MERCURY USE: DENTISTS
DRAFT WISCONSIN MERCURY SOURCEBOOK: DENTISTS 249
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MERCURY USE: DENTISTS Table of Contents
About This Handout ........................... 250
Why Should I Be Concerned About
Dental amalgam is an alloy that results from the trituration of powdered
Mercury? ............................................. 251
silver, tin and copper which hardens quickly to a solid phase. Dental
Facts About Mercury Amalgam ......... 253
amalgams have been used as the main restorative in teeth for more than
Capturing Amalgam and Mercury
150 years; it is a popular restorative material because it can be easily
Wastes .................................................. 253
manipulated and is relatively inexpensive.
Procedures for Collecting Mercury and
Mercury Amalgams ............................ 254
Keeping Mercury Out of Medical Waste
Amalgam wastes are generated from amalgam abrasion, from the
Incinerators ........................................ 257
placement or replacement of fillings, and from cremation. The Western
Keeping Mercury Out of the Solid Waste
Stream ................................................. 257
Lake Superior Sanitary District has estimated that dentists emit 0.1
Keeping Mercury Out of the WasteWater
grams of mercury per day per dentist. The approximate 1,650 dental
Stream ................................................. 257
offices in the metropolitan Seattle, Washington area contribute an
Amalgam Recyclers ............................ 258
estimated 14 percent of the mercury in that system. San Francisco has
Mercury Recyclers .............................. 258
estimated that 12 percent of the mercury contributed to that city’s
Star Program: Detroit ....................... 259
system comes from dental offices. (directly from the concern over
Alternatives to Mercury Amalgam
mercury and wastewater, journal of MDA) It has been estimated that
Fillings ................................................ 259
approximately 4 percent of the mercury entering the Lake Superior
Amalgam Use & Alternatives ............ 260
ecosystem is from amalgam wastes.
What About the Health Effects of Mercury-
Amalgam Fillings? ............................. 261
What We Can Do as a State ............... 261
Alternatives to mercury-amalgam fillings exist, but are not appropriate in
Dental Use of Amalgam: Activities in
all cases or for all patients. Until acceptable alternatives exist for every
Other Countries .................................. 262
situation, mercury will continue to be used widely in dental practices. It
Other Mercury-Containing Products that
May be Found in a Dental Office ....... 263
is imperative that dentists handle the mercury in their office carefully to
Mercury Product Focus: Detergents and
prevent releases of mercury to the environment.
Cleaners .............................................. 263
Mercury Product Focus: Lamps ....... 264
There are specific steps dentists can take to reduce their mercury
Mercury Product Focus: Switches ..... 266
releases. They may consider the use of precapsulated amalgam alloy
Mercury Spills ..................................... 268
instead of the use of bulk liquid mercury; the precapsulated amalgam
Action Ideas for Dentists .................... 269
can lessen the overall amount of mercury being used and decrease spills.
Sample Proclamation ......................... 270
Dentists may also consider the use of chair side traps to capture their
Bibliography ....................................... 272
waste mercury-amalgam and can recycle this waste.
More Articles About Mercury-Amalgam
Fillings ................................................ 279
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250 DRAFT WISCONSIN MERCURY SOURCEBOOK: DENTISTS
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ABOUT THIS HANDOUT
This is one chapter of the “Wisconsin Mercury SourceBook.” The
Sourcebook was written as a guide for communities to help identify and
reduce the purposeful use of mercury. The SourceBook contains
background information on mercury contamination and provides a seven-
step outline for drafting a mercury reduction plan.
This handout is one of the nineteen sectors that were highlighted in the
SourceBook as a potential contributor of mercury in any given
community.
What you will find in this handout:
« Information on mercury-containing products and that are unique to
the agriculture industry
« Action ideas that describe pollution prevention, recycling, and
management practices for a mercury reduction plan for a business in
this sector. This provides a good overview of the types of mercury-
containing products and alternatives that may exist in your sector.
« Current mercury projects in the agriculture industry
For more information, please contact:
DRAFT WISCONSIN MERCURY SOURCEBOOK: DENTISTS 251
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WHY SHOULD I BE CONCERNED
ABOUT MERCURY?
