This document provides information on dental healthcare waste management. It defines dental waste and classifies it according to infectiousness. The key sources of dental waste are described. Proper waste management involves segregating, storing, transporting and disposing of waste using methods like incineration, wet thermal treatment, chemical disinfection, and landfilling. Special protocols are outlined for managing amalgam waste and heavy metals from dental procedures. Effective dental waste management protects health workers, patients and the environment.

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2. Presented by : Dr. Vini Mehta
MDS 1st
Year
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3. CONTENTS
• Introduction
• Definitions
• Classification of health care waste
• Dental health care settings
• Sources of Dental Health Care Waste
• Classification of Dental waste
• Steps in waste management
• Management of Dental Waste
• Waste management for camp settings
• Conclusion
• References
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4. Introduction
• Human and industrial development along
with innovations both technologically and
socially has increased over time and
location
• With the boom of the healthcare industry
worldwide, the health care environment is
changing rapidly
• In doing so, however, waste is generated
that is hazardous to public health and the
environment.
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5. DEFINITIONS
• Health Care Waste: Defined as the total
waste stream from a healthcare
establishment, research facilities,
laboratories, and emergency relief
donations.
-WHO
• Dental waste : Any waste product
generated by a dental office, surgery,
clinic or laboratory including amalgams,
saliva, and rinse water. 5

6. Health Care WasteHealth Care Waste
Hazardous
health care waste
General waste 75% to 90%
10 to 25%
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7. Pharmaceutical
Genotoxic
Chemical
Heavy Metals
Pressurized containers
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2
3
4
5
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Pathological waste
Infectious
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Radioactive waste
Sharps
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9. Biomedical Waste Management
and Handling Rules (1998)
Waste Category
no.
Waste Category [Type]
Category No.1 Human Anatomical Waste
(Human tissues, organs, body parts )
Category No.2 Animal Waste
(Animal tissues, organs, body parts, bleeding parts, fluid,
blood and experimental animals used in research, waste
generated by veterinary hospitals, colleges, discharge from
hospitals, animal houses)
Category No.3 Microbiology & Biotechnology Wastes
(Wastes from laboratory cultures, stocks or specimens of
micro-organisms live or attenuated vaccines, human and
animal
cell culture used in research and infectious agents from
research and industrial laboratories, wastes from production
of biological, toxins, dishes and devices used for transfer of
cultures) 9

10. Waste Category no. Waste Category [Type]
Category No.4 Waste sharps
(needles, syringes, scalpels, blades, glass etc. that may
cause puncture and cuts. This includes both used and
unused sharps)
Category No.5 Discarded Medicines and Cytotoxic drugs
(wastes comprising of outdated, contaminated and
discarded medicines)
Category No.6 Soiled Waste
(Items contaminated with blood, and body fluids including
cotton, dressings, soiled plaster casts, other material
contaminated with blood)
Category No.7 Solid Waste
(wastes generated from disposable items other than the
waste [sharps] such as tubings, catheters, intravenous sets
etc.) 10

11. Waste Category no. Waste Category [Type]
Category No.8 Liquid Waste
(waste generated from laboratory and washing, cleaning,
house-keeping and disinfecting activities)
Category No.9 Incineration Ash
(ash from incineration of any biomedical waste)
Category No.10 Chemical Waste
(chemicals used in production of biologicals, chemicals used
in disinfection, as insecticides etc.)
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12. Rationale for waste disposal
• To prevent hospital acquired infection.
• To protect health care providers.
• To prevent the risk to general population
• To protect environment.
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13. Dental
settings
in
district
hospitals
Dental health care settings
CHC
and
PHC
Private
Clinics
Camp
setting
Teaching
Institutio-
ns
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14. Source of waste in Dental Health Care
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15. Procedures Waste Generated
Equipment cleaning Disinfectants
Routine dental procedures Gloves, Saliva ejectors, Needles-syringes, Scalpels and
blades, Endodontic reamers, files ,burs, head caps ,
mouth masks, Cotton
Investigative procedures Dyes, reagents, Laboratory cultures, Specimens of
microorganisms. Fixer, Developer, X-ray system cleaners ,
Lead foils and shields
Surgical procedures Extracted tooth, Excised tissues
Prosthodontic procedures. Wax, Silicones-acrylics, Alginate, Partial dentures ,
Bridges.
Orthodontic procedures Orthodontic brackets ,Bands , wires
Amalgam filling ,
Precapsulated amalgam use
Amalgam particles, Waste or bulk mercury,
Empty amalgam capsules
Office waste Paper , Plastic, Plastic-coated paper
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16. Infectious and
Potentially
Infectious
Wastes
Non –Infectious
Wastes
Domestic
Wastes
Amalgam
Waste
Infectious
Waste With
Metal
Infectious
Without
Metal
- Food waste
- Newspapers
- Magazines
- Household
Products and
their packaging
- Envelopes
Gypsum
Lead shields.
X-ray films,Developer
and fixer solution
•Gloves
•Wax
•Anaesthetic cartriges
•Silicones – acrylic
•Alginates
•Extracted teeth
•Blood contaminated
cotton and gauze
Amalgam
&
Amalgam
Capsules
Sharps
Non –
Sharps
Saliva
Ejectors
•Needle syringes
•Dental tools
•Partial dentures
•Bridges 16

