Biomedical Waste

Management:
Dental Perspective

Dr. Abhinav Sood

Consultant Prosthodontist
drabhinavsood@gmail.com
 Importance of Biomedical Waste
Management in Dental Setting

 Inspite of being a predominantly Out-Patient

Set up – the waste produced is critical not only
in quantum but also due to its hazardous
nature

 Legislations to regulate are not very stringent,

awareness is low and there is laxity in
execution of correct practices
 Healthcare delivery system (Govt.)
Govt. Medical/Dental Colleges & Tertiary care centres

District Hospitals

Community Health Centre

Primary Health Centre

Sub Centre
 Healthcare delivery system (Private)
 Private Dental Clinics
 Private Dental Hospitals
 Private Polyclinics
 Dental units in Private Hospitals/Corporate
Hospitals
 Private Dental Colleges/ Dental wing in Pvt.
Medical Colleges
Dental Auxiliaries
 Still largely unorganized Dental Laboratory
Sector – Regulations lax
 Dental Hygienists - Not utilized to the
potential
 Dental Assistants (No formal training
available)
 Quackery Prevalent
 Paradigm Shift

Waste disposal

Biomedical Waste Management

Classification as per Biomedical
Waste (Management & Handling)
Rules 1998
 Human Anatomical Waste
(Category 1)
 Pathological waste –
- Extracted/ Exfoliated teeth (teeth with amalgam
restorations to be separated)
- Biopsy tissue specimens
- Resected human tissue (oral & maxillofacial surgery)

Incineration/Deep Burial
 Waste Sharps (Category 4)
 The term sharp means any sharp or pointed object that can
penetrate the skin or oral mucosa. In dentistry, the most common
types of sharps are:
- Needles, Suture Needles
- Scalpel blades and disposable scalpels
- Exposed ends of dental arch wires
- Broken glass
(broken contaminated glass -anaesthetic carpoules)
- Burs and endodontic instruments
Needle disposal unit.
Disposal of Sharps- Blue/White/Translucent
Puncture proof container with Biohazard sign
1% Hypochlorite disinfection followed by shredding
 Soiled Waste (Category 6)
 Blood / saliva soiled
- Gloves, cotton rolls, gauze,
Impression materials removed from
trays, used x-ray film cover, RVG
sensor /Intraoral camera protective
covers, surgical disposables, soiled
models and casts

Saliva is considered to be a OPIM

Autoclaving followed by shredding

 Solid Waste (Category 7)
 Waste Generated from disposable items not
contaminated with blood/saliva

Autoclaving followed
by shredding (prevents
reuse)
 Chemical Waste (Category 10)
 Mercury from amalgam, Base metal debris*
 Radiography – Developer & Fixer*
 Organic Solvents – Methylmethacrylate monomer
in Prosthodontics
 Etchants – Orthophosphoric acid, Hydrofluoric
Acid
 Formaldehyde ( To preserve specimens in oral
surgery, oral diagnosis and oral pathology depts.)
 Disinfectants – Gluteraldehyde, ethanol,
isopropanol, sodium hypochlorite

Chemical Treatment & Discharge into drains for Liquids

Black container for solids – Secured Landfill
Managing silver and lead waste
Silver in used radiographic fixer solutions
Send used fixer solution to a silver reclaiming
facility.
Send it to a medical radiology lab or a commercial
photographic processing lab, on agreement.
 .
Lead foil in intraoral radiograph film packets.
Should be collected and recycled through a licensed
facility.
The same would apply to lead aprons and lead
collars.

LEAD CARELESSLY THROWN AS

GENERAL WASTE
 General Waste

Disposed in secured landfills

Key to Management – Segregation at
Source

MIXING OF WASTE
PURPOSE DEFEATED
 Mercury in
Dental Health
Care
 Dental Caries
High Prevalence - 40-55 % in 12 -15 year olds 50-60 % in Adults

Initial Severe Tooth

Loss
Restoration Root Canal
Restorations –amalgam, tooth coloured
bonded fillings

- Virtually Painless
-Short Sittings- even Root Canals in a single appointment
Dental Amalgam

In use since 1833- Crawcour brothers

 Survey of Practice Types
General Dentists

32%
Amalgam
Amalgam
Free
Users

68%

Haj-Ali, Gen Dent 2005

“Even with the concern about the
disposal of mercury, this
textbook advocates the
continued use of amalgam as a
direct restorative material….”

