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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
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Dental Industry Overview

„ General Dentistry
„ Pediatrics
„ Endodontics
„ Periodontics
„ Prosthedonics

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Dental Office Sizes
20 - 49 50 - 99
10 - 19 2% 0.1%
9% 100 - 249
0.02%

5-9
27% 1-4
Number of People 62%

Source: US Census - California (Late 1990s)

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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
400 Gloves
Fixtures
300 Chemical
200 Instruments / Other Devices
Other / Multiple
100 Instruments / Sharps
-
1995 1996 1997 1998 1999 2000 2001 2002

Source: State of Washington

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Chemical Injuries

Other Skin
25% 15%

Fumes
13%
Eyes
Ingested 46%
1%
Source: State of Washington

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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


„ Potassium Hydroxide
„ Restoration Work
„ Potassium Sulfite
„ Lab Work „ Sodium Thiosulfate
„ Pharmaceuticals „ Acetic Acid
„ Cleaning & Maint.

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Chemicals Dentists Use • 2

„ Photography „ Sanitizers
„ Ethyl Alcohol
„ Infection Control „ Triclosan

„ Hygiene Work „ Disinfectants


„ Alcohols (Ethyl, Isopropyl)
„ Restoration Work „ Quat. Ammonium Chloride
„ Lab Work „ Oxidizers (Bleach, H2O2)
„ Phenylphenol
„ Pharmaceuticals „ Sterilizers
„ Cleaning & Maint. „ Glutaraldehyde
„ Orthophthaldehyde (OPA)
„ Formaldehyde

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Chemicals Dentists Use • 3

„ Photography „ Amalgam (Hg, Ag, Cu)


„ Glass Ionomer
„ Infection Control
„ Resin Composite
„ Hygiene Work
„ Gold
„ Restoration Work „ Porcelain
„ Lab Work „ Tooth Whitener
„ Pharmaceuticals „ Adhesives
„ Disinfectants
„ Cleaning & Maint.
„ Antibiotics

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Chemicals Dentists Use • 4

„ Photography Typical Cleaners With:


„ Detergents
„ Infection Control
„ Surfactants
„ Hygiene Work „ pH Adjusters
„ Restoration Work „ Builders
„ Disinfectants
„ Lab Work
Concerns About :
„ Pharmaceuticals „ Endocrine Modifiers
„ Cleaning & Maint. „ 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 -1

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 !!

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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!!

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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
Autoclave ~ Steam based
Ultrasonic Cleaners ‐ ??

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

„ Chairside traps
„ Vacuum screen Vacuum Suction
____________________
„ Gloves & gauze?
Vacuum Trap
„ Air filters?
„ Instrument cleaning?
„ Carpets?
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.

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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 Sushma Dhulipala


Civil Engineer San Francisco Environment
3351 Beechwood Drive 11 Grove Street
Lafayette, CA 94549 San Francisco, CA 94102
(925) 283-8121 (415) 355-3758
tsbarron@attglobal.net sushma.dhulipala@sfgov.org

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