# Dental Category

Outreach and Data

Collection

Public Docket for the Effluent Limitation Guidelines and Standards for the Dental Category EPA Docket Number EPA

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- 0 693 ( www.regulations.gov )

23 September 2014Dental Category Outreach and Data Collection

I. Overview

Across the United States, many states and publicl y owned treatment works (POTWs) are working to reduce discharges of mercury to POTWs. EPA is proposing regulations for the dental industry that include pretreatment standards for the control of mercury in wastewater. EPA is proposing technology

- based pretr eatment standards under the Clean Water Act (CWA) for discharges of pollutants into POTWs from existing and new dental offices 1 that discharge dental amalgam. The proposed rule would require dental offices to control the discharge of mercury and other meta ls in dental amalgam into POTWs based on t he best available technology or best available demonstrated control technology (amalgam separators) and the use of best management practices (BMPs). The BMPs are (1) eliminating the flushing of scrap amalgam down d rain s and (2) cleaning chair

- side traps with non

- bleach, non

- chlorine cleaners. EPA is also proposing to amend selected parts of the General Pretreatment Regulations (40 CFR 403) to streamline oversight requirements for the Dental Category

.

EPA first ide ntified the dental industry for study in its review of the health services industry in the 2006 Effluent Guidelines Plan (71 FR 76644). EPA selected the industry based in part on public comments about discharge s of mercury from dental offices and dental laboratories. The Health Services Industry Detailed Study Report for Dental Amalgam (EPA

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- 014) was completed in August 2008 (U.S. EPA, 2008)

. EPA collected data from a variety of sources for the proposed Dental Amalgam Rule, including the Health Services Industry Detailed Study, stakeholder discussions with organizations such as the Environmental Council of the States and the American Dental Association (ADA) , amalgam separator manufacturer contacts, and journal publications and studies on the use of amalgam separator systems. EPA used data from these sources to develop a profile of the industry, describe dental mercury sources and waste characteristics, describe the environmental impacts of mercury, ident ify state and local programs to reduce mercury discharges from dental offices, characterize the effectiveness and costs of amalgam separators and BMPs, and develop pollutant discharge loadings estimates with and without control technologies.

II. Comments Received on the Preliminary 2008 Effluent Guidelines Plan that Focus on the Dental Industry

EPA published its Preliminary 2008 Effluent Guidelines Plan on October 30, 2007 (72 FR 61335). The plan included a summary of EPA’s detailed study for the healt h services industry, including mercury discharges from the dental industry. Most of the
comments received were from pretreatment programs that provided useful information on their mandatory and voluntary programs that include the use of amalgam separators. EPA used this information to update its Health Services Industry Detailed Study Report for Dental Amalgam (EPA

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. Table 2 , at the end of this document, includes a

1 This document uses the general term “offices” to refer to any dentistry practice or facility that places or removes dental amalgam containing mercury.Dental Category Outreach and Data Collection

3 list of the comments received on the Preliminary 2008 Effluent Guidelines Progra m Plan for the dental industry

.

I I I. Outreach and Data Collection Activities

The outreach and data collection goals for the Health Services Industry Detailed Study and Proposed Effluent Limitation Guidelines and Standards (ELGs) for the Dental Category included: (1) establish points of contact between the EPA and dental industry associations, POTW associations, vendors, and other stakeholders; (2) further EPA’s understanding of the dental industry, including amalgam management and disposal; (3) identify outreach opportunities to association members and other interested stakeholders; (4) provide transparency on EPA’s actions and decision

- making; (5) identify and resolve issues as early as possible; and (6) identify treatment technol ogies and BMPs for mercury in amalgam. EPA’s outreach and data collection activities helped EPA to address the following questions:

 What are the current industry practices for disposing of dental amalgam (containing mercury and other metals) , to what ext ent are each of these practices applied, and what factors affect the use of these practices?

 What are the federal, state, or local requirements or guidance for disposal of dental amalgam ?

 How are control authorities currently limiting mercury discharge s from dental offices ?

 Do POTWs report pass through or interference problems related to dental mercury discharges?

 What technologies are available (1) as alternatives to wastewater disposal and (2) to control discharges? How effective are these technol ogies?