HEALTH EFFECTS OF
ELEMENTAL MERCURY
Some of you may remember playing with mercury when you were a
The toxicity of mercury has long
child. Its silvery white shimmer was entrancing, and the ability of its
been known to humans. Hat
glistening mass to split and come back together again was magical. But
makers during the 19th century
scientists are now beginning to realize that there is another side to
developed symptoms of shaking
mercury’s wily nature. In fact, it is some of mercury’s most elemental
and slurring of speech from
qualities that make it a difficult substance to handle.
exposure to large amounts of
inorganic mercury, which was
Mercury is a common element that is found naturally in a free state or
used to give a metallic sheen to
mixed in ores. It also may be present in rocks or released during volcanic
felt hats. This gave rise to the term
activity. However, most of the mercury that enters the environment in
“mad as a hatter.”
Wisconsin comes from human uses.
The hat makers were suffering
Because mercury is very dense, expands and contracts evenly with
from neurological damage from
temperature changes, and has high electrical conductivity, it has been
the inhalation of mercury fumes.
used in thousands of industrial, agricultural, medical, and household
Exposure to elemental mercury
applications.
vapors can cause acute respiratory
problems, which are followed by
It is estimated that half of the anthropogenic mercury releases in
neurologic disturbances and
Wisconsin are the result of the purposeful use of mercury. The other half
general systemic effects. Acute
of mercury emissions originate from energy production.
exposure to inorganic mercury by
ingestion may also cause
Major uses of mercury include dental amalgams, tilt switches,
gastrointestinal disturbances and
thermometers, lamps, pigments, batteries, reagents, and barometers.
may effect the kidneys.
When these products are thrown in the trash or flushed down a drain, the
mercury doesn’t go away.
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The good news is that the majority
referred to as source reduction.
SO WHAT’S THE BIG DEAL?
of products that use mercury
Source reduction allows us to
Mercury is a bioaccumulative,
purposefully have acceptable
eliminate the use of mercury in
persistent, toxic substance that
alternatives. For example, electric
certain waste streams. This is
threatens the health of humans
vacuum gages, expansion or
especially beneficial considering
and wildlife throughout North
aneroid monitors are good
the volatile nature of mercury,
America. The USEPA,
alternatives to mercury blood
because mercury can so easily
Environment Canada, the
pressure monitors. Mechanical
transfer from air to soil to water.
International Joint Commission,
the Commission for Environmental
switches, magnetic dry reed
Cooperation and many state and
switches, and optic sensors can
Practicing source reduction in
provincial governments have
replace mercury tilt switches.
combination with recycling the
identified mercury as one of the
mercury already in the waste
most critical pollutants for
Replacing mercury-laden products
stream can have a significant
significant elimination and/or
with less toxic alternatives is
impact on reducing mercury levels
reduction.
in the environment.
252 DRAFT WISCONSIN MERCURY SOURCEBOOK: DENTISTS
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Mercury Transport and Bioaccumulation
M ercury
Direct Air Emissions
Solid Waste Disposal
Incineration
Sludge
Land Disposal
Wastewater Disposal
M ethyl
M ercury
Mercury can enter the environment from a number of paths. For example, if
a mercury-containing item is thrown into the garbage, the mercury may be
Fish Consumption
released into the atmosphere from landfill vapors or leachate, or the mercury
may vaporize if the trash is incinerated. If mercury is flushed through a
Advisories
wastewater system, the mercury will likely adhere to the wastewater sludge,
where it has the potential to volatilize and be deposited elsewhere. Mercury
There are currently 260 lakes
can enter the atmosphere through these various means because it evaporates
and more than 350 miles of
easily. It then travels through the atmosphere in a vaporized state.
rivers in Wisconsin that have
Once mercury is deposited into lakes and streams, bacteria convert some of
fish consumption advisories
the mercury into an organic form called methylmercury. This is the form of
because of mercury.
mercury that humans and other animals ingest when they eat some types of
Approximately 1 out every 3
fish. Methylmercury is particularly dangerous because it bioaccumulates in
sites that is tested is listed
the environment. Bioaccumulation occurs when the methylmercury in fish
on the advisory; no sites
tissue concentrates as larger fish eat smaller fish. A 22-inch Northern Pike
have ever been removed.
weighing two pounds can have a mercury concentration as much as 225,000
Forty-eight states now issue
times as high as the surrounding water.
fish consumption advisories
These concentrations are significant when one considers the potential toxic
to protect human health.
effects of methylmercury. Methylmercury interferes with the nervous system
Most of these warnings are
of the human body and can result in a decreased ability to walk, talk, see, and
related to mercury
hear. In extreme examples, high levels of methylmercury consumption has
contamination.
resulted in coma or death.
Many animals that eat fish also accumulate methylmercury. Mink, otters,
and loons in Wisconsin have been found to have high levels of mercury in
their tissue. Mercury can interfere with an animal’s ability to reproduce, and
lead to weight loss, or early death.
