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Dental wastes are materials that are generated by dental clinics which are no longer useful for the services provided and are therefore discarded. Dental operations units produce wastes that are classified into: hazardous, non-hazardous, sharps and pharmaceutical wastes. Improper disposal of dental wastes can result in damage to the people in the instant vicinity, the dentist who manipulates the materials, rubbish handlers or the society at large. Dental wastes generate toxins from wastes disposal or as by-products from the alteration of these wastes compounds (e.g across incineration).
A waste auditing is the major step for conducting a comprehensive waste management strategy (Glenda M. Farmer 1997). Despite the fact that dental waste clinics are viewed as few quantity in the overall healthcare waste; on the other hand, they produce a specific number of hazardous rubbish (Pruss et al., 1999). However, it is easier to achieve a proper waste management model if the quality and the quantity of the healthcare waste are well defined (Uysal and Tinmaz, 2004).
Hospitals and health care institutions have the responsibility to maintain the public health as it may be directly via patient care, or indirectly by guaranteeing a thoroughly clean of the healthcare vicinity and a healthful surrounding for the employee and the society " (Patil and Pokhrel 2005)
Dental communities generate a vast collection of wastes components that may be domestic types, infectious and toxic. However, each component should adopt a specific way for collecting, treating and proper disposal strategy (Al- Rabeah, 2002; Hiltz, 2007)
As far as a proportion of dental wastes is categorized into domestic or general wastes and which consist of wood, cardboard, plastics, food residue and glass that pose any threat to the environment as well as human health, waste management operation become easier to handle. Furthermore, if it is well separated from other variety of wastes, it can be easily directed to municipal waste (Kizlary et al., 2005; WHO, 2005).About 90% of the solid dental waste was recorded due to a considerable boost in the use of PPE such as gloves, face masks and plastics barriers( Farmer et al. 1997)
Discarded products include things like sharps, rejected materials or items that have been exposed to human tissue fluid and blood-soaked dressing is classified as infectious waste (Pruss et al., 1999). Proper management of infectious waste is essential since it is dangerous to human health and the environment. It is also classified as hazardous waste (Johannessen et al., 2000; Shinee et al., 2008) Due to its infectious and/or toxic characteristics, waste generation rely on the hospital's capacity, staff number, and the waste handle operations" (Tsakona, Anagnostopoulou and Gidarakos 2006)
"Basically, infectious waste possesses hazardous characteristics that may endanger human health or the nature" (Department of Pollution Control, n.d.). Chaerul et al.(2008) states that "lack of awareness in defining infectious waste may result to improper management of the waste, especially in the process of separation between general and infectious waste." Consideration on the segregation waste component is an essential process as it is the most important step in the healthcare waste management chain" (Bangkok Metropolitan Administration, n.d.).
Moreover, dental wastes comprise of heavy metals and chemical compounds that are toxic for the human health and the nature as whole ( Hiltz., 2007). Toxic components such as mercury, silver, lead, chemical disinfectants, X-ray fixers and films are extremely dangerous for living things if they are not properly disposed.
Mercury can diffuse into the environment in the form of solid waste as removed teeth from patient practice contain amalgam particles that are directed through waste water system. (Arenholt-Bindslev., 1998, Chin et al., 2000). As a solid stable regenerative agent, amalgam for dental operations consists of different proportion of silver, copper, tin, other metals, and mercury that forms the whole material ( Chinet al., 2000; Drummonda et al., 2003; O'Brian, 1997 ; Westman, 1997) .
The component of dental amalgam contains 50% of mercury and contributes less than 1 percent release in the environment. Since it is the dentistry's responsibility to take care for the environment as well as the patient's safety, mercury is toxic and consideration on the amount released must be controlled through their own management system (Amy knepshield Condrin, 2004)
Kontogianni et al. showed there is an absence of a well planned dental waste management programme in the dental department of Thessalonica in Greece ( kontogianni et al., 2008)
Nowadays, a huge demand in training through recent regulation and state EPA- mandate concerning amalgam separator and the importance of recycling amalgam components, X-ray residue, lead, chemicals, bio-hazardous components, and the new shift for pharmaceutical waste recycling.
Dentists should be mindful to, up to date with and practical in implementing all essential guidelines and procedures required by referring to regulations needed to meet compliance. (Alfred L. Frost III, M.S., D.D.S., 2011).