 What BMPs are used as alternatives to wastewater disposal and/or to control discharges? How effective are these practices?

 What are th e costs of the identified technologies and/or BMPs?

EPA’s data collection included a review of available lite rature on the dental industry and a focus on ways to reduce mercury discharges to POTWs. EPA reviewed literature and collected data on the dental industry , amalgam separators, and mercury discharges, including :

 C urrent, relevant technical publications tha t describe the sources and generation of mercury wastes at dental offices and the discharge of mercury and other amalgam filling metals (i.e., copper, silver, tin, and zinc) to POTWs.Dental Category Outreach and Data Collection

4  Current information on possible treatment solutions (i.e., amalgam separ ators) for dental offices to reduce mercury in the wastewater and their effectiveness.

 Current implementation costs for technologies to reduce mercury and other metal discharges at dental offices.

Some of the key references that EPA used as part of the development of the proposed rule are listed in Table 1.

Table 1 . Key References

Author Title Year Document Control Number
ADA Best Management Practices for Amalgam Waste 2007 DA00165

ADA ADA Professional Product Review 2007 DA00043
ADA ADA Distribution of Dentists in the United States by Region and State, 2008 2010 DA00123

ADA 2009 Survey of Dental Practice: Income from the Private Practice of Dentistry 2010 DA00141

Batchu, H., D. Rakowski, P.L.Fan, and D.M. Meyer Evaluating Amalgam Separators Using an International Standard, Journal of the American Medical Association, 137:999

- 1005 2006 DA00183

Batchu, H., H.N. Chou, D. Rakowski, and P.L. Fan The Effect of Disinfect ants and Line Cleaners on the Release of Mercury from Amalgam, Journal of the American Dental Association 137(10):1419

- 1425 2006 DA00215

Beazoglou T, Brown LJ, Ray S, Chen L, Lazar V An Economic Study of Expanded Duties of Dental Auxiliaries in Colorado, Dental Health Policy Analysis Series, American Dental Association 2009 DA00149

Cain, A. and R. Krauel, U.S. EPA and Environment Canada Options for Dental Mercury Reduction Programs: Information for State/Provincial and Local Governments. 2003 DA00003

Co ndrin, A.K. The Use of CDA Best Management Practices and Amalgam Separators to Improve the Management of Dental Wastewater, Journal of the California Dental Association 32(7):583

- 592 2004 DA00024

Fan, P.L., H. Batchu, H.N. Chou, W. Gasparac, J. Sandrik, and D.M. Meyer Laboratory Evaluation of Amalgam Separators. Journal of the American Medical Association, 133:577

- 584 2002 DA00008

Georgetown University Safety Net Dental Clinic Manual, National Maternal & Child Oral Health Resource Center 2003 DA00143

International Organization for Standardization ISO 11143: 2008 Dentistry

- Amalgam Separators Standard 2008 DA00138Dental Category Outreach and Data Collection

5 Author Title Year Document Control Number Larry Walker Associates Mercury Source Control and Pollution Prevention Program Evaluation. Prepared for Association for Metropolitan Sewerage Agencies (AMSA) 2002 DA00006

Massachusetts Water Resources Authority Amalgam Composition in Typical Dental Fillings 2001 DA00131

McManus, K.R., and P.L. Fan Purchasing, Installing and Operating Dental Amalgam Separators, Journal of the American Dental Association, 134:1054

- 1065 2003 DA00162

Metropolitan Council Environmental Services (MCES) Evaluation of Amalgam Removal Equipment and Dental Clinic Loadings to the Sanitary Sewer 2001 DA00007

MCES Revised

– Features of Approved Amalgam Separators 2009 DA00070

Milwaukee Metropolitan Sewerage District & University of Wisconsin Extension Amalgam Management for Dental Offices 2006 DA00232

NACWA An Examination of Mercury Levels at Clean Water Agencies 2003

- 2006 2007 DA00108

Stone, M.E. The Effect of Amalgam Separators on Mercury Loading to Wastewater Treatment Plants, Journal of the California Dental Association 32(7):593

- 600 2004 DA00018

Vandeven, J., and S. McGinnis An Assessment of Mercury in the Form of Amalgam in Dental Wastewater in the United States, Water, Air and Soil Pollution 164:349

- 366 2005 DA00163

U.S. Air Force Synopsis of Dental Amalgam Separators (Project #10

- 017) 2011 DA00 0 79

The outreach activities include meetings with stakeholders and discussions with vendors to gather specific data on the operation, maintenance, costs, and treatment effectiveness of amalgam separators and BMPs. Table 3 includes a summary of these meetings.

