WRITTEN SUBMISSION TO THE WORKS COMMITTEE CITY OF TORONTO
DESIGNATION OF POLLUTION PREVENTION PLAN FOR THE DENTAL SECTOR UNDER SEWER USE BY-LAW NO. 457-2000
FROM THE ROYAL COLLEGE OF DENTAL SURGEONS OF ONTARIO
REGISTRAR
IRWIN FEFERGRAD, B.A., B.C.L., LL.B.
(Certified as a Specialist in Civil Litigation by the Law Society of Upper Canada.)
JULY 4, 2001
INTRODUCTION
The Royal College of Dental Surgeons of Ontario (RCDSO) is the regulatory body for dentists in Ontario. Our regulatory authority is granted to us by the provincial government under the Regulated Health Professions Act, 1991 (RHPA), the Dentistry Act, 1991 and the Health Professions Procedural Code.
Currently there are over 7,000 dentists in general and specialty practice registered with the College. Over one-third of this total number are dentists practising in the Toronto and immediate area.
As the oldest regulatory college for dentists in the world, RCDSO has a long and illustrious record of serving and protecting the public of this province. Today the College continues to be legally bound to serve and protect the public interest through the regulation of the professional practice of dentists in Ontario, and the investigation of allegations of professional misconduct against provincial dentists. In fact, the governing Council of the College is made up of both dentists and public members appointed by the provincial government to represent the consumers of this province.
Our primary responsibility is the protection of the public, and it is under that mandate of acting responsibly in the public interest that the College makes this submission on the proposed Pollution Prevention Plan for the Dental Sector.
RESPONSE TO PROPOSED POLLUTION PREVENTION PLAN AND PLAN SUMMARY FOR DENTAL SECTOR
The Royal College of Dental Surgeons of Ontario respectfully requests that the Works Committee consider postponement of the approval of Clause 10, the Pollution Prevention Plan and Pollution Prevention Plan Summary for the Dental Sector with a view to making significant alterations. This recommendation is based on the following four factors:
1. The University of Toronto is now in the preliminary stage of conducting an impartial research study on the disposal of amalgam waste. The study is under the scrutiny of the University’s Ethics Committee, and therefore will be completely independent of the College. The evidence-based results of this study will make an important contribution to deliberations on disposal of amalgam waste from dental offices into sewer systems.
This study will focus its investigation on waterlines in dental offices across the province and on mercury decomposition in farmlands. The lead researcher is Dr. Philip Watson, a professor at the University of Toronto, and a leading biomaterial expert.
The governing Council of the Royal College of Dental Surgeons of Ontario at its May 2001 meeting passed a resolution to fund a significant research grant to the University of Toronto to investigate the potential for release of mercury from amalgam waste disposal. The protocols of the research study will be closely reviewed and monitored by the University’s Ethics Committee to ensure the study is impartial and to preserve the sanctity of the results.
It is already a matter of public record that there is no sound scientific evidence to support a link between amalgam fillings and systemic disease or chronic illness. In fact, in late 1997 the World Health Organization issued a statement on dental amalgam that stated: "No controlled studies have been published demonstrating systemic adverse effects from amalgam restorations." The document went on to state that, aside from rare instances of local side effects of allergic reactions, "the small amount of mercury released from amalgam restorations, especially during placement and removal, has not been shown to cause any…adverse health effects." Dental amalgam has been safely used in dentistry in North America for more than 150 years. It continues to be a safe, extremely useful and necessary part of the range of restorative materials available to dentists to improve the quality of dental health of their patients.
It is critical that policy which may impact the health status of our citizens is supported by clear and unequivocal evidence that is based on valid scientific methodology. The results of this new study will be an invaluable resource in ensuring that discussions and decisions about amalgam waste disposal are based on sound scientific evidence, and are appropriate for this jurisdiction.
2. In late March 2001, all the dental regulators across the country declined to approve in principle a memorandum of understanding between the Canadian Dental Association and Environment Canada on implementing Canada Wide Standards (CWS) on mercury waste disposal. The regulators’ decision was primarily based on their lack of confidence in the scientific data presented on mercury waste material and its disposal. The regulators continue to decline to sign on to the memorandum of understanding on CWS on mercury waste disposal.
All the dental regulators across Canada have refused to support the CWS on mercury waste disposal as currently proposed by Environment Canada and the Canadian Dental Association. This refusal is further reinforcement of the lack of confidence in current information available about what the impact of dental amalgam waste is on the environment.
It is important to note that as regulators these organizations, including RCDSO, have delegated authority from their respective provinces to govern dentists in the public interest, not to act on behalf of the dental profession.
3. Both nationally and provincially, discussions continue about amalgam waste disposal. As recently as late April 2001, the Ontario Minister of Environment refused to sign an agreement on a Canada Wide Standard (CWS) on amalgam waste disposal because of the lack of clarity in evidence-based research.
The College is already working closely with the provincial Ministry of Environment on this issue. We believe that we can also make a significant contribution to this Committee in its deliberations. We would welcome the opportunity to join in a similar collaborative effort with this Committee and city staff to arrive at a conclusion that offers the best protection to the residents of Toronto, and also ensures that any plan affecting the discharge of amalgam to wastewater is based on sound science.
A postponement of the approval of the proposed Pollution Prevention Plan for the dental sector would provide a window of opportunity for broader consultations to take place, and ensure that this important decision is based on the best possible evidence.
4. The Pollution Prevention Plan and Plan Summary as presented for the Committee’s approval moves beyond the setting of by-laws for waste management into the establishment of protocols for the actual practice of dentistry in the province. This is a clear infringement on the College’s delegated responsibility to establish, maintain and enforce practice standards for the dental profession in Ontario. If the current Plan is passed by the Works Committee, the College may be required to pursue legal action to affirm our legal rights as a regulatory body.
On close review of the Pollution Prevention Plan Summary, the Royal College of Dental Surgeons of Ontario is quite disturbed to note that in a number of its recommendations the city is clearly venturing into prescribing the professional practice of dentists in Toronto. This is a responsibility that is delegated to the College only and is statutorily entrenched in provincial legislation.
This infringement of the College’ statutory authority as a regulator certainly points to the critical importance of postponing approval of the plan for the dental sector. Thorough discussions are necessary to ensure that the City does not take action beyond its jurisdiction.
IN CONCLUSION
The College appreciates the opportunity to make this presentation to the Works Committee and looks forward to working with the City of Toronto to ensure that decisions are made that will optimize the health of all our citizens. By working together collaboratively, we are confident that what will emerge are meaningful, safe and scientifically sound solutions which will benefit the citizens of Toronto.