DRAFT WISCONSIN MERCURY SOURCEBOOK: DENTISTS 253
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Research by the University of
Sanitary District (WLSSD) reports
CAPTURING
Illinois, Chicago has shown that
that the cost of recycling chair side
AMALGAM AND
60% of the mercury from a
traps is approximately $3.50 per
dental practice is captured on
pound, probably less than $20 per
MERCURY WASTES commonly used chair-side traps. year per practice. Recycling the
The remaining portion settles out
amalgam is much less restrictive
rapidly; less than 1 percent
than managing waste as a RCRA
Because mercury amalgam fillings
remains in the water after settling
hazardous waste.
are the material of choice for
for 24 hours. Therefore, the
many fillings, it is important to
recycling of amalgam captured
capture and dispose of this waste
on disposable trays is an
safely and effectively. There are
effective way of keeping
several filtration devices available
mercury out of the environment.
to capture amalgam at the source
The Western Lake Superior
of generation. These include “low
tech” devices such as sieves and
strainers, and “high-tech” devices
such as sedimentation columns,
Facts About Mercury Amalgam
centrifuges, and complete capture
from DWSD
units. (M2P2)
Amalgam has been used extensively as tooth-filling material
There are a range of options
for more than 150 years
available for handling amalgam
The toxic effects of silver/mercury dental fillings have been
wastes. The board of trustees of
discussed and debated in professional circles since mercury’s
the ADA have identified the
introduction into dentistry in 1819
following (1994 supplement to
annual reports and resolutions):
Components of dental amalgam are: mercury, powdered
metals, silver, copper, zinc, and tin
x
lowest tech: filters (secondary
screens with finer mesh sizes,
In the past 50 years, about 75% of all direct restorations
if technically practical)
placed were of amalgam
x
low tech: holding tanks (if
Amalgam waste is created when fillings are removed or
prototypes are made
replaced
commercially available)
Particles of removed old amalgam restorations, smaller than
x
high tech: separators (the
the filter size hole, are normally lost to the sewer unless the
commercially available models,
dentist has a high efficiency filtration or separation device in
e.g., from Europe)
place
x
higher tech: electrical and
Dentists estimate that 27% of old amalgam restorations are
chemical approaches (which
lost to the sewer system
could address all of the
discharge and not just the
particulate)
x
amalgam alternatives (would
still need to address removals
of existing amalgams)
x
closed systems (if feasible)
254 DRAFT WISCONSIN MERCURY SOURCEBOOK: DENTISTS
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PROCEDURES FOR COLLECTING MERCURY AND
MERCURY AMALGAMS
From the Michigan Dental Association, “HHR Update,” March 1996 + WLSSD handout
In order to reduce the amount of mercury from amalgam particles entering the sewer system or landfill, it is
recommended that you use an amalgam trap.
Disposable Traps
Information from WLSSD
Recycling facilities recover mercury from amalgam or amalgam traps for recycling. The following techniques
will properly collect, store, and transport the chair-side traps to a recycler. Following these simple procedures,
you can reduce the amount of mercury released to the environment.
x
Flush the vacuum system with line solution before changing the chair side trap. The best method is to
flush the line the last thing before you go home, and then change the trap first thing the next morning.
y
Use barrier techniques such as gloves, glasses, and mask when handling the chair side trap. Choose
utility gloves intended for cleaning and handling wastes for this procedure.
z
Do not place gloves*, plastic bags, or paper towels into the recycling container. These add the volume
of waste created and cause problems with recycling equipment. Unless saturated with blood, dispose
of gloves, plastic bags, and paper towels in the garbage.
{
A.
Chair-Side Traps
Place the trap in widemouth plastic container. Label the container: Amalgam for recycling. Keep the
container covered.
Only traps on chairs used for amalgam placement or removal need special handling. Place
traps from chairs dedicated to hygiene in regular garbage.
B.
Vacuum Pump Traps
Reusable Traps: Empty the trap’s contents into a widemouth plastic container. Keep the
container covered.
Disposable Traps: Replace the cover after use. Place the trap in the original box for
shipment to a recycler.
Label the containers: Amalgam for Recycling.
* Please note: “AMALGAWAY” is currently the only company that will take the gloved disposable
amalgam trap. To contact the “AMALGAWAY” mail disposal system contact: AMALGAWAY, 10085
Allisonville Road, Suite 201, Fishers, IN 46038. Or call AMALGAWAY 1-800-267-1467.
