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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 2 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 4 Lab / Work Areas Chemical Storage Ultrasonic Cleaner Sterilizer X-Ray Processor Medical Wastes Amalgam & Other Chemical Wastes 5 Utility Closet Air Compressor Hot Water Vacuum System 6 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 9 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. 10 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 11 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 12 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 13 These Chemicals Generate Wastes … Hazardous Wastes Photo processing wastes Chemical sterilants Line cleaners Universal Wastes Amalgam wastes Hg lamps Computers etc. Medical Wastes Sharps Biohazardous Pharmaceuticals 14 Photo Processing Wastes -1 Lead Foils & Lead Aprons Hazardous? Yes! Contain lead Disposal: Should be recycled 15 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 18 Photo Processing Wastes - 5 X‐Ray Film Hazardous? Yes! Contains Silver Disposal: Recycle to reclaim silver Less‐toxic tip: Switch to digital 19 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 20 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 22 Amalgam Separators 23 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 24 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 26 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 27 THE END 28 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] 29
