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Mercury Reductions in the Dental Sector in Sweden

Eva Sandberg

Senior Adviser

International Secretariat

Swedish Chemicals Agency

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Outline

• Background (brief)- The mercury problem in Sweden- Swedish policy on mercury- Actions

• Dental amalgam phase-out• Mercury Reductions in the Health

Care Sector (2nd part)

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Europe and the European Union

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Sweden in brief

9 million inhabitants3 major urban areas

410 000 km2 total area240 000 km2 forest land>100 000 lakes

0.7 tonnes Hg air emission4.2 tonnes Hg deposition (mainly from outside Sweden)

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Mercury is a problem in SwedenFish in 50 000 lakes exceeds WHO limit (0.5 mg Hg/kg).

Levels in forest soil increases and probably effects important soil microbial functions.

Deposition must be reduced by 80% to reach safe levels.

International action needed.

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Environmental Quality Objective: A non-toxic environment

Interim target regarding mercury

• Newly manufactured finished products will as far as possible be free from mercury, as soon as possible, but no later than 2007.

• Nor will mercury be used in production processes unless the company can prove that human health and the environment will not be harmed.

• Finished products already available will be handled in such a way that mercury is not released to the environment.

• The spread to Sweden by air or water of mercury will decrease continuously.

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Phase out use in products and processes.

No export.

Mercury already in society should be collected and treated.

Mercury should not

be recycled.

Mercury should be safely disposed in a final storage.

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Swedish actions in brief

• Ban on the sale of fish from certain lakes in the early 1970´s

• General recommendation for fish consumption - Pregnant and breast-feeding women: No consumption- General public: Once a week

• Reductions of emissions from point sources

• Ban on certain Hg-containing products in 1992

• Export ban entered into force1997

X

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… actions in brief

• Collection of Hg and identification of Hg-products

1994 – 1999

• Parliament decision 2003 on final storage of Hg

and Hg-containing waste, latest 2015 • Notification Feb 2006 to EU and WTO of a general

ban on Hg and Hg- containing products (use, placing on the Swedish market, export and import) – Not yet entered into force

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Swedish regulation on mercury

• Mercury and its compounds and preparations may not be exported professionally from Sweden

• Certain goods (measuring instruments, electrical components such as switches, thermostats, relays and circuit breakers) containing mercury may not be manufactured or sold or used if not in use before 1995

• These goods may not be imported from third countries or exported from Sweden

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Investigation of a national general ban on the marketing and use of Mercury

• Includes for example dental amalgam,

chemicals and chlor-alkali industry

• Proposal to Government 30 June 2004

• Report is available in English at www.kemi.se

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Yearly supply of mercury in products in Sweden (kg)

0

50010001500200025003000

3500400045005000

1991/92 1997 2003

Measuringinstruments,electrical devices

Batteries

Light sources

Dental amalgam

Analytical chemicals

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Dental amalgam

• Dental amalgam contains about 50 % Hg

• Mercury is released to the environment at several steps

• Risks to the environment and to human health

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Sewage sludge

Cremation

Incineration

Land application

Sewer system

Waste

Hg

Sep

arat

or

Landfill

Waste

Hg

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0

200

400

600

800

1000

1200

1400

1600

1800

1991/92 1997 2003

Mercury supplied to dental amalgam in Sweden (kg)

US (280 million people): >30 tonnes Hg (2005)

EU (460 million people): est. 90 tonnes Hg (2005, 25 MS)

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Mercury-free dental fillings

• Dental amalgam has been replaced almost totally during the last six to seven years in Sweden

• Swedish suppliers of dental materials and users from both public and private sector are the sources of the used statistics in the new report

• Composites are the most commonly used materials in Sweden

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The shares of dental filling materials used in Sweden (% by weight*)

Composites

78 %

Glassionomers

Amalgam

Compomers 3%

Ceramics <1%

13 %

6 %

* One kilo of composites will fix many more teeth than one kilo of amalgam due to the differences in weight of the materials.

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Amalgam fillings in % of total fillings at Folktandvården in Sweden 2002 and 2003

0

0,5

1

1,5

2

2,5

3

Adults

Children

Adults 3 1,8

Children 0,1 0,05

2002 2003

Source: Swedish Board of Health and Welfare

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Success factors

• High awareness of the environmental and health risks among patients and dentists.

• Demand for and access to other filling materials.• Agreement between the state and the county

councils in 1995 to phase-out use from children's dentistry.

• Since 1999 no financial support given from Swedish dental insurance for amalgam fillings.

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Thank you for your attention!

Thanks to colleagues Petra Ekblom and Ulla Falk