In some society, especially developing countries, it is obvious that there has no specific attention in the treatment of healthcare waste. A combination of training, awareness and capital resources is needed to find solutions in housekeeping as it is a new and ambiguous issue. (Abdulla et al., 2008; Diaz et al., 2005; Mbongwe., 2008)
Education is imperative as far as behavior and discipline concerning the waste management within the dentistry community is neglected. The habit of throwing amalgam in the trash rather than properly segregated or placed in proper container, will remain in someone's attitudes until awareness and training are adopt sufficiently. However, the regulations are omnipresent and it is primordial to allocate the essential knowledge within the dentistry department. Dentist who acquired knowledge in the field of dental care should share attentions on the proper waste disposal to his subordinates and promote a healthier work environment. Researchers have precisely emphasized on the waste management system and explain the need for training and compliance with law and regulation. Moreover, capital is a limiting factor for proper treatment of waste in dental health care; as it is viewed more frequently in developing countries. However, my study is mainly based on dental disposals and its management for public sector in the Mauritian context.
Health effects of dental wastes
Type of risk
Occupational health problem
Infection due to laboratory waste, blood, regulated body fluids & saliva
Contamination from infectious body fluid due to sharps and needles wastes
Hepatitis B,C &D
Poisoning from dental components(amalgam, X-ray chemistry)
Toxicity due to sterilization practices
Contact with bottles, boxes containing or contaminated by pharmaceuticals substances
Drugs, vaccines, sera, silver -nanoparticles
Summary of health effects in modern dental waste management.
Sharps and infectious waste
"The decomposition of infectious waste generates uncomfortable smell, favour the proliferation of pests, rodents, as well as worms; however, lack of proper waste management normally give access to injuries from sharp objects leading to infection. Sharps and pathological wastes can create cross infection diseases like typhoid, cholera, hepatitis and AIDS (Henry and Heinke 1999).
Objects such as needles, scalpels as well as over sharps instrument become infectious and cut-wound the skin since they become saturated to blood, tissue fluid and other infectious body fluid agents. This kind of waste should treat differently from hazardous waste. Waste that can be defined as either infectious or hazardous waste is known as dual waste. It is important to meet compliance with both hazardous waste and infectious waste regulations.
The virus that is responsible for AIDS (Acquired immunodeficiency Syndrome is HIV ( the human immunodeficiency virus). HIV destroy the defense mechanism in the body, resulting in long-term and gradual build-up illness that causes infected people to easily prone to any sort of diseases and cancers. The signs and symptoms appear approximately 10 years after infection. AIDS is a threat to the health if there is no prompt treatment and still there is no remedy to fight against it.
HIV can be transmitted from one person to another, via blood and tissue fluid. Puncture from infected needles and sharps may facilitate the attack of HIV if there are no proper waste management for such items.
Hepatitis A, B & C
Hepatitis A is very contagious and is transmitted as Hepatitis A virus. Liver infection is common from infection to hepatitis A virus. Inflammation that inhibits the normal function of the liver is unique for the hepatitis A virus as compare to other hepatitis viruses.
No long-term effects is observed as far as the person who get infected can return to his normal state of health without any liver damage and mild cases does not require treatment. Hepatitis A is transmitted via contaminated food, water as well as exposure to tissue fluid in dental waste.
Hepatitis B virus (HBV) is a small- DNA that is transmitted easily as compare to HIV. Long ago, the mode of transmission of HBV was mainly through infected blood components, but it is rare nowadays. HBV can be transmitted through contaminated body fluid ( e.g semen, blood )
Mild and flu-like are signs and symptoms at acute infection. Symptoms of hepatitis B is normally weakness, nausea, vomiting, body aches, diarrhea, fever, joint pain, jaundice (yellowish of the skin and the whites of the eyes), loss of appetite, weight loss, and sometimes an itchy skin rash.
Acute infection stops as from 1 to 3 months and 5 -10 % of the infectious person acquired chronic hepatitis where they are extremely contagious. And the rest of the percentage will develop immunity against infected virus.
Serious liver problem can result from chronic health effects HBV example, are cirrhosis and hepatoma.
Inflammation of the liver is one the main health effects caused by hepatitis C virus. About 85% of infected person who are infected acutely will consequently infect chronically without the ability to get rid of the virus.
Basically HCV is transmitted via infected blood, in the context of waste disposal, sharps and needles are the common media for transmission of such disease. Scarring of the liver (cirrhosis) is the long-term health of HCV. However, some individuals, fatigue and other not define symptoms in the absence of cirrhosis is observed.
Dental amalgam (mercury)
Typically, a dose-response trend is necessary to evaluate the adverse effect of toxic materials; however, the type of mercury is also important. For example, methyl mercury is considerably more toxic than other mercury molecules. Mercury affects the brain, liver and kidneys.
The mercury is excreted mainly through urinary and fecal routes. However, mercury in humans has a half-life of two months approximately. A combination of metals such as silver, copper, tin and specially mercury chemically binds to form a stable regenerative component known as amalgam. However, the manipulations of dental amalgam as waste product remain great concern for dentist as well as for the surrounding. Dental amalgam contains mercury which poses great concern on human health effects.
