ISSN No: 2582-0559

Volume No: 8, Issue No: 2

REVIEW ARTICLE

‘DENTIST’S PERSPECTIVE ABOUT RADIOLOGICAL WASTE

MANAGEMENT’- A QUESTIONNAIRE STUDY IN TAMIL

NADU

Dr. Anbu Meena S, Dr. Kannan A, Dr.Krithika C L, Dr.Sanjana S, Dr. Parimala D, Dr. Yesoda Aniyan

Department of Oral Medicine and Radiology, SRM Dental College, Ramapuram, Chennai, Tamil Nadu, India

DOI:1.37841/jidam_2021_V8_I

2_03

Address for Correspondence

Dr. Anbu Meena S,

Postgraduate Student, Department of Oral Medicine and

Radiology, SRM Dental College, Ramapuram, Chennai, Tamil

Nadu, India

Email id: anbu.meena.s@gmail.com

Received: 24.01.2021

First Published: 30.04.2021

Accepted: 09.04.2021 Published: 27.06.2021

ABSTRACT

Background: Radiographs are diagnostic aids commonly

used by dentists and physicians for accurate diagnosis and proper
treatment.  Traditional  method  of  radiography  is  still  being
practiced  despite  the  invention  and  evolution  of  digitalization.
Dental  workplaces  that  practice  conventional  radiographic
techniques must use numerous chemical solutions for X-ray ﬁlm
processing.  All  these  chemical  solutions  necessitate  specific
handling and disposal techniques.

Objectives: To evaluate the knowledge on dental

radiological waste management among dentists in Tamil Nadu.

Methodology: A survey was performed for a sample size

of 379 dental clinicians. A multiple‑choice response type of
questionnaire was designed with close‑ended questions with a
maximum choice of four responses. Responses were evaluated
to extract the results.

Results: The result of this present study showed that total

correct answers which have been reported to be <50%. This
showed lack in knowledge among the dentists.

Conclusions: Harmful dental radiographic wastes should

be carefully disposed to minimize hazards to the environment.
Although  there  is  small  amount  of  contribution  of  waste
generated by individual, it’s eventual accumulation of the same
plays  a  pivotal  role  in  affecting  the  environment  and  human
health in various ways. Thus, it becomes exceedingly significant
for  proper  disposal  of  waste  products  from  conventional
radiographs  in  lowering  its  impact  on  the  surrounding
environment.

KEY WORDS:

Radiographic waste, lead foil waste,

silver waste.

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Volume No: 8, Issue No: 2

Jaishree et al: Lipoxins for Resolution of Inflammation

INTRODUCTION

Environmental pollution has become a persistent

concern  gaining  global  attention  even  with  the  adoption  of
government  policies.  One  of  the  most  important  causative
factor for contamination results from the disposal of medical
waste.  It  has  the  capacity  to  create  health  risks  to  the
environment  indirectly  by  liberating  toxic  pollutants.  In
medicine  as  well  as  in  dentistry,  radiographs  act  as  the
primary  modality  which  aid  in  diagnosis,  assessing  the
disease  status  and  formulating  appropriate  treatment.
Conventional  oral  radiography  is  still  being  practiced  and
plays a pivotal role in dentistry in the era of digitalization.

The criteria to get radiographic images includes X-ray

exposure of radiographic films; subsequently processing the
film with various chemical solution. During processing, the
residues generated should be properly handled and discarded,
aiming to minimize the environmental impacts

. Silver will

pollute the soil and ground water if it is thrown to a landﬁll
without recycling. Although there are basic biomedical waste
management protocols, its practice is very much limited
among dentists

Even while using digital radiography, one should always

keep the conventional radiographs to encounter an emergency
situation

. Digital radiography lowers the patient exposure

and does not require the usage of processing chemicals or
darkroom; inspite of these advantages’ dental practitioners in
most developing countries and teaching institutes continue to
use conventional radiography for either educational purposes
or due to financial constraints

. Dentists are usually oblivious

to detrimental effects of radiologic wastes, and perhaps feel
that discarding them improperly would cause only negligible
effect to the surrounding. The aim of the current study is to
assess the knowledge on dental radiological waste
management among dentists in Tamil Nadu.

MATERIALS AND METHODS

A survey was performed for a sample size of 379 dental

clinicians in Tamil Nadu. A multiple-choice response type of
questionnaire was designed with 18 close-ended questions
with a maximum choice of four responses. Responses were
evaluated to extract the results.

