Mercury in Dentistry: Risks to Human Health and the Environment

Mercury in Dentistry Risks to Human Health and the Environment Environment฀and฀Social Development฀Organization-฀ESDO & Asian฀Center฀for฀Environmental฀Health Mercury in dentistry Risks to Human Health and the Environment Say฀NO฀to฀mercury฀in฀dental฀treatment Move฀towards฀Mercury฀free฀dentistry฀ Environment and Social Development Organiza�onESDO is a partner organiza�on of world alliance for MercuryFree Den�stry The World Alliance for Mercury-Free Den�stry is a coali�on of consumer, dental, and environmental organiza�ons working together to phase out amalgam use The Asian Center for Environmental Health is founded by ESDO and the World Alliance for Mercury-Free Den�stry Campaign for Mercury free Den�stry is a founding member of the World Alliance for Mercury free Den�stry, an interna�onal coali�on of organiza�ons Mercury in Dentistry Risks to Human Health and the Environment Published by Environment and Social Development Organiza�on-ESDO & Asian Center for Environmental Health Publica�on Year October, 2014 (First Publica�on) December, 2014 (Web Edi�on) Editorial Team Dr. Shahriar Hossain Ms. Siddika Sultana Research and Compila�on Biddut Chandra Sarker Associate Raisa Sultana, Amena Begum Ruma, Pra��e Kamal, Jessica Clark ISBN: 987-984-33-8320-4 Design & Print S.A Printers Limited, 1/1 Sheikh Shaheb Bazar, Azimpur, Dhaka Produced as part of the Asian Centre for Health and Environment Programme Supported by the World Alliance for mercury-free den�stry Project Contact Address House # 8/1, Level # 5, Block # C, Lalma�a, Dhaka-1207, Bangladesh, Phone: 880-2-912-2729 Fax: 880-2-913-0017, E-mail: [email protected], URL: www.esdo.org Copyright © ESDO and Asian Center, 2014, all rights reserved. Foreword This booklet describes the use of Mercury in dental treatment and its detrimental effects on human health and the environment. It is hoped this small contribu�on will help to increase public awareness regarding this toxic issue. Environment and Social Development Organiza�on-ESDO, is a non-government organiza�on working on environmental and health issues with various stakeholders. Since 1990, the organiza�on has been working to create a toxic and pollu�on free Bangladesh and sustainable living environment. In line with this effort, ESDO has been working to ban mercury in den�stry since 2011. ESDO with World Alliance for mercury-free den�stry has taken the responsibility to make Bangladesh aware of mercury free den�stry. ESDO is trying to eliminate the use of Mercury in dental treatment and raise widespread awareness among den�sts, dental students, and pa�ents as well as the mass popula�on about the adverse human health impacts of using Mercury dental amalgam. This booklet has been made to encourage den�sts not to use Mercury dental amalgam considering its health and environmental impacts. We believe, the combined efforts of all stakeholders can promote the importance of Mercury free den�stry in Bangladesh. Siddika Sultana Execu�ve Director Environment and Social Development Organiza�on-ESDO Declara�on This study has been conducted and the report prepared by ESDO and has not previously been submi�ed. The work contained within this report was executed by ESDO, unless otherwise stated. Table of Content 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. Why Mercury is a concern? What is a dental filling? What is dental amalgam or amalgam filling? Characteris�cs of amalgam filling What are the harmful effects of dental amalgam? 5.1. Major Health impacts of Mercury Dental Amalgam 5.2. Harmful effects of dental amalgam/mercury on the environment The pathway of toxic mercury from dental amalgam to the human body Sources of human exposure Environmental transport, distribu�on, and transforma�on What are the alterna�ves to dental amalgam? Mercury Amalgam: A broad line perspec�ve Minamata Conven�on: Phase out of Mercury by 2020 ESDO’s ini�a�ves regarding mercury-free den�stry ESDO’s Objec�ves Asian Center’s roll for Health and Environment What should we do? 7 7 7 8 8 8 9 10 11 11 12 12 13 13 14 15 16 Fact Sheet on Mercury Dental Amalgam Some Campaign Photographs News Clippings IEC Materials Informa�on Sources 19 21 23 25 28 1. Why Mercury is a concern? Mercury (chemical symbol Hg), is a metallic element that occurs naturally in the environment. It is also a poten�al contaminant of the environment as well as a global concern