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Study on Potential for Reducing Mercury Pollution from Dental Amalgam and Batteries

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Study on Potential for Reducing Mercury Pollution from Dental Amalgam and Batteries Study on the potential for reducing mercury pollution from dental amalgam and batteries Final report European Commission – DG ENV 11 July 2012 Document information CLIENT European Commission – DG ENV 07.0307/2011/594114/SER/C3 CONTRACT NUMBER REPORT TITLE Final report Study on the potential for reducing mercury pollution PROJECT NAME from dental amalgam and batteries DATE 11 July 2012 AUTHORS Mr. Shailendra Mudgal, BIO Ms. Lise Van Long, BIO Mr. Andreas Mitsios, BIO Mr. Sandeep Pahal, BIO Ms. Arianna De Toni, BIO Dr. Lars Hylander, Uppsala University KEY CONTACTS Shailendra Mudgal + 33 (0) 1 53 90 11 80 [email protected] Or Lise Van Long + 33 (0) 1 53 90 11 80 [email protected] ACKNOWLEDGEMENTS The project team would like to thank all the stakeholders who provided input to this study. DISCLAIMER The project team does not accept any liability for any direct or indirect damage resulting from the use of this report or its content. This report contains the results of research by the authors and is not to be perceived as the opinion of the European Commission. Please cite this publication as: BIO Intelligence Service (2012), Study on the potential for reducing mercury pollution from dental amalgam and batteries, Final report prepared for the European Commission – DG ENV Photo credit: cover @ Per Ola Wiberg 2 | Study on the potential for reducing mercury pollution from dental amalgam and batteries Table of Contents EXECUTIVE SUMMARY 9 CHAPTER 1: INTRODUCTION 27 1.1 The mercury issue 27 1.2 EU policy context 29 1.3 International policy context 29 1.4 Objectives of the study 30 1.5 Overall approach, methodology and timeframe 31 1.6 Document structure 34 PART A: ASSESSMENT OF POLICY OPTIONS TO REDUCE ENVIRONMENTAL IMPACTS FROM DENTAL AMALGAM USE 35 CHAPTER 2: PROBLEM DEFINITION AND OBJECTIVES 37 2.1 Introduction 37 2.2 Policy context 37 2.2.1 EU policy context 37 2.2.2 Initiatives in EU Member States 39 2.2.3 International policy context 40 2.3 Problem definition 40 2.3.1 Dental amalgam use 40 2.3.2 Environmental aspects of dental amalgam use 41 2.3.3 Health aspects of dental amalgam use 45 2.4 Who is affected? 47 2.5 Justification for an EU action 48 2.6 Baseline scenario 48 2.6.1 Demand for dental amalgam and other filling materials 49 2.6.2 Environmental aspects 60 2.6.3 Economic aspects 61 2.6.4 Social aspects 74 2.7 Policy objectives 79 CHAPTER 3: POLICY OPTIONS 81 3.1 Policy options selected for further analysis 81 3.2 Policy options excluded from the analysis 84 Study on the potential for reducing mercury pollution from dental amalgam and batteries | 3 CHAPTER 4: ANALYSIS OF IMPACTS 85 4.1 Environmental impacts 85 4.1.1 Option 1 85 4.1.2 Option 2 86 4.1.3 Option 3 87 4.2 Economic impacts 88 4.2.1 Option 1 88 4.2.2 Option 2 90 4.2.3 Option 3 95 4.3 Social impacts 99 4.3.1 Option 1 99 4.3.2 Option 2 99 4.3.3 Option 3 101 4.4 Other impacts 102 CHAPTER 5: COMPARISON OF OPTIONS AND CONCLUSIONS 103 5.1 Comparison of policy options 103 5.2 Conclusions 108 PART B: ASSESSMENT OF POLICY OPTIONS TO REDUCE ENVIRONMENTAL IMPACTS FROM MERCURY-CONTAINING BATTERIES 111 CHAPTER 6: PROBLEM DEFINITION AND OBJECTIVES 113 6.1 Introduction 113 6.2 Policy context 114 6.2.1 EU policy context 114 6.2.2 International policy context 115 6.3 Problem definition 115 6.3.1 The mercury problem 115 6.3.2 Specific issues related to mercury-containing button cell batteries 116 6.4 Who is affected? 118 6.5 Baseline scenario 118 6.6 Justification for an EU action 120 6.7 Policy objectives 121 CHAPTER 7: POLICY OPTIONS 123 7.1 Policy options selected for further analysis 123 7.2 Policy options excluded from the analysis 124 4 | Study on the potential for reducing mercury pollution from dental amalgam and batteries CHAPTER 8: ANALYSIS OF IMPACTS 125 8.1 Selection of impact categories and indicators 125 8.2 Environmental impacts 126 8.2.1 Option 1 (‘no policy change’) 126 8.2.2 Option 2 128 8.3 Economic impacts 128 8.3.1 Option 1 (‘no policy change’) 128 8.3.2 Option 2 129 8.4 Social impacts 131 8.4.1 Option 1 (‘no policy change’) 131 8.4.2 Option 2 132 CHAPTER 9: COMPARISON OF OPTIONS AND CONCLUSIONS 133 9.1 Comparison of options 133 9.2 Conclusions 135 ANNEXES 137 ANNEX A: QUESTIONNAIRE TO MEMBER STATES 139 ANNEX B: OVERVIEW OF POLICY MEASURES CONCERNING DENTAL AMALGAM 146 ANNEX C: ASSESSMENT OF ENVIRONMENTAL EMISSIONS FROM DENTAL AMALGAM USE 150 ANNEX D: LITERATURE REVIEW ON HEALTH EFFECTS OF USING DENTAL AMALGAM 178 ANNEX E: ADDITIONAL DATA FROM THE MARKET REVIEW ON DENTAL AMALGAM AND MERCURY-FREE ALTERNATIVES 187 ANNEX F: ADDITIONAL DATA ON ENVIRONMENTAL COSTS OF DENTAL AMALGAM USE 207 ANNEX G: MARKET REVIEW OF BUTTON CELL BATTERIES IN EU 