What's new?

We regularly update with information on what's happening in the project as well as news related to the project's purpose and objectives.

Uppdaterad 3 februari, 2017

Results water sampling

One objective in the project is that clinics participating in the demonstration project with mercury levels in sewage waste from suction systems above 1,000 μg/l, will have their mercury levels reduced by 50%. The results of the screening shows that a majority of the clinics already have results less than 200 μg/l. This could be an evidence of efficient maintenance and use of amalgam separators at the clinics.

Resultat vattenprover_life

Dialouge meetings

Draft of guidelines for improved routines at dental facilities in Sweden has been developed. The aim is reducing the emissions of mercury at dental clinics. The guidelines have been discussed at several dialogue meetings with dental teams, dental technicians and environmental offices in the county's municipalities. The meetings have resulted in many comments which have been documented. The guidelines have been updated with respect to comments.

The guidelines have been discussed at following meetings with dental actors and responsible authorities:

  • Meeting with environmental responsibles at the Swedish Dental Service organisations – November 2017
  • Swedental, the largest dental conference in the Nordic countries, digital questionnaire in order to get comments on the draft of national guidelines – November 2017
  • Technicians at Sweden Recycling – December 2017
  • Dental teams in Praktikertjänst – February 2018
  • Conference at Dental Hygiene Association for Dental teams and dental technicians – February 2018
  • County's municipalities, The Swedish Environmental Protection Agency has informed the inspectors at the county's municipalities about the project and asked for interest in participated in a dialogue group – March 2018
  • Dental technicians, Plandent – May 2018

The project has also participated in a conference arranged by Privattandläkarna – The association for private dental care providers in Sweden in May 2018.

Quotes after the meetings:
"It was very interesting and rewarding day!"

"Thank you for a fruitful meeting!"

“The meeting gave us a lot to think about for the future”.

“An enlightening and instructive presentation”

 

Checklists for maintenance

Laws and recommendations on dental mercury management in the EU

The project Hg-rid LIFE has produced a report comparing the Regulation (EU) 2017/852 of the European Parliament and of the Council of the 17 May 2017 with the current situation of handling dental amalgam in the EU countries according to “Study on the potential for reducing mercury pollution from dental amalgam and batteries”, BIO Intelligence Service, European Commission, 2012.

According to the report:

Hg-free alternatives to dental amalgam can be used in most medical conditions, but are still not widely used in a number of Member States. Hg-free materials are estimated to be used in 66% of restorations in the EU countries.

The quantity of mercury contained in people´s mouths in the EU Member States has been estimated to over 1 000 tonnes.

In ten Member States 100% of dental facilities are equipped with amalgam separators.

It is estimated that approximately 34 200 additional dental clinics will have to install a separator, assuming an average number of 2.1 dentists per clinic.

Mercury in dental waste represents about 50 t/year. It is estimated that 45 t/year from dental practices and up in chairside effluents, with only a part of which being captured and treated as hazardous waste in compliance with EU legislation. Out of the 52 t Hg/year of waste produced it can be estimated that around 36 t/year (69%) are managed as hazardous waste, 3 t/year (7%) as biomedical waste and 13 t/year (24%) as non-hazardous waste

Report on laws and recommendations on dental mercury management in the EU

Regulation (EU) 2017/852 of the European Parliament and of the Council of the 17 May 2017

Study on the potential for reducing mercury pollution from dental amalgam and batteries”, BIO Intelligence Service, European Commission, 2012

New EU regulations

Dental amalgam is one of the main sources of mercury use within the EU. There is evidence that 25% of dental practices in the EU have no amalgam separators.
The EU has decided on a new regulation concerning mercury which will enter into force 1 January 2018 (REGULATION (EU) 2017/852 OF THE EUROPEAN PARLIAMENT AND OF THE COUNCIL of 17 May 2017 on mercury).

This means, inter alia, that:

amalgam may only be used in pre-dosed, encapsulated form.

children under the age of 15 and pregnant or breastfeeding women may not be treated with amalgam unless it is considered absolutely necessary for medical purposes

amalgam separators with a specific efficacy must be fitted at dental establishments where amalgam is used or amalgam fillings are removed

(Sources: Source: BIO Intelligence Service and the Swedish Chemicals Agency)

Newsletter November 2017

During this years Swedental, the Nordic region's most important trade fair for the dental industry, representatives from Life Hg-rid worked in Sweden Recycling's booth to promote the project and its purpose.

To increase the knowledge of mercury in dental care and the project, a newsletter was distributed, click here to read.

