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IAOMT-Philippines Position Statement on Dental Mercury Use

While there isn’t any doubt of mercury’s toxicity; in dentistry circles, the use of mercury remains contentious. On one side of the debate are dentists attesting to the safety of dental mercury and on the other are dentists stating that mercury and mercury-containing products have no place in the health sector, including dentistry.

This debate has been raging for two hundred years and today, despite growing data against its use – some sectors or individuals remain adamant. Dental mercury supporters often state that research on the safety of dental amalgam fillings are inconclusive and that it is a restorative material that can be easily accessed by the underprivileged. In a country where oral health problems – particularly dental caries - are prevalent  especially among the poor, the affordability of dental amalgam fillings seems sensible.


Is dental mercury safe?

"Is dental mercury safe?" is the million dollar question and supporters are eager to answer with a clear and loud "Yes!".

The research group, the International Academy of Oral Medicine and Toxicology (IAOMT) however revealed through its numerous studies that there are risks involved in using dental amalgam fillings.  Composed of a worldwide network of dentists, toxicologists, and researchers, IAOMT is devoted to compiling data on dental mercury toxicity and its phase-out.

As dental amalgam fillings are fifty percent mercury, IAOMT studies have shown that people with dental amalgam fillings display a high-level of mercury in their tissues as opposed to those who do not have the dental restorative material. Simply put, mercury – primarily is a neurotoxin and therefore has no place in dentistry.

Supporters endorse its safety but even the World Health Organization (WHO) has stated in a report that mercury has no safe level of exposure . Meaning, even the minutest amount is harmful and can easily penetrate the blood-brain barrier, thus compromising the development of children in utero  and putting children, pregnant women, and women of childbearing age at risk.


The WHO continues, “It 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 fetal 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.”

IAOMT research also indicated that patients with amalgam fillings are constantly exposed as chewing, drinking hot beverages, and even brushing  can cause mercury to leak into the saliva and into the bloodstream . Further, dental professionals and dental assistants who work unprotected are also susceptible to its fumes on a daily basis .

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 confirmed the study’s premise as these areas registered staggeringly high mercury emission levels – some even reaching figures that would warrant an immediate evacuation by the US-EPA.   This study also affirms the findings of an earlier research on mercury vapour emissions coming from exhaust air and dental vacuum systems.

Apart from tainting the air (through emissions from dental facilities, cremation, and human wastes),   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 contaminate fish and cause second-hand mercury poisoning when consumed.  

Taking all these into account, mercury fillings may be regarded as the cheaper dental restorative material but the dangers it poses on the health of communities and the environment, plus the cost of dealing with its potential consequences is incomprehensible.

Given these, IAOMT-Philippines is not encouraging patients to remove their mercury fillings as we lack dentists and clinics equipped in handling the complex and delicate process. Instead, IAOMT-Philippines is proposing the following steps to aid the Department of Health’s (DOH) strategic plan to phase out dental mercury and mercury-containing devices in the health sector:

•    The implementation of a sound approach in handling dental mercury wastes. As earlier stated, if mismanaged and improperly handled, mercury can leach and contaminate ground and water systems. The EPA estimates that 3.7 tonnes of discharged mercury from dental clinics contaminate waterways each year.   IAOMT-Philippines will work and actively participate in the DENR’s technical committee as it prepares the Philippine Roadmap to Mercury-Free Dentistry by 2015.

•    The strategic phasedown of the use of mercury dental amalgams among mercury manufacturers, importers, distributors, traders and retailers; and the eventual removal of the use of mercury and mercury containing products including dental amalgam fillings in public and private dental clinics, dental universities, and dental supply stores.

•     IAOMT- Philippines is encouraging the DOH to explore and use mercury-free restorative materials for public needs. Critics are quick to denounce these mercury-free alternatives but several dental organizations, including the British Dental Association, Canadian Dental Association, and American Dental Association verified that mercury-free restorative materials are safe and fit for human use.   

IAOMT adds that, “It would take heating to a temperature of several hundred degrees to liberate the BPA from these resins. Second, measurements of exposure to BPA from dental resins reveal potential doses that are hundreds or thousands of times less than any known toxic level.”  
IAOMT-Philippines is also recommending a series of trainings for dentists and dental technicians on mercury waste management and mercury-free alternatives.

