May 6, 2020 Opioid Painkillers After Oral Surgery May Put Teens at Risk for Later Opioid Abuse Most parents worry about their teens getting access to drugs at school or in social settings – not at the dentist. However, the American Dental Association and private insurers have expressed concerns about the widespread practice of prescribing opioid painkillers to teens after oral surgeries. The patients who filled those opioid prescriptions were nearly three times as likely to use opioids in the year after the prescription. Teens Are at Risk for Substance Abuse During the past decade, opioid addiction rates exploded across the country and created an ongoing public health crisis. Centers for Disease Control (CDC) statistics show the rate of drug overdose was four times higher in 2018 compared to 1999. In 2018, almost 70% of drug overdose deaths involved an opioid. Public health professionals have become concerned about the intersection between legitimate opioid prescriptions for teens and later opioid use and addiction. The American Academy of Pediatrics Journal addressed the issue of teen opioid use in 2015: “Legitimate opioid use before high school graduation is independently associated with a 33% increase in the risk of future opioid misuse after high school. This association is concentrated among individuals who have little to no history of drug use and, as well, strong disapproval of illegal drug use at baseline.” During adolescence, teen brains are still developing. That makes them particularly susceptible to a drug’s effect on the reward pathways in the brain. Parents and prescribers need to be alert to common risk factors for teen substance abuse. Wisdom Teeth Extraction Can Lead to Opioid Misuse Insurers and dental professionals are looking closely at “best practice” pain management strategies for children and teens. A2015 study of private insurance patients age 16-25 found 13% of participants had received at least one opioid prescription, and dentists wrote 30% of them. Within the next year, 5.8% of those patients were diagnosed with opioid abuse. In 2019, Delta Dental reported: Compared to their peers around the world, teens in the United States are much more likely to be prescribed opioids after wisdom tooth extraction. Many American teens leave their dentist’s office with a prescription for hydrocodone, also known as Vicodin or Norco. Almost all of this drug’s supply worldwide — 99% — is prescribed and used in the U.S. United Healthcare (UHC) launched an initiative to “limit teens’ exposure and inform dentists, patients, and parents about opioid medications.” The company’s public education efforts include radio and TV public service announcements and a public toolkit. The toolkit includes a downloadable dental opioid flyer and checklist and other educational materials. UHC implemented a new in-network pharmacy policy that “limits all first-time opioid prescriptions for people age 19 and under to no more than three days and fewer than 50 morphine milligram equivalents per day, as recommended by the Centers for Disease Control and Prevention (CDC).” The company also created an outreach program to dentists who have a pattern of “prescribing opioids outside of CDC guidelines.” Questions to Ask the Dentist about Pain Relief The National Institute on Drug Abuse for Teens has a list of suggested questions to discuss with your dentist before filling a prescription for opioids: Ask if there’s an option other than prescription opioids to treat your pain. Some non-opioid medicines might offer the best balance between benefits and risks. Tell the dentist about any substance use disorders or addiction in your family. This will help the dentist decide if opioids are safe for you. Talk about your medical history and any medications you’re taking. It might not be safe to take opioids with some other medicines. The vast majority of medical professionals are happy to discuss options with patients. They realize that patient education about opioids helps prevent misuse and encourages safe disposal of unused/unwanted opioid prescriptions. Always Safely Store and Dispose of Opioids Two=thirds of teens who report misusing prescription pain medications got them from friends, acquaintances, or family members. Many people have extra: a 2017 meta-analysis found up to 92% of people don’t finish their prescription painkillers, and fewer than 10% safely dispose of the leftovers. Three-quarters of patients fail to keep opioids in a locked cabinet. Safe disposal of unused/unwanted medication is just as important as safe storage. Consider the community and environmental effects before flushing medication or throwing it away with household trash. This infographic highlights the dangers of improper disposal of medication and pharmaceutical wastes. Households and professionals alike share a responsibility to protect America’s teens from indiscriminate access to opioid painkillers. Ensuring residual medications are properly disposed means those same medications no longer pose a threat to our vulnerable youth. As part of their patient education efforts, we encourage dentists to discuss safe disposal options for unused/unwanted opioid medications. For example: Provide information about nearby MedSafe medication collection receptacles in nearby pharmacies or other public locations. Offer the patient a TakeAway Medication Recovery System envelope along with the prescription. Provide the dates of semi-annual Prescription Drug Takeback Day events – if the local community participates. In addition to offering safe, convenient pharmaceutical disposal solutions to generators and ultimate users, Sharps Compliance also helps dental offices comply with other waste disposal regulations regarding dental carpules, amalgam recycling, and more. Read More