212 ANNEX H: USE OF AMALGAM SEPARATORS 220 ANNEX I: AMALGAM WASTE DATA 225 ANNEX J: SEWAGE SLUDGE MANAGEMENT STATISTICS 228 ANNEX K: MERCURY CONTENT OF SEWAGE SLUDGE 232 ANNEX L: MERCURY EMISSIONS FROM CREMATORIA 234 ANNEX M: STATISTICS ON DENTAL HEALTH 243 Study on the potential for reducing mercury pollution from dental amalgam and batteries | 5 List of Tables Table 1: Overview of economic impacts associated with the two policy options 24 Table 2: Assumptions on future dental amalgam demand in the baseline scenario 57 Table 3: Estimated costs for amalgam separators by size of dental office in the USA (EUR) 63 Table 4: Average dental restoration costs borne by patients 65 Table 5: Additional costs borne by patients (EUR) in the baseline scenario, for the period 2010- 2025 70 Table 6: Examples of BPA-free composite dental materials 78 Table 7: Additional costs borne by patients under Policy Option 2, for the period 2010-2025 93 Table 8: Additional costs borne by patients under Policy Option 3, for the period 2010-2025 97 Table 9: Overview of key impacts associated with the policy options analysed, over a 15-year horizon (2010-2025) 106 Table 10: List of impact categories and the corresponding methods of evaluation 125 Table 11: Mercury contained in button cells placed on EU market from 2006 until 2010 127 Table 12: Semi-quantitative score matrix 133 Table 13: Comparison of the two policy options according to economic, environmental and social indicators 134 Table 14: Overview of MS and international legislation and best practices going beyond EU policy 146 Table 15: Share of dental facilities equipped with dental amalgam separators 159 Table 16: Projections on sewage sludge management options in EU27 (in % of total sludge produced) 167 Table 17: Comparison between dental Hg release estimates and overall Hg releases in the EU 176 Table 18: Estimation of annual dental mercury demand per Member State 188 Table 19: Estimated shares of dental amalgam and Hg-free restorations in 2010 190 Table 20: Expected future trends in dental restorations and use of dental filling materials (based on replies to study questionnaire) 192 Table 21: Estimated demand for dental mercury in 2025, in the baseline scenario (t) 193 Table 22: Estimated demand for dental mercury in 2025, in Option 2 (t) 194 Table 23: Estimated demand for dental mercury in 2025, in Option 3 (t) 195 Table 24: Overview of dental restoration costs borne by patients, per Member State (EUR) 196 6 | Study on the potential for reducing mercury pollution from dental amalgam and batteries Table 25: Actual costs of dental restorations for a sample of Member States (EUR) 197 Table 26: Coverage of dental restorations by national health insurance schemes 197 Table 27: Statistics on the number of dentists, 2009 - Source: Eurostat 201 Table 28: Producers of dental filling materials in the EU27 203 Table 29: Estimated annual costs for amalgam separators by size of dental office (2008) 207 Table 30: Cost of dental amalgam waste management for dentists 208 Table 31: Cost of strategies to avoid Hg pollution related to cremation 209 Table 32: Costs to switch from agricultural use of sludge (landspreading) to other sludge management methods (EUR/t dry solids) 210 Table 33: PRODCOM classification of button cells 212 Table 34: Quantity (million units) of different types of button cells placed on the EU market from 2004 until 2007 (Source: PRODCOM) 213 Table 35: EU statistics for import and export of mercury oxide batteries as reported by IMTS for the period 2007-2010 (button cells as well as larger batteries) 214 Table 36: Sales (in ‘000 units) of EPBA member companies for different button cell technologies in EU in 2010 (Source: EPBA) 215 Table 37: Main companies involved in the recycling of button cell batteries waste arising in EU 218 Table 38: Quantities of button cell battery waste recycled (in tonnes) as per country of origin of button cell battery waste in 2009 (Source: EBRA) 219 Table 39: Use of amalgam separators in EU27 220 Table 40: Estimated amounts of dental amalgam waste produced in EU Member States 225 Table 41: Sewage sludge produced in the Member States and treatment methods 2006-2009 (Source: Eurostat) 228 Table 42: Estimates of mercury quantities introduced into agricultural soils 232 Table 43: Estimates of mercury emissions from crematoria in the EU Member States 234 Table 44: Share of EU population with unmet needs for dental examination by sex, age, reason and income quintile (%) – Source: Eurostat 243 Table 45: Health care indicators by group of Member States 244 Study on the potential for reducing mercury pollution from dental amalgam and batteries | 7 List of Figures Figure 1: Projected annual demand for dental mercury in the EU (t Hg) 16 Figure 2: Annual costs borne by EU dental patients due to the substitution of dental amalgam according to different policy options
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