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Dental Office Chemicals

Tom Barron • Civil EngineerSushma Dhulipala • SF Environment

Dental Industry Overview

Dental Office Injuries

Chemicals Used

Wastes Generated

Waste Management Issues

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Dental Industry Overview

General Dentistry

Pediatrics

Endodontics

Periodontics

Prosthedonics

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Dental Office Sizes

5 - 927%

10 - 199%

1 - 462%

20 - 492%

50 - 990.1%

100 - 2490.02%

Source: US Census - California (Late 1990s)

Number of People

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Dental Office Layout

Front OfficeOperatoriesBack Office

Lab AreasBreak RoomStorageUtility Closet

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Lab / Work Areas

Chemical StorageUltrasonic CleanerSterilizerX-Ray ProcessorMedical WastesAmalgam & Other Chemical Wastes

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Utility Closet

Air CompressorHot WaterVacuum System

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Dental Office Injuries

-100200300400500600700800900

1995 1996 1997 1998 1999 2000 2001 2002

GlovesFixturesChemicalInstruments / Other DevicesOther / MultipleInstruments / Sharps

Source: State of Washington

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Chemical Injuries

Fumes13%

Other25%

Ingested1%

Eyes46%

Skin15%

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

PhotographyInfection ControlHygiene WorkRestoration WorkLab WorkPharmaceuticalsCleaning & Maint.

HydroquinoneSilverGlutaraldehydePotassium HydroxidePotassium SulfiteSodium ThiosulfateAcetic Acid

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Chemicals Dentists Use • 2

PhotographyInfection ControlHygiene WorkRestoration WorkLab WorkPharmaceuticalsCleaning & Maint.

SanitizersEthyl AlcoholTriclosan

DisinfectantsAlcohols (Ethyl, Isopropyl)Quat. Ammonium ChlorideOxidizers (Bleach, H2O2)Phenylphenol

SterilizersGlutaraldehydeOrthophthaldehyde (OPA)Formaldehyde

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Chemicals Dentists Use • 3

PhotographyInfection ControlHygiene WorkRestoration WorkLab WorkPharmaceuticalsCleaning & Maint.

Amalgam (Hg, Ag, Cu)Glass IonomerResin CompositeGoldPorcelainTooth WhitenerAdhesivesDisinfectantsAntibiotics

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Chemicals Dentists Use • 4

PhotographyInfection ControlHygiene WorkRestoration WorkLab WorkPharmaceuticalsCleaning & Maint.

Typical Cleaners With:DetergentsSurfactantspH AdjustersBuildersDisinfectants

Concerns About :Endocrine ModifiersLow & High pHBleach

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These Chemicals Generate Wastes …

Hazardous WastesPhoto processing wastesChemical sterilantsLine cleaners

Universal WastesAmalgam wastesHg lampsComputers etc.

Medical WastesSharpsBiohazardousPharmaceuticals

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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

Fixer and Developer must NOT be mixed !!

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

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Photo Processing Wastes - 3

Fixer and Developer must NOT be mixed!!

Used X‐Ray Fixer

Hazardous? Yes! Contains Silver

Disposal: Recycle to reclaim silver

Less‐toxic tip: Switch to digital

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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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Hazardous? Yes! Contains glutaraldehyde

Disposal: Treat on‐site & discharge to sewer

Less‐toxic tip:  Autoclave or Dry heat oven

Ultrasonic Cleaners ‐ ??

Cleaning & Sterilization Wastes

Chemiclave ~ Chemical based

Autoclave ~ Steam based

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Disinfectants

Bleach must NOT be used to clean vacuum lines!!

Hazardous?: Contain a variety of toxics (see MSDS)

Disposal: Treat as hazardous waste

Less‐toxic tip: Fully use up product, removing need for disposal.

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Scrap amalgam“Empty” capsulesExtracted teethChairside trapsVacuum screen

____________________Gloves & gauze?Air filters?Instrument cleaning?Carpets?

Amalgam Wastes

Cuspidor

Most amalgam goes here

Vacuum Suction

Vacuum Trap

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Amalgam Separators

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Universal WastesCommonly 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

Recycle extracted teeth with amalgam.  Do NOTplace in the Biohazard (RED) bin.

Sharps

Biohazardous

Pharmaceutical

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Surviving Inspections

StrategiesSchedule AppointmentConfirm Day BeforeAsk for ChecklistFocus 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 AssociationBay Area Pollution Prevention GroupPalo Alto RWQCPCity of San FranciscoMid-Peninsula Dental SocietySouthern Alameda Co. Dental SocietyUnion Sanitary DistrictBetsy Elzufon, LWAKeith Linn, NEORSDDr. Mark Stone, DDS, US NavyDr. Jim Stevens, DDSDr. Bryan Scott, DDS

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THE END

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Tom BarronCivil Engineer3351 Beechwood DriveLafayette, CA 94549(925) 283-8121tsbarron@attglobal.net

Today’s Presenters

Sushma DhulipalaSan Francisco Environment11 Grove StreetSan Francisco, CA 94102(415) 355-3758sushma.dhulipala@sfgov.org