Short-term exposure to high dose of mercury vapour creates adverse effects on the nervous, digestive, respiratory systems, and the kidneys. In most cases, exposure occurred when mercury was heated. For example, during incineration of dental amalgam in extracted-teeth.
Symptoms similar to "metal fume fever" are observed when high dose of mercury is inhaled, including fatigue, fever, and chills. Respiratory system effects include cough, breathlessness, tightness and burning pains in the chest and swelling of the lungs.
Tremors (normally affecting the hands and gradually spread throughout the body), emotional instability (narcotic effects), dizziness, loss of memory, weakness in muscles, headaches, slow reflexes and a loss of feeling or paralysis .
A typical short term exposure to high dose of mercury is inflammation of the bucal cavity (stomatitis), sometimes with a metallic taste, increase in saliva production and harder to swallow. Other digestive system effects include abdominal pains, nausea, vomiting and diarrhea.
Moreover, Kidney injury occurs due to high concentrations of mercury. It is normally observed as excess of protein in the urine for kidney failure. Exposure to high dose of mercury also increased blood pressure and heart rate.
Long-term effects of mercury
Outcomes on muscles coordination, state of mind, attitudes, memory, sensation and nerve impulse transmission were due to long term exposure. Since dental amalgam fillings (containing mercury) are toxic, it provides a long term effects, as far as it particularly involved nervous system disorders, such as multiple sclerosis, chronic fatigue syndrome and Alzheimer's disease.
Moreover, health effects result from long-term exposure of mercury vapour are:-
Anxiety , Excessive shyness , Anorexia, Sleeping problems , Loss of appetite , Irritability, Fatigue forgetfulness , Tremors , lost of vision and hearing loss.
Silver is one the main hazardous waste constituent of dental offices found in x-ray fixer solution and used in x-ray film. In U.S the toxicity of silver is merely regulated under the Resource Convention and Recovery Act, since rejected photographic or x-ray film processing liquids that may contain silver at or above 5 mg/L are considered as hazardous waste when collecting, store or dispose for treatment.
Basically, most people are exposed to very low dose of silver from food and drinking water, this is because it occur naturally in soil and underground water. However, long term exposure for people who ingest or breathe excess (above normal dose) of silver components can cause part of the skin and other skin tissues to turn gray or blue-gray, known as "argyria." Argyria, is the most predominant health effect of high concentration of silver exposure. It is a permanent condition and it is known to cause damage for skin only.
Lead aprons, shields, foils, batteries, and computers are the common sources of lead wastes generate by dental office. X-ray films are securely wrapped and protected by lead foil. Besides, Lead aprons and shields are therefore used to give protection for radiation while operating patient x-rays. Moreover, rechargeable and single use batteries contain lead and other hazardous metals. Electronic components, such as computers, monitor and analytical equipment also contain lead as toxic component.
Signs and symptoms normally happen when lead build up in the body for a certain amount of time, without taking into consideration its hazardous properties. Health effects are basically, weakness, anemia, colic, constipation, palsy, and often ankles and wrist paralysis. Children are more prone to risk even at low concentration. IQ deficiencies, studying disabilities, becomes careless, hearing loss and impaired balance occur when ingestion at high concentration occur. Blood pressure appears only at minimum dose level in adults.
Pharmaceutical waste and chemicals
The utilization of chemicals and pharmaceuticals throughout the dental health sector are mainly hazardous to health (e.g. toxic, genotoxic, corrosive, flammable, reactive, explosive, and shock-sensitive). Few amounts of these substances are present in dental care waste; it exists in larger quantity disposal only if products are no longer useful and has already reached the maximum period for usage. Short-term or Long-term exposure may cause intoxication, Injuries, including burns. Routes of entry for chemical or pharmaceutical are mainly through the skin or the mucous membranes, or from ingestion or inhalation. Flammable, corrosive, or reactive chemicals may cause injury to the eye, mucus membrane or skin (e.g. formal-dehyde and other volatile substances). Burns results mainly as accidents. Disinfectants are more popular in its group as it is corrosive and reactive chemicals are found to be highly toxic secondary substances.
Inhalation of corrosive vapour such as ammonia and hydrogen chloride from toxic pharmaceuticals and chemical residue may cause acute irritation. Symptoms include coughing, irritation of mucous membranes as well as pain and burns in eyes, mouth and respiratory tracts. Higher dose exposure result in oedema (secretion of tissue fluid from mucus membrane).
Long-term health effect results from pharmaceutical and chemicals compounds are contact irritant dermatitis. Prolonged and repeated exposure to the residue of oxidizing agent, organic solvent and detergent waste may result in irreversible skin disease, especially for waste handlers.