Dental amalgam: Alarmingly high mercury levels detected

Study recommends legislation, training for proper handling of carcinogenic element

Study recommends legislation, training for proper handling of carcinogenic element.


A dangerously high level of airborne mercury has been detected indoors as well as outdoors in larger cities of the country, an assessment survey on the use of mercury amalgam at private dental clinics has found.

According to the study, conducted in mid-2015 by the Sustainable Development Policy Institute (SDPI), the contributing factors included non-mechanical mixing while making mercury amalgam, use of the element in liquid form, and lack of environment-friendly practices to control emissions.

“The objectives of the study included checking status of mercury amalgam use and informing dentists and practitioners about its health hazards,” SDPI Researcher Saeed Waqar told The Express Tribune. He conducted the study along with Dr Mahmood Khawaja.

He said patients mostly rely on advice of dentists, as they generally do not know about what kind of material should be chosen for fillings. “It has no immediate affects, but has serious long-term health hazards,” Waqar said.

The study also highlights general unawareness among dental professionals, regarding appropriate handling of mercury and careless use by undergraduate students.

Acute toxicity by mercury vapours occurs in three phases, the research underlines. It states that initial phase is characterised by flu like symptoms, which lasts for one to three days. Signs and symptoms of severe pulmonary toxicity dominate intermediate phase, whereas, sufferers in final phase experience gingivostomatitis, tremors, erythrism, memory loss, depression and insomnia.

The element can retain in the brain for a longer period and may cause severe neurologic disorders. Mercury from dental amalgams in pregnant women may also contribute to the development of autism in children.

Long-term exposure to low concentration of mercury vapours from amalgams either causes or worsens degenerative diseases, the study states.

According to a 2013 SDPI study, alarmingly high mercury levels were observed in the air at 11 out of 34 visited dental sites in five main cities of the country.

A follow-up study was carried out in 2014, to review and evaluate contents of Bachelor of Dental Surgery (BDS) curriculum. The aim was to see whether the syllabus provided adequate information and training to upcoming dental professionals, regarding hazardous use of mercury in dentistry. The survey was carried out at 38 dental teaching institutions in 12 main cities of the country. Around 43 per cent respondents were of opinion that the curriculum does not effectively guides outgoing dental professionals and does not provide them adequate knowledge and training about effects of mercury on human health and other related issues. About 90 per cent respondents supported review and revision of the curriculum at the earliest.

In view of earlier SDPI studies, the present study was conducted to assess the status of mercury amalgam use in private dental clinics in Gilgit, Hunza, Peshawar, Rawalpindi and Islamabad.

The survey team visited over 90 private dental clinics and interviewed professionals during June-July 2015. The focus areas were mercury amalgam toxicity, its waste management practices and safety measures practiced by dental practitioners.

In light of the findings, the study strongly suggests following best preventive approach and recommends that use of finest environment friendly technology and in-house environmental practices should be encouraged. Standard operating procedures for handling mercury be developed and implemented, it adds. An institutional mercury waste management plan must be put in place at all mercury use sites and should be periodically monitored and evaluated by management, it further suggests.

Non-mercury dental fillings be offered and advised to patients by dentists, the research stresses. Mercury specific legislation and protocols for permits be introduced for establishing and functioning of private clinics, teaching hospitals and dental colleges, it adds.

Published in The Express Tribune, December 1st, 2015.


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