|
Questions |
Scale |
N |
% |
|
During dental
care, do you reuse dental rotary burs and scalpel blades (sharps) after
disinfection and sterilization (autoclaving)? |
Strongly disagree |
100 |
58.8% |
|
Disagree |
26 |
15.3% |
|
|
Neither agree nor
disagree |
14 |
8.2% |
|
|
Agree |
16 |
9.4% |
|
|
Strongly agree |
14 |
8.2% |
|
|
Do you
dispose of sharps waste containers when they are three-quarters full? |
Strongly disagree |
14 |
8.2% |
|
Disagree |
14 |
8.2% |
|
|
Neither agree nor
disagree |
27 |
15.9% |
|
|
Agree |
52 |
30.6% |
|
|
Strongly agree |
63 |
37.1% |
|
|
During dental
care, do you disinfect sharps using 0.5% or 1% sodium hypochlorite for 30
minutes? |
Strongly disagree |
17 |
10.0% |
|
Disagree |
10 |
5.9% |
|
|
Neither agree nor
disagree |
39 |
22.9% |
|
|
Agree |
52 |
30.6% |
|
|
Strongly agree |
52 |
30.6% |
|
|
In dental
practice, do you use intermediate cleaning and disinfection for the disposal
of anatomical waste (extracted teeth)? |
Strongly disagree |
9 |
5.3% |
|
Disagree |
18 |
10.6% |
|
|
Neither agree nor
disagree |
33 |
19.4% |
|
|
Agree |
51 |
30.0% |
|
|
Strongly agree |
59 |
34.7% |
Regarding the section assessing current dental amalgam
disposal practices, the question concerning the use of a leak-proof, airtight,
chemical-resistant container for amalgam disposal showed a majority of
responses in the "agree" and "strongly agree" categories
(55.3%). This suggests that a significant proportion of dentists recognize and
apply basic containment conditions, demonstrating appropriate handling of
residual material (Figure 1).
Regarding the delivery of dental amalgam waste to a
company for reuse during the provision of dental services, there was a lower
concentration of responses in the "agree" and "strongly
agree" categories (20%). This indicates that few dentists apply this
practice when managing amalgam waste (Figure 1).
The question concerning the storage of chemicals,
disinfectants, and flammable agents in appropriate containers showed a higher
concentration of responses in the "agree" and "strongly
agree" categories (71.2%). This suggests that safety measures associated
with the storage of potentially hazardous substances are more standardized
within dental office routines (Figure 1).
Regarding the availability of an environmental waste
management provider for the disposal of chemical and flammable waste, responses
were predominantly concentrated in the "agree" and "strongly
agree" categories (74.7%). This result indicates that a considerable
number of healthcare settings have some level of support or a formal channel
for managing this type of waste, thereby reducing improvisation in disposal
practices (Figure 1).
Figure 1.
Current dental amalgam disposal practices
_archivos/image002.jpg)
The analysis of the section concerning the waste
standardization model showed that the question regarding the reuse of rotary
burs and scalpel blades (sharps) after disinfection and sterilization had a low
proportion of responses in the "agree" and "strongly agree"
categories (17.6%). This suggests a low reported rate of reuse of these
instruments associated with sharps (Table 2).
Regarding the disposal of sharps containers when they
reach three-quarters of their capacity, there was a high proportion of
agreement (67.9%). This result suggests that there is a clear operational
criterion regarding the point at which containers should be replaced,
indicating greater adherence to measures intended to prevent overflow,
unnecessary handling, and accidental exposure (Table 2).
The question concerning the disinfection of sharps
using sodium hypochlorite at concentrations of 0.5% or 1% for a defined period
of 30 minutes showed that the majority of participants selected the
"agree" category (61.2%). This indicates that most participants
recognize disinfection as an important preliminary step in the waste management
process (Table 2).
Regarding intermediate cleaning and disinfection for
the disposal of anatomical waste (extracted teeth), the results showed a
favorable trend, with a greater concentration of responses in the
"agree" and "strongly agree" categories (64.7%). This
finding suggests that preventive measures are adopted before the final disposal
of this type of waste (Table 2).
Table 2. Waste Standardization Model
|
Questions |
Scale |
N |
% |
|
During dental care, do
you reuse dental rotary burs and scalpel blades (sharps) after disinfection
and sterilization (autoclaving)? |
Strongly disagree |
100 |
58.8% |
|
Disagree |
26 |
15.3% |
|
|
Neither agree
nor disagree |
14 |
8.2% |
|
|
Agree |
16 |
9.4% |
|
|
Strongly agree |
14 |
8.2% |
|
|
Do you dispose of sharps
waste containers when they are three-quarters full? |
Strongly disagree |
14 |
8.2% |
|
Disagree |
14 |
8.2% |
|
|
Neither agree
nor disagree |
27 |
15.9% |
|
|
Agree |
52 |
30.6% |
|
|
Strongly agree |
63 |
37.1% |
|
|
During dental care, do
you disinfect sharps using 0.5% or 1% sodium hypochlorite for 30 minutes? |
Strongly disagree |
17 |
10.0% |
|
Disagree |
10 |
5.9% |
|
|
Neither agree
nor disagree |
39 |
22.9% |
|
|
Agree |
52 |
30.6% |
|
|
Strongly agree |
52 |
30.6% |
|
|
In dental practice, do
you use intermediate cleaning and disinfection for the disposal of anatomical
waste (extracted teeth)? |
Strongly disagree |
9 |
5.3% |
|
Disagree |
18 |
10.6% |
|
|
Neither agree
nor disagree |
33 |
19.4% |
|
|
Agree |
51 |
30.0% |
|
|
Strongly agree |
59 |
34.7% |
The section assessing risk
levels associated with improper waste handling showed a clear predominance of
favorable responses to the question regarding color coding for the disposal of
anatomical waste. The concentration of responses in the “agree” and “strongly
agree” categories (75.3%) suggests greater
standardization in the identification and disposal of this type of waste
(Figure 2).
