How should a dental practice use and dispose of dental amalgam?
Practices should dispose of amalgam under article 10 of the European Union Regulation 2017/852. Article 10 is specific to the use and disposal of dental amalgam.
When we inspect
Our inspectors will consider the use and disposal of dental amalgam when we review if the practice is safe and well-led. This relates to:
- Regulation 12: Safe care and treatment
- Regulation 15: Premises and equipment
- Regulation 17: Good governance
Dental practices must be equipped with an amalgam separator.
- All separators must retain at least 95% of amalgam particles. This applies to any new amalgam separators installed from January 2018 onwards. If the separator is fitted centrally (rather than chairside), the practice should have evidence that the wastewater from each chair is going through this separator.
- Maintain amalgam separators following the manufacturer's instructions. This ensures the highest level of amalgam retention possible.
- Providers may wish to consider if separators need to be fitted to other equipment, depending on the risk of amalgam contamination.
Authorised waste management establishments must handle and collect a practice's amalgam waste including:
- amalgam residues
- particles and fillings
- teeth (or parts of teeth) contaminated by dental amalgam.
Dental amalgam must only be used in pre-dosed encapsulated form. The use of mercury in bulk form by dental practitioners is prohibited.
Use of amalgam
Dental amalgam must not be used for dental treatment of:
- deciduous teeth of children under 15 years
- pregnant or breastfeeding women.
This is except when deemed strictly necessary by the dental practitioner based on the patient’s specific medical needs.
Amalgam – appropriate clinical waste containers
Amalgam waste consists of amalgam in any form. It includes all other materials contaminated with amalgam.
- Place amalgam waste in rigid receptacles with a mercury suppressant.
- Send amalgam waste to suitably licensed or permitted waste management facilities. There, the waste undergoes a mercury recovery process before final disposal.
Teeth containing amalgam
Dental teams must ensure that all clinical waste is treated appropriately. Teeth containing amalgam should be segregated, stored and sent for appropriate recovery/disposal.
Ensure all patients, parents and carers receive oral health advice. Include advice on effective toothbrushing with fluoride toothpaste and a healthy diet. This is to reduce the need for future restorations.
- When treating primary teeth, avoid using dental amalgam.
- When treating permanent teeth in a patient under 15 years old, avoid using dental amalgam. This is unless justified by specific clinical circumstances or the patient’s needs.
- When treating a pregnant or breastfeeding patient, avoid using dental amalgam.
- When dental amalgam use is justified, explain this to the patient. Obtain the usual valid consent. Document the justification in the patient’s record.