2. Reducing Mercury Pollution in the Environment Presentation by : Marc M. Sussman President and CEO Dental Recycling North America, Inc. To the Western Attorney General's Conference Sun Valley, Idaho August 4 th, 2009 Presentation by : Marc M. Sussman President and CEO Dental Recycling North America, Inc. To the Western Attorney General's Conference Sun Valley, Idaho August 4 th, 2009

3. Overview How does mercury make it into our waterways? Why is it a hazard? What is being done? What more can & should be done? How does mercury make it into our waterways? Why is it a hazard? What is being done? What more can & should be done?

4. Amalgam Waste: What is It? Amalgam is a mixture of materials used by the dental industry for fillings Amalgam fillings contain a significant amount of mercury, which does not pose a health threat unless released into the environment Amalgam is a mixture of materials used by the dental industry for fillings Amalgam fillings contain a significant amount of mercury, which does not pose a health threat unless released into the environment

5. How Amalgam is Released into the Environment Amalgam waste makes its way into the environment by improper discarding of excess amalgam from mixture preparation & removed fillings For Example... Discarding waste in the dental chair side traps Rinsing residual waste down the sink Depositing waste in biomedical waste containers Putting amalgam waste in the trash Amalgam waste makes its way into the environment by improper discarding of excess amalgam from mixture preparation & removed fillings For Example... Discarding waste in the dental chair side traps Rinsing residual waste down the sink Depositing waste in biomedical waste containers Putting amalgam waste in the trash

6. Implications of Improper Disposal Sewage waste is taken to Publicly Owned Treatment Works (POTWs), where the POTW try to filter mercury out, but it is difficult to do once it has been converted to methylmercury Impact on POTWs: Imposes extra costs on POTWs POTW cannot eradicate all mercury content within their sludge Sewage waste is taken to Publicly Owned Treatment Works (POTWs), where the POTW try to filter mercury out, but it is difficult to do once it has been converted to methylmercury Impact on POTWs: Imposes extra costs on POTWs POTW cannot eradicate all mercury content within their sludge

7. What Happens to Mercury Containing Waste? POTW Sludge Incinerated Biohazard medical waste Incinerated Landfill waste Emits landfill gases Discharges liquid via leachates that is ultimately processed by POTWs POTW Sludge Incinerated Biohazard medical waste Incinerated Landfill waste Emits landfill gases Discharges liquid via leachates that is ultimately processed by POTWs

8. What Began as Waste Ends Up in Our Food Waste Air Rain Water Fish Humans Waste from POTW sludge & biomedical waste is incinerated, which volatizes the mercury, releasing it into the atmosphere where it is then captured by rain and delivered into waterways and oceans Landfill waste may release the mercury into the atmosphere via landfill gases, or may deliver the mercury to POTWs when the landfill produces liquid that is discharged through their leachate system Waste Air Rain Water Fish Humans Waste from POTW sludge & biomedical waste is incinerated, which volatizes the mercury, releasing it into the atmosphere where it is then captured by rain and delivered into waterways and oceans Landfill waste may release the mercury into the atmosphere via landfill gases, or may deliver the mercury to POTWs when the landfill produces liquid that is discharged through their leachate system

9. The Concern Fish and shellfish bio-accumulate methylmercury in their systems When sea-life is exposed to methylmercury, it is retained in its system so that its mercury content increases overtime The levels of methylmercury in fish are typically 100,000 times more than the content in the water where they reside Fish and shellfish bio-accumulate methylmercury in their systems When sea-life is exposed to methylmercury, it is retained in its system so that its mercury content increases overtime The levels of methylmercury in fish are typically 100,000 times more than the content in the water where they reside

10. Implications Mercury may be consumed directly by young children when they eat seafood, or it can be passed from the mother's system to her unborn child or through breast-milk Mercury has the ability to damage the nervous system of young children and unborn children

11. A Serious Health Concern The Federal Drug Administration (FDA) has administered advisories concerning mercury FDA recommends that women and children should not exceed 12 ounces of most fish and shellfish per week Some fish (ex. albacore tuna) contain higher levels of mercury and should be limited to only 6 ounces per week 6 ounces is the equivalent to the average amount of tuna in a can The Federal Drug Administration (FDA) has administered advisories concerning mercury FDA recommends that women and children should not exceed 12 ounces of most fish and shellfish per week Some fish (ex. albacore tuna) contain higher levels of mercury and should be limited to only 6 ounces per week 6 ounces is the equivalent to the average amount of tuna in a can

12. FDA recommends the complete elimination of shark and swordfish for pregnant women Studies show that at least 16% of women who are pregnant or are at a stage where they may become pregnant have been exposed to excess levels of mercury in their diets FDA recommends the complete elimination of shark and swordfish for pregnant women Studies show that at least 16% of women who are pregnant or are at a stage where they may become pregnant have been exposed to excess levels of mercury in their diets

13. What Can be Done? Mercury-containing waste is hard to control once it has been released into sewage systems or other waste management systems This can be mitigated by implementing programs and equipment that contain the waste before it leaves a facility Mercury-containing waste is hard to control once it has been released into sewage systems or other waste management systems This can be mitigated by implementing programs and equipment that contain the waste before it leaves a facility

14. The Role of the Dental Industry Based on ADA's Best Management Practices (BMP), it has been determined that dental facilities can eliminate the release of mercury by more than 95% if they install and operate amalgam separators in conjunction with abiding by ADA's Best Management Practices for the collection and recycling of mercury- containing wastes