Dental practice routines and municipalities’ supervision – summary of surveys on mercury control

Surveys have been sent to Praktikertjänst’s dental practices and to all environmental supervision departments. The questions concerned, inter alia, knowledge, routines and supervision. The results will form part of the ongoing project work, including reviewing the guidance for mercury control as well as developing educational and information material.

Read a summary of the survey responses here. 

Decontamination for more effective technology

Decontamination of drainage pipes is an important element of the project in order to develop more effective and cheaper technologies. The project will work to develop a more effective technology for decontaminating thin, thick and poorly-accessible pipes. New equipment, methods and procedures will be developed to check whether the decontamination method removes all sediments.

Video inspection of pipes
Video inspection equipment will be tested and evaluated as filming is the best tool for getting a clear picture of the inside of the pipes. By carefully examining the films, decontamination methods can be evaluated and improved. Video inspection is carried out both prior to the commencement of decontamination and after completion. For dry systems this means from all dental chairs and downstream. For wet systems, the suction pipe is filmed both from the dental chairs and downstream, as well as from the suction room and upstream.


Video inspection in premises where 142 grams of mercury was collected
 

Before decontamination
https://drive.google.com/file/d/0B8aD7MaU9y96MUxuSUJHbHloZnM/view 

After decontamination

https://drive.google.com/file/d/0B8aD7MaU9y96YXlYU0RNQkJXY3c/view 

 

Video inspection in premises where 1688 grams of mercury was collected 

Before decontamination:
https://drive.google.com/file/d/0B8aD7MaU9y96NFltaWhaVEZNdXc/view 

 

After decontamination:
https://drive.google.com/file/d/0B8aD7MaU9y96a2NMNHBESHZKM0k/view


Testing of mercury-binding chemicals
This sub-project includes testing chemical treatment of pipe systems to reduce mercury leakage from newly-treated surfaces that have been contaminated with metallic mercury. The chemicals bind metallic mercury so that it will not dissolve in water. Mercury content before and after treatment will be evaluated in order to determine the effectiveness of the chemicals. The proposed chemicals have no negative environmental impact. They rapidly degrade into harmless substances so that the original chemicals will not reach the general sewage network.

Collected mercury
So far, 18 practices have been decontaminated within the framework of the project and many more are in the pipeline. The collected quantity of elemental mercury varies thus far from 55 to 1,700 grams. So far, a total of 7.9 kilograms of mercury has been collected in the decontaminations carried out (17, results still unavailable for one practice).

 Life-diagram_17



rör innan sanering_1rör innan sanering_2

Example of pipe before decontamination, autumn 2017.

 vattenlås

Water locks that are decontaminated can contain large amounts of amalgam residues, autumn 2017.

What is the procedure for decontamination?

Mercury contaminated drainage pipes, water locks and floor wells are flushed clean. All water from the decontamination process is then collected for post-treatment. Sweden Recycling has mobile flushing devices so that pipes located higher up in a property can be reached. Pipes that have been decontaminated are labelled with the date of decontamination and who performed the work. Decontamination usually takes 3–4 hours.
Treatment of patients can continue immediately after decontamination has been completed.

 sanering 2_2017

Disposal of the decontamination waste
The decontamination wastewater and sludge are collected and transported to Sweden Recycling's plant in Växjö for intermediate storage, before further transportation to its sister company Medentex GmbH in Germany for processing.

Sweden Recycling AB and Medentex GmbH have all permits required.

The Minamata Convention has entered into force

The Minamata Convention on Mercury, which will restrict the use of mercury in the worldm, entered into force on 16 August 2017. This means, among other things, that the use of dental amalgam is limited.

The Minamata Convention is signed by 128 countries and has been ratified by 74 countries. In accordance with the convention, the use of amalgam to in teeth will be limited. In Sweden it is already prohibited, with certain exceptions, but the use will now be prohibite throughout the EU for children under the age of 15 and for breastfeeding and pregnant women.

Most of the mercury emissions that falls on Swedish soil comes from other countries. In order to reduce pollution of the Swedish environment, it is therefore important that measures be taken at global level.

The Minamata Convention has been named after the environmental disaster in Minamata, Japan, in the 1950s. It was caused by the release of methylmercury in the industrial wastewater. Thousands of people suffered brain damage and neurological syndromes. Mercury is classified as one of the most dangerous environmental hazards, especially when it transitions into methyl mercury after a chemical reaction - a substance that is easily absorbed by living organisms and can spread in the nutrient chain.

Read more on the Minamata Convention website.

