Comparison of chlorine and chloramine in the release of mercury from dental amalgam.

The purpose of this project was to compare the ability of chlorine (HOCl/OCl(-)) and monochloramine (NH(2)Cl) to mobilize mercury from dental amalgam. Two types of amalgam were used in this investigation: laboratory-prepared amalgam and samples obtained from dental-unit wastewater. For disinfectant exposure simulations, 0.5 g of either the laboratory-generated or clinically obtained amalgam waste was added to 250 mL amber bottles. The amalgam samples were agitated by end-over-end rotation at 30 rpm in the presence of 1 mg/L chlorine, 10 mg/L chlorine, 1 mg/L monochloramine, 10 mg/L monochloramine, or deionized water for intervals of 0 h, 2 h, 4 h, 8 h, and 24 h for the clinically obtained amalgam waste samples and 4 h and 24 h for the laboratory-prepared samples. Chlorine and monochloramine concentrations were measured with a spectrophotometer. Samples were filtered through a 0.45 microm membrane filter and analyzed for mercury with USEPA standard method 245.7. When the two sample types were combined, the mean mercury level in the 1 mg/L chlorine group was 0.020 mg/L (n=25, SD=0.008). The 10 mg/L chlorine group had a mean mercury concentration of 0.59 mg/L (n=25, SD=1.06). The 1 mg/L chloramine group had a mean mercury level of 0.023 mg/L (n=25, SD=0.010). The 10 mg/L chloramine group had a mean mercury level of 0.024 mg/L (n=25, SD=0.011). Independent samples t-tests showed that there was a significant difference between the natural log mercury measurements of 10 mg/L chlorine compared to those of 1 mg/L and 10 mg/L chloramine. Changing from chlorine to chloramine disinfection at water treatment plants would not be expected to produce substantial increases in dissolved mercury levels in dental-unit wastewater.

Design and evaluation of a filter-based chairside amalgam separation system.

This study evaluated the ability of a chairside filtration system to remove particulate-based mercury (Hg) from dental-unit wastewater. Prototypes of the chairside filtration system were designed and fabricated using reusable filter chambers with disposable filter elements. The system was installed in five dental operatories utilizing filter elements with nominal pore sizes of 50 microm, 15 microm, 1 microm, 0.5 microm, or with no system installed (control). Daily chairside wastewater samples were collected on ten consecutive days from each room and brought to the laboratory for processing. After processing the wastewater samples, Hg concentrations were determined with cold vapor atomic absorption spectrometry (USEPA method 7470A). Filter systems were exchanged after ten samples were collected so that all five of the configurations were evaluated in each room (with assignment order balanced by a Latin Square). The numbers of surfaces of amalgam placed and removed per day were tracked in each room. In part two, new filter systems with the 0.5 microm filter elements were installed in the five dental operatories and vacuum levels at the high-velocity evacuation cannula tip were measured with a vacuum gauge. In part three of the study, the chairside filtration system utilizing 0.5 microm and 15 microm filter elements was evaluated utilizing the ISO 11143 testing protocol, a laboratory test of amalgam separator efficiency utilizing amalgam samples of known particle size distribution. Mean Hg per chair per day (no filter installed) was 1087.38 mg (SD = 993.92 mg). Mean Hg per chair per day for the 50 microm, 15 microm, 1 microm, 0.5 microm filter configurations was 79.13 mg (SD = 71.40 mg), 23.55 mg (SD = 23.25 mg), 17.68 mg (SD = 17.35 mg), and 4.25 mg (SD = 6.35 mg), respectively (n = 50 for all groups). Calculated removal efficiencies from the clinical samples were 92.7%, 97.8%, 98.4%, and 99.6%, respectively. ANCOVA on data from the four filter groups, with amalgam-surfaces-removed included as a significant covariate, was statistically significant (P < 0.0001). Tukey post-hoc comparisons (P < or = 0.05) indicated that the 50 microm filter removed less mercury than all other filters and the 0.5 microm removed more mercury than the 50 microm and 15 microm filters. Chairside vacuum measured on chairs with the 0.5 microm filters installed were minimally affected at the time of installation, and then gradually diminished as the filters became loaded with debris. The 0.5 microm configuration passed the ISO 11143 testing protocol at 96.8% efficiency.