•    A change in the dentistry curriculum and to stop requiring dental students in handling mercury fillings to pass the course.  Schools and universities should rethink their dentistry syllabus and prepare its students to meet mercury-free standards by training students to use composites or other mercury-free alternatives. Eliminating dental mercury from the dentistry curriculum also removes the risk of exposure and protects our youth and future dentists from toxic mercury vapours. Northern European countries (Norway, Denmark, and Sweden) have already ceased dental amalgam usage  and their dentistry curriculum can serve as a guide for our dentistry schools/universities.

•    And finally, patients should have access to information and be allowed to choose their kind of treatment based on such information. The DOH should conduct an information dissemination campaign and inform patients of mercury-free alternatives. Likewise, the department should also make such treatment available to the public.

For the sake of our people’s health and the environment, The DOH should spearhead a phasedown of dental mercury and ensure that the dentistry sector is equipped to handle the standards of the Minamata Convention on Mercury.

With dental mercury use, the lives of patients, dental professionals, and even dentistry students are at risk. As dentists, we have a responsibility to campaign for oral health and an obligation to champion patients' rights to information and access to favourable treatment. The country’s health sector has already proven that it can go mercury-free and it is about time that the dental sector follow suit and do its part in the phase-out of dental mercury and other mercury-containing products. IAOMT-Philippines will be working closely with government agencies, particularly the DOH, the DENR, and CHED, and with dental organizations to ensure that the shift to mercury-free dentistry is a smooth one.

References:

Castillo, R. (22 and 29 March 2014. Dental Amalgams- boon or bane?) Medical Files. The Philippine Daily Inquirer. Retrieved from http://www.inquirer.net

A report by the  DOH found that about 92.4% of Filipinos have tooth decay (dental caries) and 78% have gum diseases (periodontal diseases). http://www.doh.gov.ph/node/1066.html

For further info, see IAOMT-International’s position statement on dental amalgam fillings. http://iaomt.or/wp-content/uploads/IAOMT-2013-Position-Statement.pdf

http://iaomt.org/understanding-risk-assessment-mercury-dental-amalgam/

http://iaomt.org/wp-content/uploads/IAOMT-2013-Position-Statement.pdf

http://www.who.int/water_sanitation_health/medicalwaste/mercurypolpaper.pdf

http://www.who.int/phe/news/Mercury-flyer.pdf
World Health Organization. Mercury in Health Care: Policy Paper. Geneva, Switzerland; August 2005: 1.

http://www.who.int/water_sanitation_health/medicalwaste/mercurypolpaper.pdf

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

http://www.hygienic-healing.com/HHG-Hazards/Mercury.pdf
Duplinsky TG, Cicchetti DV. The health status of dentists exposed to mercury from silver amalgam tooth restorations. International Journal of Statistics in Medical Research.2012; 1(1):1-15. Abstract available at http://lifescienceglobal.bizmarksolutions.com/pms/index.php/ijsmr/article/view/433

 A Study on Mercury Levels of Ambient Air in Dental Clinics and its Impacts on Occupational Safety and Health (OSH) and the Environment. Unpublished.

http://www.demajournal.com/article/S0109-5641%2806%2900088-1/abstract

http://iaomt.org/wp-content/uploads/IAOMT-Fact-Sheet.pdf

http://www.env-health.org/IMG/pdf/mercury_chapter2.pdf

 http://ec.europa.eu/health/scientific_committees/consultations/public_consultation/scher_cons_06_en.htm

http://water.epa.gov/scitech/wastetech/guide/304m/index.cfm

http://www.zeromercury.org/phocadownload/Developments_at_EU_level/Appendix_I_The_Safety_of_Alternatives_to_Dental_Mercury_2.pdf

IAOMT, Bisphenol-A in Dental Composites, http://www.iaomt.org/articles/files/files276/BPA%20 review.pdf

Orthomolecular Medicine News Service. Mercury Dental Amalgams Banned in 3 Countries: FDA, EPA, ADA Still Allow and Encourage Heavy-Metal Fillings. November 20, 2008


Dental Amalgam Causes Poisoning. Advocacy Groups Call for Immediate Ban.