Regarding the question of
whether the dental clinic where the participants perform their duties has a
refrigerator exclusively for the storage of anatomical waste (extracted teeth),
a low concentration of responses was observed in the “agree” and “strongly
agree” categories (17.1%), indicating limited standardization regarding this
equipment in the clinical setting (Figure 2).
Regarding the disposal of
common (non-hazardous) waste once a day, a tendency toward agreement was also
observed (61.8%). This suggests that, in a significant proportion of healthcare
settings, there is a relatively consistent routine to prevent waste accumulation
(Figure 2).
Regarding the availability
of space for recycling uncontaminated materials, a relevant proportion of
respondents reported favorable conditions (50%). This pattern indicates that
recycling is integrated across the settings, suggesting the presence of appropriate
organizational strategies or logistical availability (Figure 2).
Figure
2. Risk levels associated with improper waste handling
_archivos/image004.jpg)
Regarding the section assessing barriers to the
implementation of waste management, the question concerning the daily
identification of the number of kilograms of hazardous waste disposed of showed
an important proportion of responses in the "agree" category (50.6%).
This result indicates progress in internal control and management traceability
(Table 3).
The question concerning cost control through weighing
also showed a concentration of responses in the "agree" and
"strongly agree" categories (48.2%). This indicates that participants
recognize economic control mechanisms associated with the disposal of
infectious waste (Table 3).
Regarding whether the dental clinic where participants
provided services applied an assessment of compliance with internal healthcare
waste management procedures, the favorable trend was maintained, with 54.1% of
responses in the "agree" and "strongly agree" categories.
This indicates that internal evaluation or verification processes are being
conducted, which are key aspects for maintaining a protocol continuously (Table
3).
Regarding participation in healthcare waste management
training lasting at least eight hours, a majority of responses were
concentrated in the "agree" and "strongly agree" categories
(64.1%). This suggests that participants have had opportunities for
professional updating that may help reduce barriers associated with
insufficient knowledge or a lack of technical criteria concerning healthcare
waste management (Table 3).
Table 3.
Barriers to the implementation of waste management
|
Questions |
Scale |
N |
% |
|
At the dental facility where you work, do they
identify the number of kilograms of hazardous solid waste disposed of per
day? |
Strongly disagree |
13 |
7.6% |
|
Disagree |
29 |
17.1% |
|
|
Neither agree nor disagree |
42 |
24.7% |
|
|
Agree |
40 |
23.5% |
|
|
Strongly agree |
46 |
27.1% |
|
|
Do you monitor the costs of infectious biomedical
waste disposal through weighing measurements? |
Strongly disagree |
12 |
7.1% |
|
Disagree |
26 |
15.3% |
|
|
Neither agree nor disagree |
50 |
29.4% |
|
|
Agree |
33 |
19.4% |
|
|
Strongly agree |
49 |
28.8% |
|
|
At the dental clinic where you provide your
services, is compliance with internal healthcare waste management procedures
assessed? |
Strongly disagree |
8 |
4.7% |
|
Disagree |
25 |
14.7% |
|
|
Neither agree nor disagree |
45 |
26.5% |
|
|
Agree |
48 |
28.2% |
|
|
Strongly agree |
44 |
25.9% |
|
|
Have you participated in healthcare waste management
training lasting at least 8 hours? |
Strongly disagree |
9 |
5.3% |
|
Disagree |
12 |
7.1% |
|
|
Neither agree nor disagree |
40 |
23.5% |
|
|
Agree |
41 |
24.1% |
|
|
Strongly agree |
68 |
40.0% |
DISCUSSION
In the section on the segregation of hazardous and
non-hazardous waste in dental clinics, the overall trend was concentrated in
favorable responses regarding control practices during amalgam removal. The
observed pattern indicates that direct operative practices are applied more
frequently than infrastructure or complementary equipment measures. In this
regard, the World Health Organization (WHO)⁶ emphasizes that healthcare waste
includes both hazardous and non-hazardous fractions and that safe management is
critical because of the risk of exposure and contamination. Therefore,
segregation and preventive controls are not optional in clinical practice.