Statistical modeling of dental unit water bacterial test kit performance.

OBJECTIVE: While it is important to monitor dental water quality, it is unclear whether in-office test kits provide bacterial counts comparable to the gold standard method (R2A). Studies were conducted on specimens with known bacterial concentrations, and from dental units, to evaluate test kit accuracy across a range of bacterial types and loads. METHODOLOGY: Colony forming units (CFU) were counted for samples from each source, using R2A and two types of test kits, and conformity to Poisson distribution expectations was evaluated. Poisson regression was used to test for effects of source and device, and to estimate rate ratios for kits relative to R2A. RESULTS: For all devices, distributions were Poisson for low CFU/mL when only beige-pigmented bacteria were considered. For higher counts, R2A remained Poisson, but kits exhibited over-dispersion. Both kits undercounted relative to R2A, but the degree of undercounting was reasonably stable. Kits did not grow pink-pigmented bacteria from dental-unit water identified as Methylobacterium rhodesianum. CONCLUSION: Only one of the test kits provided results with adequate reliability at higher bacterial concentrations. Undercount bias could be estimated for this device and used to adjust test kit results. Insensitivity to methylobacteria spp. is problematic.

Mercury vapor levels in exhaust air from dental vacuum systems.

OBJECTIVE: This study was undertaken to determine mercury (Hg) vapor levels in the air exhausted from dental vacuum systems. METHODOLOGY: Hg vapor concentrations from the dental vacuum system exhaust ports of three dental clinics were measured utilizing the Jerome 431-X mercury vapor analyzer and the United States Occupational Safety and Health Administration's (OSHA) method ID-140 in units of ng Hg/m3. Air velocity measurements and temperatures were determined with a constant temperature thermal anemometer. Hg emissions per unit time were then calculated in ng Hg/min. Ambient Hg concentrations from a location approximately 1000 feet away from the closest clinic sampled in this study were measured with an Ohio Lumex Inc. RA-915+ Hg vapor analyzer. RESULTS: Mean Hg vapor concentrations analyzed with the Jerome 431-X were: 46,526, 72,211, and 36,895 ng/m3 for clinic I (110 chairs), clinic II (30 chairs) and clinic III (2 chairs), respectively. Mean Hg vapor concentrations utilizing OSHA method ID-140 were 45,316, 73,737, and 35,421 ng/m3, respectively. Air flow values were: 11.6, 1.8, and 0.5 standard m3/min, respectively. Hg emission data utilizing air flow measurements were calculated to be 532,684, 131,353, and 18,079 ng/min, respectively, (P<0.001). There was no statistical difference between the two methods used to measure Hg vapor concentrations. The mean Hg concentration in ambient air approximately 1000 feet from the nearest clinic sampled was 13.2 ng/m3. CONCLUSION: The two different methods used to measure Hg vapor concentrations provided similar estimates of Hg concentrations from the exhaust air of three dental vacuum systems. Hg vapor release to the atmosphere from dental vacuums can be substantial and can exceed human exposure limits.

Effect of iodine on mercury concentrations in dental-unit wastewater.