September 25, 2019 Proper Disposal of Dental-Related Wastes Protects Staff, Patients, and the Environment Last updated on October 28, 2019 Like all medical offices, a dental practice generates medical wastes that require careful handling and disposal. Each type of dental waste is governed by specific state and federal regulations. Regulatory non-compliance can result in large fines, so it’s important to understand the requirements. Compliance is more than a financial issue, however. Improper handling and disposal of waste can spread disease and put employees and the public at risk. Proper handling and disposal help you reduce workplace injuries, control costs, and protect the public and environment from harmful substances. Sharps Compliance offers an affordable, convenient selection of disposal solutions for each waste stream. Disposal of Dental Carpules and Other Dental Sharps Are used dental anesthetic carpules classified as medical waste? It depends on several factors. Contains visible blood: The carpule is classified as sharps medical waste and must be placed in a sharps container. Empty, unbroken, no traces of blood or anesthetic: In some states, these carpules can be placed in regular trash but may break during handling/disposal and present a danger. Disposal depends on each state’s definition of a medical sharp and whether they consider any glass, broken or unbroken, to be a sharp. Broken carpules, no traces of blood or anesthetic: Some states require incineration, so check your state’s regulations regarding disposal and transport to a medical waste treatment facility for proper disposal. Carpules containing residual anesthetic: These are considered pharmaceutical waste and must be labeled as such and transported to a medical waste facility for proper treatment. Some states have special guidelines for evaluating pharmaceutical wastes. Always check your state’s requirements. States regulate carpule disposal, and regulations change over time. Make sure you understand the requirements and are following the most current guidelines. Other dental sharps that require disposal in sharps containers include: Endo files Needles, including sutures, and IV needles Ortho wires Scalpel blades Sharps Compliance provides your busy office with dental sharps disposal options that combine affordability with convenience and regulatory compliance. Our biohazard mailback systems include a primary collection container, prepaid return shipping in a sturdy shipping box, a waste manifest tracking form, and instructions for use. They provide complete cradle-to-grave compliance with local, state, and federal regulations. TakeAway Recovery Systems offer small quantity generators a cost-effective treatment solution for used sharps and healthcare wastes. TakeAway Environmental Return Systems are the ideal solution for disposal of unused, non-controlled medications and used dental carpules with trace anesthetic (without blood). Our TakeAway systems come in a variety of sizes and configurations. Contact us for help selecting the best option for your practice. Dental Red Bag Waste Dental practices also generate small quantities of non-sharp regulated medical wastes (RMW) which must also be handled according to regulatory guidelines. “Red bag” waste could include items that can potentially spread bloodborne pathogens, such as: Materials saturated with blood or OPIM OPIM or blood-soaked personal protective equipment Items caked with dried blood or other potentially infectious materials (OPIM) and capable of releasing during handling Because these items carry the risk of infection, staff must be thoroughly trained on the proper handling and disposal of red bag items. That training provides a double benefit: it protects health and safety by separating potentially infectious wastes from other trash. Additionally, since it’s more expensive to dispose of RMW than it is to dispose of regular trash, it’s important that staff is properly trained on what goes into the red biohazard container – and what does not. Because dental practices generate so little red bag waste, Sharps Compliance offers a cost-effective way to dispose of it using our 20-gallon TakeAway Recovery System. The waste can be placed in the same 20-gallon container as the used sharps containers. Offices that purchase multipacks of