Ministry of environment, water and natural resources state department of natural resources report of the kenya implementation of the



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4.2 Practice guidelines and standardisation


The presence of written guidelines for handling both health care waste and restorative materials waste did exist in 21(84%) of the facilities Table 3. Similarly, 24 (96%) of the dentists did not have certificate for amalgamator calibration. Only one (4%) had calibration certificate.

Guideline

Number

Percentage

No Health care management guideline

21

84

Health care management guideline present

4

16

Table 3. Presence of written health care guidelines in the dental facilities

4.3 Handling of dental amalgam and dental amalgam waste


Majority of the dentists used capsule mixing amalgamators 22 (88%) where as 4 (12%) used mercury liquid and alloy mixing devices.

Less than half 11 (44%) of the respondents reported that they had containers designated for waste dental amalgam, seven (28%) did not have such containers and a similar number declined to answer the question.

Facilities that had containers for storing waste restorative materials practiced the following

Practice




Number

Percentage

Restorative waste containers labelled?

Yes

8

32

No

8

32

No response

7

28

Do the containers have a tight seal

Yes

8

32

No

11

44

No response

6

24

Storage of surplus accumulated waste amalgam

No

1

4

Yes

22

88

No response

2

8

Table 4. Disposal of waste restorative materials

With regard to trapping waste amalgam particles in waste water, ten (40%) responded that they had chair side traps in their clinics, 2 (8% vacuum filters and one (4%) had installed an amalgam separator.


4.4 Trade and Supply of Restorative Materials


Nine dental material suppliers completed the questionnaire.

4.4.1 Stocking and supply of restorative materials


Almost all the traders stocked Dental amalgam, Resin composite and Glass ionomer cements as shown in Table 5.

Material stocked

Number

Percentage

Dental amalgam

8

88.9

Resin Composite

8

88.8

Glass ionomer cements

9

100

Compomers

3

12

Ceramics

5

55.6

The most types sold most by the suppliers is dental amalgam 4 (44.4%), followed by non-amalgam alternatives 2 (22.2%). Two (22.2%) indicated that they sell both types equally.

Of the amalgam stocked by the suppliers, 6 (66.7%) sold capsulated version, 2 (22.2%) elemental mercury and alloy powder and one (11.1%) did not stock amalgam. With regard to type of dental amalgam sold, demanded more 8 (88.8%) indicated capsulated version whereas one (11.1%) it was elemental mercury and alloy powder. No supplier repackaged dental amalgam.

The traders imported restorative materials from the companies shown in Table 6.


Dental amalgam source

Non-dental amalgam source

Medespa (Spain)

PSP Dental

Incidental (Turkey)

Dentsply (UK)

Dentam (UK)

GC Fuji

BMS (Italy)

3M ESPE

Citem (Dubai)

Henry Schein

Quale (UK)

PD Switzerland

SDI (Australia)

SDI Australia

Dentsply (UK)

Ivoclar Germany

Utradent (USA)




Table 6. Source of restorative materials by the traders

All traders 9 (100%) sold the restorative materials in both urban and rural parts of the country. Only 3 (33.3%) sold internationally to eight countries. Of the suppliers who sold filling materials internationally, all (100%) sold to Tanzania, whereas two thirds 2 (66.7%) sold to Uganda Table 7.



Country

Number of suppliers

Percentage

Tanzania

3

100

Uganda

2

66.7

Rwanda

1

96

Zambia

1

33.3

Nigeria

1

33.3

Malawi

1

33.3

Ethiopia

1

33.3

Burundi

1

33.3

Table7. Distribution of countries sold to by the traders

The most demanded capsule size of dental amalgam was F2 6 (66.7%), followed by F1 and F3 by 5 (55.6%).

Of the sample five responded when asked the amount of dental amalgam materials stocked; 25kgs, 25gs, 20Kgs, 10 kgs, 5kgs, 4kgs a total of 89Kgs. Only one supplier stocked mercury liquid 20Kgs and Alloy powder 5 Kgs.

With regard to the amount of dental amalgam sold per month, six suppliers responded to the question. The amount ranged from 1-25Kgs with a total of 51Kgs. The one supplier who stocked mercury liquid and alloy powder sold 4 Kg each per month.



Conclusions

  • Within the limitations of this studies;

  • The use of alternatives is high as realised in the baseline. All clinics that do restorations was the high and 100% in the facilities.

  • BMP is known to professionals theoretically but practiced by a few.

  • Traders stock and sell mostly capsulated but some still liquid mercury and alloy powder. The demand for it still exists!

The results of this validation were presented in the Results workshop in Tanzania which is hereby attached.
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