due to its health and environmental impacts. It is toxic in nature, bioaccumulates and has transboundary impacts to health and the environment. Mercury toxicity mediated by different forms of mercury is a major health problem; however, the molecular mechanisms underlying toxicity remain elusive. Mercury poisoning (also known as hydrargyria or mercurialism) is a type of metal poisoning and a medical condi�on caused by exposure to mercury or its compounds. Between 313 and 411 tonnes of mercury are consumed globally each year due to the use of amalgam, accoun�ng for 10% of global mercury consump�on. This makes amalgam among the largest consumer use of mercury in the world. 2. What is a dental filling? A filling is a way to restore a tooth damaged by decay back to its normal func�on and shape. When a den�st gives a filling, he or she first removes the decayed tooth material, cleans the affected area, and then fills the cleaned out cavity with a filling material. Silver amalgam Gold filling White filling Figure: different dental fillings 3. What is dental amalgam or amalgam filling? Dental amalgam is a dental filling material used to fill cavi�es caused by tooth decay. It has been used for more than 150 years in hundreds of millions of pa�ents. Dental amalgam is a mixture of metals, consis�ng of liquid mercury Mercury in dentistry Risks to Human Health and the Environment 7 and a powdered alloy composed of silver, �n, and copper. Approximately 50% of dental amalgam is elemental mercury by weight. Dental amalgam fillings are also known as “silver fillings” because of their silver-like appearance. 4. Characteris�cs of amalgam filling     It is a metal filling where 50% is elemental mercury It is compara�vely cheap Its aesthe�cs are poor There is pa�ent concern over toxicity 5. What are the harmful effects of dental amalgam? Use of dental amalgam increases environmental pollu�on and health hazards. 5.1.Major Health impacts of Mercury Dental Amalgam Poten�al amalgam-induced health risks which have been studied by researchers are:     Reduc�on of body’s disease defensive capacity Damage to the brain, kidneys, and immune system of children Memory disturbances Lack of adhesion, which may lead to marginal leakage Mercury in dentistry Risks to Human Health and the Environment 8          Respiratory problems Oral cavity problems Effects on reproduc�on Neurological problems Reduc�on of vision and hearing capacity Hair loss Skin cancer and kidney damage Damage to healthy cell �ssue Gastrointes�nal problems 5.2. Harmful effects of dental amalgam/mercury on the environment Mercury dental amalgam causes detrimental harm to our environment. Mercury vapor escapes into the environment during prepara�on of amalgam when being placed into the tooth cavity. Pollu�on is from solid and liquid waste of amalgam. This mercury pollutes the air. Unused amalgam from dental clinics is disposed into nearby land or water bodies and mercury from amalgam causes water and air pollu�on. Some por�on of mercury is emi�ed into the air. Mercury in the air eventually se�les into water or on the land where it can be washed into water. Once deposited, certain microorganisms can change it into methyl mercury and then the bacteria are eaten by molluscs, crustaceans etc.  Released by-products of amalgam have a broad effect on waterways because a por�on of mercury will be converted into highly toxic methyl mercury by anaerobic organisms present in rivers, lakes and waterways;  Mercury pollu�on is par�cularly damaging for long-living fish species as they have a high exposure to methyl mercury over �me.  Dental amalgam waste has been iden�fied as the major source of mercury soil pollu�on because it reduces microbial ac�vity in the soil, reducing soil fer�lity and produc�vity. Therefore, it can be said that mercury emi�ed from dental amalgam has a detrimental effect on human beings, aqua�c and terrestrial animals, micro-organisms, plants and the en�re environment. Mercury in dentistry Risks to Human Health and the Environment 9 6. The pathway of toxic mercury from dental amalgam to the human body Mercury is used to bind the alloy par�cles together into a strong, durable, and solid filling. When placing dental amalgam, the den�st first drills the tooth to remove the decay and then shapes the tooth cavity for placement of the amalgam filling. Then, the den�st mixes the powdered alloy composed of silver and �n with the liquid mercury