What Every Dentist Needs to Know About the New Amalgam Regulations

Marc M. Sussman


Dealing with a new dental regulation may seem as appealing as getting a root canal, but the latest ruling is a smart step forward for both the dental community and the environment. Effective July 14, the US Environmental Protection Agency (EPA) is cracking down to reduce the amount of metals—including mercury—that end up in municipal sewage treatment plants (aka publicly owned treatment works, or POTWs).

Here’s why that matters. According to a 2005 study, dental offices are responsible for about 50% of the mercury that enters these treatment plants. After the wastewater is treated, mercury tends to stick around in the solid sludge material and may then enter the environment through landfilling, incineration, and other means.

When the pollutant lands in lakes, streams, or other bodies of water, microscopic organisms convert it into highly toxic methylmercury, which works its way up the aquatic food chain until it lands on your plate in form of a seemingly healthy tuna fish dinner. In high quantities, methylmercury can damage the nervous system, and it is especially risky for women who are pregnant or breastfeeding.

The new regulations are an effort to curb the dental industry’s role in this hazardous chain of events. In fact, the EPA expects that compliance will keep a whopping 5.1 tons of mercury, along with 5.3 tons of other metals, out of POTWs.

The ADA, which offered input as the EPA drafted the regulation, calls the standards a “fair and reasonable approach to the management of dental amalgam waste” and believes that the regulation is a better option to the previous patchwork of state-by-state rules. (Twelve states already have mandatory programs in place to reduce mercury discharge.) And dentists in the United States are in good company. Many of your colleagues abroad are complying with similar regulations under the Minamata Convention.

While the ruling goes into effect this month, existing dental offices have until July 14, 2020, to comply. New practices, however, will need to adopt the standards from the getgo. As the CEO of Dental Recycling North America, I’m well versed in what compliance entails, but understand that some practices may need to be brought up to speed. To help the dental community get on board with the new regulation, I’ve put together my top 4 tips.

Know the Requirements

It can take some time to read through the Federal Register’s 25 pages on the new standards, but here’s the nitty-gritty. The regulation requires most dental offices as well as dental schools and clinics to install amalgam separators.

These devices collect amalgam waste when a cavity is filled or removed, preventing it from ending up in sewage treatment plants. The mercury collected by these devices then can be recycled. Dental practices that already have amalgam separators in place may continue to operate them for their lifetime or 10 years, whichever comes first, as long as the devices comply with other rule requirements including operation and maintenance.

Dentists also will need to follow 2 best management practices. The first bans flushing waste or scrap dental amalgam into any drain. The second prohibits the use of certain cleaners for side traps and vacuum lines that solubilize mercury, increasing discharges. These include bleach, chlorine, iodine, and peroxide cleaners that have a pH lower than 6 or greater than 8.

Don’t Forget to File a Compliance Report

Practices that place or remove amalgam will need to submit a One-Time Compliance Report to Control Authorities with information on the facility’s operations and a certification showing that their amalgam separators meet requirements. If a third party is hired to maintain the office’s amalgam separators, this will also need to be stated in the report. (If your practice doesn’t work with amalgam except in limited circumstances, you’re not off the hook. You’ll also need to submit a one-time compliance report stating as such.)

Once the equipment is in place, dentists who don’t work with a waste management company must provide a description of what their office is doing to ensure proper operation and maintenance of the separator devices. The EPA recommends setting up reminders, whether in-office signs or calendar alerts, so that staff don’t forget to document monthly inspections and other procedures. If you work with a waste management company, however, you typically won’t need to worry about this step as it’s taken care of for you. 

Get an Early Start

True, you have until 2020 to comply, but procrastinating won’t save you money or make the transition any easier. The EPA estimates that the average cost to dental offices will be $800 a year. In the past, some states have offered financial incentives for early adopters. Partnering with a company that handles the amalgam recycling process from start to finish may make abiding by the new regulations less of a headache. 

Spread the Word

Green is in. A recent Pew Research survey found that 75% of American adults say they are particularly concerned about helping the environment as they go about their daily lives. Keeping pace with your patients’ ecofriendly lifestyles can earn you their respect and future business. Whether in-person or through newsletters, let your patients know about your practice’s new waste recycling program. They’ll be impressed to learn that you’re at the forefront of an effort to keep toxins out of our environment. 

Ready to adopt the new standards and set your practice up with amalgam separators? Find the complete guidelines for the new regulation here, or partner with dental waste management professionals who can walk you through the process.

Mr. Sussman is the founder, president, and CEO of Dental Recycling North America. He’s also the founder, president, and CEO of Dental Recycling International, which was created to operate in all markets outside the US. Some of the most renowned dental clinics in the United States, including the US Air Force Academy, the Cleveland Clinic, and the University of Colorado Dental School, have sought out DRNA’s 360° compliance solution for amalgam recycling requirements. He can be reached at mmsussman@drna.com.

Disclosure: Marc S. Sussman is the founder, president, and CEO of Dental Recycling North America and founder, president, and CEO of Dental Recycling International.

Related Articles

EPA Issues Final Rule Requiring Amalgam Separators

Environmental Group Sues to Reinstate Amalgam Separator Rule

Australian Government to Promote Voluntary Use of Amalgam Separators