The environmental implications of amalgam waste disposal with focus on the Dental Amalgam Ban: a scoping review
Creators: name: Clark, Isabel
name: Bell, Olivia
name: Nagraj, Sumanth Kumbargere
name: Khan, Numa
name: Isaam Baig
name: Chambers, Nathan David
name: Macdonald, Oliver
name: Harper, Leah
name: Ward, Emily
name: Eachempati, Prashanti
Publisher: name: OSF Registries
Year: 2024
Subjects: subject: Other Dentistry
subject: Medicine and Health Sciences
subject: Dentistry
subject: FOS: Clinical medicine
subject: Dental Amalgam Ban
subject: Dental Amalgam Disposal
subject: Scoping review

description: The pressing global concern for environmentally sustainable practices, as emphasised by the United Nations' Sustainable Development Goal 12 (SDG 12 Hub, 2024), underscores the critical need for effective management of chemicals and wastes to reduce their detrimental impacts on the environment. Waste disposal of amalgam in dentistry poses a significant challenge to these principles since the material is comprised of a mixture of metals, including mercury (FDA, 2024). There is a growing concern over the pollution effects of amalgam if not disposed of appropriately; emerging evidence suggests that amalgam, particularly the mercury component, risks contamination of water and soil. It is estimated that around two-thirds of dental mercury is released back into the environment (BDJ, 2019). Wastewater from dental offices has been identified as a major source of mercury discharges into sewage treatment works, which can be re-released into the atmosphere via incineration, or pollute soil if treated waste contaminated with mercury is used as a fertiliser (IAOMT, 2019). Within this context, the disposal of dental amalgam has emerged as a significant hurdle to overcome, due to its widespread use as a restorative material, frequently by NHS dental practices, and its potential environmental impact. Recognising this evolving landscape, marked by the European Commission's revision of the Minamata Regulation (UN Environment Programme, 2021) and the scheduled phase-out of dental amalgam from January 2025 (Nature, 2024), there is a growing commitment to align dental practices with the objectives of SDG 12. 
This scoping review aims to examine the evolving guidelines on amalgam waste disposal and evaluate the progress since 2013 to more sustainable dental practises. 

Operational Terms and Definitions:
1. SDG 12: Refers to the United nations’ Sustainable Development Goal 12, focusing on responsible consumption &amp; production. This includes Environmentally sustainable waste management. 
2. Dental Amalgam: A material commonly used in restorative dentistry, comprised of mercury and an alloy consisting of silver, tin, and copper.
3. Minamata Convention on Mercury: A multilateral environmental agreement that addresses specific human activities which are contributing to widespread mercury pollution. This includes the use and disposal of dental amalgam used in clinical practice.
4. Minamata Regulation: Refers to the regulatory framework initiated after the Minamata Convention on Mercury in 2013 (EPA, 2024).

Rationale for the Review:
Existing knowledge on mercury waste disposal highlights it is prevalent across fields of medicine and environmental sciences, focusing on the potential environmental repercussions as a result of inappropriate disposal. The extensive use of mercury-containing amalgam in dentistry has led to concerns about its disposal methods and environmental impact, prompting regulatory interventions, such as the European Commission's recent revisions and the scheduled phase-out. The review will cover the time frame from the 2013 Minamata Convention to current developments, including the enforcement date of the amalgam ban, capturing recent changes in practices related to amalgam waste disposal. The geographic scope extends to the EU, reflecting the UK's post-Brexit decision to align with EU mercury regulation. The review also explores the evolution of restorative practices and the transition from traditional amalgam materials to adopt new environmentally friendly recommendations, which will contribute valuable insights that can inform policy decisions within the field. 
A scoping review is deemed appropriate for this study since no current or previous systematic reviews or scoping reviews on this topic were identified. Given the multifaceted aspects of dental amalgam waste disposal, a scoping review allows for a comprehensive exploration of available literature, incorporating a variety of study designs such as peer-reviewed articles and grey literature (including sustainability organisations, government publications, and relevant reports). This method aligns with the need to map and synthesise evidence on evolving guidelines, regulations, and practices related to dental amalgam waste disposal, providing a foundation for informed decision-making and policy development.
Evidence Availability:
The need for this scoping review arises from the recognition that the waste disposal of dental amalgam requires a nuanced understanding and examination of evolving guidelines. A preliminary search on MEDLINE (Ovid), completed on 21st February 2024, revealed a gap in systematic reviews or scoping reviews specifically addressing the evolving guidelines on dental amalgam waste disposal. This gap underscores the necessity of conducting a scoping review to map the available evidence and provide a comprehensive overview.

Aim:
This scoping review aims to investigate the environmental impact of dental amalgam waste disposal, focusing on evolving European Union (EU) recommendations and guidelines since the Minamata Convention in 2013.
Objectives:
The objective of this scoping review is to identify and evaluate guidelines and recommendations from regulatory bodies for environmentally responsible amalgam waste disposal in dental settings. The review will provide a comprehensive overview of the evidence base, emphasising environmental implications, and assessing policy development to enhance overall environmental stewardship in dental amalgam waste disposal.

Conclusion:
In conclusion, this scoping review, rooted in a rationale acknowledging the complexity and environmental concerns surrounding dental amalgam waste disposal, aims to bridge existing knowledge gaps. By exploring evolving guidelines and regulations post-2013, the review seeks to contribute valuable insights to inform sustainable dental practices and policy development. A scoping review is the most appropriate format, justified by the need for a broad exploration of the available evidence, aligning with the complex nature of dental amalgam waste disposal and a changing regulatory landscape.