum Trap

Most amalgam goes here

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Amalgam Separators

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Universal Wastes Commonly found hazardous wastes that are generally less toxic and therefore, less regulated. E.g. -

„ Fluorescent Lamps „ Batteries „ Aerosol Cans „ Mercury Thermometers „ Computers

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Medical Wastes Sharps

Biohazardous

Pharmaceutical Recycle extracted teeth with amalgam.  Do NOT place in the Biohazard (RED) bin. 25

Surviving Inspections Strategies „ Schedule Appointment „ Confirm Day Before „ Ask for Checklist „ Focus on Key Points

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Acknowledgements This presentation is the product of a team effort involving a number of organizations and individuals. Today’s presenters wish to acknowledge the important technical contributions this team made, as well as the persistence with which individual members expressed their views. California Dental Association Bay Area Pollution Prevention Group Palo Alto RWQCP City of San Francisco Mid-Peninsula Dental Society Southern Alameda Co. Dental Society Union Sanitary District Betsy Elzufon, LWA Keith Linn, NEORSD Dr. Mark Stone, DDS, US Navy Dr. Jim Stevens, DDS Dr. Bryan Scott, DDS

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THE END

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Today’s Presenters Tom Barron Civil Engineer 3351 Beechwood Drive Lafayette, CA 94549 (925) 283-8121 [email protected]

Sushma Dhulipala San Francisco Environment 11 Grove Street San Francisco, CA 94102 (415) 355-3758 [email protected]

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