Reducing Dental Mercury Releases in New Hampshire Paul Lockwood (603) National Environmental Partnership Summit May 8 – 11, 2006 (How to blend compliance assistance with regulatory enforcement)

Background: NH Mercury reduction efforts Rules development process Assistance and Rules implementation Measurement results Amalgam Rules Development & Implementation in New Hampshire

NH Mercury Reduction Strategy (Reports & Documents)

NH Mercury Reduction Strategy Recommended Actions Regarding Dental Amalgam Conduct outreach to the general public and dentist’s offices…to encourage the voluntary use of alternatives to mercury-containing amalgam and encourage the proper collection and disposal of waste amalgam. Draft legislation…with an effective date of July 1, 2003 to prohibit the use of mercury- containing amalgam. R-27 R-28

2002 Legislation HB 1251 – “An Act relative to the use of mercury amalgam fillings by dentists.” Introduced June, 2002 as a ban on the use of mercury-amalgam in New Hampshire NH Mercury Reduction Strategy

2002 Legislation Problems and Issues: Environmental or Public Health issue? Insurance issues Credibility of support data NH Dental Society support HB 1251 – As a ban on mercury amalgam: NH Mercury Reduction Strategy

2002 Legislation DES to draft rules relative to amalgam disposal (RSA 485-A:4 XVIII) DHHS to create pamphlet for dentists to provide to patients HB 1251 – Final version required: NH Mercury Reduction Strategy

Amalgam Management Rules Development in New Hampshire Rules Development Workgroup first met summer, 2002 Key issue = Enforcement Is the best approach a discharge limit? or a performance standard? (over 1,250 dentists and over 600 facilities)

Performance Standard = Amalgam Separator Issues: Level of performance required? “Home built” technologies? Particulate and soluble Hg? Waivers and exemptions? Amalgam Management Rules Development in New Hampshire

Performance Standard = Amalgam Separator Key issue still = Enforcement: 600 practices = 600 installations to inspect and monitor. Amalgam Management Rules Development in New Hampshire

Amalgam Management Rules Development in New Hampshire The Environmental Results Program (ERP) format offers best solution to managing a large regulated sector like dentists… …especially if ERP has rules backing it up.

installation of ISO certified amalgam separator or practitioner is exempt or requesting waiver Env-Ws 905 STANDARDS FOR MANAGEMENT OF MERCURY-CONTAINING AMALGAM Requires written self-certification from “owner of the practice”: Amalgam Rules Implementation in New Hampshire

Exemption for: Orthodonists, periodontists, oral or maxillofacial surgeons, oral pathologists, oral or maxillofacial radiologists who don’t generate amalgam wastes Retired & out-of-state practitioners (NH licensed but not practicing in NH) Amalgam Rules Implementation in New Hampshire

Waiver for: “de minimis” discharge of up to 0.5 gram Hg/year (= 1 gram amalgam = 2 fillings) equivalent alternative technology “zero discharge” (holding tank) Amalgam Rules Implementation in New Hampshire

Concurrent to Rules Development (2003 – 2005): Surveys & outreach with NH Dental Society Information provided at annual conferences Articles in journals, newspapers, etc. Site visits to dental facilities Best Management Practices manual Amalgam Rules Implementation in New Hampshire

Initial Notification July 8, ,260 Licensed practitioners notified 10% response in first two weeks even though none required until October 1. Amalgam Rules Implementation in New Hampshire

Early issues & problems: Mobile units & schools Semi-retired or not in state “Amalgam-free” practitioners Endodontists Amalgam Rules Implementation in New Hampshire

Amalgam Rules Implementation in New Hampshire

Next steps: Project turned over to enforcement staff January, 2006 Recalcitrants are being contacted. Requests for de-minimis waivers will be reviewed. Random sampling to determine accuracy of self-certification. Amalgam Rules Implementation in New Hampshire

Measurement: Outputs (beans) –367 surveys completed 860 BMP Guides distributed 5 presentations provided 7 site visits performed etc., etc. Outcomes (behavioral changes) 2002 – Separators in use = 12 dentists = 1% 2005 – Separators in use = 500 dentists = 40% Baseline survey is crucial to establish changes! Amalgam Rules Implementation in New Hampshire

Environmental Indicators (“hard” numbers) Measurement: Dental Mercury Generation Rates: NH % of National Releases 6.34 tons (Environ Report) x.004 (NH population) = 52 lbs/year/900 practicing dentists = 0.06 lbs/dentist/year Per Chair Generation Rate: 240 mg/chair/day x 4 days/wk x 48 weeks/454 grams/lb = 91 lbs/dentist/year/900 practicing dentists = 0.10 lbs/dentist/year 500 dentists x 0.06/lbs/yr x 95% separator efficiency = 28.5 lbs Hg recycled Amalgam Rules Implementation in New Hampshire

Conclusions: The Environmental Results Program (ERP) model is effective for addressing the dental sector. The ERP format can also be used to help develop regulations making their implementation easier. ERP is also useful for today’s “results-driven” projects and programs. Amalgam Rules Implementation in New Hampshire

Reducing Dental Mercury Releases in New Hampshire What’s the real P2 solution? Not this…

Reducing Dental Mercury Releases in New Hampshire What’s the real P2 solution? …but this!!!