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MERCURY-FREE DENTISTRY NOW!

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01 June 2016 – Bangkok, Thailand. Emphasizing worldwide concern over the environment and people'€™s health, environmentalists from around the Asian region today stressed the importance of ratifying the Minamata Convention on Mercury and devising a strategy to mount pressure to phase down amalgam use and move towards mercury-free dentistry.

While experts and activists have commended government efforts in restricting the use of dental mercury, participants of a conference on dental amalgam use, also cited that government agencies cannot work alone as it needs the support of consumers, the media, and the dental health sector itself.

Attending the conference, Dr Lillian Lasaten-Ebuen, President of the International Association of Oral Medicine and Toxicology in the Philippines (IAOMT-Philippines), commented, "We have very strong laws on mercury and mercury-containing products, unfortunately, dental amalgam is left untouched by these current laws."

Composed of 50 percent mercury and other heavy metals, dental amalgam or silver fillings have always been a point of contention among dental health practitioners, health experts, and environmental activists. Dental amalgam supporters have argued that silver fillings are safe and are far superior to other restoration materials.

Dr Ebuen however is quick to demystify the claims and have presented research demonstrating dental amalgam fillings as environment and health hazards. Studies have shown that dental amalgam fillings can leach and can release mercury vapors during the course of its lifetime. The UNEP also estimates that the cost of health and environmental damage caused by exposure to mercury is $22 billion. “Mercury is very toxic, chronic exposure to even to small amounts can lead to illnesses and other health problems."€ Dr Ebuen shared.

However, many consumers and even some dental health practitioners may not even be aware of the dangers posed by dental amalgam. Dr Ebuen added, “We need to work hard to raise awareness on the issue and inform the dental health sector of their vital role in keeping our environment and communities€™ safe.

Dr Ebuen commented, "€œOur government agencies such as the EMB-DENR - recognize that dental amalgam use needs to be addressed, however, dental institutions - particularly the dental universities have remained resistant - holding on to old-fashioned techniques even when the global community is moving towards change.


The Regional Conference likewise determined that representatives should work closely with academicians and dental associations to bring changes to the profession and the dental curriculum.

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The conference, “Successful Strategies to End Use of Dental Amalgam in Asia” was attended by Charlie Brown of World Alliance for Mercury-Free Dentistry; Shahriar Hossain of ESDO, Satish Sinha of Toxics Link, Mahmood A Khwaja of SDPI, Lilian Ebuen of WAMFD-VO for SEA Philippines, Surya Anaya of Bali Fokus Foundation, Ram Charitra Sah of CEPHED, Yao Lingling of All China Environment Federation, Samuel Chademana of Groundwork.

Are Dental Amalgam Fillings A Health Risk?

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The present American Dental Association acknowledges that small amounts of mercury vapour is released during placement, mastication, and brushing€ but extensive studies have found no correlation between the mercury vapours released and any adverse health effects. [1]

The World Health Organization however has determined that even small amounts of mercury exposure can have serious health effects. [2] Mercury exposure can compromise the development of children in utero and put children, pregnant women, and women of childbearing age at risk. [3]


The WHO continues, €œIt may cause harmful effects to the nervous, digestive, respiratory, immune systems and to the kidneys, besides causing lung damage. Adverse health effects from mercury exposure can be tremors, impaired vision and hearing, paralysis, insomnia, emotional instability, developmental deficits during foetal development, and attention deficit and developmental delays during childhood. Recent studies suggest that mercury may have no threshold below which some adverse effects do not occur.€ [4]

The research group, the International Academy of Oral Medicine and Toxicology (IAOMT) further revealed through its studies that there are risks involved in using dental amalgam fillings. [5] In one of their studies, IAOMT reports that people with dental amalgam fillings display a high-level of mercury in their tissues as opposed to those without the restorative material. [6] Additional research also found that individuals with amalgam fillings are constantly exposed as chewing, drinking hot beverages, and even brushing [7] can cause mercury to leak into the saliva and into the bloodstream. [8] Further, patients are not the only ones at risk. Researchers have found that dentists, dental assistants, and even dental students who work unprotected are continuously exposed. [9] [10]

On the local front, IAOMT-Philippines collaborated with environment group BAN Toxics! on a study which measured the level of mercury vapour emissions in areas that use dental mercury. Armed with a sophisticated measuring device, the research group focused on dental clinics, dentistry schools/universities, and even dental supply stores. The study found that these areas registered staggeringly high mercury emission levels, some even reaching figures that would warrant an immediate evacuation by the US-EPA. [11] This study also affirms the findings of an earlier research on mercury vapour emissions coming from exhaust air and dental vacuum systems. [12]

Apart from tainting the air (through emissions from dental facilities, cremation, and human wastes), [13] other studies also pointed to dental mercury as responsible for contaminating water systems (through waste water coming from dental offices) where it can transform into methylmercury, and according to the reports by the European Scientific Commission, can contaminate fish and cause second-hand mercury poisoning when consumed. [14] For the Philippines, with a diet that is mainly based on fish and seafood, mercury-tainted fish can lead to health problems for children and women of reproductive age.


