Use of mercury-containing dental restorations (Dental Amalgam) in - - PowerPoint PPT Presentation
Use of mercury-containing dental restorations (Dental Amalgam) in Pakistan Dr. . Fe Feroze oze Ali Kalhoro lhoro BDS, S, FC FCPS S Assoc ociate iate Profe ofessor ssor (Operative perative Dent ntistr stry) y) Principal, ncipal,
Dr. . Fe Feroze
lhoro BDS, S, FC FCPS S Assoc
iate Profe
ssor (Operative perative Dent ntistr stry) y) Principal, ncipal, Instit titut ute e of Dentistry tistry LUMHS HS Ja Jamsh shoro
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Dental amalgam has been used for over 150 years for the treatment of dental cavities and is still used world-wide in particular, for the treatment of larger cavities due to its:
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dental amalgam in the US population, post-2000. Sci Total Environ 409(20):4257–4268
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In 1845, the American society of dental surgeons condemned the use of all filling materials other than gold as toxic, thereby igniting 1st Amalgam war.
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Controversy on the use of dental amalgam reappeared again in 1926 and into the 1930’s , when a German physician Dr. Alfred stock, demonstrated that mercury escaped from fillings in the form of dangerous vapour that could cause significant medical damage. This led to the 2nd Amalgam war.
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A neurobiologist Mats Hanson in 1981, started the fight against authorities and had led the
3rd Amalgam war.
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Due to its common use in dental practice amalgam is major source of Hg usage. It emits the mercury and emission takes place during:
environment/air)
patient)
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Among these, two are more critical situations in terms of release of mercury from dental amalgam
Both lead to high exposures to respirable amalgam particulate and as well as to mercury vapor
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These vapors of mercury released from the dental amalgam can be inhaled and rapidly absorbed and distributed through
questions a traditional dental paradigm. FASEB J 9(7):504–508
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The mercury can also be transferred to breast milk in proportion to maternal dental amalgam load
from dental amalgam in the US population, post-2000. Sci TotalEnviron 409(20):4257–4268
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In the body mercury mostly target the neuron specially developing neurons and may impair the neonatal growth
intoxication and the brain pathology in autism. Acta Neurobiol Exp (Wars) 72:113–153
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Germany and Canada advised against the use of dental amalgam in pregnant women and children
health service strategy for research, education and regulation. US Department of Health and Human Services, Washington, DC
report to the Environmental Health Policy Committee. US Department of Health and Human Services, Washington, DC
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The mercury is excreted from the body through urine and
to disturbance in the function of detoxification enzyme this lead to increase retention of mercury in the body and may cause unpredictable toxicity.
compounds’ by Clarkson and Magos (2006). Crit Rev Toxicol 37:537–549
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Handbook on the toxicology of metals, 3rd edn. Academic Press, Burlington
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compounds: human health aspects. World Health Organization, United Nations Environment Programme
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The FDA believes that the actual exposure is 1–5 µg/d in its current amalgam rule [PHS 1993 (as cited in FDA 2009)]. The level is well below to cause any adverse effect
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The Exposure variables may include:
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inhalation exposure (RfC). In: Integrated risk information system. US Environmental Protection Agency.http://www.epa.gov/iris/subst/0370.htm#revhis. Accessed 26 Dec 2013
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Where as the California Environmental Protection Agency (CaLEPA) gives the reference exposure level (REL) for chronic mercury inhalation of 0.03 µg/m3 or /day—which was set in 2008,
levels: technical support document for noncancer RELs, Appendix D.1.F. Office of Environmental Health Hazard Assessment
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The FDA and the American Dental Association (ADA) are continuously supporting the dental amalgam as a safe and effective material for dental restorations
products and medical Procedures /DentalProducts /Dental Amalgam/ucm171094.htm. Accessed 26 Dec 2013
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The US Food and Drug Administration (FDA) advocates the use of dental amalgam and its report on resolving the mercury issue clearly acknowledge that mercury released from dental amalgam is of low level than safety threshold .
74(148): 38686–38714
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There are two well-known clinical trials which supported the use of dental amalgam
There was no difference found in both trials in term of neurobehavioral outcome between the amalgam group and the composite (non-amalgam) group—although in both trials the amalgam group showed a statistically significant increase in urinary mercury levels.
