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

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5. Mercury waste in dental practices in Kenya, Tanzania and Uganda

Best Waste Management Practice and Kenya, Dean, University Dental Hospital, Nairobi.

Presented by :Dr. Kisumbi on behalf of the Dean.

We have policy of medical waste management in Kenya

The National Injection and Related Medical Waste Management (RMWM) document has no mention of amalgam in it.

The curriculum entails training in the science of handling, application and management of waste amalgam.

It is mandatory for students store amalgam waste in fixer in specific sealed containers.

Dental amalgam particles from spittoon and suction percolate into reusable amalgam traps and filters in-built in the dental chairs.

There are no recycling plants for mercury in Kenya.

Behavioral change communication is key to adherence to best dental amalgam waste management practices.

Two studies done among dentists in Nairobi showed 2002,2010 50% and 70%.

The way forward:

  • Need to prevent dental caries.

  • Education to embrace BWMP (Best Waste Management Practice) to reduce mercury in waste water.

  • Support for Oral Health Services

5.1 Questions and answer session

  1. Q: Since there is no recycling plant in Nairobi, how can we ensure recycling is done?

A: We need to invite a recycler to East Africa to be included in action plan.

  1. Q: Today’s seminar concentrates mainly on East Africa from UNEP what is the concern on phasing down amalgam from other parts the world and developed world?

A: Some countries have done phase down.

  1. Q: Is “Phase down” used in regard to the consumption of amalgam or timelines?

A: The term phase down refers to reducing the use of amalgam. It is phase down and not phase out as we cannot do without amalgam as of now

  1. Q: Is the phase down drive coming from environmental concerns or human health concerns or both concerns?

A: The drive towards a phase-down in amalgam comes from both hence both WHO and UNEP involved.

  1. Q: What is the phase down timeline?

A: So far there is no timeline but there is a commitment to make a planned action on the phase down.

  1. Recommended a discussion for African states to be clear on approach to choose either phase down or phase out. This should be communicated to Kenyan delegation to INC5 so that it lobbies in our favor at the meeting.

6. Selection of Pilot Dental Facilities, Pam Clark, International Association of Dental Manufacturers

Amalgam Waste Management

  • Preparation when handling amalgam involves use of protective clothing including gloves, face mask and protective glasses. Protective clothing should also be utilized during amalgam disposal.

  • Place amalgam capsule remains (this is the non contact amalgam) in a container marked Amalgam Capsules.

  • Do not tip unused amalgam in the sink or garbage bins. Place signs at the sink for all staff to remember this.

  • Amalgam waste will be generated when polishing fillings or removing amalgam waste in the mouth. Place the contact amalgam in a container marked “Amalgam Waste”. Place any extracted teeth with amalgam fillings and anything caught in the chair filter in the Amalgam Waste container.

  • Cover the contents of the Amalgam Waste container with antibacterial solution. Never use bleach or any chlorine.

  • Empty the in-line suction filter in Amalgam Waste container.

  • Smaller amalgam particles will be captured by the separator which is installed prior to the Municipal drain point.

  • It is important to flush the dental unit with suction cleaner at the end of each day to kill micro-organisms. Do not use bleach as this will dissolve mercury out of the amalgam.

  • The separator will eventually get full. Never open the separator. Cap it off and remove it. Place it in a container which you will then place in another container awaiting collection by the recycler.

  • Never burn amalgam because it will release mercury fumes into the air, therefore never dispose amalgam in general rubbish.

6.1 Clinic Selection for Amalgam Separator for Project

  • Separators to be used are known as Sedimentation Separators and certified as ISO 11143 compliant.

  • To get ISO certification, separator must achieve a minimum efficient=y of capturing 95% of standard amalgam sample. Particles range in size from 100micron to 1micron.

  • The separator works by water passing through baffles that will catch amalgam particles. Water flow is regulated by flow regulators or capacitors

  • Installation requirements:

  • Should be near drain outlet

  • Suction system must be clean and free of debris and have no leaks

  • Piping used to connect separator must be kept straight and free of bends

  • Ensure there is a slight fall between suction system, waste header tank and separator or else amalgam will settle in pipes instead of separator

  • Maintenance:

  • Interim amalgam waste storage – interim waste storage may be necessary until commercially viable amount is ready for recycling.

  • Recommendation:

Proving that dentists can manage amalgam waste is a way to keep amalgam in the dentist’s tool to support amalgam storage

  • kit.

6.2 Question and Answer session:

  1. Q: What is the cost of a separator?

A: The separators shown during the presentation cost about $800 in Australia

A local dental equipment supplier confirmed they would give cost separator in Kenya.

  1. Q: Can an appeal be made to the government to reduce cost of separator which is an important but expensive piece of equipment

A: There may be an opportunity for funding once this project is complete and needs have been analyzed. Funding can only come if it is identified as a real need and that it is vitally important.

  1. Q: Are there separators available for alternative materials?

A: There are no separators available yet for non amalgam materials.
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