to make amalgam pu�y. This so�ened amalgam pu�y is placed in the prepared cavity, where it hardens into a solid filling. About 80% of inhaled mercury vapor is retained in the body, and dissolved mercury vapor concentrates in circula�ng red blood cells. Mercury is carried throughout the body crossing both the blood-brain and placental barriers. High levels of mercury vapor exposure are associated with adverse effects to the brain and the kidneys. Mercury in dentistry Risks to Human Health and the Environment 10 7. Sources of human exposure Mercury is a naturally occurring element (around 80 μg/kg) in the Earth’s crust. Over geological �me, it has been distributed throughout the environment by natural processes, such as volcanic ac�vity; fires; movement of rivers, lakes, and streams; oceanic upwelling; and biological processes. Major anthropogenic sources of mercury in the environment have been mining opera�ons, industrial processes, combus�on of fossil fuels (especially charcoal), produc�on of cement, and incinera�on of municipal, chemical, and medical wastes. Point sources of anthropogenic mercury release, revola�liza�on from environmental media, absorp�on to soil and sediment par�cles, and bioaccumula�on in the food webs contribute to further distribu�on and subsequent human exposure. Dental amalgam fillings are the primary source of mercury exposure for the general popula�on. 8. Environmental transforma�on transport, distribu�on, and Mercury is transported in the environment by air and water, as well as by biological organisms through the food-chain. Off-gassed mercury vapor from the soil and water enters the air, where it may be transported and Figure: The Many Pathways of Amalgam into the Environment. Mercury in dentistry Risks to Human Health and the Environment 11 redistributed over the Earth’s surface. Upwelling along the con�nental shelves helps to bring minerals to the surface, where mercury can enter the air as a vapor, se�le to the bo�om sediment, be absorbed by phytoplankton, or be ingested by zooplankton, other microorganisms, or fish. Over geologic �me, volcanic ac�vity may bring mercury from below the Earth’s crust to the surface, where it may either enter the atmosphere as a vapor or be redistributed to soil or bodies of water. 9. What are the alterna�ves to dental amalgam? Different materials can be used to fill cavi�es caused by dental decay. Like dental amalgam, these direct filling materials are used to restore the bi�ng surface of a tooth that has been damaged by decay. Currently, a number of different material types are being used as subs�tutes to dental amalgam and these include:       Composite resins Glass ionomer cement Compomers Giomers plas�c ionomer Gold foil Figure: Dental amalgam alterna�ve 10. Mercury Amalgam: A broad line perspec�ve The WHO report acknowledges that amalgam has been associated with general health concerns and that its use releases a significant amount of mercury into the environment. It is es�mated that mercury contamina�on to the environment from the use of dental amalgam contributes between 1800 and 2700 tons of mercury per annum. Globally, between 20,000-30,000 tons of mercury are discharged into the environment each year as a result of human ac�vi�es. The new economics report ‘The Real Costs of Dental Mercury’ confirms that once these environmental costs are taken into account, amalgam is far more expensive than the environmentally-responsible alterna�ves. Mercury in dentistry Risks to Human Health and the Environment 12 11. Minamata Conven�on: Phase out of Mercury by 2020 The Minamata Conven�on on Mercury is a global treaty held in 2013 to protect human health and the environment from the adverse effects of mercury. The Conven�on requires each party to “phase down the use of dental amalgam.” The proposals of the conven�on were as follows:  Se�ng na�onal objec�ves aiming for dental cavity preven�on and health promo�on, thereby minimizing the need for dental restora�on;  Promo�ng the use of cost-effec�ve and clinically effec�ve mercury-free alterna�ves for dental restora�on;  Encouraging representa�ve professional organiza�ons and dental schools to educate and train dental professionals and students on the use of mercury-free dental restora�on alterna�ves and on promo�ng best management prac�ces;  Discouraging insurance policies and programmes that favour dental amalgam use over mercury-free dental restora�on;  Encouraging