DRAFT WISCONSIN MERCURY SOURCEBOOK: DENTISTS 255
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project has been met with great
Reusable Amalgam
Bulk Mercury
success. They offered three
Traps
options for the collection of bulk
mercury from dentists: 1) mail -in
First, disinfect the trap for 24
The Detroit Water and Sewerage
programs 2) drop-off locations 3)
hours using a minimum amount of
Department has estimated that
infectious waste haulers take-back
disinfectant. Then, remove all
approximately 10-15% of the
program. We hope to implement a
visible amalgam and store it in an
dentists in their area use bulk
similar program here in Wisconsin.
airtight container, labeled “WASTE
mercury and bulk amalgam alloy
AMALGAM.” The disinfected
for their amalgam restorations.
trap can then be reused. Recycle
This correlates with information
Amalgam Capsules
the waste amalgam as outlined for
from the federal Food and Drug
the scrap amalgam.
Administration Dental Products
Panel, which estimates that 8 to
Used, empty amalgam capsules
10% of dental mercury an
have been determined to be non-
amalgam alloys are sold to dentists
hazardous, based on toxicity test
Secondary Filters on
in bulk form.
results. Empty amalgam capsules
(DWSD task force for
can be disposed of with all other
the Vacuum Pump
mercury min from dental facilities,
summary of June 13, 1995 meeting)
office solid waste in the garbage.
Change these filters at least once
a month, or more frequently if
Since 1984, the American Dental
needed. DO NOT dispose of the
Associations’s Council on Dental
filters as regulated medical waste.
Materials, Instruments and
Place facial tissue or towels inside
Equipment, as part of its dental
to absorb the liquid.
mercury hygiene
recommendations, has recommend
that dentists discontinue the use of
bulk dental mercury and bulk
Scrap Amalgam
amalgam alloy and that they only
Dispose of Your Waste
Excess amalgam remaining at the
use precapsulated amalgam alloy
Amalgam and Filters
end of a procedure should be
in their practices. The use of these
Properly
stored in an air-tight container
pre-mixed capsules decreases the
labeled “SCRAP AMALGAM.”
potential of occupational exposure
The Western Lake Superior
The American Dental Association
to mercury by eliminating the
Sanitary District audits have
recommends that the scrap
possibility of bulk mercury spills
shown that 80% of the traps
amalgam container be stored
and leaky dispensers, and can
used by dentists are improperly
under a small amount of
lessen the overall amount of
disposed of by placement in
photographic fixer. Most
mercury being used.
the garbage or in medical
reclaimers/recyclers will only
waste bags. Care should be
accept dry amalgam, so you may
The 1994 American Dental
taken when handling waste
need to decant off the fixer and
Association house of Delegates
amalgam or waste mercury -
blot the amalgam dry with a paper
and the 1995 Michigan Dental
used filters should NEVER be
towel.
Association House of Delegates
passed a resolution recommending
placed in the garbage or in a
that dentists eliminate the use of
medical waste red bag.
bulk mercury and bulk amalgam
alloy. The MDEQ (???) has set up
a bulk mercury collection program
for their dental offices and this
256 DRAFT WISCONSIN MERCURY SOURCEBOOK: DENTISTS
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Mercury Cycle in Dentistry
New amalgam
fillings
Surplus of
Mercury
triturated
in
amalgam
Dental Practices
Collection
amalgam
recycling
separator
Carved
surplus of
amalgam
sludge
Minor
Drain/sewage
amalgam
particles
central vacuum
system
Removal of old
amalgam fillings
Lost/extracted
Waste
teeth with
amalgam fillings
Interment
Amalgam fillings
in deceased
persons
Cremation
from Horsted-Bindslev et al., 1991
DRAFT WISCONSIN MERCURY SOURCEBOOK: DENTISTS 257
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Keeping Mercury Keeping Mercury
Sewer Pipes
Out of Medical
Out of the Solid
Mercury was used extensively
Waste
Waste Stream
in medical settings in the past.