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Flickr/PGordon

Presented with the key findings of the Scientific Committee on Health and Environmental Risks (SCHER), the EU scientific community finally acknowledged that the continued use of dental amalgam fillings and its resulting wastes could cause second-hand mercury poisoning when tainted fish is consumed.


“While we are pleased with the announcement, we can’t help but wonder why it took this long.,” states Dr Lillian Lasaten-Ebuen of The International Academy of Oral Medicine and Toxicology (IAOMT) in the Philippines. “We have been talking about the dangers posed by dental amalgam fillings for years and this acknowledgement by the European scientific community validates our statement.”

Often regarded by supporters as harmless and safe, European scientists found that dental amalgam fillings can methylate and turn into methylmercury – mercury’s most toxic form – and can contaminate fish. Mercury does not dissolve or breakdown, but instead it accumulates and increases at every level. Once consumed by humans, mercury content in large predatory fish such as tuna, mackerel, and swordfish have exceeded acceptable and safe levels,   leading to second-hand mercury poisoning.

With long-term exposure or consumption, mercury can wreak havoc on the body’s systems primarily targeting the brain and nervous system. Children and pregnant or women of child-bearing age are more vulnerable to mercury poisoning as the neurotoxin can accumulate in vital organs and can easily break the blood-brain barrier. 

Recently, IAOMT-Philippines collaborated with social and environmental justice group BAN Toxics! and measured the levels of mercury emissions in locations where dental amalgam fillings are used or stockpiled. The tests yielded high results that confirmed Dr Ebuen’s suspicions all along. 

“The astonishingly high mercury levels would require an evacuation by the Environment Protection Agency (EPA) but sadly, even some in the dental health profession remain resolute.” Dr Ebuen shares. However, IAOMT-Philippines is working with the Department of Health (DOH) and other concerned groups in pushing for a mercury-free approach to dentistry.

Through a series of training-lectures, dental outreach programmes, and information dissemination, IAOMT-Philippines is reaching out to vulnerable sectors such as dentists, women, and youth. Together with the removal and phasing out of mercury-containing products and devices in all (dental) healthcare facilities including dental institutions, IAOMT-Philippines is pushing for dental amalgam ban and a revision in the dentistry curriculum that endorses the use of the material.

“Our research and the EU’s stand are a wake-up call to the government and the dental health sector in the country. We all should take heed and impose a ban on the use of dental amalgam fillings and implement effective measures in handling dental mercury wastes.” 

 

References:

 

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[3] http://www.rappler.com/nation/51875-immediate-ban-dental-amalgam-pushed

Presented with the key findings of the Scientific Committee on Health and Environmental Risks (SCHER), the EU scientific community finally acknowledged that the continued use of dental amalgam fillings and its resulting wastes could cause second-hand mercury poisoning when tainted fish is consumed.

“While we are pleased with the announcement, we can’t help but wonder why it took this long.,” states Dr Lillian Lasaten-Ebuen of The International Academy of Oral Medicine and Toxicology (IAOMT) in the Philippines. “We have been talking about the dangers posed by dental amalgam fillings for years and this acknowledgement by the European scientific community validates our statement.”

Often regarded by supporters as harmless and safe, European scientists found that dental amalgam fillings can methylate and turn into methylmercury – mercury’s most toxic form – and can contaminate fish. Mercury does not dissolve or breakdown, but instead it accumulates and increases at every level. Once consumed by humans, mercury content in large predatory fish such as tuna, mackerel, and swordfish have exceeded acceptable and safe levels,[1]  leading to second-hand mercury poisoning.

With long-term exposure or consumption, mercury can wreak havoc on the body’s systems primarily targeting the brain and nervous system. Children and pregnant or women of child-bearing age are more vulnerable to mercury poisoning as the neurotoxin can accumulate in vital organs and can easily break the blood-brain barrier. [2]

Recently, IAOMT-Philippines collaborated with social and environmental justice group BAN Toxics! and measured the levels of mercury emissions in locations where dental amalgam fillings are used or stockpiled. The tests yielded high results that confirmed Dr Ebuen’s suspicions all along. [3]

“The astonishingly high mercury levels would require an evacuation by the Environment Protection Agency (EPA) but sadly, even some in the dental health profession remain resolute.” Dr Ebuen shares. However, IAOMT-Philippines is working with the Department of Health (DOH) and other concerned groups in pushing for a mercury-free approach to dentistry.

