Mercury Safe Dentists: What You Need to Know to Make Your Practice Mercury Safe
Mercury Safe Dentistry: Why be Mercury Safe
There are a number of things to consider if you want to make your dental practice as occupationally Mercury Safe as possible. It is essential to understand Why you should make your practice Mercury Safe, What you need in regard to equipment and products, and How you can put it all together in the most efficient and cost-effective way possible.
It is also important to understand that making your office Mercury Safe has nothing to do with the amalgam filling controversy - whether or not amalgam fillings are a health hazard. Another important factor to consider is that because of OSHAs existing regulations all dental offices will have to be Mercury Safe in the near future. In fact, even if the FDA, legislative action, or a class action lawsuit, results in amalgam fillings being banned - you will still have to make your office Mercury Safe because of OSHA. All of these - and more - will be discussed here.
The bottom line here is that even though you aren't yet required to make your office Mercury Safe - it is simply the right thing to do - for yourself, your staff, the environment, and the patient. The unsafe removal of amalgam fillings generates excessive and unnecessary toxic levels of mercury vapor - and once that is understood it is difficult to imagine why any dentist not wanting to make his or her office Mercury Safe.
This article will introduce you to the concept and philosophy of Mercury Safe Dentistry. Where necessary I'll include resources that you can easily access to provide additional information and support.
The first thing is to understand the significant difference between being Mercury Safe and Mercury Free.
The Difference Between a Mercury Safe Dentist and a Mercury Free Dentist
Strictly speaking, the term “Mercury Free” refers to dentists who do not put amalgam fillings in their patients’ teeth. This term was first used over 40 years ago by dentists who wanted to distinguish themselves from other dentists who believed that amalgams were safe and continued to place them.
However, even then the term Mercury Free wasn’t a truly accurate description because dentists who didn’t put in amalgam fillings still had to remove them – and the unsafe removal process released excessive and harmful amounts of toxic mercury vapor. But being Mercury Free was a good beginning.
Over time, dentists who were Mercury Free developed equipment and safe removal protocols that allowed them to dramatically minimize a patient’s exposure to mercury during the removal process. In effect, using these protocols meant that their practices were now also Mercury Safe. Yet they continued to only use the term Mercury Free to describe what they did. However, things have changed and that term no longer works!
Today it is not enough for a dentist who is both Amalgam Free and Mercury Safe to just promote his or her practice as being Mercury Free. Why? Recently a survey showed that 52% of general dentists no longer use amalgam and are referring to themselves as being Mercury Free. But, and this is important for patients (and dentists) to know, not because they were concerned about safely removing mercury amalgams – but primarily because they no longer felt amalgam was a good filling material when compared to the newer composite fillings.
This of course has created a dilemma for patients who believed that dentists who said they were Mercury (Amalgam) Free also meant they used protocols to safely remove amalgam fillings. But patients are catching on and now look for dentists who are not only Mercury Free, but will safely remove their amalgam fillings. More and more patients and are asking this question of the dentist: “Are you both Mercury Free and Mercury Safe?” Bottom line . . . patients can longer assume that a dentist who advertises his or her practice as being Amalgam (Mercury) Free, is also Mercury Safe! So it is no longer enough just to say you are Mercury Free if you want patients to know you are also Mercury Safe.
The Main Difference between a Mercury Safe Dentist and a Dentist who is only Mercury Free
Unsafe removal of amalgam fillings can generate huge amounts of toxic mercury vapor, easily over 200 times more than the maximum levels of mercury vapor allowed by all government regulatory agencies. What really separates Mercury Safe dentists from those who are only Mercury Free, is their understanding that:
Thus, if you are serious about protecting yourself, your staff, your patients, and the environment from excessive and unnecessary occupational exposure to mercury vapor at the dental office - you must commit to making sure your office is not just Mercury Free - but also Mercury Safe!
Occupationally Mercury Safe and the Amalgam Filling Controversy
Next, it is very important to understand that making your office occupationally Mercury Safe has nothing to do with whether or not the mercury released from amalgam fillings is a health hazard for those who have them in their teeth. They are totally separate issues - but for years these two were pretty much lumped together and a clear distinction wasn't made.
While it is true they both are related to amalgam fillings each is unique. For over 200 years there has been a controversy regarding amalgam fillings and the effect of the mercury released to those who have them their teeth. There are those who strongly believe amalgams are a health hazard and those who just as strongly believe they are not. Certainly there isn't a consensus and while I personally believe that they are a health hazard - the battle still wages.
However, there is no controversy and there is complete consensus about the need and importance of making the dental office occupationally Mercury Safe. Taking this action is also supported by the ADA, which I will discuss shortly, and its support is significant for many reasons.