References:
[1] Amalgam. (n.d.) American Dental Association's website. Retrieved on 06 October 2014 at http://www.ada.org/en/member-center/oral-health-topics/amalgam Accessed 26 Sept 2014

[2] Mercury and health. (Sept 2013) In World Health Organization's website. http://www.who.int/mediacentre/factsheets/fs361/en/ Accessed 26 Sept 2014

[3] World Health Organization. 2007. Exposure to Mercury: A Major Public Health Concern. Retrieved on 06 April 2014 at http://www.who.int/phe/news/Mercury-flyer.pdf

[4] World Health Organization. 2005. Mercury in Health Care: Policy Paper. Geneva, Switzerland; August 2005: 1 Retrieved on 06 April 2014 at http://www.who.int/water_sanitation_health/medicalwaste/mercurypolpaper.pdf Accessed 26 Sept 2014

[5] IAOMT Scientific Review, 2013. International Academy of Oral Medicine and Toxicology (IAOMT) Position Statement against Dental Mercury Amalgam Filliongs for Medicla and Dental Practitioners, Dental Students, and Patients. Retrieved on 06 April 2014 at http://iaomt.org/wp-content/uploads/IAOMT-2013-Position-

[6] Koral, Stephen, 2013. Understanding Risk Assessment for Mercury from Dental Amalgam. International Academy of Oral Medicine and Toxicology website. Retrieved on 26 September 2014 at
http://iaomt.org/understanding-risk-assessment-mercury-dental-amalgam/

[7] Hansen G, Victor R, Engeldinger E, Schweitzer C. Evaluation of the mercury exposure of dental amalgam patients by the Mercury Triple Test. Occup Environ Med. 2004;61: 535 –40. Abstract available at http://oem.bmj.com/content/61/6/535.short

[8] Mercola, Joseph, 2012. Mercury: The Hidden Trigger to Alzheimer's and Parkinson's That 75% of People Carr. Mercola’s website. Retrieved on 26 September 2014 at
http://articles.mercola.com/sites/articles/archive/2012/04/07/dangers-of-mercury-contamination.aspx par. 12

[9] Red de Revistas Científicas de América Latina y el Caribe, España y Portugal, 2012. Assessment of occupational exposure of dental professionals to mercury in dental offices of a public primary health care in Maringá, Paraná State, Brazil. Retrieved on 06 October 2014 at http://www.redalyc.org/articulo.oa?id=307226825001

[10] Warwick, Robin, O' Connor, Andrea and Lamey, Brianne. Mercury vapour exposure during dental student training in amalgam removal. Journal of Occupational Medicine and Toxicology. 2013. Retrieved on 06 October 2014 at http://www.occup-med.com/content/8/1/27 Accessed 26 Sept 2014

[11] BAN Toxics! and IAOMT-Philippines. What's Up In The Air? Mercury Vapor Levels in Dental Institutions. 2014

[12] Stone, Mark E, Cohen, Mark E, Debban, Brad A. Mercury vapor levels in exhaust air from dental vacuum systems. Dental Materials. Vol. 3 pp 527-532. 2007

[13] IAOMT, 2011. The toxics effects of mercury in dental amalgam fillings on the environment and human health. Retrieved on 06 April 2014 at http://iaomt.org/wp-content/uploads/IAOMT-Fact-Sheet.pdf Accessed 26 Sept 2014

[14] Scientific Committee on Health and Environmental Risks, 2008.Opinion on the environmental risks and indirect health effects

of mercury in dental amalgam. Retrieved on 26 September 2014 at http://ec.europa.eu/health/ph_risk/committees/04_scher/docs/scher_o_089.pdf

Dental Amalgam Fillings and the Environment

Mercury in the environment comes from natural (volcanic and geothermal activites) and human sources. However, since the advent of industry, mercury pollution coming from human sources have increased. Coal power plants, small-scale gold mining, and medical sources have been cited by the United Nations Environment Programme as a significant contributor to mercury levels in the environment. [1] (see figure 1 below)

