Amalgam Rules Development & Implementation in New Hampshire

1. Amalgam Rules Development & Implementation in New Hampshire 2005 Northeast Environmental Summit September 28, 2005 Paul Lockwood (603) 271-2956 plockwood@des.state.nh.us

2. Amalgam Rules Development & Implementation in New Hampshire • Background: NH Mercury reduction efforts • House Bill 1251 & Rules adoption process • Rules implementation and status

3. NH Mercury Reduction Strategy www.des.state.nh.us (Reports & Documents)

4. NH Mercury Reduction Strategy 4.7.1 Recommended Actions Regarding Dental Amalgam R-27 Conduct outreach to the general public and dentist’s offices…to encourage the voluntary use of alternatives to mercury-containing amalgam and encourage the proper collection and disposal of waste amalgam. R-28 Draft legislation…with an effective date of July 1, 2003 to prohibit the use of mercury-containing amalgam.

5. NH Mercury Reduction Strategy 2002 Legislation HB 1251 – “An Act relative to the use of mercury amalgam fillings by dentists.” Introduced June, 2002 as a ban on the use of mercury-amalgam in New Hampshire

6. NH Mercury Reduction Strategy 2002 Legislation HB 1251 – “An Act relative to the use of mercury amalgam fillings by dentists.” Problems and Issues: • Environmental or Public Health issue? • Insurance issues • Credibility of support data • NH Dental Society support

7. NH Mercury Reduction Strategy 2002 Legislation HB 1251 – “An Act relative to the use of mercury amalgam fillings by dentists.” Final outcome: • DES to draft rules relative to amalgam disposal • DHHS to create pamphlet for dentists to provide to patients

8. Amalgam Management Rules Development In New Hampshire Stakeholder workgroup met in summer, 2002 Key issue = Enforcement Discharge limit? or Performance standard?

9. Amalgam Management Rules Development In New Hampshire Performance Standard = Amalgam Separator • Level of performance required? • “Home built” technologies? • Particulate and soluble Hg? • Self-certification procedures? • Waivers and exemptions? Issues:

10. Amalgam Rules Implementation In New Hampshire Env-Ws 905 STANDARDS FOR MANAGEMENT OF MERCURY-CONTAINING AMALGAM Requires written self-certification from “owner of the practice”: • installation of ISO 11143-certified amalgam separator • or • practitioner is exempt or requesting waiver

11. Amalgam Rules Implementation In New Hampshire Exemption for: • Orthodonists, periodontists, oral or maxillofacial surgeons, oral pathologists, oral or maxillofacial radiologists who don’t generate amalgam wastes • Retired practitioners

12. Amalgam Rules Implementation In New Hampshire Waiver for: • “de minimis” discharge of up to 0.5 gram Hg/year (= 1 gram amalgam = 2 fillings) • equivalent alternative technology • “zero discharge” (holding tank)

13. Amalgam Rules Implementation In New Hampshire Initial Notification July 8, 2005 1,260 Licensed practitioners notified 10% response in first two weeks even though none required until October 1.

14. Amalgam Rules Implementation In New Hampshire Early issues & problems: • Mobile units & schools • Semi-retired or not in state • “Amalgam-free” practitioners • Endodontists

15. Amalgam Rules Implementation In New Hampshire Next steps • Certifications due by Oct 1, 2005 • Requests for de-minimis waivers will be reviewed • Random sampling to determine accuracy of self-certification