OSHA’s Respiratory Protection Standard & Dental Mercury

When discussing occupational safety with dentists, it is inevitable that OSHA requirements are brought up. Quite often dentists are unaware of requirements such as the need for respiratory protection in workplaces where employees are exposed to hazardous airborne contaminants above safety standards. Unfortunately, the most common response is “But I’m a dentist. Respiratory protection isn’t needed… is it?”

While that answer depends upon a number of factors, one thing is for certain, OSHA requires all workplaces with known hazards to inform the employees of the exposure, provide personal protection but first to perform a hazard assessment that will determine exactly what kinds of safety implementation is necessary. That is where Dental Safety Solutions can help achieve full compliance. This not only protects you and your employees from most workplace hazards but it may also defend your business from lawsuits.

1910.132(d)(1)
The employer shall assess the workplace to determine if hazards are present, or are likely to be present, which necessitate the use of personal protective equipment

1910.132(d)(2)
The employer shall verify that the required workplace hazard assessment has been performed through a written certification that identifies the workplace evaluated; the person certifying that the evaluation has been performed; the date(s) of the hazard assessment; and, which identifies the document as a certification of hazard assessment.

An initial hazard assessment will determine whether or not employees are exposed to hazards above OSHA safety standards, thus requiring engineering and administrative controls to reduce exposure. If exposure to the hazard cannot be reduced below safety standards then respiratory protection and personal protective equipment must be implemented to protect employees. Additionally, the results of a hazard assessment will help the employer identify the type of personal protective equipment (PPE), respiratory protection, filter selection and the filter change out schedule, which are all required when protecting employee’s from a hazardous contaminant such as mercury. Lastly, your hazard assessment must be documented and available for inspection.

“But I was taught mercury doesn’t escape from amalgams!” We have heard this refrain from dentists more times than we’d like to admit. Fortunately, to help bring clarity to this issue there are many examples to be found in the scientific literature and surprisingly even from national dental organizations stating that mercury is released from amalgam fillings.

Below is a short authoritative list of those government entities, organizations and manufacturers who warn that mercury is released from amalgam fillings during  the placement, polishing and removal of amalgam fillings.

• Amalgam Manufacturer Kerr – SDS sheet that ships with amalgam
• The American Dental Association: 2003 Mercury Hygiene Recommendations
• The Food and Drug Administration: “Mercury vapor concentrations are highest immediately after placement and removal of dental amalgam”
• The World Health Organization
• The Agency for Toxic Substances & Disease Registry (subset of the CDC)
• Fédération Dentaire Internationale: Mercury Hygiene Guidance
• The International Academy of Oral Medicine & Toxicology: Safe Mercury Amalgam Removal Technique
• Published studies on dental mercury (IAOMT position paper with over 900 citations)

With such a large body of published literature indicating mercury exposure while working with amalgam, OSHA will expect you to have performed a hazard assessment to determine your employee’s exposure and will not accept that you were told in dental school that the mercury is retained within the amalgam. Not performing required tasks or having proper documentation can result in citations and fines from OSHA as well as lost of trust with your most valued asset, your employees.

Upon realizing that mercury vapors generated during the removal of amalgam dental fillings exceeds safety levels, dentists and practice owners will likely want to implement respiratory protection for employees right away.  However, before hastily purchasing respirators, it’s important to know if your employees may have any potential health conditions that would prevent them from wearing a respirator such as lung disease, heart conditions and even psychological conditions like claustrophobia. For these reasons, OSHA  requires employers to evaluate if the employee is medically able to wear the respirator.

1910.134(e)(1)
The employer shall provide a medical evaluation to determine the employee’s ability to use a respirator, before the employee is fit tested or required to use the respirator in the workplace. The employer may discontinue an employee’s medical evaluations when the employee is no longer required to use a respirator.

Workers are required to be medically evaluated using the OSHA suggested medical questionnaire or an equivalent method.  OSHA requires that the employer pays for the medical evaluation and that, if necessary, they give the employee the time off to have the evaluation or follow up performed. Luckily, there are also online medical evaluations, which save both time and money when having the initial evaluation completed. While there are no yearly medical evaluations requirements, all medical evaluations must be documented and available for inspection.

• Complete questionnaire in 15-30 minutes
• Immediate notification of clearance
• Can be used with any brand of NIOSH approved respirator
• Exam can be taken on any computer or tablet with internet access
• Online record keeping tracks employee’s clearance status
• Available 24/7-Schedule at your convenience
• 97% average pass rate (due to built-in expanded questionnaire)
• Physician or other licensed health care professional (PLHCP) provides review and, if needed, will follow up with employee
• Questionnaire available in English or Spanish