Through a series of training-lectures, dental outreach programmes, and information dissemination, IAOMT-Philippines is reaching out to vulnerable sectors such as dentists, women, and youth. Together with the removal and phasing out of mercury-containing products and devices in all (dental) healthcare facilities including dental institutions, IAOMT-Philippines is pushing for dental amalgam ban and a revision in the dentistry curriculum that endorses the use of the material.

“Our research and the EU’s stand are a wake-up call to the government and the dental health sector in the country. We all should take heed and impose a ban on the use of dental amalgam fillings and implement effective measures in handling dental mercury wastes.” 



[1] http://www.nrdc.org/health/effects/mercury/effects.asp

[2] http://www.mercury.utah.gov/health_effects.htm

[3] http://www.rappler.com/nation/51875-immediate-ban-dental-amalgam-pushed

Normal 0 false false false EN-GB X-NONE X-NONE

Research Reveals Substantial Mercury Emissions Coming From Dental Amalgams

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Photo by Diane Mendoza/Rappler

Confirming suspicions raised by different environment and health groups on dental amalgams, recent research revealed that there is a substantial amount of mercury emissions coming from facilities with a considerable volume of the mercury-containing product.

With support from the World Alliance for Mercury-Free Dentistry and the Swedish Society for Nature Conservation (SSNC), researchers from the International Academy of Oral Medicine and Toxicology (IAOMT) in the Philippines and BAN Toxics!, measured ambient mercury vapour levels in selected dental schools, clinics, and supply stores around the country. Sampling the air, with a Lumex RA915+, they found that mercury emissions in and around those facilities are high and “Exceed generally accepted human exposure limits.”  

According to lead researcher, Myline Macabuhay, “The results ranged from a low 967 nannogram per cubic meter (ng/m3) to high levels that would require an immediate evacuation by the Environment Protection Agency (EPA).”

Presenting the results to a group of dental health professionals and government representatives, IAOMT-Philippines’ Executive Director, Dr Lillian Lasaten-Ebuen pointed to dental amalgams as the source of the elevated mercury emission levels. “Silver fillings are an alloy of mercury, silver, tin, copper, and other trace materials. Due to its high mercury content, toxicologists have continuously warned us of its effects on the body’s system.”

According to the World Health Organization (WHO), as one of the most toxic elements known to man, mercury can damage the nervous, reproductive, and immune systems – and in some cases, can even be fatal.

However, despite the local and international endeavours to phase-out mercury and mercury containing products, some dentists persist in using dental amalgams and dentistry schools continue to require students to practice and hone their skills using this type of restorative material.

“We cannot continue to ignore the situation,” adds Dr Ebuen. “Continued exposure to mercury vapour has its consequences and we are putting the health of dental professionals, students, patients, and the community at stake.”

Concluding the study, IAOMT-Philippines and BAN Toxics! recommend steps to be taken by the government and other concerned institutions. This includes the immediate prohibition of dental amalgams, revision of school curriculum, the ratification of the Minamata Convention on Mercury, and putting up an environmentally sound system for the storage and disposal of mercury and mercury-containing products.

IAOMT on SIGNATURE CAMPAIGN

September 2012 – The International Association of Oral Medicine & Toxicology Philippines (IAOMT Phils.) persists with its signature campaign for seeking the public involvement in phasing out dental amalgam throughout the Philippines. IAOMT gathers supporters' signature to provide information to the government on mercury used in dental amalgam as public concern.

signature

IAOMT calls on to the public through this campaign to be involved in refusal of mercury used in dental amalgam and promotion of Mercury-free dentistry in the Philippines. Through public veto on mercury in dental industry, IAOMT hopes to awaken the government regarding this issue and looks forward to immediate action on this matter.

IAOMT together with its supporters call upon the Philippines government, especially the Department of Health, Environment and Natural Resources, and Trade and Industry to take following actions:

1. Phase-out the importation, sale, production, and use of dental amalgam in the Philippines at the soonest time practicable.

