Dental Practice Waste Handling and Disposal 101

In the average American home, there are generally 2 main sources of waste­–trash and recycling. One may be asked to separate recycling into paper, glass, and metal, but for the most part, it’s a straightforward affair. The same is not true of dental practices. Like any healthcare setting, waste comes in various forms and must be handled and disposed of properly, bowing to local regulations and safety protocols.

Biohazard

Because they are healthcare settings, dental practices often handle biohazardous waste which is any waste containing blood.

“Biohazard waste would be waste that is hazardous, because it has either blood or blood-saturated items,” infection control consultant and speaker Leslie Canham, CDA, RDA, CDIPC, says. “Sharps like used needles are 1 type of biohazard waste and cannot go into the regular trash. There are other items that are considered biohazardous, for example, blood-saturated items that have fluid blood would be considered biohazardous and these items would go in a red bag. It’s called a biohazard bag or red bag waste. It has a biohazard symbol on it and it cannot be thrown in the trash. It needs to be picked up by a company that manages biohazard waste. In additional to blood-soaked items sometimes, in surgery practices, they may have IV tubing containing blood products.”

“You need a biohazard company to remove it, and it goes in special bags,” Lisa Kane, DMD, of Dental Office Compliance of New England adds. “Everything must be labeled. There are medical waste incinerators that you can use in your office. There are also different types of sharps containers that you can put the biohazard in, and then you add a chemical in it and it makes it so it’s not at risk of causing an infection anymore.”

Practices are advised not to go overboard with filling up the biohazard containers. Placing things that aren’t hazardous is a common mistake. Remember, the more that’s disposed of, the greater the cost of disposal.

“I see a lot of people putting irregular trash in the biohazard containers,” Dr Kane observes. “Biohazard is only something that could cause you an infection. For instance, personal protective equipment (PPE) or tray covers are not normally biohazards.”

Medications

Sometimes, practices have leftover or expired medication. Its disposal is governed by state regulations.

“You’ve got to look at your state and see what the Department of Environmental Protection rules are in your area,” Dr Kane advises. “Some medications can be thrown in the trash. Some have to be sent back to the company where you got them from. In your town, probably there’s a medication dropbox in a pharmacy. You can return it, but you just have to check your area and see what the regulations are for the specific medications.”

“Many times I get asked the question, ‘Can the anesthetic carpules go into the sharps container after it’s been used on a patient and it’s empty?’” Canham adds. “If it’s empty, it can go in the sharps container, but if it has anesthetic in it, it’s considered pharmaceutical waste. In most states, an empty anesthetic carpule can go into the regular trash if it is not broken (be sure to check with your own local regulations). If it’s broken, it definitely goes in the sharps container. If it has any blood aspirated in it, it goes in the sharps container.”

Amalgam

Dental practices have their own, unique waste with amalgam. Composite is more prevalent now, but new and old amalgam must be disposed of properly.

“The kind of waste that I would say is the most concerning is any kind of amalgam waste, because of the effects of mercury on the environment,” Canham says. “A lot of dental offices use composite, so not as many dentists are placing amalgam. Many offices say, ‘Well, we don’t place amalgam,’ but sometimes they’re removing amalgam fillings. They might have some amalgam caught in their chairside trap.

“Even with mandatory requirements for installing amalgam separators,” she continues, “there are parts of the dental unit where the amalgam gets trapped before it gets to an amalgam separator. And this is where we find dental assistants or other team members will take the little chairside trap and throw them into the trash. If the trap has any amalgam or even gray colored debris, it needs to be recycled. It’s important to have a container that you place these amalgam chairside traps in, and it’s also important not to rinse those little plastic traps underneath running water, because that will send some amalgam particles down into the sewer system and eventually out into the environment.”

It isn’t just removing an old filling that can be the source of amalgam waste. If a tooth with an amalgam filling is extracted, it must be disposed of in its own unique way.

“Extracted teeth can be given back to the patient if the patient wants them,” Canham adds. “But it’s better to put them in the amalgam recycle container. As long as the company that picks up your amalgam recycle is willing to take it with an extracted tooth. We don’t want to put extracted teeth with amalgam in biohazard containers though, because those biohazard red bags are incinerated, and that would allow those teeth with amalgam to be incinerated and release the mercury back into the environment.”

Waste Management

When it comes time to pick up waste from the practice, a company that specializes in such removal must be enlisted.

“There are several companies that do that, and you can Google them,” Canham recommends. “They deal with dental office waste, such as amalgam, sharps, biohazard, and pharmaceutical waste. You can also check with your local dental society or state association. Sometimes they have them listed on their website or they can make a recommendation. You can also check with a colleague for which company they use.”

“You have to go to a specific biohazard waste company and they would be trained in how to dispose of it, how to safely remove it,” Dr Kane adds. “It must be someone that’s certified in biohazard, or they must have training. You also must make sure that you keep all the documentation, and there should be logs to keep track of what you sent out.”

Hazardous waste, disposal companies can deal with all kinds of the practice’s waste.

“Another kind of dental waste is lead foil if you are still using regular X-rays instead of digital imaging.” Canham says. “Lead foil must be collected and then recycled. Lead foil does not go in the trash, as that’s introducing lead into the environment.”

Patient Information

It isn’t just medical waste that practices must be mindful of in their handling and disposal. The Health Insurance Portability and Accountability Act (HIPAA) lays out rules for properly handling confidential patient information, and there are also considerations for how long records must be maintained.

“You’ve got to first check, again, with your state board to see what the requirements are as far as how long you keep the records,” Dr Kane says. “The records include models and films and paper charts. If you scan them and you end up having a copy on the computer, or if it’s past the time and you’re allowed to dispose of them, you definitely have to do it in a confidential way. You want to either shred them in the office or get a shredding company. You wouldn’t want to bring them home or put them in your trash.”

In addition to paper patient records, anything with patient information on it must be destroyed or redacted–including the boxes that come from the lab.

“We don’t want to put anything in the trash that would have anybody’s protected health information or financial information on it,” Canham says. “Sometimes dental practices get lab cases in boxes, and it has the patient’s name on the outside of the box. If they throw the box in the trash, they should redact the patient’s name with a Sharpie marking pen or cut the name off the box so protected health information is not placed in the trash.”

Disposing of the practice’s waste is largely an issue of safety, regulation, and protocols. However, paying attention to those details protects both the practice and the environment.