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Source: US- Environment Protection Agency

This historical accumulation is evident in a recent study done on global oceans. The research team found that North Atlantic waters and most intermediate waters (between 100 and 1,000 meters) are €œanomalously enriched€ in mercury, compared to the deep waters of the South Atlantic, Southern, and Pacific oceans. Since industrialization, human disturbances have led to a 150 percent increase in the amount of mercury in intermediate waters .” [Lamborg et al, 2014] [2]

To trace the historical accumulation of mercury in the environment from anthropogenic sources, [3] Morowitz et al conducted an inventory of commercial sources from the 1850s to the present century. The research group concluded that decades of commercial mercury use have contributed to an additional 540 Gg of mercury to the environment€.[Morowitz, et al 2014] [4] (see Figure 2)

Figure 2.

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Source: Hardvard Publications

The researchers also reiterated that sources such as coal plants, small-scale gold mining, battery and chlor-alkali production have contributed significantly to mercury levels, thus upholding previous findings by the EPA and UNEP.

Mercury from dental amalgam fillings, the team also cite, is unique as it has pathways that affect land, air, and water. [5] Mercury from dental amalgam fillings may appear minimal but because of these different pathways, it is clear that mercury from the material can enter the environment as vapors released during cremation and incineration, as medical wastes in landfills or as water sludge, or as vapors released during application and removal. As a result, 50-70 metric tons of mercury from dental amalgam is released into the atmosphere, 35-45 metric tons is released into surface water, 20-25 metric tons is released into groundwater, and 75-100 metric tons is released into soil. [6]

The implication of high mercury levels in the environment cannot be fully understood unless there is a basic comprehension of mercury’s unique properties: mercury cannot be created nor destroyed. It is persistent, it is highly mobile, and it bioaccumulates in the food chain. If left unchecked and unaddressed, the steady increase of mercury levels in the environment will have serious implications on wildlife, the environment, and human health.

Reference:
[1] United Nations Environment Programme. 2002. Global Mercury Assessment. Geneva, Switzerland. Retrieved on 10 November 2014 at http://www.chem.unep.ch/mercury/Report/GMA-report-TOC.htm
[2] Lamborg, C.H., Hammerschmidt, C.R., Bowman, K. L., Swarr, G. J. m Munson, K. M., Ohnemus, D.C., Lam, P.J., Lars-Eric, H., Rijkenberg, M.J.A., & Saito, M.A. 2014. A Global Ocean Inventory of Anthropogenic Mercury Based on Water Column Measurements. Nature. Issue 512. Pp 65-68. Retrieved on 10 November 2014 at http://www.nature.com/nature/journal/v512/n7512/full/nature13563.html
[3] Fang, Janet, 06 August 2014. Mercury Levels in the Surface Ocean Have Tripled Since Industrial Revolution. IFLScience.com. Retrieved on 10 November 2014 at http://www.iflscience.com/environment/mercury-levels-surface-ocean-have-tripled-industrial-revolution
[4] Morowitz, H.M., Jacob, D.J., Amos, H.M., Streets, D.G., & Sunderland, E.M. 2014. Historical Mercury Releases from Commercial Products: Global Environment Implications. Environmental Science and Technology, Volume 48 Issue 17, Pp 10242-10250. Harvard University, Cambridge Massachusetts, USA. Retrieved on 10 November 2014 at http://acmg.seas.harvard.edu/publications/2014/Horowitz_2014_EST_HgProducts.pdf
[5] Ibid. p.7
[6] World Health Organization, 2011. Future Use of Materials for Dental Restoration. Geneva, Switzerland, Retrieved on 10 November 2014 at http://www.who.int/oral_health/publications/dental_material_2011.pdf

The UNEP & World Alliance for Mercury-Free Dentistry Pushes for Immediate Phase-Down of Dental Amalgam Use

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Dead Sea, Jordan 9, March 2016 - The United Nations Environment Programme (UNEP) and The World Alliance for Mercury-Free Dentistry (WAMFD) urged governments around the world to a phase-down of dental amalgam use.

Speaking at a side-event at the ongoing Intergovernmental Negotiating Committee on Mercury in Jordan, the groups stressed that only a strong national implementation plan on the phase-down of dental amalgam use can minimize and halt the environment and health risks associated with continued mercury use.

The side-event, entitled "€œImplementing Successful Strategies to Phase Down Amalgam Use", was held at the King Hussein Bin Talal Convention Centre in Jordan and was organized by the WAMFD and UNEP, saw speakers from regions such as Asia, Latin America, and Africa.


