Clinical Guide Adaptation for Amalgam Waste Management in Dental Settings in Iran
Abstract
Objectives: Dental clinics are one of the major producers of mercury-containing waste due to the use of dental amalgam. The atmospheric transport and persistence of mercury and its compounds in the environment, coupled with their high potential for bioaccumulation and detrimental effects on human health and ecosystems, underscore the necessity for effective management of mercury waste. Due to the lack of comprehensive and integrated guidelines for the effective management of dental amalgam waste in Iran, the objective of this study was to adapt a guideline for the management of amalgam waste in dental settings within the country.
Materials and Methods: The method used was based on the adaptation principles presented by the Ministry of Health and Medical Education, and included searching and reviewing guidelines related to the management of amalgam waste in developed countries, extracting recommendations, revising the recommendations considering the local infra-structures and conditions, and receiving expert opinions and reaching consensus according to the RAND/UCLA Appropriateness Method.
Results: The final guideline includes 34 recommendations in 5 areas: manage-ment of the amalgam scraps, considerations for dental equipment, management of the extracted teeth containing amalgam restorations, management of the amalgam capsules, and considerations for placement and replacement of the amalgam restorations.
Conclusion: The use of this guideline in medical universities, public and private dental clinics, along with the supervisory role of the Ministry of Health and Medical Education, can be a way to minimize the environmental hazards of mercury.
2. Malhotra T, Vats V, Yadav L, Sachdeva A. Biomedical waste management in dental office. Int Dent J Stud Res. 2021;9(2):68-72.
3. Bharti R, Wadhwani KK, Tikku AP, Chandra A. Dental amalgam: An update. J Conserv Dent. 2010 Oct;13(4):204-8.
4. Park JD, Zheng W. Human exposure and health effects of inorganic and elemental mercury. J Prev Med Public Health. 2012 Nov;45(6):344-52.
5. Myszograj M. Dental Waste - Management and Statistics. Civil Environ Eng Rep. 2023;33(2):55-63.
6. Hylander LD, Lindvall A, Uhrberg R, Gahnberg L, Lindh U. Mercury recovery in situ of four different dental amalgam separators. Sci Total Environ. 2006 Jul 31;366(1):320-36.
7. Jokstad A, Fan PL. Amalgam waste management. Int Dent J. 2006 Jun;56(3):147-53.
8. Larose P, Basciano M. Dental mercury and Norway. J Dent Res. 2008 May;87(5):413; author reply 413.
9. Lofstedt R. Chemical Control Policy in Sweden, What is Next? European Journal of Risk Regulation. 2014 Sep;5(3):351-8.
10. Amalgam (Part 1): Safe Management of Waste and Mercury: Adopted by the FDI General Assembly: 27-29 September 2021, Sydney, Australia. Int Dent J. 2022 Feb;72(1):10-11.
11. Nafez AH, Ebrahimi A, Nejad MH, Bina B. Quantity and composition of produced dental solid waste in Isfahan, 2011. Int J Env Health Eng 2014 Jan;3(1):17.
12. Bazrafshan E, Mohammadi L, Mostafapour FK, Moghaddam AA. Dental solid waste characterization and management in Iran: a case study of Sistan and Baluchestan Province. Waste Manag Res. 2014 Feb;32(2):157-64.