insurance policies and programmes that favour the use of quality alterna�ves to dental amalgam for dental restora�on;  Restric�ng the use of dental amalgam to its encapsulated form; and,  Promo�ng the use of best environmental prac�ces in dental facili�es to reduce releases of mercury and mercury compounds into water and land. 12. ESDO’s ini�a�ves den�stry regarding mercury-free Environment and Social Development Organiza�on-ESDO has been working to ban mercury in den�stry since 2011. ESDO with World Alliance for mercury-free den�stry has taken the responsibility to make Bangladesh aware of mercury free den�stry and with the partner organiza�on it aims at a Mercury in dentistry Risks to Human Health and the Environment 13 na�onal level to ban mercury use in den�stry. In line with this aim, ESDO organizes different programs to promote the campaign of mercury free den�stry, such as a successful workshop on August 31, 2013. ESDO will con�nue its work to make a toxic free world for future genera�ons. ESDO is the pioneer organiza�on working in Mercury phase out in the country. Besides the den�stry issue, ESDO worked with mercury product iden�fica�on, assessment of mercury in fish and human hair sampling. The phase out of mercury dental amalgam from the health care sector is now an issue of worldwide concern. ESDO has been working for Mercury phase out from the dental care sector through proposing guidelines and na�onal policy formula�on since 2011. As part of interna�onal campaigns to stop using Mercury Dental Amalgam globally, ESDO in associa�on with World Alliance for Mercury Free Den�stry has ini�ated countrywide campaigns in Bangladesh. In addi�on, ESDO has conducted research and baselines on Mercury (Hg) free den�stry in Bangladesh. 13. ESDO’s Objec�ves  To encourage doctors/den�sts to avoid mercury containing dental amalgam and hence to promote alterna�ves to dental amalgam.  To increase awareness among the general people about the injurious effects of dental amalgam on human health.  To increase den�sts awareness to follow appropriate ways to discharge of mercury waste a�er use for a filling to save the environment.  To build the awareness of relevant ministries to formulate a na�onal policy to stop the use of dental amalgam in the health care sector. Mercury in dentistry Risks to Human Health and the Environment 14 14. Asian Center’s role for Health and Environment Asian Center was founded by Environment and Social Development Organiza�on-ESDO and World Alliance for Mercury-Free Den�stry (WAMFD) on 28th December, 2013. It aimed to serve the en�re Asia-Pacific Region to work with and welcome input from interna�onal agencies, na�onal and local governments, academic ins�tu�ons, and the breadth of civil society. Mission Statement It was established to develop ideas, polices and strategies to reduce and eliminate environmental toxins in Asia. It also aims to play the role of watchdog against industrial abuses- stopping the toxic trade to developing na�ons and ending the shipping of products no longer wanted in developed socie�es, but which are dumped into developed na�ons. Furthermore, the Asian Center a�empts to deal with the fundamental research and academic a�ribute for sustainable and alterna�ve curriculum development. Objec�ves and Goal • Within each par�cipa�ng country establish a network of civil society organiza�ons (including professional networks and NGOs) to advocate for legisla�on on mercury dental amalgam. • To build awareness of public health and the environment. • Establish the Asian Center as a lead organiza�on on the issues of mercury and the safe management of chemicals in Asia. • Create an interven�on for legisla�on on the issue of mercury dental amalgam, via a mass awareness movement and media coverage. • Increase technical capacity of Asian countries to manage the impacts of mercury dental amalgam on human health and environment. Mercury in dentistry Risks to Human Health and the Environment 15 15. What should we do?  Den�sts should avoid the use of mercury dental amalgam and use alterna�ves.  Public awareness must be increased to phase out the use of dental amalgam and the hazards associated with it.  Den�sts, dental hygienists and dental/oral health therapists should discourage the use of mercury dental amalgam and encourage safe alterna�ves.  Government, non-government and civil society organiza�ons should step forward to raise awareness of the impacts of mercury based dental amalgam on human health and the environment.  