sharps containers can use the 5-gallon Medical Professional Pail to dispose of the tied, individual red bags. Disposal of Dental Amalgam Waste The use of amalgam separators to prevent amalgam from discharging into publicly owned treatment works (POTWS) will soon be mandatory. The EPA amalgam separator rule becomes effective as of July 14, 2020 for all existing and new dental practices. An amalgam – commonly called a “silver filling” – is an alloy composed of liquid mercury, tin, copper, and silver. When dentists either place or remove amalgam fillings without discharge safeguards, mercury can be released into the wastewater stream. According to the EPA, “studieshave shown that dental offices are the largest source of mercury discharges to POTWs, contributing about half of the mercury received by POTWs.” The resulting compounds are highly toxic, particularly to infants and children. Once a dental practice installs a compliant amalgam separator, it needs to employ a compliant recycling program to manage the separator and collected mercury. Sharps Compliance’s 5-gallon Dental Amalgam Recycling System contains two pails. The small inner pail is lined with a silver foil bag for small amounts of amalgam-containing items that have come in contact with blood and saliva, sludge from filters, and teeth with amalgam. Use the outer pail to safely recycle other dental materials like lead foils, non-contact amalgam, old radiographs, containerized x-ray fixer, and used lead aprons. The system provides collection and shipment for recycling through UPS. Single-Use Device Recycling Nearly every dental procedure will result in the disposal of single-use devices (SUDs). Prophylaxis angles, impression trays, and dental burs are just a few such disposable items. SUDs are typically not designed to be reprocessed as the materials are difficult to disinfect and sterilize. If bloodied during intraoperative work, SUDs might have to be disposed of as regulated medical waste. Alternately, most dental SUDs can be recycled via TakeAway Recycle Systems, which decrease the burden on your local landfill and streamline the disposal process of all your SUDs, regardless of the level of contamination. Additionally, once instruments have reached their end-of-useful-life, they too may be recycled via the TakeAway Recycle System. Once processed and treated at our disposal facility, a Certificate of Recycling as well as Sustainability Reports are provided via your SharpsTracer account. Handling Waste in Your Dental Office Every medical professional must take waste disposal seriously because regulators do. For example, New Jersey legislators passed a bill in 2012 that said medical professionals who illegally dispose of medical waste could lose their licenses. Still, in a busy dental practice, compliance can feel like an overwhelming task. Let Sharps Compliance help. ComplianceTrac is an online compliance and training management system. Training: Employees have access to in-depth training videos allowing them to train on their own schedule and receive instant certification. Training subjects include OSHA bloodborne pathogen, HazCom, Medicare, HIPAA, and others. Safety Data Sheets (MSDS/SDS): ComplianceTrac offers a database of thousands of safety data sheets where you can create individualized lists of SDSs specific to your facility along with the required corresponding Chemical Inventory List. Safety plans: Develop customized OSHA required safety plans for your office using the fill-in-the-blank plans in ComplianceTrac. Workplace audits: With ComplianceTrac, perform regular workplace audits, assign corrective action to individuals, and generate reports showing audit results as well as the status of corrective measures taken. SharpsTracer helps you track and verify the receipt and treatment of returned waste. It helps avoid paperwork errors by eliminating the need for paper-based manifest tracking and on-site paper document storage. Contact Sharps Compliance to learn more about our medical and pharmaceutical waste collection and treatment solutions for your dental practice. Read More
July 28, 2016 Understanding the EPA’s Proposed Amalgam Separator Rule UPDATE: The EPA’s final rule (July 14, 2017) “requires dental offices to use amalgam separators and best management practices recommended by the American Dental Association (ADA).” UPDATE: The 2016 EPA Dental Effluent Guidelines were pulled from The Office of The Federal Register; and, though signed, will not be published at this time. Therefore, this rule WILL NOT go into effect. However, many states have state level laws requiring the installation of amalgam separators in their state’s Dental Offices. These state level laws will be unaffected by the withdraw of the EPA rule and remain in full force and effect. If there are any further changes related to this rule, we will be sure to update this blog accordingly. In September 2014, the Environmental Protection Agency (EPA) proposed a new rule regarding dental amalgam. This regulation would require all existing and new dental