A S S O C I A T I O N R E P O R T ABSTRACT

Background. The ADA has long recog-

Dental mercury nized the importance of observing proper

mercury hygiene practices for the safety of

hygiene
dental professionals. In 1999, the ADA
Council on Scientific Affairs adopted mer-
cury hygiene recommendations to provide

recommendations guidance to dentists and their staff mem-

bers for safe handling of mercury and
dental amalgam. These mercury hygiene
ADA COUNCIL ON SCIENTIFIC AFFAIRS recommendations have been developed to
update those previously adopted by the

T
Council.
he American Dental Association has long rec- Overview. In addition to discussing
ognized the importance of observing proper sources of mercury in the dental office, this
mercury hygiene practices for the safety of Council report describes office engineering
dental health care workers. The following rec- considerations and hygiene recommenda-
ommendations were developed as an update of tions to be used during preparation and
the ADA Council on Scientific Affairs’ 1999 recommenda- placement of dental amalgam restorations.
tions1 to provide guidance to dentists in adopting an appro- New information included in this report
priate mercury hygiene program, ensuring the safety of all covers the management of mercury spills.
dental personnel involved in the handling of mercury or Practice Implications. These recom-
dental amalgam and minimizing the release of mercury mendations are intended to provide guid-
into the environment. They are not intended to establish a ance to the dental practitioner in ensuring
standard of care or to set requirements that must be fol- the safety of personnel who handle dental
lowed in all cases. amalgam and in minimizing the release of
The current update mercury into the dental office environment.
duses a new format to make the information more
accessible;
drecommends against the use of carpeting in dental pensers (although the ADA recommends
operatories, where a mercury spill might occur; against the use of bulk elemental mercury);
dprovides more information on the management of trituration, placement and condensation of
mercury spills. amalgam; polishing or removal of amalgam;
In February 2003, the ADA published Best Manage- vaporization of mercury from contaminated
ment Practices for Amalgam Waste.2 Dentists are instruments; and open storage of amalgam
strongly urged to follow the ADA Best Management scrap or used capsules.
Practices, or BMPs, and any that may have been
adopted by their state or local dental associations. The GENERAL MERCURY HYGIENE
RECOMMENDATIONS
ADA BMPs are available online in the members-only
portion of the ADA Web site (“www.ada.org”); interested dTrain all personnel involved in the handling
readers also can obtain a copy of the ADA BMPs by of mercury and dental amalgam regarding the
sending an e-mail to “[email protected]” or calling the potential hazards of mercury vapor and the
ADA toll-free number, Ext. 2878, or 1-312-440-2878. necessity of observing good mercury hygiene
Dentists are urged to include the ADA BMPs in their practices.
mercury hygiene training programs. dRemove professional clothing before leaving
the workplace.
SOURCES OF MERCURY IN THE DENTAL OFFICE
Dental personnel potentially can be exposed to mercury OFFICE ENGINEERING
through direct skin contact with mercury (or freshly dWork in well-ventilated work areas, with
mixed dental amalgam) or through exposure to the fol- fresh air exchanges and outside exhaust. If
lowing potential sources of mercury vapors: accidental the work areas are air-conditioned, the air-
mercury spills; malfunctioning amalgamators, leaky conditioning filters should be replaced
amalgam capsules or malfunctioning bulk mercury dis- periodically.

1498 JADA, Vol. 134, November 2003

Copyright ©2003 American Dental Association. All rights reserved.

 A S S O C I A T I O N R E P O R T

dUse proper work area design to facilitate spill ammonia or chlorine.