The Government should take ini�a�ves to support the interna�onal mercury nego�a�on treaty especially to phase out dental amalgam. What to do? Mercury in dentistry Risks to Human Health and the Environment 16 How to implement this amalgam phase-down measure Na�ons can set objec�ves for minimizing amalgam use by following these key steps: Engage stakeholders: To obtain input from a variety of perspec�ves, consult stakeholders including den�sts who do not use amalgam, den�sts who do s�ll use amalgam, dental pa�ent groups, and environmental organiza�ons, among others. This consulta�on can take many forms, such as mee�ngs, workshops, public hearings, interviews, ques�onnaires, or wri�en comments. Establish baseline amalgam usage data: To learn how much amalgam is currently used, na�ons can (1) determine the average amount of amalgam used per year by one den�st and then mul�ply that amount �mes the number of den�sts in the na�on or (2) ask amalgam manufacturers or distributors to report how much amalgam they sell in the na�on annually. Set goals: To ensure steady progress, na�ons can set both long-term goals and short-term goals. For example, the long-term goal could be to phase out amalgam use completely, but a short-term goal might be to reduce amalgam use by 25% each year or end its use in children and pregnant women by a certain date. Develop a plan: To achieve the above goals, na�ons can develop plans of ac�on that define the amalgam phase-down strategies best suited to their needs, abili�es, and domes�c circumstances. Announce goals and plan: To increase coopera�on and support from stakeholders, na�ons can publicly announce (via press releases and other strategies) their commitment to minimizing amalgam use. Track progress: To determine amalgam use reduc�ons over �me, it is important to con�nue tracking the amount of amalgam used at regular intervals. Mercury in dentistry Risks to Human Health and the Environment 17 NO more Mercury in dental treatment Treatment using Mercury dental amalgam hinders sound health of teeth and the human body Never let your den�st use Mercury in your mouth during dental treatment Mercury in dentistry Risks to Human Health and the Environment 18 Mercury in dentistry Risks to Human Health and the Environment 19 Mercury in dentistry Risks to Human Health and the Environment 20 Some Campaign Photographs School Campaign on mercury Consulta�on on mercury free den�stry Mercury in dentistry Risks to Human Health and the Environment 21 Human Chain to Ban Mercury in Den�stry Youth Rally to Ban Mercury in Den�stry Mercury in dentistry Risks to Human Health and the Environment 22 News Clippings Mercury in dentistry Risks to Human Health and the Environment 23 Mercury in dentistry Risks to Human Health and the Environment 24 IEC Materials Mercury in dentistry Risks to Human Health and the Environment 25 Mercury in dentistry Risks to Human Health and the Environment 26 Mercury in dentistry Risks to Human Health and the Environment 27 Informa�on Sources           Medscape, 2014. Electronic references. Retrieved h�p://emedicine.medscape.com/ar�cle/1175560-overview. from: Asian Center for Environmental Health, 2013. Electronic references. Retrieved from: h�p://environmentalhealth.asia/den�stry/ E-medicine health, 2014. Electronic references. Retrieved from:h�p://www.emedicinehealth.com/mercury_poisoning/ar�cle_e m.htm Den�st on Main, 2014. Electronic references. Retrieved from: h�p://www.den�stonmain.co.za/dental-services/fillings/ Minamata Conven�on on Mercury, 2013. Electronic references. Retrieved from: h�p://www.mercuryconven�on.org/Conven�on World Alliance for Mercury-Free Den�stry, 2011. Electronic references. Retrieved from: h�p://mercury-free-den�stry.blogspot.com/search/ label/English Carvalho CM, Chew EH, Hashemy SI, Lu J, Holmgren A., 2008. Inhibi�on of the human thioredoxin system. A molecular mechanism of mercury toxicity. J Biol Chem. 283(18): 11913-23. Health Canada, 1997. Health Canada Posi�on Statement on Dental Amalgam. Toward Mercury-Free Den�stry, 2014. Implement the Dental Amalgam Phase-Down Measures of the Minamata Conven�on. Swedish Chemical Agency, 2005. Mercury-free Dental Fillings: Phase-out of amalgam in Sweden. Mercury in dentistry Risks to Human Health and the Environment 28 Comment, Constructive Criticism & Suggestion: Biddut Chandra Sarker [email protected]