OBJECTIVE: This study was undertaken to determine whether iodine used to control bacteria in dental unit waterlines could increase mercury concentrations in dental wastewater. METHODS: The study was conducted in four parts. Part 1. Solutions containing iodine in concentrations ranging from zero (control) to 20 mg/L were mixed with ground and sieved dental amalgam and then allowed to equilibrate by settling. Cold vapor atomic absorption spectrometry was used to determine mercury levels in the settled supernatants at 24 h and at 7 days. Part 2. Deionized water was pumped through an iodine-releasing water-treatment cartridge, collected, and mixed with ground and sieved dental amalgam. Mercury levels in settled supernatants were measured at 24 h and at 7 days. Part 3. Iodine in water from two commercial iodine-releasing cartridges was measured using Inductively Couple Plasma Mass Spectrometry. Part 4. Baseline mercury levels in settled supernatants from wastewater collected from two dental chairs were compared to samples taken from chairs equipped with iodine-releasing cartridges. RESULTS: Part 1. A linear correlation between iodine and mercury concentration (r2=0.9167 and 0.9459, respectively, both P<0.001) was seen at both 24 h and 7 days. Part 2. Mean mercury levels in 24h samples were 3.0 times higher than the controls (0.2864 mg/L compared with 0.0939mg/L for the 24 h controls). Mean mercury levels in the 7-day samples were 5.9 times higher than the 7-day controls (0.2048 mg/L compared with 0.0348 mg/L for the 7-day controls). Part 3. The effluent from two iodine-releasing cartridges showed iodine concentrations averaging 3.2 mg/L (n=10, SD=0.8, range=2.5-4.6). Part 4. Data from the clinical study showed a statistically significant 2.5-fold increase in mercury levels with iodine-containing samples compared to baseline (0.0853 mg/L, n=18, SD=0.0441 and 0.0345 mg/L, n=18, SD=0.0145, respectively; P<0.001). SIGNIFICANCE: Data suggest that iodine can increase concentrations of dissolved mercury in dental unit wastewater.

The effect of amalgam separators on mercury loading to wastewater treatment plants.

Mercury (Hg) release from dental offices has become an acute issue for the dental profession and has resulted in efforts by regulators to mandate both the use of Best Management Practices (BMPs) as well as the installation of amalgam separators. Concern has been expressed by some regarding the efficacy of amalgam separators in reducing the Hg loads to wastewater treatment plants (WWTPs). Data from several Publicly Owned Treatment Works (POTWs) serving areas with installed bases of separators suggest these devices can substantially reduce Hg burdens to WWTPs. The data consists of Hg levels in sewer sludge (biosolids) and in some cases includes Hg concentrations in WWTP influent and effluent. Data comes from various geographical locations, and suggest separators can have a positive effect in reducing the amount of Hg reaching WWTPs.

Determination of methyl mercury in dental-unit wastewater.

OBJECTIVE: The objective of this investigation was to establish whether monomethyl mercury (MMHg) is present in dental-unit wastewater and if present, to determine the concentration relative to total mercury. METHODS: Wastewater samples were collected over an 18-month period from three locations: at the dental chair; at a 30-chair clinic, and at a 107-chair clinic. Total mercury determinations were completed using United States Environmental Protection Agency's (USEPA) method 1631. MMHg was measured utilizing modified USEPA method 1630. RESULTS: The total mercury levels were found to be: 45182.11 microg/l (n=13, SD=68562.42) for the chair-side samples, 5350.74 microg/l (n=12, SD=2672.94) for samples at the 30-chair clinic, and 13439.13 microg/l (n=13, SD=9898.91) for samples at the107-chair clinic. Monomethyl Hg levels averaged 0.90 microg/l (n=13, SD=0.87) for chair side samples, 8.26 (n=12, SD=7.74) for the 30-chair facility, and 26.77 microg/l (n=13, SD=34.50) for 107-chair facility. By way of comparison, the MMHg levels for the open ocean, lakes and rain are orders of magnitude lower than methyl mercury levels seen in dental wastewater (part per billion levels for dental wastewater samples compared to part per trillion levels for samples from the environment). SIGNIFICANCE: Environmentally important levels of MMHg were found to be present in dental-unit wastewater at concentrations orders of magnitude higher than seen in natural settings.

Waterline biofilm and the dental treatment facility: a review.

Biofilms are well-organized communities of cooperating microorganisms that can include bacteria, protozoa, diatoms, and fungi. Surveys of dental unit waterlines (DUWLs) indicate that biofilm formation is a universal problem and that environmental and human-derived opportunistic pathogens can be cultured consistently from biofilms retrieved from DUWLs and other dental devices. Although the health risks presented by waterline bacterial colonization have yet to be adequately addressed, professional and ethical considerations indicate that steps should be taken to improve the quality of DUWLs. To address these concerns, the Council on Scientific Affairs of the ADA recently published a list of products cleared by the FDA to control dental waterline contamination. The goal of this article is to increase the awareness of potential health risks posed by biofilm formation and provide information on techniques and devices designed to control the microbial contamination of DUWLs.