INCLUSION CRITERIA

All the Dentists owning a dental clinic in Tamil Nadu

All the Dentists practicing in a dental clinic in Tamil
Nadu

Dental Students who have entered clinical posting

Dentists with work experience but not practicing
presently

Interns presently working at a dental set-up

EXCLUSION CRITERIA

Dentists who are not practising

Dental students who haven’t entered clinical postings

Dentists who are not practising in Tamil Nadu.

RESULTS

This study aimed towards assessing the knowledge

about dental radiological waste management among the
dentists in Tamil Nadu and also discusses about the biological
effect of conventional radiographic wastes produced by
dental specialists and their group to bring awareness about the
conceivable dangers they bring to the environment.

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Jaishree et al: Lipoxins for Resolution of Inflammation

Fig 5: Depicts various response received from each question in pie chart.

Fig 1 shows the questionnaire format used in this study.

Fig 2 shows the overall correct results have been reported to
be  <50%  in  almost  all  the  questions.  Total  responses  were
evaluated  for  all  the  participants  on  the  percentage  basis
which is depicted in the bar chart in Fig 3. Comparative bar
chart  showing  the  values  for  expected  correct  response
against the other responses in Fig 4. Individual questions were
also evaluated for results. Almost 33.3% of clinicians practice
only  conventional  radiology,  17.4%  practice  digital
radiography whereas 49.3% practice both. Regardless of the
method of practice the respondents answered all the questions
in  the  questionnaire  for  evaluating  their  outlook.  Figure  5
shows 68% dentists discard the lead foils along with regular
clinical wastes, 5% give away the foils with patient’s X-ray
packets and the remaining 27% believe in recycling. Around
50% of the dentists dispose the used X-ray films along with
regular waste, 32% give them to the patients and 18% send
for  recycling.  Once  again  54%  of  the  dentists  discard  the
unused expired X-ray films along with regular waste, 36% of
them  return  it  to  the  manufacturer  and  only  10%  send  for
recycling. Only 50% responders firmly believed that the used
developer and fixer solutions are harmful to the environment
whereas 18% don’t and 32% have no idea about it. 33% of
the  dentists  believe  that  the  water  used  for  rinsing  X-ray
during processing is harmful to the environment whereas 31%
of them don’t and 36% have no idea. The results for method
of disposal of used developer suggested that 62% clinicians
dispose  the  solution  in  their  sink,  5%  in  the  soil  and  33%
discard  after  special  treatment.  Similarly,  the  results  of
disposal  of  used fixer  solution  shows  69%  dispose  it  in  the

sink,  5%  into  the  soil  and  29%  give  it  for  recycling
considering it as a hazardous waste.77% of the dentists throw
away  the  water  used  for  rinsing  purpose  during  film
processing into the sink, 9% into the soil and roughly about
14% give it for recycling. Out of the 84% of the dentists using
automatic film processor in their clinic, 10% use Chromium
based cleaner and 16% use environmentally friendly cleaner
whereas  the  remaining  don’t  use  a  cleaner.  64%  of  the
dentists believe that digital dental radiography does not create
waste, 11% believe it does and 26% of them have no idea. 7%
of the dentists think they are bio degradable waste, 12% think
it to be hazardous waste, 23% recyclable waste whereas the
majority  58%  of  them  had  no  idea.  Regarding  electronic
waste,  37%  of  the  practitioners  discard  it  along  with  the
regular clinic waste, 26% return to the manufacturer and 37%
give for recycling. 54% of the dentists use lead aprons. 95%
of the responders think there is a need for an inclusion of a
chapter  on  radiological  waste  management  in  the  BDS
curriculum and 92% think there is a need for an organizing
authority to provide guidelines on management and control of
dental  radiographic  waste.  The  percentage  analysis  thus
proved  that  the  results  were  establishing  evidence  for
knowledge  gap  in  dental  clinicians  regarding  radiological
waste management.

DISCUSSION

Radiographic assessments being the major instrument in

dentistry, a few headways like innovative technologies,
gadgets and procedures have teamed up in the decrease of

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presentation of their unsafe impacts. Sudhakar V et al in their
study had reported that in India, dentists pay no attention to
waste management.