Photo: Minamata Convention

A study of knowledge, inspection methods and legislative demands

As a part of Hg-Rid-LIFE a thesis has been conducted by Märta Tobiasson, student at Umeå University, Bachelor's program Environmental protection.

The purpose of the thesis was to investigate how environmental offices in the county's municipalities work with the supervision of dental care clinics and the requirements under current legislation the municipalities. The purpose was also to investigate the causes of possible differences and similarities between small and large municipalities.

Abstract:

There’s been a general ban on use of mercury in Sweden since 2009 but it’s still estimated that the Swedish population have between 40 – 60 tons of amalgam in their teeth. Dental amalgam contains about 50 % mercury and studies have shown that despite the installation of amalgam separators mercury emissions from dental clinics still occur. Environmental officers in Swedish municipalities are important in the work to reduce mercury emissions from dental clinics in Sweden. The purpose of this report was to investigate how Swedish municipalities carry out supervision of mercury management in dental clinics as well as to investigate the legislative demands on the mercury management in dental clinics. The purpose was also to investigate possible similarities and differences between municipalities with varying populations. Environmental officers in Swedish municipalities answered a web survey. The results show that the knowledge about mercury management in dental clinics is greater among environmental officers in larger municipalities compared to smaller municipalities. Some of the smaller municipalities don’t carry out any inspections of dental clinics whereas every larger municipality does. Larger municipalities have higher demands on mercury management in dental clinics than smaller municipalities. The legislations used are broadly the same among the municipalities but because the demands made by the municipalities differ, it indicates that the interpretation of the legislations vary between municipalities in Sweden. Collaborations between different municipalities, more distinct guidelines and guidance are probably necessary to achieve a consensus amongst the municipalities when it comes to mercury management in dental clinics.

Praktikertjänst has at the same time investigated dental care clinics' mercury management based on a survey of the company's dental care activities.

The survey results will be a part of the ongoing work of the project, including reviewing mercury control guidance as well as educational and information material. The answers should not be seen as guidelines, but describe how the environmental inspectors and dental staff work today. It may be necessary for the guidelines to change, which the project should review.

In the project, there will also be different types of networking, including environmental inspectors through a reference group and in different types of dialogue meetings. This work is expected to be completed by the beginning of 2018.

 

Link to the thesis

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Sweden ratifies the Minamata Convention on mercury

In May 2017, the Government decided that Sweden should ratify the Minamata Convention on mercury. The UN Convention limits and prohibits mercury in both products and industrial processes from 2020. Sweden becomes party to the Convention three months after ratification has been made.

The Minamata Convention on Mercury is a global treaty to protect human health and the environment from the adverse effects of mercury. It aims to reduce or phase out the use of mercury and better control emissions so that the environmental impact is decreasing globally.

Mercury can be transported long distances and the majority of supplies to Sweden come from abroad. 43 states have ratified the Minamata Convention and EU countries have negotiated a common regulatory framework in 2016 to fulfill the requirements of the Convention.

Read more about the Minamata Convention here.

Raises awareness

Dentist Lena Gavelin works at one of the 200 dental facilities that's been screened so far.

- We don't use amalgam in Sweden anymore, which has lead to that many don't believe that mercury still is a problem in dental care. But ut acutally is. I'm drilling in amalgam fillings every day, and I think most of my colleagues do, says dentis Lena Gavelin, who runs one of Praktikertjänst's dental facilities since 2013.

- I have a separator in the chair that takes care of everything from fragments to dust when drilling away amalgam. It's great that I get to know if it collects as much as possible.

Lena Gavelin thinks the project is important and believes in particular that it is good to raise awareness and to set routines for work against mercury emissions from dental care facilities.

- Sweden Recycling visits my clinic and checks that everything works as it should. Then I get feedback on what may need to be rectified and if I need to decontaminate the pipes. That's really good. This venue has been a dental clinic for many years but I have never thought that there may be a lot of mercury in the pipes.

- Many people probably don't think that simple things like care and supervision of separators can make a difference for the release of mercury.

Breakfast seminar about sustainability

On April 26, Praktikertjänst participated at Stockholm Läns Landsting's Sustainability seminar to talk about Hg-Rid-LIFE. Among the invited were employees working with the environment within the county council's activities and private healthcare providers as well as the county council's politicians.

Anna Svensson and Helena Franzon from Praktikertjänst presented the project and received many interesting questions from the audience. Many were surprised that mercury is still a major environmental problem.

Warmer climate leads to more mercury in fish

A study made by researchers at Umeå University and the Swedish University of Agricultural Sciences has shown that a warmer climate could cause up to seven times higher levels of toxic methylmercury in zooplankton. Climate change has been projected to induce increased runof for large coastal regions globally,  thereby adding more organic matter to the aquatic ecosystems in the major regions of the northern hemisphere, including the Baltic Sea.