practices to use amalgam separators to prevent amalgam from discharging into publicly owned treatment works (POTWs). Amalgam is a mixture of metals consisting of liquid mercury and a powdered alloy composed of tin, copper, and silver. Elemental mercury reacts with and binds together with the alloy particles to form an amalgam. Amalgam restorations are often referred to as “silver fillings.” Mercury is released into dental offices’ wastewater when dentists either place or remove amalgam fillings. “Studies have shown that dental offices are the largest source of mercury discharges to POTWs, contributing about half of the mercury received by POTWs.” Mercury is converted to methylmercury and builds up in fish and shellfish. When consumed, methylmercury is highly toxic, especially to fetuses, infants and children. Under this regulation, dentists would have to decrease their amalgam discharge “to a level achievable through the use of the best available technology (amalgam separators) and the use of Best Management Practices.” Many states have enacted rules requiring separators over the last few years. Therefore, if dental offices already have amalgam separators “that do not meet the proposed amalgam removal efficiency,” they would remain in compliance while the separator was still functioning. Once an office has installed a compliant amalgam separator, it’s important to manage the separator and collected mercury through a compliant recycling program. Utilizing Sharps Compliance’s 5-gallon Dental Amalgam Recycling System, which provides collection and shipment for recycling through UPS, cannot only help comply with the new regulations but can assure your mercury is safely and properly recycled. The EPA has delayed the release of the final rule twice. In May 2016, they postponed the regulation’s final release until this December in order to have time to review all of the comments they received for the proposal. Read More
August 25, 2015 What You Need to Know about Dental Amalgam Last updated on October 28, 2019 Controversy surrounds dental amalgam, the material sometimes used to fill cavities, because about half of it is composed of elemental mercury. Amalgam is a mixture of metals consisting of liquid mercury and a powdered alloy composed of tin, copper and silver. Elemental mercury reacts with and binds together with the alloy particles to form an amalgam. These fillings are also referred to as “silver fillings” due to their silver appearance.1 Elemental mercury releases mercury vapor that is primarily absorbed through the lungs, harmfully affecting them. Coughing, difficulty breathing and headaches are just a few of the symptoms of inhaling mercury. It is also possible for mercury to be absorbed through the skin; however, it is a much slower process.2 There are pros and cons for dental amalgam. Dental amalgam fillings are very durable and less likely to break than some other types of fillings. Amalgam is also the least expensive filling material. However, the elemental mercury in amalgam can pose a threat to people with amalgam fillings because the mercury can be absorbed through the lungs. Amalgam fillings are still considered safe for people six years and older according to the FDA.3 Composite resin and glass ionomer cement fillings are alternatives to dental amalgam. Composite resin fillings are more popular and consist of a type of plastic (acrylic resin) reinforced with powdered glass filler. Glass ionomer cement fillings are composed of organic acids and bases and may include acrylic resins. Both fillings are tooth-colored. Composite resin is harder to place than amalgam, not as strong as amalgam and more expensive. Glass ionomer cement can only be used in small restorations.4 It is important to dispose of amalgam correctly since it contains mercury. If dental amalgam is placed into the medical waste for disposal, it will end up in either an autoclave or an incinerator. Both of these disposal options result in the release of mercury vapors, which can be harmful to people and the environment. Several states have passed regulations, resulting in non-compliance for dentists who improperly disposal of amalgam. Amalgam can be handled either as hazardous waste and picked up or shipped to a hazardous waste disposal facility, or the dental office can recycle the amalgam. When the amalgam is recycled, the elemental mercury is extracted from the amalgam and reused in a number of different applications. Sharps Compliance offers a Dental Amalgam Recycling System, composed of two pails. The inner pail is lined with a silver foil bag for small amounts of amalgam-containing items that have come in contact with blood and saliva, sludge from filters and teeth with amalgam. The outer pail can be used for safe recycling of other dental materials, such as lead foils, used lead aprons, non-contact amalgam (not contaminated with blood), containerized x-ray fixer and old radiographs. 1 About Dental Amalgam Fillings 2 MERCURY (ELEMENTAL): Lung Damaging Agent 3 See FN 1. 4 Alternatives to Dental Amalgam Read More
