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Capt-all, a handheld device that captures amalgam waste at the source — the patient’s mouth — and meets the EPA’s requirements for an “equivalent device.”
A few years ago, I went to a Green Dentistry lecture at the ADA meeting in San Francisco. The speaker, a professor at Marquette School of Dentistry, advised “just get an amalgam separator,” as an environmentally sound way to capture amalgams. He then went on to other topics in his lecture.
Later, I asked the speaker, “What about the chair side traps and other secondary filters?”
“What do you mean?” he replied.
“Well,” I said, “It’s a fact that more than 70 percent of the amalgam is captured in the chair side traps as well as other filters before the mercury waste even reaches the amalgam separator. The amalgam separators fill up mostly with sludge and prophylaxis paste and very little amalgam. Shouldn’t the primary and secondary filters collecting the bulk of the amalgam waste be considered since the law requires they too be recycled with a certified mercury recycler? And what about monitoring the amalgam separator so that it doesn’t overflow or go into bypass mode?”
The ADA’s Best Practice Management and the EPA’s final ruling are clear on complying with these issues, but not having an answer, the professor simply walked away.
Frequently, we look for an easy solution to a complex problem. It is a misconception that you simply buy an amalgam separator, have it installed and you’re done.
The EPA and ADA’s mandate is to prevent toxic mercury from contaminating the water supply and environment. If we are only collecting 30 percent of the waste in an amalgam separator and throwing the bulk of the material in the trash or, worse, in biohazardous containers, we are spending money on something grossly ineffective.
If the dentist buys an amalgam separator and doesn’t change the filters, the amalgam separator is useless, and the amalgam waste will slip right by the equipment into the wastewater stream. Also, if the equipment is not monitored, the filter could shut down the vacuum. This can cause lost production and increased stress.
There is a risk of fines from the EPA or POTW (Publicly Owned Treatment Works). In many areas, the municipal water and sewage system enforces this issue (40 CFR 441.50 Effluent Limitations and Guidelines and Standards for the Dental Office Category).
In compliance with the EPA, the amalgam waste in the chair side trap, vacuum pump filters or amalgam separator filter must be tracked and recorded yearly. Some amalgam separator companies sell separate containers to recycle chair-side traps and other filters ($125 to $375 per container), but most amalgam separator companies do not even mention this EPA requirement.
Recently, new technologies for amalgam waste recycling have been developed. One new method is Capt-all, a handheld device that captures amalgam waste at the source — the patient’s mouth — and meets the EPA’s 441.30(a)(2) requirements for an “equivalent device.”
Capt-all is used instead of your regular HVE tip. This single use tip has an internal filter that captures the amalgam, preventing it from entering the suction line and getting caught in the chair-side trap and secondary filters. There is a check valve to keep the waste encapsulated and prevent the back flow phenomenon.
Capt-all is used only when needed. This is important for reducing cost today and in the future. Most dentists today do not use amalgam as a restorative, but they still remove amalgams. As the need to capture amalgam declines, so will the cost of recycling when using this method.
The Capt-all tip also prevents dissolved mercury by eliminating amalgam waste from the chair-side traps and vacuum lines and protects the dental professional tasked with recycling the various containers from potential exposure to toxic mercury. Studies have shown that when elemental mercury is exposed to organic material and lipids, it changes to methyl mercury, which is dangerous to humans.
After using the recyclable HVE tip, it can be recorded in the patient’s chart as D9999 adjunctive procedure or any code number can be assigned as an environmental fee (e.g. ACD, amalgam capture device). The dentist can charge a nominal $7 to $10 fee as an environmental compliance charge or write-off to the patient as added value.
This also serves as a perpetual record of compliance. The tip then gets deposited into a provided recycling container similar to a sharps container. When the container is full, it is picked up by UPS and sent to the recycler. A manifest is sent to the dentist and no filters need to be recycled.
Whether it is a handheld “equivalent device,” or equipment installed next to the vacuum pump, make sure you are following the EPA’s final ruling intended to keep toxic mercury out of our water supply and environment.
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