[5]

Dental radiographic systems produce

squander substances with possible test to nature. Instances of
such waste materials incorporate spent X-ray processing
solutions, lead aprons, lead foil, processor system cleaners,
utilized and unused X-ray films

. The amount of lead present

in  lead  foil  is  between  69  to  85%.  No  safe  degree  of
presentation to lead was discovered; lead was harmful even
in low dosages. The lead foil present inside X-ray film packet
is  a  leachable  toxin  which  can  contaminate  the  soil  and
groundwater in landﬁll destinations7. In Tsuji et al’s study, it
was reported that approximately 11 grams of lead waste could
be created during full mouth radiographic assessment8. The
lead foil from the films should be collected to return them to
the manufacturer for recycling. Apparently, there is absence
of  awareness  among  the  dental  specialists  on  this
administration offered by makers as the organizations report
that just about 5% of the sold items are returned

Silver from the developer and fixer solutions ought to be

considered as a significant asset and ought to be reused

Dental  hospitals  working  with  individual  septic  removal
frameworks  should  make  sure  they  dispense  the  developer
solution  safely  as  they  contain  aromatic  phenols  and  amino
acid.  These  chemicals  require  enormous  amount  of  oxygen
and  result  in  harmful  septic  framework.  However,  used
developer solutions are not that dangerous enough because of
its  lower  content  of  silver9.    But  still,  the  they  should  be
neutralized preceding its disposal in light of the fact that it has
a pH around 11 to 12, (i.e.) it is a profoundly basic solution

Even the water utilized in the washing of the radiographs
displays levels of silver, well over the permitted esteem.

Silver from the fixer solution can be discarded in two

different  ways  specifically  (1)  Onsite  treatment  and  (2)
Offsite  treatment.  Onsite  recovery  of  silver  from  the  fixer
solution includes either electroplating techniques or metallic
replacements.  Through  off-site  removal  of  fixer,100%
recovery of silver in fixer is ensured by sending them to the
producers or distributors of the solutions

. The clinic should

make  sure  to  enclose  the  solutions  in  tightly  closed  plastic
containers during storage or disposal of these solutions. The
containers  could  be  named  as  "Used  fixer"  with  labels
denoting  the  date  it  was  first  added  to  the  containers8.  The
sad  news  about  dental  specialists  is  that  they  disregard  and
are  unaware  of  the  harmful  effects  of  these  radiographic
wastes as they believe these wastes created by them could be
insignificant. Indeed, even lead aprons and lead shields ought
not  be  tossed  into  the  normal  trash,  yet  got  back  to  the
producer6,11. Automatic processor’s cleaners usually contain
chromium,  which  again  is  one  of  the  dangerous  waste
products.  System  cleaners  without  chromium  could  be
preferred  with  an  added  benefit  of  cost  effectiveness10.

Additionally, certified waste carriers can be used to discard
radiologic wastes

. Dentistry being a health care service, the

dental radiographic waste management should be sorted
out

. Educational instructive pictures and posters in the

dental office might be helpful and will act as a guidance for
the dental staff

. Considering the aforementioned discussion,

there is a need of more prominent consideration regarding the
disposal of radiographic waste. The lack of care in handling
the dental radiographic residues might cause serious damage
to the people working to execute the garbage collection, the
public and the environment which could be avoided by a
system of previous separation of these materials

. Intending

to diminish the harmful impact on the public health and
environment, the clinicians need to take initiative to enquire
and acquaint themselves with correct knowledge and change
the perspective.

CONCLUSION

Considering the approach utilized and the outcomes

acquired, it is clear that a large portion of the dental specialists
didn't  dispose  of  the  radiographic  waste  appropriately.  The
solution  is  to  practice  digital  radiography  with  computer-
based  devices.  This  would  eliminate  the  wastes  associated
with conventional method of film processing. Dentists have
moral  and  professional  responsibility  towards  the  dental  as
well as the general health of the patients they care. So, it is
the responsibility of the dentists to save the environment by
proper waste disposal while using conventional imaging.

ACKNOWLEDGEMENT

‘a’ designed the study, searched relevant articles and collected
data. ‘a’ and ‘b’ participated in the data interpretation and
analysis. ‘a’ and ‘c’ prepared the manuscript. All the three
authors read and approved the final manuscript.

CONFLICTS OF INTEREST

There are no conflicts of interest.

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