Pg. 653, Sturdevant’s Art & Science of

Operative Dentistry, 4th Edition, 2002

POSITION STATEMENTS OF MOST

NATIONAL DENTAL GOVERNING
BODIES RECOMMENDS USE OF
DENTAL AMALGAM ALBEIT WITH
PROPER MANAGEMENT
 The other side of the coin…
 Legislation restricting and in some
cases phasing out the amalgam has
been implemented in-
- Japan
- Denmark
- Sweden
- Denmark
- Germany
Dental amalgam is safe only if we take
adequate precautions for Mercury
Management – But Do We Really Do????
 Methyl Mercury – Highly toxic crosses BBB
 Mercury toxic when inhaled, ingested and
even contact with skin
 Detrimental to – nervous, digestive
respiratory, immune system, lungs and kidneys
- Minamata Bay, 1956
 OSHA mercury vapour limit- 50
microgram/m3 (time weighted avg.) in any 8
hour work shift over 40 hour work week.
 In effluent water 0.2 microgram/L
 Types of amalgam waste
 Scrap amalgam
 Contact – cotton rolls with amalgam,
amalgam derived from finishing of
new/removal of old amalgam/ tooth
preparation for Fixed Prosthodontics
 Non Contact – Unused extra amalgam,Used
capsules, spilled mercury/ amalgam
 Extracted teeth with amalgam fillings
 Amalgam from chairside traps, amalgam
separators and vacuum pump filters
24
Amalgam disposal
Three aspects of amalgam waste may be
considered.
Amalgam scrap.
Other waste contaminated with
amalgam.
Amalgam in waste water.
 
 Amalgam scrap:
Stored under spent radiographic fixer solution in a
covered container with airtight lid. Should be
recovered and recycled whenever possible.

It should not be disposed with waste that would

be eventually incinerated since amalgam
decomposes on heating
Other waste contaminated with amalgam:
- like amalgam capsules

- extracted teeth with amalgam restorations

- cotton rolls and gauze with amalgam particles

Teeth with amalgams could release mercury vapor

during incineration, thus, they should be
disinfected and stored in an airtight bottle and sent
for recycling or deep burial.
Amalgam in waste water:
1. Chairside traps and vacuum pump
filters
2. Amalgam separators
They are devices used to remove amalgam waste
particles in dental office discharge .
Best Management Practices for
Dental Amalgam Use & Waste
 Don’t use bulk mercury
(Eliminates spills) -Use
amalgam in recapsulated
form with amalgamator

 Have multiple sizes of

capsules to avoid wastage
 Best Management Practices for
Dental Amalgam Use & Waste
 Non Contact (Scrap) Amalgam & Empty
capsules after mixing

- Place it in wide mouthed container for

recycling
- Container lid should be well sealed
- When container is full – Send to recycler
 Best Management Practices for
Dental Amalgam Use & Waste
Disposable chair side traps
- When full send to recycler

Reusable chair side traps

- Remove trap and empty waste in wide mouthed
airtight container for recycling amalgam
- Don’t wash trap with water as it will
contaminate water stream
 Use of Alternative Materials
 Direct Composite Restoration
 Indirect Composite Restoration
 Ceramic Inlays/Onlays
 Cast Gold restorations
 New mercury free alloys – based on gallium
and indium ( Eg: Galloy)
 Miracle Mix
 COMPOSITE
RESINS

PROS CONS
 AESTHETIC – AVAILABILITY  POST OPERATIVE
IN MULTIPLE SHADES SENSITIVITY
 CONTROL SET- LIGHT  TECHNIQUE SENSITIVE
CURED  COST FACTOR
 MECHANICAL PROPERTIES  MECHANICAL PROPERTIES
SUFFICIENT FOR CLINICAL INFERIOR TO AMALGAM
LONGEVITY  COSTLY
 SAFE
Management of mercury spills
-Wear protective gloves, eyewear & mask.
-Never use a vacuum cleaner, broom or paintbrush or
household cleaning products like ammonia or chlorine.
Never touch with bare hands. Avoid contact with gold
jewelry
-Never allow mercury to go down the drain
- In case the shoes are contaminated with the spilt
mercury, the person is asked not to walk around or leave
the spill area until the contaminants are removed
- Switch off airconditioner and open windows for fresh
air ventilation
Mercury spills are cleaned up properly
by using:

- Stiff paper to pick up droplets

- A syringe with water to suck mercury

- Sticky tapes, or fresh mixes of amalgam
to pick up droplets,

- Commercial clean up kits

Collect mercury in a wide mouthed bottle

with airtight lid containing spent fixer/
water/ glycerin
 Need of the Hour
 Focus on BMW Management in Curriculum
both UG and PG programmes
 CHCMW – as CDE .
 Regulations and strict enforcements of Best
Use practices
 Development of recycling facilities
 Focus on alternatives
 Legislation to restrict or stop use of dental
amalgam
Thank You