17. Final
Disposal
4
Transportation
3
2
Segregation
1
There are four key steps in Waste
management
Storage
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18. Segregation
• Segregation should always be the
responsibility of the waste producer,
should take place as close as possible.
• The most appropriate way of identifying
the categories of health-care waste is by
sorting the waste into colour-coded plastic
bags or containers.
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19. • Biomedical waste should be segregated
into containers/bags at the point of
generation in accordance with schedule II
of biomedical waste ( management and
handling ) rules 1998
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20. COLOUR CODING
Colour Coding Type of
Container
Waste Category
Yellow Plastic bag Excised tissues, biopsy tissue,
granulation tissue, human and animal
cell culture
Red Disinfected
container/plastic
bag
cotton, dressings, other material
contaminated with blood, Laboratory
cultures, Specimens of
microorganisms.
Blue/White
translucent
Plastic
bag
Gloves ,tubings, catheters,
intravenous set, needles, syringes,
scalpels, blades, glass
Black Plastic bag discarded medicines, chemicals used
in disinfection, ash from incineration
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21. Storage
• A storage location should be designated
inside the health-care establishment or
research facility.
• Separate area - size appropriate to the
quantities of waste.
• Impermeable, hard-standing floor with good
drainage.
• It should be easy to clean and disinfect.
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22. • Unless a refrigerated storage room is
available, storage times for healthcare
waste should not exceed the following:
• Temperate climate: 72 hours in winter
48 hours in summer
• Warm climate: 48 hours during the cool
season
24 hours during the hot
season
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23. Labeling
• All waste bags or containers should be
labelled with basic information of their
content and on the waste producer:
– Waste category
– Date of collection
– Place in hospital where produced.
– Waste destination
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24. Transport
• Transportation of medical waste within
the medical institution can be done by
small trolleys or carts.
• Transportation from the point to the
onsite by specialized trucks marked with
symbols denoting the type of waste
carried.
24Safe management of wastes from health-care activities, WHO

25. 25
Encapsulation
Chemical
Disinfection
Disposal
Incineratio
n
Land
Disposal
Microwave
Irradiation
Wet thermal