Neuropsychological and renal effects of dental amalgam in children: a randomized clinical trial. JAMA 295(15):1775–1783
Neurobehavioral effects of dental amalgam in children: a randomized clinical trial. JAMA 295(15):1784–1792
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Whereas, In 2011 Geier et al reanalyzed the mercury exposure and its level in patients body. This time they used an exposure metric based on amalgam size and years of exposure— And found a significant association between amalgam and the porphyrin biomarkers for mercury-related enzyme blockage. This association suggests that amalgams are a significant chronic contributor to mercury body burden.
from dental amalgams and urinary porphyrins: a further assessment of the Casa Pia Children’s Dental Amalgam
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In 2013 they also found a significant association between amalgam and a biomarker for kidney damage in the same genetically susceptible subpopulation
between mercury exposure from dental amalgams and kidney integrity biomarkers: a further assessment of the Casa Pia Children’s Dental Amalgam Trial. Hum Exp Toxicol 32(4):434–440
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Norway and Sweden have banned dental amalgam (Norway Ministry of Environment 2007;
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In October 2013, more than 140 (incl Pakistan) nations signed the a well known Minamata Convention, and released an agreement to:
pollution
strategies and programs
Nations Environment Programme. http://www.unep.org/newscentre/ default.aspx?DocumentID=2702&ArticleID=9373. Accessed 26 Dec 2013
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Adhes Dent 14(5):407–431
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based composite called bisphenol A (BPA), which is under investigation as an endocrine disruptor.
BPA from dental materials is unlikely to contribute substantially to chronic exposure.
exposure of consumers. Paper presented at the expert meeting on Bisphenol A (BPA) of the Food and Agriculture Organization of the United Nations and the World Health Organization, Ottawa, 2–5 Nov 2013
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information regarding the frequency of use of dental amalgam restoration and its handling and waste management.
September 2014.
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the consent and appointment taken from the Head of Institute or HOD of Operative Dentistry Department.
private sector) and all were contacted but from 11 public sector only 8 responded where as from 29 private sector 15 responded.
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relation to resin based composite.
management in Dental Institutes (private and public sector) of Pakistan.
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5 10 15 20 25 30 35 40 college 1 college 2 college 3 college 4 college 5 college 6 college 7 college 8 Amalgam Composite Average 13 Average 23.3
Number of Amalgam & Composite restorations done in public sector dental colleges and hospitals per day
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5 10 15 20 25 30 college 1 college 2 college 3 college 4 college 5 college 6 college 7 college 8 college 9 college 10 college 11 college 12 college 13 college 14 college 15
Amalgam Composite Average
17.8
Average 13.3
Number of Amalgam & Composite restorations done in private dental colleges and hospitals per day.
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frequently used and taught in the Dental Institutes of Pakistan.
studies.
environmental perspective. EMHJ 2010.
Med Coll Abbottabad 2011;23(4)
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found more in private sector Institutes as compared to Dental Amalgam.
cited earlier.
conducted on basis of separate private and pubic sector Institutes.
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The reasons for more frequent use of amalgam in public sector and composite in private sector could be that in public sector the dental treatment provided free of cost or
than composite that’s why it is selected by public sector Institutes where as in private sector treatment is provided
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Hand mixing Encapsulated combination 20% 20% 25% 25%
55%
55%
Method of Trituration used Dental Colleges & Hospitals.
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mixing is combination of hand mixing and encapsulated.
post graduate student and faculty members where as hand mixing method is used by undergraduates.
environmental perspective. EMHJ 2010.
Abbottabad 2011;23(4
Teaching Hospitals of Karachi. JPakDentAssoc. 2012: 21 (2): 108 – 111
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10 20 30 40 50 60 70 sink coloured bottle bin proper recycling method
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Amalgam is by bin. These results are in similarity with
much emphasized in Dental curriculum.
management of mercury disposal
environmental perspective. EMHJ 2010.
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A scientific committee may be formed to:
indirect health effects from use of dental amalgam and identified a number of lacunae that need to be addressed.
PMDC & HEC and PDA to make law & legal bindings regarding use of mercury in dentistry in particular its handling and disposal and changes in the BDS curriculum.
to human exposure and the environment.
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mercury-free alternatives for dental restoration
and training programs on proper handling of mercury during amalgam restoration and its removal and waste management.
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