Meetings with Stakeholders

 Environmental Council of the States : EPA participated in several meetings with the Quicksilver Caucus (QSC) of the Environmental Council of the States. From QSC, EPA collected information on implementing mandatory amalgam separ ator programs at the state level, mandatory program language, and compliance reporting and monitoring. QSC also provided EPA with information on efficiency standards for amalgam separators (ECOS, 2010).

 Environmental Organizations : EPA met with a coalition of environmentalDental Category Outreach and Data Collection

6 organizations, led by The Environmental Law and Policy Center and the National Resources Defense Council. Meetings between EPA and the coalition of environmental organizations focused on identifying the environmental impacts of dental ama lgam discharges. In spring 2011, the coalition submitted a letter listing its suggested BMPs for the proposed Dental Amalgam Rule (Wu, 2011).

 American Dental Association (ADA) : EPA met with ADA in 2010 and 2011. ADA submitted data to EPA on their recently adopted principles for addressing mercury discharges from dental offices, the number of specialty offices in the industry, the geographic distribution of dental offices, financial characteristics of the industry, and operating characteristics of the indus try (ADA, 2010).

 National Association of Clean Water Agencies (NACWA) : EPA met with NACWA in 2010 and 2011 to discuss the impact of pretreatment standards on POTWs. NACWA provided EPA information on its members’ experiences with handling mercury wastes fro m dental offices, implementing pretreatment programs for dental offices, and implementing pretreatment standards for industries with similar characteristics as the dental industry. NACWA also provided EPA with information on the burden to permitting author ities of implementing a dental amalgam pretreatment standard under the existing requirements in Part 403 (U.S. EPA, 2011).

Amalgam Separator Manufacturers (Vendor Contacts)

EPA met with, or participated in calls with, representatives of multiple amalgam separator manufacturers (ERG, 2010; ERG and Air Techniques, 2011; ERG and American Dental Accessories, 2011; ERG and DRNA, 2011; ERG and Rebec Solutions, 2011; ERG and SolmeteX, 2011) . The purpose of the meetings was to gather information on the following issues:

 How amalgam separators work, limitations of the technology, and system capacity.

 Treatment technology effectiveness.

 I nstallation

, operation, and maintenance requirements and equipment lifetime.

 Capital costs and operating and maintenance costs.

 M a nufacturers’ distribution methods

.

 Amalgam disposal.

 I nstallation trends.

IV. References

ADA. 201 0

. ADA Principles to be U sed to Develop Mandatory Separator Pretreatment Rule

. Washington, DC. October 29. Document Control Number (DCN) DA00137.Dental Category Outreach and Data Collection

7 ECOS. 2010. Letter to EPA: Implementing a National Vision of Mercury. Washington, DC. August 19. DCN DA00158.

ERG (Eastern Research Group). 2010 . SolmeteX meeting minutes for 15 December 2010. Chantilly, VA. DCN DA00081

.
ERG and Air Techniques. 2011. Notes from telep hone conversation between Kimberly Landick, ERG

, and Air Techniques

. March 2, 2011

. Subject : Amalga m Separator Questions. DCN DA00060

.
ERG and American Dental Accessories. 2011. Email correspondence between Kimberly Landick, ERG

, and American Dental Accessories

. February 28, 2011

. Subject : Request for Amalgam Separator Information. DCN DA00061

.
ERG and DRNA ( Dental Recycling North America ) . 2011. Notes from telephone conversation between Kimberly Landick, ERG

, and Marc Sussman and Darwin Moreira, DRNA

. March 1, 2011

. Subject : Amalgam Separator Questions. DCN D A00062

.
ERG and Rebec Solutions. 2011. Notes from telephone conversation between Kimberly Landick, ERG