26. Incineration
• Incineration is a high temperate dry
oxidation process, that reduces organic
and combustible waste to inorganic
incombustible matter and results in a very
significant reduction of waste-volume and
weight.
• The process is usually selected to treat
wastes that cannot be recycled, reused or
disposed off in a land fill site.
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27. Suitable for :
• Infectious waste, sharps and pathological
waste.
• All chemical and pharmaceutical wastes,
including cytotoxic waste.
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28. Wet thermal treatment
• Wet thermal is based on exposure of
infectious waste to high-temperature, high-
pressure steam, and is similar to the
autoclave sterilization process.
• Commonly used only for highly infectious
waste, such as microbial cultures or
sharps.
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29. Chemical disinfection
• Chemicals are added to waste to kill or
inactivate the pathogens it contains.
• Chemical disinfection is most suitable for
treating liquid waste such as blood, urine,
stools, or hospital sewage.
• Formaldehyde, Glutaraldehyde, Sodium
hypochlorite.
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30. Microwave Irradiation
• In a microwave treatment unit, a loading
device transfers the wastes into a
shredder, where it is reduced to small
pieces.
• The waste is then humidified, transferred
to the irradiation chamber, which is
equipped with a series of microwave
generators, and irradiated for about 20
minutes.
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31. • After irradiation, the waste is compacted
inside a container and enters the
municipal waste stream.
• Suitable for infectious waste and
sharps.
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32. Land disposal
• If a municipality or medical authority
genuinely lacks the means to treat wastes
before disposal, the use of a landfill has to
be regarded as an acceptable disposal
route.
• There are two distinct types of waste
disposal.
– Open dumping.
– Sanitary landfill.
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33. Encapsulation
• Involves filling containers with waste,
adding an immobilizing material, and
sealing the containers
• The process uses either cubic boxes
made of high-density polyethylene or
metallic drums, which are three-quarters
filled with sharps and chemical or
pharmaceutical residues
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34. • The containers or boxes are then filled up
with a medium such as plastic foam,
sand, cement mortar, or clay material.
• After the medium has dried, the containers
are sealed and disposed of in landfill sites.
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35. Management of Dental Waste
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36. Management of Amalgam
• Collect empty capsules in a covered
container and dispose with solid waste.
• Retrieve excess amalgam during
placement with gauze.
• Larger particles should be recycled
• Recover amalgam from instruments prior
to washing.
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37. • Use precapsulated alloys.
• Do not place extracted teeth with
amalgam fillings in the regular garbage.
• It should be disposed of in the "Scrap
Amalgam" container to avoid incineration
• Never flush amalgam down the drain.
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38. Chair-side trap
• Chair-side trap - Use disposable traps
instead of reusable traps - Change at least
once a week.
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39. Heavy metals
The three most common source of heavy
metals are:
• X-ray fixer: Used X-ray fixer contains
silver.
• X-ray film: X-ray film contains silver and
lead foil.
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40. X ray fixer
• Store the fixer solution in a container
provided by the disposal company.
• Use a certified waste carrier for recycling.
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41. • Spent developer is permitted to be
discharged into the septic systems
provided it is diluted with water
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42. X ray - Films
• Undeveloped film contains a high level of
silver and must be treated as a hazardous
waste.
• Silver can contaminate the soil and
groundwater if it is sent to a landfill.
• Unused film should be recycled.
• Developed film - regular solid waste
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43. Lead foil packets
• The lead foil inside each x-ray packet is a
leachable toxin and can contaminate the
soil and groundwater in landfill sites.
• Collect lead foil packets in a marked
container and contact a certified waste
carrier for recycling.
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44. Rubber Gloves
• Autoclaving and reuse.
• Chemical disinfection for 1 hr after
mutilation
• Once it is thoroughly disinfected and
mutilated it should be sent for receiving
industry.
• Where the facilities for receiving the
plastics are not available it can be sent for
land filing
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45. Needles, syringes, scalpels and
blades• They should be disinfected by 1% sodium
hypochlorite solution, destroyed before
disposal
• All sharps must be put in a pit which is
well covered and protected and not
accessible to rag pickers.
• Needle burners: Eliminates the possibility
of reuse of the used needles and syringes,
even by mistake.
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46. • Orthodontic brackets and wires and
endodontic reamers, files :They are
treated as infected sharps- Sanitary land
filled or Recycled.
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47. Extracted Teeth
• Extracted teeth that are being discarded are
subject to the containerization and labeling -
provisions of the Occupational Safety and
Health Administration (OSHA) Bloodborne
Pathogen Standard.
• The new CDC guideline allows extracted
teeth to be returned to the patient
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48. • Plaster of Paris cast- This should be
stored separately.
• Sold to a buyer who uses it as a raw
material for cement manufacturing.
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49. • Crown and bridges- Can be recycled if
sold to a certified buyer
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50. Waste management in camp
settings
• The procedures about handling of
infectious sources should be based on the
universal precautions recommended by
Centers for Disease Control (CDC).
• The centers should have containers used
specifically for disposal of sharps.
• Infectious waste from health centre should
be separated from other health care
waste.
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51. • Disposal towels and tissues, materials
contaminated with blood should be
disposed of in a trash container lined with
plastic.
• Liquid, semi liquid and items dripping with
blood should be placed in closable and
labeled containers.
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52. • Determine if infectious waste needs to be
left at a location different from where
solids waste is left.
• Landfill the infectious waste or arrange for
disposal through the local health care
community.
• If neither are possible, storage and
transportation of waste from the camp site
back to hospital should be done with
utmost care.
• The waste can finally be disposed
according to the hospital regulations 52

53. Conclusion
• Waste management is the collection,
transport, processing, recycling or
disposal, and monitoring of waste
materials.
• A proactive approach will allow our
profession to succeed in an era of
increased public environmental concern
and environmentally protective legislation.
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54. Refernces
• Park’s textbook of Preventive & Social
medicine
• Safe management of biomedical sharp
waste in India – regulatory framework in
India, WHO.
• Safe management of wastes from health-
care Activities, WHO - Legislative,
regulatory, and policy aspects.
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55. • Infection Control & Occupational Safety
Recommendations for Oral Health
Professionals in India- Dr. Anil Kohli.
• Best management practices for dental
waste: city of boulders.
• The Environmentally Responsible Dental
Office: A Guide to Proper Waste
Management in Dental Offices: Northeast
Natural Resource Center of the National
Wildlife Federation and The Vermont State
Dental Society June 1999
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