Amalgam Rules Development & Implementation in New Hampshire Paul Lockwood (603) Northeast Environmental Summit September 28, 2005

Background: NH Mercury reduction efforts House Bill 1251 & Rules adoption process Rules implementation and status 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

NH Mercury Reduction Strategy 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 – “An Act relative to the use of mercury amalgam fillings by dentists.”

NH Mercury Reduction Strategy 2002 Legislation Final outcome: DES to draft rules relative to amalgam disposal DHHS to create pamphlet for dentists to provide to patients HB 1251 – “An Act relative to the use of mercury amalgam fillings by dentists.”

Amalgam Management Rules Development In New Hampshire Stakeholder workgroup met in summer, 2002 Key issue = Enforcement Discharge limit? or Performance standard?

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

Amalgam Rules Implementation In New Hampshire 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 practitioners

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 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 Next steps Certifications due by Oct 1, 2005 Requests for de-minimis waivers will be reviewed Random sampling to determine accuracy of self-certification