13. The Ministry of Health, Treatment, and Medical Education of Iran. Developing Guidelines. 2020. Available at: https://research.umsha.ac.ir/uploads/36/2023/Jun/15/%D9%81%D8%B1%D8%A2%DB%8C%D9%86%D8%AF%20%D8%AA%D9%87%DB%8C%D9%87%20%D8%B1%D8%A7%D9%87%DA%A9%D8%A7%D8%B1%D9%87%D8%A7%DB%8C%20%D8%B7%D8%A8%D8%A7%D8%A8%D8%AA%20%D8%A8%D8%A7%D9%84%DB%8C%D9%86%DB%8C.pdf
14. Sarrafzadegan, N., Shahidi, S., Bagheri-Kholenjani, F. How to Develop, Update and Adapt Clinical Practice Guideline: A Comprehensive Application Package. Journal of Isfahan Medical School, 2022; 40(665): 179-187. doi: 10.48305/jims.v40.i665.0179
15. Fitch K, Bernstein SJ, Aguilar MD, Burnand B. The RAND/UCLA Appropriateness Method User's Manual 2001. Available at: https://www.rand.org/content/dam/rand/pubs/monograph_reports/2011/MR1269.pdf
16. ADA Council on Scientific Affairs. Dental mercury hygiene recommendations. J Am Dent Assoc. 2003 Nov;134(11):1498-9.
17. Amalgam (Part 2): Safe Use and Phase Down of Dental Amalgam: Adopted by the FDI General Assembly: 27-29 September 2021, Sydney, Australia. Int Dent J. 2022 Feb;72(1):12-13.
18. Alberta Dental Association and College. Standard of Practice: Infection Prevention and Control Standards and Risk Management for Dentistry. 2023. Available at: https://www.cdsab.ca/wp-content/uploads/2019/03/CDSA-SoP-Infection-Prevention-and-Control.pdf
19. ADA American Dental Association. Best Management Practices for Amalgam Waste October 2007 Available at: https://www.ada.org/-/media/project/ada-organization/ada/ada-org/files/resources/library/oral-health-topics/topics_amalgamwaste_brochure.pdf
20. Australian Dental Association. ADA Guidelines for Clinical Handling of Dental Amalgam. 2023. Available at: https://ada.org.au/resources?_Production_Resources%5Bquery%5D=amalgam
21. California Dental Association. Dental Amalgam: Public Health and the Environment 2016. Available at: https://www.cda.org/wp-content/uploads/issue_amalgam.pdf
22. Centers for Disease Control and Prevention. Best Practices for Handling Extracted Teeth. Available at: https://www.cdc.gov/dental-infection-control/hcp/dental-ipc-faqs/extracted-teeth.html
23. New South Wales Ministry of Health. Dental Amalgam Clinical Use and Disposal2020. Available at: https://www1.health.nsw.gov.au/pds/ActivePDSDocuments/GL2020_015.pdf
24. New York State Department of Environmental Conservation. Managing Dental Mercury. Available at: https://dec.ny.gov/environmentalprotection/mercury/managing-dental-mercury/Accessed December 15, 2023.
25. Northeast Natural Resource Center of the National Wildlife Federation. The Environmentally Responsible Dental Office: A Guide to Proper Waste Management in Dental Offices 1999. Available at: https://dec.vermont.gov/sites/dec/files/wmp/SolidWaste/Documents/nwfdentalguide.pdf
26. The ADAPTE Collaboration. The ADAPTE Process: Resource Toolkit for Guideline Adaptation. Version 2.0. 2009. Available at: https://g-i-n.net/wp-content/uploads/2021/03/ADAPTE-Resource-toolkit-March-2010.pdf
27. Fisher J, Varenne B, Narvaez D, Vickers C. The Minamata Convention and the phase down of dental amalgam. Bull World Health Organ. 2018 Jun 1;96(6):436-8.
28. Aggarwal VR, Pavitt S, Wu J, Nattress B, Franklin P, Owen J, Wood D, Vinall-Collier K. Assessing the perceived impact of post Minamata amalgam phase down on oral health inequalities: a mixed-methods investigation. BMC Health Serv Res. 2019 Dec 21;19(1):985.
29. Graham ID, Harrison MB. Evaluation and adaptation of clinical practice guidelines. Evid Based Nurs. 2005 Jul;8(3):68-72.
Issue | Vol 21 (Continuously Published Article-Based) | |
Section | Original Article | |
Keywords | ||
Dental Amalgam Dental Waste Practice Guideline |
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