Briefly, the difference between the two is that the issue of whether or not amalgam fillings are a health hazard is directly related to the mercury released from the fillings and the effect of that mercury on the person with the amalgams. The occupational issue is specifically related to the mercury released from amalgam fillings during the various procedures done at the dental office and its impact on the dentist, staff, patient, and environment; including placing, unsafely removing, and polishing them.
Becoming a Mercury Safe Dentist
Becoming Mercury Free is simply a decision one makes to not place mercury amalgam fillings. Making your practice fully Mercury Safe is not difficult but does involve a greater commitment, both in time and money.
Once you are clear about Why you should be Mercury Safe; you will need to know What you need to do to make your practice fully Mercury Safe and then How to implement the safe removal protocols once that has been accomplished.
There are three distinct aspects to making your practice fully Mercury Safe, protecting;
While they do overlap, they are not the same and it is important to understand the differences.
For example, you could install a mercury separator and make your office environmentally safe. Or you could make your practice Mercury Safe for the patient and do nothing to make it safe for the environment or the dentist and staff. You could even take steps to make it safe for the dentist and staff and not make it safe for the environment or the patient.
I believe there are many dental offices whose practice is only Mercury Safe for the patient - and in areas where separators have been mandated, Mercury Safe for the environment and the patient. One of the reasons for this is that for a long time all the efforts that were made relating to Mercury Safe Dentistry were directed at protecting the patient.
There is nothing wrong with this as far as it goes. Dentists can and do promote their practices as Mercury Safe for the patient even if they aren't fully Mercury Safe in regards to protecting themselves and the staff. It is fantastic for the patient and as I consider Mercury Safe Dentistry to be the new growth area in dentistry it is critical to protect the patient. But if you want to be fully Mercury Safe it isn't enough to just protect the patient.
The good news is that dentists finally caught on and realized that their own occupational exposure to mercury was exponentially greater than any patient. This awareness eventually lead to the equipment and protocols that also included protecting dentists, their staff, and the environment.
Thus, the key here is that to make your practice as Mercury Safe as is possible today - you will have to make the choice as to which of the three listed above that you are committing to. If you commit to all three you will need to take all of the steps necessary to make it happen.
This is a summary of what you will have to commit to make your practice Fully Mercury Safe:
Why Your Practice Should be Mercury Safe
Being Mercury Safe should be the cornerstone of the modern dental practice. In my opinion, every dentist who is considering making their practices Mercury Safe needs to understand Why it is in their best interests to do so.
To that end Dr. Paul Rubin and I produced a website that explains in detail all the reasons Why your dental practice should be fully Mercury Safe. (The website www.newdirectionsdentistry.com will also give you access to our DVD Course: How to Make Your Practice Mercury Safe: Minimizing Occupational Exposure to Mercury in the Dental Office. This is the only course of its kind and is the A to Z guide necessary to make your practice Mercury Safe. I will introduce the DVD Course itself a little later.)
Other Important Considerations
The most obvious reasons have been discussed - making your practice Mercury Safe for yourself, your staff, your patients, and the environment. But there are other important considerations that go far beyond the basic protocols.
Here are some other reasons Why every dentist - regardless of how one personally feels about the amalgam filling controversy - should consider making their practices Mercury Safe - as soon as possible.
Everything you will need to know about Why you should make your practice Mercury Safe can be found on our website: www.newdirectionsdentistry.com. However, I feel a brief discussion about making your practice Mercury Safe so you can be OSHA compliant is warranted here.
OSHA is the Federal regulatory agency whose mandate it is to protect the employee from all harmful toxins and poisons (including mercury) and unsafe equipment at the workplace. Every dental office has had to deal with OSHA at some point. If a business is not in compliance and has to be monitored by OSHA the process the business has to go through is extraordinarily time intensive - involving a significant amount of monitoring and paper work.
OSHA's mandate has no requirement to protect dentists, patients, or the environment; only employees, such as assistants and other office staff. The ADA and State Boards place no restrictions on placing amalgams or removing amalgams. Also there are no Federal or State regulations against putting in amalgams or unsafely removing them - but that doesn't mean dental offices are not regulated or off the hook. It only means that existing regulations are not being enforced.
OSHA already has regulations regarding the amount of mercury vapor in the workplace that it considers unsafe. Thus any business that uses mercury can be monitored by OSHA to insure that employee exposure to it will not exceed a set level of mercury vapor. This is already the law of the land. The key point here is that although dental offices (collectively as an industry) are the second biggest users of elemental mercury - they are the only industry using mercury that is not monitored by OSHA for mercury vapor.
So what does this mean to a dental office that is not occupationally Mercury Safe? It means you are most definitely skating on thin ice. Just because OSHA hasn't yet seen fit to actively monitor the dental office for mercury vapor doesn't mean it can't and won't in the future. If it does you will wish that your office was already Mercury Safe.