2. Develop phase down strategies for reducing and eventually phasing out dental amalgam, paying close attention to the transition period until the amalgam phase out begins with particular focus on protecting vulnerable populations, such as women of childbearing age and children.

3. Develop, promote, and implement the environmentally sound management of mercury and mercury wastes, such as dental amalgam wastes, including environmentally sound storage of mercury and mercury wastes, such as dental amalgam waste.

BAN ON MERCURY – LACED DENTAL AMALGAMS SOUGHT

An advocacy group is asking the Department of Health (DOH) to ban dental amalgams that contain mercury, which is harmful to health and the environment.

In a recent meeting with Dr. Irma Asuncion, acting director of the DOH – National Center for Disease, the International Association of Oral Medicine and Toxicology (IAOMT) – Philippines presented a number of documents and studies citing the ill-effects of mercury-laced dental fillings, otherwise known as “Hg-Am”.

Dr. Lillian Ebuen, IAOMT-executive director, said amalgams, with a high concentration of mercury, that leach into the mouth can “in the long run cause birth defects, mental retardation and a host of other illnesses such as cancer and respiratory-related problems.”



“The irony of it all is that we are concerned with mercury contaminating our air, land and water systems, yet we put mercury fillings in our mouths without having any second thoughts,” Ebuen said.

The World Health Organization (WHO) has listed dental amalgams as among the products containing mercury which it describes as “one of the 10 groups of chemicals of major public health concern.”

WHO describes mercury on its website as a “naturally occurring element that is found in air, water and soil” and is “harmful to humans, especially pregnant women, infants and children.”

“Options such as resin-based composites and atraumatic restorative treatment (ART) have consistently proven to be more practical, more durable and more affordable than dental amalgams. In fact, developed countries have moved away from using mercury in treating caries,” she said.

According to Ascuncion, they will review DOH Administrative Order No. 21-2008 to determine if dental amalgams are included in the mercury products being phased out in all health care facilities in the country.

“We are looking into the administration order to know the best thing that we can do. If it is not yet included, we will get it if there is enough evidence (to show its mercury content),” she said.

Ascucion added that if dental amalgams are proven to contain mercury and is therefore hazardous to health, her office would propose its inclusion in the ban.

 

By Sheila Crisostomo, The Philippine Star
February 9, 2012


BAN ON MERCURY – LACED DENTAL AMALGAMS SOUGHT

By Sheila Crisostomo, The Philippine Star

February 9, 2012

 

An advocacy group is asking the Department of Health (DOH) to ban dental amalgams that contain mercury, which is harmful to health and the environment.

 

In a recent meeting with Dr. Irma Asuncion, acting director of the DOH – National Center for Disease, the International Association of Oral Medicine and Toxicology (IAOMT) – Philippines presented a number of documents and studies citing the ill-effects of mercury-laced dental fillings, otherwise known as “Hg-Am”.

 

Dr. Lillian Ebuen, IAOMT-executive director, said amalgams, with a high concentration of mercury, that leach into the mouth can “in the long run cause birth defects, mental retardation and a host of other illnesses such as cancer and respiratory-related problems.”

 

“The irony of it all is that we are concerned with mercury contaminating our air, land and water systems, yet we put mercury fillings in our mouths without having any second thoughts,” Ebuen said.

 

The World Health Organization (WHO) has listed dental amalgams as among the products containing mercury which it describes as “one of the 10 groups of chemicals of major public health concern.”

 

WHO describes mercury on its website as a “naturally occurring element that is found in air, water and soil” and is “harmful to humans, especially pregnant women, infants and children.”

 

“Options such as resin-based composites and atraumatic restorative treatment (ART) have consistently proven to be more practical, more durable and more affordable than dental amalgams. In fact, developed countries have moved away from using mercury in treating caries,” she said.

 

According to Ascuncion, they will review DOH Administrative Order No. 21-2008 to determine if dental amalgams are included in the mercury products being phased out in all health care facilities in the country.

 

“We are looking into the administration order to know the best thing that we can do. If it is not yet included, we will get it if there is enough evidence (to show its mercury content),” she said.

 

Ascucion added that if dental amalgams are proven to contain mercury and is therefore hazardous to health, her office would propose its inclusion in the ban.

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