18-19th Dec, 2012 Acknowledgement The East Africa Dental Project

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4. iLima Organization, Cecilia Ng’ang’a

Cecilia Ng’ang’a gave a brief on the iLima Organization.

iLima is a not for profit organization established in 2005.

iLima has been focusing on mercury pollution. It is an active participant in the on-going intergovernmental negotiating committee towards a legally binding instrument on mercury.

The project team comprises the iLima team and the research team:

The iLima team is:

  • Cecilia Ng’ang’a

The research team is:

  • Dr. B. Kisumbi

  • Dr. L. Gathece

  • Dr. L. Koiyo

  • Dr. Jane Wamai

4.1 Dental Amalgam and its Alternatives, Trade and Waste Management Practices, Dr. Benina Kisumbi

There are Country coordinators in the three countries:

  • Kenya – Dr. Benina Kisumbi

  • Uganda – Dr. Margaret Wandera

  • Tanzania – Prof. Febronia Kahabuka.


To conduct trade survey and survey current waste management practices of dental amalgam and its alternatives in East Africa, Kenya, Uganda and Tanzania

Specific objectives

  1. To assess dental amalgam trade flows and its alternatives in the three selected countries, Kenya, Uganda and Tanzania

  2. To assess the current practices of dental amalgam waste management and its alternatives in the three countries.

  3. To estimate the environment cost externalities/avoidance costs with non amalgam use


Study design: It was based on responses both on-line, email, and face to face interview surveys Study populations: all dentists and traders in dental materials in the three countries

It included all 1054 dentists registered with respective regulatory bodies and all 31 traders

Data collection tools: two self administered questionnaires. Online mode(Using survey monkey). An offline mode was later introduced which was a printed version

Data analysis: SPSS version 17.0

4.2 Results of waste management survey

Response rate: Kenya 8.5%, Uganda 1.7%, Tanzania 7.9% .

The overall response rate was 6.5%.

  • Online response not favorable especially in Tanzania

  • 70.6% held Bachelors degree with 84% being graduates of local universities.

  • More dental extractions are done than restorations

  • Amalgam ,composite resins & GIC restorations the more popular restoration materials

  • Only 48.5% of the dentists had concern on use of amalgam, 22.1% had concerns about non amalgam materials. Concerns were related to biological safety, none had concerns on environment, need for training on risks with emphasis on environmental risks.

  • On handling of amalgam, most dentists use capsulated amalgam but 10.3% used mercury liquid and powder. Only 11.8% had calibrated amalgamators. There is a high risk of mercury exposure in dental settings.

  • On handling of amalgam alternatives, 88.2% dentists used light cured resin composite 89.7% dentists mixed GIC manually,7.3% used computer aided design for ceramics,25% used fired ceramics. Modern technology needs to be developed among dentists*

  • On handling of waste amalgam, there is systematic way of disposing used amalgam capsules, extracted teeth with amalgam fillings are discarded with other infectious waste. Majority of dentists, 77.9%, did not separate contact amalgam and non contact amalgam. 16.2% decontaminate content of contact amalgam and non contact amalgam

  • Only one dentist knew of commercial company that disposes contact amalgam and non amalgam waste.

  • Only 5 of the facilities had a plan for disposal of amalgam waste.

  • Only 27.9% planned to install amalgam separators.

  • 48.5% mentioned using the minimal amount of amalgam for each restoration.

  • 54.4% use amalgam capsules.

  • 55.9% mentioned stocking of amalgam capsules in variety of sizes

  • On protection the use of latex gloves, face masks and eye glasses was universal

  • Most knew of at least one way of keeping minimum use of amalgam

  • Challenges in waste management were noted as:

      • Poor handling of amalgam waste due to lack of guidelines and policy.

      • Inadequate knowledge and training on waste management

      • Lack of seriousness and compliance on amalgam waste management

4.3 Results of trade survey

  • Response rate: Kenya 52.9%, Tanzania 0%, Uganda 20%. Overall response rate is 35.5% with only two completing the questionnaire fully. Online response was not favorable.

  • Supply of dental materials: Total amalgam supplied in last 12 months was approximately 2945kg.Private clinics are the major consumers of amalgam, emphasis on private clinics in phase down.

  • Amalgam and non amalgam dental restorative materials are widely supplied and used in East Africa.

  • Resin composites and GIC are the commonly supplied alternatives.

  • Costs of composites and GIC are higher than amalgam.

  • Capsulated amalgams mostly used but some facilities still procure and use liquid mercury and alloy powder.

  • Most suppliers met demand of clientele.

Challenges in supply of materials

  • Increase in cost of importation of mercury

  • Price fluctuations

  • Competition among traders

  • Brochure/manuals are in foreign language hence difficult to interpret

  • Low quality packaging

Limitation of the study

  • Low response rate of 6.5%

  • Online mode of administration of questionnaire was not favorable in our setting.

  • Bias as only I.T. competent respondents or those with internet access responded

  • Incomplete records


  1. Dental amalgam and non amalgam materials are widely used and supplied in the three countries.

  2. All restoratives materials are imported.

  3. There is regional/cross border trading across the three countries.

  4. Most prevalent treatment is dental extractions.

  5. Dental amalgam, resin composites and GIC are used widely.

  6. Capsulated amalgam is mostly used.

  7. Alternative materials used GIC and composites had higher costs than amalgam.

  8. Majority of dentists did not handle waste according to best dental amalgam practice guidelines.


  1. Develop guidelines and policies in supply, handling and waste management of dental restorative materials

  2. Incorporate a module in waste management in the present curricula.

  3. Financial support in getting separators and recycling plants is needed.

  4. Implement oral health promotion and preventive measures.

  5. Conduct a survey with a representative sample in the East Africa region.

  6. Assess the readiness(willingness of the dentists, appropriate equipment and infrastructure)in In poor countries.


All partners, UNEP, WHO global oral health program, Ministries of Environment and Health , Amalgam phase down Steering Committee, country respondents, national dental associations, country coordinators and the research team.

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