Reducing Dental Mercury Releasesin

New Hampshire

Paul Lockwood (603) 271-2956plockwood@des.state.nh.us

2005 National Environmental Partnership SummitMay 8 – 11, 2006

(How to blend compliance

assistance with regulatory

enforcement)

Background: NH Mercury reduction efforts

Rules development process

Assistance and Rules implementation

Measurement results

Amalgam Rules Development & Implementation

inNew Hampshire

NH Mercury Reduction Strategy

www.des.state.nh.us(Reports & Documents)

NH Mercury Reduction Strategy

4.7.1 Recommended Actions Regarding

Dental AmalgamConduct outreach to the general public and dentist’s offices…to encourage the voluntary use of alternatives to mercury-containing amalgam and encourage the proper collection and disposal of waste amalgam.

Draft legislation…with an effective date of July 1, 2003 to prohibit the use of mercury-containing amalgam.

R-27

R-28

2002 Legislation

HB 1251 – “An Act relative to the use of mercury amalgam fillings by dentists.”

Introduced June, 2002 as a ban on the use of mercury-amalgam in New Hampshire

NH Mercury Reduction Strategy

2002 Legislation

Problems and Issues:

• Environmental or Public Health issue?

• Insurance issues

• Credibility of support data

• NH Dental Society support

HB 1251 – As a ban on mercury amalgam:

NH Mercury Reduction Strategy

2002 Legislation

• DES to draft rules relative to amalgam disposal (RSA 485-A:4 XVIII)

• DHHS to create pamphlet for dentists to provide to patients

HB 1251 – Final version required:

NH Mercury Reduction Strategy

Amalgam Management Rules Developmentin

New Hampshire

Rules Development Workgroup first met summer, 2002

Key issue = Enforcement

Is the best approach a discharge

limit?

or

a performance standard?

(over 1,250 dentists and over 600 facilities)

Performance Standard = Amalgam Separator

Issues:• Level of performance required?

• “Home built” technologies?

• Particulate and soluble Hg?

• Waivers and exemptions?

Amalgam Management Rules Developmentin

New Hampshire

Performance Standard = Amalgam Separator

Key issue still = Enforcement:

600 practices = 600 installations to

inspect and

monitor.

Amalgam Management Rules Developmentin

New Hampshire

Amalgam Management Rules Developmentin

New Hampshire

The Environmental Results Program (ERP) format offers best solution to managing a large regulated sector like dentists…

…especially if ERP has rules backing it up.

• installation of ISO 11143-certified amalgam separator

or

• practitioner is exempt or requesting waiver

Env-Ws 905 STANDARDS FOR MANAGEMENT OF MERCURY-CONTAINING AMALGAMRequires written self-certification from “owner of the practice”:

Amalgam Rules Implementationin

New Hampshire

Exemption for:

• Orthodonists, periodontists, oral or maxillofacial surgeons, oral pathologists, oral or maxillofacial radiologists who don’t generate amalgam wastes

• Retired & out-of-state practitioners (NH licensed but not practicing in NH)

Amalgam Rules Implementationin

New Hampshire

Waiver for:

• “de minimis” discharge of up to 0.5 gram Hg/year (= 1 gram amalgam = 2 fillings)

• equivalent alternative technology

• “zero discharge” (holding tank)

Amalgam Rules Implementationin

New Hampshire

Concurrent to Rules Development (2003 – 2005):

• Surveys & outreach with NH Dental

Society• Information provided at annual

conferences• Articles in journals, newspapers, etc.• Site visits to dental facilities• Best Management Practices manual

Amalgam Rules Implementationin

New Hampshire

Initial Notification July 8, 2005

1,260 Licensed practitioners notified

10% response in first two weeks even though none required until October 1.

Amalgam Rules Implementationin

New Hampshire

Early issues & problems:

• Mobile units & schools

• Semi-retired or not in state

• “Amalgam-free” practitioners

• Endodontists

Amalgam Rules Implementationin

New Hampshire

Results as of J anuary, 2006

out of 1261 dentists

40%

Has amalgam

separator installed

(500)

15%

Exempt

(187)

20%

Retired/Not

in NH

(256)

25%

Haven't

Responded

(318)

Amalgam Rules Implementationin

New Hampshire

Next steps:

• Project turned over to enforcement staff January, 2006

• Recalcitrants are being contacted.

• Requests for de-minimis waivers will be reviewed.

• Random sampling to determine accuracy of self-

certification.

Amalgam Rules Implementationin

New Hampshire

Measurement:Outputs (beans) – 367 surveys completed

860 BMP Guides distributed5 presentations provided7 site visits performed

etc., etc.

Outcomes (behavioral changes)

2002 – Separators in use = 12 dentists = 1%2005 – Separators in use = 500 dentists = 40%Baseline survey is crucial to establish changes!

Amalgam Rules Implementationin

New Hampshire

Environmental Indicators (“hard” numbers)

Measurement:

Dental Mercury Generation Rates:NH % of National Releases 6.34 tons (Environ Report) x .004 (NH population) = 52 lbs/year/900 practicing dentists = 0.06 lbs/dentist/yearPer Chair Generation Rate:240 mg/chair/day x 4 days/wk x 48 weeks/454 grams/lb = 91 lbs/dentist/year/900 practicing dentists = 0.10 lbs/dentist/year

500 dentists x 0.06/lbs/yr x 95% separator efficiency = 28.5 lbs Hg recycled

Amalgam Rules Implementationin

New Hampshire

Conclusions:

The Environmental Results Program (ERP) model is effective for addressing the dental sector. The ERP format can also be used to help develop regulations making their implementation easier.

ERP is also useful for today’s “results-driven” projects and programs.

Amalgam Rules Implementationin

New Hampshire

Reducing Dental Mercury Releasesin

New Hampshire

What’s the real P2 solution?

Not this…

Reducing Dental Mercury Releasesin

New Hampshire

What’s the real P2 solution?

…but this!!!