containment and cleanup. Floor coverings should dNever pour mercury, or allow it to go, down the
be nonabsorbent, seamless and easy to clean. The drain.
Council does not recommend the use of carpeting dNever use a broom or a paintbrush to clean up
in operatories, where an accidental mercury spill the mercury.
might occur. Chemical decontamination of car- dNever allow people whose shoes may be con-
peting may not be effective, as mercury droplets taminated with mercury to walk around or leave
can seep through the carpet and remain inacces- the spill area until the mercury-contaminated
sible to the decontaminant. Removal of the con- items have been removed.
taminated carpet may be the only way to ensure
decontamination. MANAGEMENT OF SMALL MERCURY
SPILLS
dPeriodically check the dental operatory atmos-
phere for mercury vapor. This may be done using A spill is considered small if there are less than
dosimeter badges or through the use of mercury 10 grams of mercury present (a pool no larger
vapor analyzers for rapid assessment after any than the size of a quarter).6,7 Small spills can be
mercury spill or cleanup procedure. The current cleaned safely using commercially available mer-
Occupational Safety and Health Administration, cury cleanup kits and by observing the steps
or OSHA, standard for mercury is 0.1 milligram listed in the Michigan Department of Environ-
per cubic meter of air averaged over an eight- mental Quality’s table entitled “Management of
hour work shift.3 The National Institute for Occu- Mercury Spills.”8
pational Safety and Health has recommended the
permissible exposure limit to be changed to MANAGEMENT OF LARGE MERCURY SPILLS
0.05 mg/m3 averaged over an eight-hour work A mercury spill is considered large if there are
shift over a 40-hour workweek,4 but OSHA has more than 10 g of mercury present (a pool larger
not yet adopted this recommendation. than the size of a quarter).6,7 Cleanup of large
mercury spills requires the use of an experienced
HYGIENE RECOMMENDATIONS DURING environmental contractor who specializes in toxic
PREPARATION AND PLACEMENT OF
AMALGAM spill cleanup. Contact your state or local Environ-
mental Protection Agency office for a list of con-
dUse only precapsulated amalgam alloys. The tractors who clean up toxic spills. ■
ADA recommends against the use of bulk alloy This report was prepared on behalf of the ADA Council on Scientific
and bulk elemental mercury, also referred to as Affairs by Division of Science staff members Dr. Yasser Elseweifi; P.L.
Fan, Ph.D.; Kathleen Todd; and Roger Connolly.
liquid or raw mercury, in the dental office. If you
still have bulk elemental mercury in the office, it Address reprint requests to American Dental Association, Council on
Scientific Affairs, 211 E. Chicago Ave., Chicago, Ill. 60611.
should be recycled (refer to the ADA BMPs2).
dUse an amalgamator with a completely 1. ADA Council on Scientific Affairs. Dental mercury hygiene recom-
mendations. JADA 1999;130:1125-6.
enclosed arm. 2. American Dental Association. Best management practices for
dIf possible, recap single-use capsules after use, amalgam waste. Chicago: American Dental Association; 2003.
3. Occupational Safety and Health Administration. Standard inter-
store them in a closed container and recycle them. pretations. (1996) PEL for inorganic mercury is a time weighted
dUse care when handling amalgam. Avoid skin average, not a ceiling. Available at: “www.osha.gov/pls/oshaweb/
owadisp.show_document?p_table=INTERPRETATIONS&p_id=
contact with mercury or freshly mixed amalgam. 23866&p_text_version=FALSE”. Accessed April 17, 2003.
dUse high-volume evacuation systems (fitted 4. National Institute for Occupational Health and Safety. Occupa-
tional health guidelines for inorganic mercury. Available at:
with traps or filters) when finishing or removing “www.cdc.gov/niosh/pdfs/0383.pdf”. Accessed April 8, 2003.
amalgam. 5. U.S. Environmental Protection Agency/Purdue University. Mer-
cury in buildings. Available at: “pasture.ecn.purdue.edu/~mercury/src/
frame.htm”. Accessed March 24, 2003.
MANAGEMENT OF MERCURY SPILLS 6. Virginia Commonwealth University, Office of Environmental
Health and Safety, Chemical/Biological Safety Section. Mercury spills.
In case of an accidental mercury spill (regardless Available at: “www.vcu.edu/oehs/chemical/mercuryspills.html”.
of size), the Council endorses the following Accessed March 25, 2003.
7. Prince Edward Island [Canada] Department of Fisheries, Aquacul-
recommendations5: ture, and Environment. Guidelines for the safe clean-up of household
dNever use a vacuum cleaner of any type to mercury spills. Available at: “www.gov.pe.ca/photos/original/
fae_mercury.pdf”. Accessed April 8, 2003.
clean up the mercury. 8. Michigan Department of Environmental Quality. (2003). Cleaning
dNever use household cleaning products to up small mercury spills. Available at: “www.michigan.gov/deq/1,1607,7-
135-3585_4127_4175-11751--,00.html”. Accessed March 24, 2003.
clean up the spill, particularly those containing

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