Mercury can easily be converted to methylmercury when it's released into the environment and is classified, by WHO, as one of the top ten chemicals that pose the greatest threat to global public health. It works like a strong neurotoxin in the body and affect the nervous system in humans.

This is further proof of how important it is to stop mercury emissions at the sources. The dangerous chemical can be spread over very long distances in the atmosphere, it is therefore important that other countries within the EU is fully committed to reducing emissions of mercury.

Read the full research article at Science Advances.

Inta Düce, our EU monitor, visiting Praktikertjänst

In early December,  our EU monitor Inta Düce, visited Sweden and Praktikertjänst. She works for the EU program and has been appointed to be our contact.

Her task is to monitor and evaluate the progress of the project so that the everything is going according to plan. During the visit, she got a closer presentation of the project and the plan forward.

Inta Düce together with Helena Franzon and Anna Svensson at Praktikertjänst

The EU negotiates on legislation to reduce use of mercury

In December 2016, negotiations began between the European Parliament, the Council and the European Commission on a draft regulation on mercury. The new rules aim to enhance the protection against the pollution by this highly toxic substance.  The use of amalgam for dental treatment of milk teeth, children under 15 years and pregnant or breastfeeding women will be banned from 1 July 2018 unless there are specific medical needs. 

Member States must also draw up national plans for reducing the use of dental amalgam before 1 July 2019. Dental amalgam is one of the main uses of mercury in the EU. Within the project LIFE Hg-rid, we welcome the news and hope that the proposal national guidelines that we will develop during this project can benefit both Sweden and other EU countries.

Read full press release here.

The winners in our competition

Five winners have been appointed in our competition. They answered the question correctly and gave their best environmental tips. The contest was open to all who visited the dental fair Swedental or our website. We will send a cookbook about vegetarian food to everyone who won. Congratulations!

The question in the competition was: "It is estimated that 75 percent of the Swedish population still have amalgam fillings. How much mercury is estimated to be found in the Swedes' mouths?". The correct answer was 40 tonnes.

Here are the winners and their environmental tips:


Magnus Steen, Dentist
Tips: Good dental care with a lot of preventive dentistry. Good oral health is the best way to protect the environment. The fewer new operative dentistry that needs to be done, the more we spare the environment with less use of materials and less waste. 

Christer Persson, Dentist
Environmental tips: Take samples of the effluent water from the amalgam seperator. We did it last spring and the levels of mercury was to high!

Evelyn Krantz, personnel consultant, Praktikertjänst
Environmental tips: Buy eco-products, waste sorting and choose to use public transport more often.

Margaret Hastings Horath, dental hygienist, head of department at Specialist Dental, Dental School Umeå
Environmental tips: Put a timer on your lights.


Elisabet Jonsson, dentist in Norway
Environmental tips: I live on an island in the Atlanterhavet. It's a sad sight to walk one the beach and see the huge amount of various plastic products pollute our seas. These plastics are ground down by the sea's movements to small and even smaller pieces and ends up in the belly of aquatic animals. My environmental tips is: Gather all the plastic waste that you produce and submit it to the recycling! Think of the environment!

As a dentist, my best environmental advice is to separate even the smallest chip of amalgam from removed teeth so that it is disposed as hazardous waste.

"It goes without saying that we should work for a better environment"

Anders Jonsson is a dentist in Gothenburg, Sweden and is a part of Life Hg-rid's project group. We asked him two questions to hear his thoughts on the project.

What are your thoughts about this project?
I think it is very positive that Praktikertjänst together with Sweden Recycling and IVL has received financial support from the EU for this project. It goes without saying that we should work to improve the environment and waste management, and help us learn from each other throughout Europe.

What are the benefits for you as a dentist to participate in the screenings?
The great benefit is of course a more sustainable dentistry, I think everyone wants to be involved and contribute to reduced emissions of mercury. In addition, you simply and easily review suction systems and amalgam separators. It is obviously an advantage to have it on paper when municipal environmental inspectors knocks on the door.

Meet us at the dental fair Swedental

During this years dental fair, Swedental, you can meet us in Sweden Recycling's booth. We are in booth A17:48 every day during the fair.


Swedental, Stockholm International Fairs, November 16 to 18, 2016.
http://www.swedental.org/

Contact us

Please contact us if you want to know more about our project.

lifehg@ptj.se

Financially supported by EU LIFE Programme