Implementing a Dental Amalgam Program

Implementing a Dental Amalgam Program

Presented by:Roberta DunlapCity of San José

for the San José/Santa Clara Water Pollution Control Plant

Dental Amalgam Program

• Program Design

• Implementation

• Lessons Learned

• Q & A

SJ0509i1_overall

SJ0509i1_overall

Santa Clara8%

San José71%

SJ/SC WPCP

Milpitas5%

Cupertino4%

Saratoga2%

Los Gatos

2%Monte Sereno

Campbell3%

SJ0509i1_overall


San Francisco BaySan Francisco Bay

Mercury exceeds allowable levelsMercury exceeds allowable levels


• November 2007 Mercury Watershed Permit for Dischargers to SF Bay

• Requirement for Pre-treatment Strategy for Dental Offices.

Target : 85% of Dental Offices Participating within Five Years.


Mine tailings are a significant source of mercury in the Central Valley and SF Bay Watersheds

Sources of Mercury in Wastewater

Universities

Dental Offices

HospitalsVehicle ServicesMedical Clinics

Human Waste - AmalgamHousehold

Products

LaundryGreywater

AMSA/EPA Mercury Pollution Prevention Project (2001)


Amalgam Vacuum PlasticRemoval Suction Chairside

Procedure Tip Screen

Swallowed CollectedBy For

Patient Recycle

Amalgam PlasticPlacement Cuspidor Chairside& Carving Screen

Filling CollectedIn For

Tooth Recycle

70%

7%

10%

1%

2%

20%

90%


Where Amalgam Goes

• Program Design

• Pre-Implementation Tasks

• Implementation

• On-going Program

Four Phases:



• Permit vs Self Certification

• Mandatory vs “Recommended”

• Do we inspect?

• Mandate Best Management Practices?

Decisions, Decisions, Decisions!


Program Design• Dental practices as critical users• Five-year Wastewater Discharge Permit – No Fee• Self-Certification of Best Management Practices• Installation of ISO Certified Amalgam Separator• Maintenance & amalgam disposal records• Annual Report• Inspections – once during permit period

• Identify dentists• Reach stakeholders & build partnerships• Amend the Muncipal Code• Develop several forms • Modify an existing database


Pre-Implementation


Locating the DentistsLocating the Dentists

• California State Department of Consumer Affairs http://www.dca.ca.gov/consumer/public_info/index.shtml

• Business Licenses

• County Department of Environmental Health

• Phone Book/Internet


Stakeholder ProcessStakeholder Process

• Local Dental Society- Dinner Meetings

- Presentations - Newsletter

• California Dental Association http://www.cda.org

• Vendor Workshops


Forms!Forms!• Permit Application

• Identify who owns practice• Who works with whom• Shared Separators!

• Permit • BMPs• Certifications • FAQs• Approved Separators & Vendors• Sample Maintenance Log

• Two or more dentists share a vacuum line

• Need to ID who is responsible

• Aligning permit effective dates

• Challenge of determining how they are sharing


Shared SeparatorsShared Separators


BrochureBrochure

• Step by Step Guide

• Visual BMPs

• Common FAQ’s on back


Issue permits


DatabaseDatabase

• Able to use existing Source Control Database

• Track Dentists- who has and has not responded

• Track Permits Issued

• Track Inspections


Some Logistic SuggestionsSome Logistic Suggestions

• Guidance Document• Decide who is responsible for what

• Filing protocol

• Finalize Forms

• Order Supplies in Advance


ImplementationImplementation

• Sent Application Packet to each individual dentist• Cover letter

• Permit Application

• Brochure


PermitsPermits

• Implement BMPs for amalgam waste- 90 days to certify BMPs

• Install an approved amalgam separator -180 days to certify separator installation

• Keep maintenance records

• Annual report due every January

From effective date of permit:

• Check placement and operation of the amalgam separator

• Confirm implementation of the BMPs

• Review amalgam waste management practices

• Review waste shipment records

• Enforcement Plan

Dental Amalgam ProgramInspectionsInspections


Lessons LearnedLessons Learned• Simple forms

Shared separators – list suite #’s/names• Send certified mail• Be prepared – files, labels, etc.• Communication with stakeholders/partners key• 10-15% will be hard to find• Need to send reminders

It will take time!

• Over 1,800 dentists identified• 740 permits issued to date• Processing BMP & separator

installation certifications• Sending reminders• Started doing some inspections

– Two inspectors, part-time– Ramping up this summer


City of San José web sitehttp://www.sanjoseca.gov/esd/wastewater/dental-amalgam-program.asp

California Dental Associationhttp://www.cda.org/

Baywise.orghttp://www.baywise.org

Roberta [email protected](408) 277-5364



Questions?

Implementing a Dental Amalgam Program

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