Mercury Reductions in the Dental Sector in Sweden Eva Sandberg Senior Adviser International Secretariat Swedish Chemicals Agency

Outline Background (brief) - The mercury problem in Sweden - Swedish policy on mercury - Actions Dental amalgam phase-out Mercury Reductions in the Health Care Sector (2nd part)

Europe and the European Union

Sweden in brief 9 million inhabitants 3 major urban areas km 2 total area km 2 forest land > lakes 0.7 tonnes Hg air emission 4.2 tonnes Hg deposition (mainly from outside Sweden)

Mercury is a problem in Sweden Fish in lakes exceeds WHO limit (0.5 mg Hg/kg). Levels in forest soil increases and probably effects important soil microbial functions. Deposition must be reduced by 80% to reach safe levels. International action needed.

Environmental Quality Objective: A non-toxic environment Interim target regarding mercury Newly manufactured finished products will as far as possible be free from mercury, as soon as possible, but no later than Nor will mercury be used in production processes unless the company can prove that human health and the environment will not be harmed. Finished products already available will be handled in such a way that mercury is not released to the environment. The spread to Sweden by air or water of mercury will decrease continuously.

Phase out use in products and processes. No export. Mercury already in society should be collected and treated. Mercury should not be recycled. Mercury should be safely disposed in a final storage.

Swedish actions in brief Ban on the sale of fish from certain lakes in the early 1970´s General recommendation for fish consumption - Pregnant and breast-feeding women: No consumption - General public: Once a week Reductions of emissions from point sources Ban on certain Hg-containing products in 1992 Export ban entered into force1997 X

… actions in brief Collection of Hg and identification of Hg-products 1994 – 1999 Parliament decision 2003 on final storage of Hg and Hg-containing waste, latest 2015 Notification Feb 2006 to EU and WTO of a general ban on Hg and Hg- containing products (use, placing on the Swedish market, export and import) – Not yet entered into force

Swedish regulation on mercury Mercury and its compounds and preparations may not be exported professionally from Sweden Certain goods (measuring instruments, electrical components such as switches, thermostats, relays and circuit breakers) containing mercury may not be manufactured or sold or used if not in use before 1995 These goods may not be imported from third countries or exported from Sweden

Investigation of a national general ban on the marketing and use of Mercury Includes for example dental amalgam, chemicals and chlor-alkali industry Proposal to Government 30 June 2004 Report is available in English at

Yearly supply of mercury in products in Sweden (kg)

Dental amalgam Dental amalgam contains about 50 % Hg Mercury is released to the environment at several steps Risks to the environment and to human health

Sewage sludge Cremation Incineration Land application Sewer system Waste Hg Separator Landfill Waste Hg

Mercury supplied to dental amalgam in Sweden (kg) US (280 million people): >30 tonnes Hg (2005) EU (460 million people): est. 90 tonnes Hg (2005, 25 MS)

Mercury-free dental fillings Dental amalgam has been replaced almost totally during the last six to seven years in Sweden Swedish suppliers of dental materials and users from both public and private sector are the sources of the used statistics in the new report Composites are the most commonly used materials in Sweden

The shares of dental filling materials used in Sweden (% by weight*) Composites 78 % Glassionomers Amalgam Compomers 3% Ceramics <1% 13 % 6 % * One kilo of composites will fix many more teeth than one kilo of amalgam due to the differences in weight of the materials.

Amalgam fillings in % of total fillings at Folktandvården in Sweden 2002 and 2003 Source: Swedish Board of Health and Welfare

Success factors High awareness of the environmental and health risks among patients and dentists. Demand for and access to other filling materials. Agreement between the state and the county councils in 1995 to phase-out use from children's dentistry. Since 1999 no financial support given from Swedish dental insurance for amalgam fillings.

Thank you for your attention! Thanks to colleagues Petra Ekblom and Ulla Falk