Maceda et al.²² have indicated that the management of waste containing toxic
components, including metals and clinical by-products, requires specific
technical precautions to minimize release and accidental contact. In the same
context, the study by Makanjuola et al.⁹ on mercury
hygiene and biomedical waste management among dental personnel describes
practice and control gaps, particularly when operational or system barriers are
involved. Muriau et al.¹ emphasize that actual
compliance depends not only on knowledge but also on institutional support and
the availability of supplies.
In this study, the section on current dental amalgam
disposal practices showed that the best-performing component was related to
safe storage and the existence of a person or mechanism responsible for waste
management. This reflects important operational progress in the management of
amalgam-related waste within dental services. In this regard, Makanjuola et al.⁹ emphasized that waste management in
dentistry should include clear procedures for classification, containment, and
removal to prevent exposure and secondary contamination. According to the WHO,⁶ the observed pattern is consistent with a scenario in
which progress has been made in containment and internal management, while
challenges persist when practices depend on external logistics and
comprehensive standardization.
In the section concerning the waste standardization
model, the strongest component was compliance with operational guidelines,
including timely replacement of containers, disinfection, and management of
anatomical waste. This suggests an appreciable degree of standardization in
routine procedures related to waste management. In this context, Mahesh et
al.¹⁸ mention that the most frequent failures are related to incomplete
segregation, irregular handling of sharps, and weaknesses in compliance
monitoring, particularly when regulations have not been fully incorporated into
the clinical workflow. Likewise, Dhole et al.¹⁹ emphasize that standardization
depends on operational protocols, training, and supervision, rather than
theoretical knowledge alone. According to the WHO,⁶
the observed results are consistent with majority compliance with critical
actions, although there is still room for improvement in consistency and
process assurance.
In the section concerning risk levels associated with
improper waste handling, the most widely implemented practices corresponded to
easily applicable operational procedures, such as color coding and daily
disposal, whereas measures requiring specific physical resources, such as
dedicated refrigeration and, to a lesser extent, recycling areas, showed
greater variability and lower consolidation.
In relation to this finding, studies such as that by Janik-Karpinska et al.²³ indicate that analyses of
healthcare waste emphasize that the hazardous fraction, although a minority,
has the greatest potential for harm and requires robust controls to prevent
exposure and contamination. Likewise, Wilmott and Duane²⁴ associate responsible
waste management with measurable impacts on public health, including water,
sanitation, and safety. In this regard, the regulatory framework established by
Ecuador's Ministry of Public Health² sets out procedures for the
classification, containment, and management of waste within healthcare
establishments, supporting the importance of color coding and regular waste
removal as essential components of risk control.
In the section concerning barriers to the
implementation of waste management, the results indicated that implementation
may be supported by training and control mechanisms, although their application
varies according to the component assessed. In this context, Wilmott and
Duane²⁴ have described a frequent barrier as the challenge of transforming
"knowledge" into a measurable management system, including weighing,
internal auditing, and compliance monitoring, particularly when these
activities compete with clinical workload and operational limitations. Antonidou et al.²⁵, in their analysis of non-biodegradable
waste loads and their impact, emphasize that management and disposal costs can
become a significant limitation when clear control and financing mechanisms are
not available.
CONCLUSIONS
Waste management in the dental setting, based on
participants' responses, was found to rely primarily on established operational
practices, such as control measures during procedures, color coding, and
routine disposal practices.
In contrast, components that depend on infrastructure,
traceability, and administrative control, including specific equipment,
measurement of waste volumes and costs, and systematic verification of
compliance, showed greater variability.
A limitation recognized in this study is that, because
the questionnaire used a Likert-type scale, the results were based on
self-reporting and may not fully reflect what is actually carried out in daily
practice. Future research is therefore recommended to complement questionnaires
with a checklist or on-site observation, including audits of containers,
labeling, storage areas, and waste disposal routes.
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DECLARACIÓN DE CONTRIBUCIÓN
“Conceptualization and design: J
Álvaro Chile Cayo, María Angélica Terreros de Huc;
Literature review: Álvaro
Chile Cayo, María Angélica Terreros de Huc; Methodology and validation: Álvaro
Chile Cayo, María Angélica Terreros de Huc; Formal
analysis: Álvaro Chile Cayo, María Angélica
Terreros de Huc; Investigation
and data collection: Álvaro Chile Cayo;
Resources: Álvaro Chile Cayo;
Data analysis and interpretation:
Álvaro Chile Cayo, María
Angélica Terreros de Huc; Writing
– original draft preparation: Álvaro Chile Cayo;
Writing – review and editing: Álvaro
Chile Cayo, María Angélica Terreros de Huc; Supervision: Álvaro Chile Cayo, María
Angélica Terreros de Huc; Project administration: Álvaro Chile Cayo, María
Angélica Terreros de Huc; Funding
acquisition: Not applicable.”
CONFLICTS OF INTEREST
The authors declare that there were no conflicts of
interest during the conduct of the research. The manuscript was submitted
exclusively to the Scientific Journal “Especialidades
Odontológicas UG” for review and publication.
FUNDING
The authors declare that the research was conducted
using their own funds.
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Chile Cayo AR. Terreros de Huc MA. Biomedical waste management in dental practice in the
city of Guayaquil, year 2025. Revista
Científica Especialidades Odontológicas UG. 2026:9(2):25-35