Promoting the ‘phase down’ approach of dental amalgammes
in developing countries
A UNEP-United Nations Environment Programme/WHO-World Health Organization project, in collaboration with the FDI World Dental Federation, National Dental Associations (Kenya, Tanzania, Uganda) and the International Association of Dental Manufacturers.
The Global Mercury Partnership is mandated by the UNEP Governing Council to be a vehicle for immediate actions to reduce mercury pollution. Dental amalgam is one category of mercury-added products that is being addressed by the Global Mercury Partnership. Dental amalgam, a restorative material that contains mercury, has been widely used for some 150 years. Its use represents more than 1/4 of total global mercury consumption in products or approximately 8% of global mercury consumption. In 2007, an estimated 250-350 metric tons of mercury were used globally in this sector. In the past decades, the awareness and recognition of the environmental implications of mercury have increased and development and use of alternative materials for dental restoration has become increasingly important.
In 2009, a WHO meeting in collaboration with UNEP was held in Geneva to highlight the future use of materials for dental restoration. Strengthening of disease prevention and health promotion is the most relevant approach to reduce the need for restorative care and it may be prudent to consider “phasing down” instead of “phasing out” dental amalgam at this stage. The approach promotes best professional practice incorporating preventive care along with the research and development of quality alternative materials for dental restoration. In the meantime, dental clinics will have to deal with amalgam waste from dental care and will need to promote measures to reduce environmental releases of amalgam.
The Norway ODA 2012 project will deal with those stages of the life-cycle of dental amalgam pertinent to UNEP’s mandate, in particular its potential for environmental release during trade and supply, its environmental release from dental clinics, and its environmentally sound management as waste. WHO will endeavour to strengthen oral health promotion and disease prevention through awareness raising. In clinical dental care, available alternative materials may be recommended for dental restoration provided there are pure clinical indications or criteria and a positive response from the patient.
The project is being implemented in three East African countries - Kenya, Tanzania and Uganda - and is expected to finish by August 2013. UNEP Chemicals and WHO Oral Health Programme are jointly coordinating the project implementation.
The objective of the EADAP project is to explore essential conditions for a phase down in the use of dental amalgam. These include:
- Investigate the current supply and trade of dental amalgam and materials alternative to amalgam and make recommendations for future information systems.
- Assess the current waste management practices in the three East African countries.
- Create awareness of preventive dental care and encourage a switch to appropriate alternatives to dental amalgam, when clinically indicated, among dentists and patients.
- Demonstrate environmentally sound management of dental restoration materials waste in selected dental facilities in the three countries.
Project Components and Activities
- Trade study of dental amalgam and its alternatives as well as survey of dental amalgam waste management practices.
- Selection of national project coordinator and social preparation.
- Development of awareness raising materials on available alternatives for dental restoration.
- Inception and results workshops.
- Demonstration activities at country level:
- Stakeholder/interagency meetings to present the trade and waste survey results and proposed demonstrations in the phase down approach.
- Selection of three demonstration dental health clinics (one representing government hospital/facility, one private clinic, one University/teaching hospital) based on criteria set by the International Association of Dental Manufacturers (IDM).
- Coordination with local waste management provider/company.
- Capacity building/training of the dental health sector in the environmentally sound management of dental materials waste, using training materials developed by WHO, FDI World Dental Federation and IDM.
- Demonstration of best practices in the environmentally sound management of dental amalgam waste: source reduction, use of dental amalgam separators, collection of waste, recuperation of contaminated capsules by manufacturers/recyclers, on-site storage, and the treatment of contaminated sludge (where treatment facilities exist).
- Awareness-raising activities to promote preventive dental care and encourage appropriate use of alternative materials for dental restoration amongst patients and dentists.
Project Expected Output
- Report on supply and trade flow data of all dental restorative materials and recommendations for future information systems.
- Report on dental waste management practices of all dental restorative materials, of the participating countries.
- Raised awareness amongst patients and dentists on preventive dental care and use of clinically relevant alternative materials for dental restoration.
- Demonstration of best dental waste management practices for all dental restorative materials.
- Report of lessons learned providing recommendations for promoting the ‘phase down’ approach in developing countries, including process analysis.