, and Rebec Solutions

. March 2, 2011

. Subject : Amalgam Separator Q uestion s. DCN DA00063

.
ERG and SolmeteX. 2011. Notes from telephone conversation between Kimberly Landick, ERG

, and SolmeteX, March 2, 2011: Subject Amalgam Separator Questions. DCN D A00064

.
U.S. Air Force. 2011

. Synopsis of Dental Amalgam Separators (Project #1 0

- 017)

. Dental Evaluation and Consultation Service. February. DCN DA0007 9

.
U.S. EPA. 2008. Health Services Industry Detailed Study: Dental Amalgam. EPA

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08

- 014. Washington, DC. August. DCN DA00057.

U.S. EPA, 2011. Information Collection Request: National Pretreatment Program

. OMB Control No. 2040

- 0009, EPA ICR No. 0002.14 (Draft). Office of Wastewater Management. March. DCN DA00144.

Wu, Mae. 2011. Comments from Multi

- state Mercury Products Campaign, the Environmental Law and Policy Center, and Nat ional Resources Defense Council

. April 1

. Washington, D.C. DCN DA00136

.Dental Category Outreach and Data Collection

8 Table 2 . Comments Submitted on the Preliminary 2008 Effluent Guidelines Program Plan for the Dental In dustry

Commenter Name Affiliation Date Posted Preliminary 2008 Plan, EPA Docket Number Dental Category Record DCN

William J. Walsh Pepper Hamilton LLP, on behalf of the American Dental Association (ADA) 2/27/2007 EPA

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- 0003 DA 0 0324

William J. Walsh Pepper Hamilton LLP, on behalf of the ADA 12/28/2007 EPA

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- 0837 DA00238

Leo H. Hermes Metropolitan Council Environmental Services (MCES) 12/7/2007 EPA

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- 2006

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- 0828 DA 0 0321 Bruce E. Cunha Marshfield Clinic 12/13/2007 EPA

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- 2006

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- 0829 DA 0 0322

Linda Eichmiller Association of State and Interstate Water Pollution Control Administrators 12/21/2007 EPA

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- 0834 DA 0 0323

Christie True County Wastewater Treatment Division (WTD) 1/14/2008 EPA

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- 0860 DA 0 0325 Thomas P. Uva The Narragansett Bay Commission (NBC) 1/15/2008 EPA

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- 2006

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- 0861 DA00237

Janet Gillaspie Oregon Association of Clean Water Agencies (ACWA) 1/2/2008 EPA

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- 2006

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- 0845 DA00240

Cynthia A. Finley National Association of Clean Water Agencies (NACWA) 1/2/2008 EPA

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- 2006

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- 0849 DA00236 Beryl B. Fletcher Oregon Dental Association 1/2/2008 EPA

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- 2006

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- 0846 DA 0 0320

Larry Lamperti City of Corvallis, Oregon (OR) 1/3/2008 EPA

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- 0857 DA00235 Sheila Lockwood University of Washington 1/29/2008 EPA

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- 1008 DA 0 0326Dental Category Outreach and Data Collection

9 Table 3 . Dental Industry Outreach and Data Collection Meetings

Title Location Date Dental Category Record DCN

Meeting with Environmental Council of States Washington, DC 2010 Follow

- up Comments: DA00158 (8/19/2010) Meeting with SolmeteX Washington, DC 12/15/2010 DA00081

Meetings with ADA Washington, DC 2010; 2011 Follow

- up Comments: DA00137 (10/29/2010) Meetings with NACWA Washington, DC 2010; 2011 Follow

- up Comments: DA00144 Meeting with The Environmental Law and Policy Center and the National Resources Defense Council Washington, DC 2011 Follow

- up Comments: DA00136 (4/1/2011) Meeting with Dental Recycling North America, Inc. Washington, DC 1/19/2011 DA00059 Teleconference with Dental Recycling North America, Inc. Teleconference 3/1/2011 DA00062 Teleconference with Air Techniques Teleconference 3/2/2011 DA00060 Teleconference with Rebec Solutions Teleconference 3/2/2011 DA00063 Teleconference with SolmeteX Teleconference 3/2/2011 DA00064 Teleconference with SolmeteX Teleconference 5/10/2011 DA00120