THE REAL €O$T OF DENTAL MERCURY March 2012 Sprl concorde 10 av. René Gobert 1180 Brussels +32(2) 374 3647 [email protected] ACKNOWLEDGEMENTS Concorde East/West Sprl would like to thank the European Environmental Bureau, the Mercury Policy Project, the International Academy of Oral Medicine & Toxicology, Clean Water Action and Consumers for Dental Choice for co-releasing this report. While valuable input has been received from many colleagues, Concorde East/West Sprl would like to express its special appreciation to Dr. Michael Fleming for his patience while greatly contributing to a rigorous interpretation of the dental data and to a better appreciation of dental techniques. Disclaimer While all reasonable precautions have been taken to control the quality of this report, it is published without warranty of any kind, either express or implied. Concorde East/West Sprl is solely responsible for any inaccuracies or omissions. Nevertheless, any consequences that may flow from any inaccuracies or omissions, or from any interpretation and use of the information herein, lies with the reader. Neither Concorde East/West Sprl nor any entity involved in the preparation or promotion of this report shall be liable for any injury, loss, damage or prejudice of any kind that may result from persons who have acted on the basis of their interpretation or understanding of the information contained in this report. Table of Contents Executive summary ......................................................................................................................... 1 1 Purpose ................................................................................................................................... 5 2 Mercury in the environment ...................................................................................................... 5 3 Dental clinic mercury consumption and wastes ........................................................................ 7 3.1 Consumption of mercury in dental applications ................................................................ 7 3.2 Mercury waste generated by dental clinics ...................................................................... 9 4 Dental mercury wastes and emissions ..................................................................................... 9 4.1 Pathways to the environment......................................................................................... 10 4.2 Wastewater releases ..................................................................................................... 12 4.3 Solid waste generated ................................................................................................... 14 4.4 Air emissions at the dental clinic .................................................................................... 14 4.5 Biomedical waste treatment ........................................................................................... 15 4.6 Recycling ....................................................................................................................... 15 4.7 Mercury storage and final disposal ................................................................................ 16 4.8 Burial ............................................................................................................................. 16 4.9 Cremation ...................................................................................................................... 16 5 Air emissions from dental mercury ......................................................................................... 16 5.1 Municipal wastewater and sewage sludge ..................................................................... 16 5.2 Cremation ...................................................................................................................... 17 5.3 Summary of dental mercury atmospheric emissions ...................................................... 18 6 Dental mercury mass balance ................................................................................................ 19 6.1 Dental mercury pathways .............................................................................................. 19 6.2 Dental mercury disposal/media matrix ........................................................................... 20 6.3 Dental mercury pathways quantified .............................................................................. 20 7 Commercial cost of fillings ...................................................................................................... 22 7.1 Commercial cost of dental amalgam .............................................................................. 23 7.2 Commercial cost of composites ..................................................................................... 23 7.3 Comparison of commercial costs of fillings .................................................................... 24 8 Cost of keeping dental mercury out of the environment .......................................................... 26 8.1 Key pathways ................................................................................................................ 26 8.2 Operating chair-side traps to capture the larger mercury waste particles ....................... 26 8.3 Operating separators to capture mercury in the clinic wastewater stream ..................... 26 8.4 Treatment or safe disposal of hazardous mercury waste ............................................... 27 8.5 Landfill of municipal waste ............................................................................................. 27 8.6 Dental clinic air emissions of Hg from the chair and from the wastewater ...................... 27 8.7 Removing mercury from the flue gas of municipal waste incinerators ............................ 27 8.8 Removing mercury from incinerator ash of municipal waste incinerators ....................... 28 8.9 Removing mercury from wastewater sludge to meet agricultural soil limits .................... 28 8.10 Removing mercury from the flue gas of sewage sludge incinerators.............................. 28 8.11 Removing mercury from the flue gas of recycling systems ............................................ 29 8.12 Removing mercury from the exhaust gas of biomedical waste treatment systems ......... 29 8.13 Removing mercury from the process water of biomedical waste treatment systems ...... 29 8.14 Secure landfill or other safe disposal of biomedical waste ............................................. 29 8.15 Removing mercury from the flue gas of crematoria ........................................................ 29 8.16 Long-term storage or sequestration of elemental mercury ............................................. 29 8.17 Recycling (thermal treatment cost) ................................................................................ 30 8.18 Cemetery releases to the soil ........................................................................................ 30 8.19 Management, manipulation and handling costs ............................................................. 30 8.20 Summary costs of avoiding dental mercury releases ..................................................... 31 9 Benefits of a dental amalgam phase-out ................................................................................ 33 9.1 Human health effects ..................................................................................................... 33 9.2 Environmental effects .................................................................................................... 39 9.3 Socioeconomic impacts ................................................................................................. 40 9.4 Additional benefits for children ....................................................................................... 42 9.5 Summary costs/benefits of phasing out the use of amalgam ......................................... 43 10 Potential hazards of mercury-free filling materials .................................................................. 46 11 Conclusions ........................................................................................................................... 46 12 References ............................................................................................................................ 49 The Real Cost of Dental Mercury March 2012 Executive summary While its use has essentially been eliminated in many countries, dental amalgam is now being considered for a global phase-out in the ongoing mercury treaty negotiations1 and in the European Union (BIO 2012) because of significant environmental concerns. The negative effects of mercury releases related to amalgam use are widely recognized in countries where its use has been prevalent: it is often the largest source of mercury in municipal wastewater as well as an increasing source of mercury air pollution from crematoria. On the other hand, high-quality mercury-free alternatives have long been available. While most dental professionals charge lower prices for amalgam fillings than for mercury-free alternatives, this paper shows that when factoring in “external” environmental and societal costs,2 amalgam is a higher-priced dental material by far (Hylander and Goodsite 2006). Ultimately, society pays for mercury releases related to amalgam use through additional pollution control costs, the loss of common (public-owned) resources, and the health effects associated