"Setting up national objectives for minimizing amalgam use and the promotion of mercury-free dental restorations is very important.", Atty Charles Brown, President of the WAMFD stated, "We also need to include public awareness campaigns on dental amalgam'™s mercury content and encourage government programs to favor mercury-free dentistry particularly for children and women of reproductive age."

As the Philippine representative to the INC 7, Dr Lilian Lasaten-Ebuen, WAMFD's VP for South East Asia and President of IAOMT-Philippines added, "€œMercury-free dental restorations should be made available to all, most importantly to marginalized sectors where oral health problems are more rampant."€

Citing the Department of Health'™s AO21 and the country'€™s experience in addressing mercury use in healthcare, Dr Ebuen also stressed that the Philippines is in a unique position and should take a lead role in the South East Asian region and push for an immediate phase-out instead of a phase-down. "€œThe Minamata Convention requires involved parties to meet their treaty obligations according to their experience. In our case, we already have laws and regulations in place, so why go through a phase-down? For us, a phase-out is the practical route."€ She shared.

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Desiree Montecillo Narvaez, Programme Officer, UNEP Chemicals and Waste Branch Chaired the session. Dr. Lillian Ebuen, practicing dentist in the Philippines, Dr. Shahriar Hossain, environmental leader and journalist of Bangladesh, Maria Carcamo, environmentalist of Uruguay, Dominique Bally of JVE-Cote d'€™Ivoire, environmentalist were the speakers of the event.

Michel Bender of Mercury Policy Project, USA presented the overview of UNEP Brochure which contained lessons from countries phasing down dental amalgam use.Michel Bender of Mercury Policy Project, USA presented the overview of UNEP Brochure which contained lessons from countries phasing down dental amalgam use.

Why An Amalgam Phase-Out Will Promote Better Health

Many points and advantages to an amalgam phase-out have been raised but aside from environment and public safety reasons, another important aspect of removing mercury use in dentistry is that it will encourage better oral health.

Since concerns about the safety and efficiency of dental amalgam fillings have been raised, there have been a number of studies devoted to developing mercury-free dental fillings. As a result, a wide variety of mercury-free alternatives are available today. Composite resins and glass ionomers are mercury-free fillings that offer significant advantages over amalgam in a number of ways.

Environment-friendly: Research has been done on these modern fillings and each study concluded that composites and glass ionomers have no detrimental effect to the environment.

Preserve teeth: Amalgam placement requires the removal of a significant amount of tooth structure. The World Health Organization (WHO) states that "Adhesive resin materials [like composite] allow for less tooth destruction and, as a result, a longer survival of the tooth itself. Funding agencies should take the initiative and encourage the replacement of amalgam as the material of choice for posterior teeth with adhesive systems." The WHO adds, "€œIt may be more important to examine tooth survival and to preserve tooth structure than filling survival." Preservation of the tooth in a functional state should be taken into consideration rather than retention of the material used for restoration; this is in line with goals for oral health suggested by WHO.

User-friendly: According to a 2012 report prepared for the European Commission, "Iœt has been shown that the time needed to carry out a Hg-free [mercury-free] restoration has reduced significantly as dentists have gained more experience in the handling of Hg-free materials, so that there is currently no (or minor) time difference to perform Hg-free restorations compared to amalgam."

Longevity: According to the World Health Organization, "Rœecent data suggest that RBCs [resin-based composites] perform equally well€ as amalgam. For example, a 2010 study conducted over the course of 12 years found that, "€œLarge composite restorations showed a higher survival in the combined population and in the low-risk group." And a 2007 study comparing amalgam and composite longevity (published in Dental Materials) concluded that “Life tables calculated from the data reveal a survival for composite resin of 91.7% at 5 years and 82.2% at 10 years. For amalgam the survival is 89.6% at 5 years and 79.2% at 10 years.

More accessible: The Pan American Health Organization report Oral Health of Low Income Children: Procedures for Atraumatic Restorative Treatment (PRAT) says, "The traditional treatment for dental caries disease remains the Amalgam-based approach, which can be costly and is not always widely available, especially for disadvantaged populations." Fortunately, the alternatives to amalgam are more widely available: techniques using non-mercury alternatives, such as atraumatic restorative treatment (ART), can be more accessible particularly in areas with no electricity and only costs half as much as amalgam restorations.

Given these awesome benefits, one could only wonder why there are those who are quite stubborn and persistent in advocating continued dental amalgam use.

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