In addition, the public is becoming increasingly more and more aware of this issue and there is more and more information being provided by the media concerning this topic. Thus, in my opinion, it won't be long now until OSHA expands its monitoring to include the dental office. After all, it is mandated to protect all employees who are subjected to excessive amounts of mercury vapor at the workplace - including dental offices. Its mandate does not say - all employees except those working in dental offices. It is already the law and that fact just needs to be pointed out - not proven.
What we do know is that OSHA's permissible exposure limit (PEL) for mercury vapor is 100mcg (micrograms per cubic meter of air). If OSHA monitored a business using mercury and found that the average levels exceeded that amount everyone would have to leave that facility until it was safe to return. Measure OSHA's level against the amount of mercury vapor that can be released when unsafely removing an amalgam filling (more than 3000mcg, depending on the source of information). It is easy to see why an office that is not safely removing amalgams would never be OSHA compliant for its ceiling limit for mercury. Even polishing an amalgam can release at least 8 times more mercury vapor than allowed in the workplace.
Minimizing a Lawsuit
OSHA can issue a citation, file a lawsuit, and even fine you. There is also a direct relationship between not being OSHA compliant and possibly being sued by an employee. For example, if a dental assistant discovered she was being exposed to unnecessary levels of mercury vapor at the office that exceeded OSHA limits, you didn't inform her of the risks, and you didn't take the necessary steps to protect her at the workplace - she could file a lawsuit against you. As I said, there are many other important reasons to make your practice occupationally mercury safe but this one would have to be high on the list.
I should also point out that there have been many studies done about the harm to employees exposed to occupational mercury at the workplace, including dentists and their staff. Some of these studies are available on the New Directions Dentistry website. (You can access them by going to www.newdirectionsdentistry.com and clicking on Links to Hg Studies in the Main Menu.)
American Dental Association & Mercury Safe Dentistry
As I mentioned previously, there is a huge distinction between whether or not the mercury released from amalgam fillings pose a health risk for those with them in their teeth - and making a dental office occupationally Mercury Safe. In fact, the ADA's position on both issues dramatizes this distinction.
The ADA adamantly defends the use of mercury amalgam fillings and states that they are a practical, inexpensive, and a safe dental filling material. Its position on amalgam fillings is very clear! Yet, it just as convincingly promotes safe handling of mercury in the dental office. While they may call it Dental Mercury Hygiene Recommendations - there is little difference between their position and the one we take and call Mercury Safe Dentistry.
Scientifically the ADA has no choice in the matter as, given abundant number of scientific studies and OSHA's position, there is no way to defend intentionally making the workplace unsafe for employees regarding mercury exposure. Which in turn means the ADA cannot even hint that that the elemental mercury used in dentistry is somehow safer than the elemental mercury used in other industries.
About 75% of what the ADA recommends supports the philosophy behind the Mercury Safe Removal Protocols. It even recommends that the dental office periodically use a mercury vapor analyzer to test the office for mercury vapor levels. The only real difference between what we recommend and what the ADA recommends is that it doesn't extend their concern, or protective protocols, to patients who are having amalgam placed or removed.
The ADA's stated position on occupationally Mercury Safe Dentistry is found in a position paper from the ADA Council on Scientific Affairs, published in the JADA in 1999. This is not so easy to find on the ADA's website but you can access it by Clicking Here.
In addition, the ADA has also added its support for mercury separators to its Best Management Practices. Thus, the ADA supports protecting the dentist, the office staff, and the environment. The only one not on our list is protection for the patient while having an amalgam placed or removed.
Bottom Line: You are "Safe" Being Mercury Safe
Over the years I've consulted with hundreds of dentists who finally understood that there are short and long-term health consequences directly related to on-going exposure to mercury at the office - and then wanted to learn how to make their practices as Mercury Safe as possible.
They became even more concerned when I explained the other important reasons to do so, mentioned above. But no matter how concerned they were and how much they wanted to move forward, everyone of them expressed a sincere concern that if they made their practices Mercury Safe they would get hassled but the State Dental Boards. Not just hassled, but possibly lose their license to practice dentistry.
This is a legitimate concern and most of them had heard horror stories about dentists losing their licenses just for talking to patients about the potential health hazards of mercury amalgam fillings. This concern and confusion existed because most dentists did not understand the difference between the amalgam filling controversy and practicing Mercury Safe Dentistry.
Of course as I explained above - this is a non-issue and there is no risk involved with the dental boards for making your practice Mercury Safe. After all, doing so is supported by the ADA! Plus it will also make your office compliant for mercury with OSHA. In short, you can feel completely safe and protected from any State Dental Board when you make your practice Mercury Safe.