15. ADA Recommendations ADA signed a Memorandum of Understanding (MOU) with the Office of Water and the National Association of Clean Water Agencies (NACWA) to establish and monitor the effectiveness of a Voluntary Dental Amalgam Discharge Reduction Program

16. Mixed Results from Voluntary Participation The voluntary program in King County of Washington State yielded only a 3% participation rate by the dental industry between 1994 and 2000 The low participation rate was in lieu of a rebate subsidy offered to install amalgam separators Once enforcement was introduced participation rose to 80% by 2003 Results From Voluntary Programs Indicate that Legislation is Necessary The voluntary program in King County of Washington State yielded only a 3% participation rate by the dental industry between 1994 and 2000 The low participation rate was in lieu of a rebate subsidy offered to install amalgam separators Once enforcement was introduced participation rose to 80% by 2003 Results From Voluntary Programs Indicate that Legislation is Necessary

17. New Jersey - An Example for the Country Rational for Legislation Mercury pollution presents high monetary costs to the public as well as high costs on quality of life The costs of preventing mercury’s release into the environment are incurred by the tax-payer Dental facilities are releasing mercury into the environment, therefore, dental facilities should treat the cost of proper amalgam disposal and recycling as an operation costs, rather than passing the costs on to the public Rational for Legislation Mercury pollution presents high monetary costs to the public as well as high costs on quality of life The costs of preventing mercury’s release into the environment are incurred by the tax-payer Dental facilities are releasing mercury into the environment, therefore, dental facilities should treat the cost of proper amalgam disposal and recycling as an operation costs, rather than passing the costs on to the public

18. New Jersey – A Case in Point Recently Passed Legislation “The most Effective and Efficient way to keep mercury from dental amalgam out of the environment is for the facilities who release it to effectively collect and recycle their amalgam wastes in compliance with the proposed new rule” “…treating mercury at the source is much more feasible and cost effective” Recently Passed Legislation “The most Effective and Efficient way to keep mercury from dental amalgam out of the environment is for the facilities who release it to effectively collect and recycle their amalgam wastes in compliance with the proposed new rule” “…treating mercury at the source is much more feasible and cost effective”

19. Annual Cost Analysis “…treating mercury at the source is much more feasible and cost effective” “…the annual cost for treatment of mercury at the POTW would range from 1.28 to 1.98 billion (dollars).” The NJ Jersey State annual cost at the POTW is at least 474 times greater than the dental facilities! “…treating mercury at the source is much more feasible and cost effective” “…the annual cost for treatment of mercury at the POTW would range from 1.28 to 1.98 billion (dollars).” The NJ Jersey State annual cost at the POTW is at least 474 times greater than the dental facilities!

20. Annual Cost to Dental Facility vs. Annual Cost to Public When recycled at the dental facility level, the average cost per patient is 0.54¢ to 0.84¢ Recycling at dental facility level will result in 2,550 Lbs of mercury removed and recycled -Conversely- Annual costs for treatment of mercury at the POTW would range from 1.28 to 1.98 billion dollars The NJ Jersey State annual cost at the POTW is at least 474 times than the dental facilities

21. Cost Overview – In Perspective Removal of Mercury will cost the dentist 0.54¢ to 0.84¢ per patient If a dentist sees 4 patients a day and works 4 days a week that will total between $8.64 - $13.44 per week Resulting in annual costs for the dentist of $449 to $699 -vs.- 1.28 to 1.98 billion (dollar) in annual costs to local POTWs Removal of Mercury will cost the dentist 0.54¢ to 0.84¢ per patient If a dentist sees 4 patients a day and works 4 days a week that will total between $8.64 - $13.44 per week Resulting in annual costs for the dentist of $449 to $699 -vs.- 1.28 to 1.98 billion (dollar) in annual costs to local POTWs

22. Regulatory Action Examples of Legislative Measures State level through the passage of specific legislation: New York State, New Jersey, Connecticut, Maine, Massachusetts, Vermont, New Hampshire, and Oregon have established statewide regulations Local communities have adopted regulations in Rhode Island, Minnesota, California, Washington and Louisiana Permits via State Environmental Protection Agency Departments Examples of Legislative Measures State level through the passage of specific legislation: New York State, New Jersey, Connecticut, Maine, Massachusetts, Vermont, New Hampshire, and Oregon have established statewide regulations Local communities have adopted regulations in Rhode Island, Minnesota, California, Washington and Louisiana Permits via State Environmental Protection Agency Departments

23. Regulatory Movements and The Attorney General There is discussion in the Congress about the role of the EPA in taking a more aggressive stance towards regulating the dental industry The Next Phase is the Enforcement What is the role of the office of Attorney General? Ensuring that these regulations are enforced How? By establishing one standard in order for all dental offices/facilities to be treated fairly There is discussion in the Congress about the role of the EPA in taking a more aggressive stance towards regulating the dental industry The Next Phase is the Enforcement What is the role of the office of Attorney General? Ensuring that these regulations are enforced How? By establishing one standard in order for all dental offices/facilities to be treated fairly

24. Works Cited  Courtesy copy of this rule proposal, Environmental Protection, Environmental Regulation, Division of Water Quality Watershed Permitting Element, Water Pollution Control, Requirements for Indirect Users – Dental Facilities, Proposed New Rules: N.J.A.C. 7:14A-21.12, Proposed Amendments: N.J.A.C. 7:14A-1.2.