Often times the mercury may
Incinerators
If your waste amalgam is placed in
have found its way into the
the garbage, it could potentially be
pipes of a dental facility when
If your amalgam waste or filters are
incinerated, and the mercury will
placed in your medical waste red
items were broken, disposed of,
volatilize and enter the atmosphere
bags, the amalgam will be sent to a
or spilled. This mercury can
as described above. If the solid
Medical Waste Incinerator (MWI).
settle at a low point such as a
waste is sent to a landfill, the
There are approximately 5,000
sump or trap and remain in the
mercury may volatilize out with the
MWIs distributed evenly throughout
pipes of a dental facility for
methane gas that is released from
the United States. MWIs are a large
many years. Often the slow
the landfill.
source of mercury to the
dissolution of the mercury in a
environment. There is up to 50
sump, trap, or pipe is enough to
times more mercury in medical
cause violations of wastewater
waste than in general municipal
discharge standards even after
waste, and the amount of mercury
poor management practices
emitted from general medical
have been eliminated. Hot
incinerators averages more then 60
spots in a dental facility’s piping
times that from pathological
may appear where equipment
Keeping Mercury
incinerators. In Wisconsin, MWIs
maintenance areas were
are responsible for approximately
Out of the
located. Whenever traps or
25 percent of air emissions in
sumps are moved or cleaned,
WasteWater
Wisconsin that are associated with
the solid contents should be
the purposeful use of mercury.
Stream
treated as a hazardous waste
unless proven otherwise. For
Mercury is a very volatile metal that
Mercury amalgam that is not
more information, please see
evaporates easily. When a mercury-
captured by a trap in your office
containing product finds its way
the excerpts from the MWRA/
will travel to your local
into a medical waste red bag and is
MASCO Infrastructure
wastewater treatment plant. Once
incinerated, the mercury becomes
Subcommittee Maintenance
mercury enters the wastewater
gaseous and exits through
Guidebook that appear in the
treatment plant, most of it
smokestacks into the air. The
“Resources” section of this
concentrates in wastewater
mercury then settles on land and in
sourcebook.
biosolids during treatment. Since
water where it can be changed into
most treatment plants dispose of
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its organic form, methylmercury.
generated solids by land spreading,
Fish bioconcentrate the mercury to
mercury enters the terrestrial
such levels that it can harm wildlife
environment by this process. Some
and can be a potential human health
of this mercury spread on land
risk. It is very important to educate
may, over time, be volatilized to the
employees about the dangers of
atmosphere. This mercury may
putting amalgam wastes in the red
then be deposited into lakes and
medical waste bags to prevent this
streams, methylated, and ingested
contamination.
by fish, eventually reaching wildlife
and humans.
258 DRAFT WISCONSIN MERCURY SOURCEBOOK: DENTISTS
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AMALGAM
MERCURY
RECYCLERS
RECYCLERS
Acme Scrap Iron and Metal
Bethleham Apparatus
7588 N. Syvania Avenue
890 Front Street
Sturtevant, WI 53177
Hellertown, PA 18055
(414) 835-2662
(215) 838-7034
Amalgaway
10085 Allisonville Road, Suite
Garfield Refining
203
810 East Cayuga
Fishers, IN 46038
Philadelphia, PA 19124
(800) 267-1467
(800) 523-0968 ext. 300
Dental Recycling North America
Inmetco
PO Box 1069
PO Box 720
Hackensack, NJ 07601
Elwood City, PA 16117
(800) 360-1001
(412) 758-5515
D.F. Goldsmith
Mercury Refining Company
909 Pitner Avenue
790 Wateruliet-Shaker Rd.
Evanston, IL 60602
Latham, NY 12110
(708) 869-7800
(800) 833-3505
Made Ltd.
Mercury Waste Solutions, Inc.
Rt. 1 Box 127a
21211 Durand Avenue
Hillman, MN 56338
Union Grove, WI 53182
(612) 277-3981
(414) 878-2599
Maguire and Strickland Refining
Co.
1290 81st Avenue NE
Minneapolis, MN 55432
(800) 486-2858
Mercury Refining Company, Inc.
1218 Central Ave.
Albany, NY 12205
(518) 459 -0820
Recyclights Inc.
401 West 86th Street
Bloomington, MN 55420
(800) 831-2852
Mercury Waste Solutions, Inc.
21211 Durand Avenue
Union Grove, WI 53182
(414) 878-2599
DRAFT WISCONSIN MERCURY SOURCEBOOK: DENTISTS 259
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STAR PROGRAM: DETROIT
From the Journal of the Michigan Dental Association, April/May 1995
The Detroit Water and Sewerage Department (DWSD) is a large municipal utility that supplies both drinking
water and wastewater treatment services to millions of individuals and industries in southeastern Michigan.
The DWSD has initiated a pilot program for dental facilities which seeks to reduce or eliminate mercury use
and improve disposal practices within dental offices. The pilot program has multiple objectives:
B to identify mercury usage and disposal practices among dentists
B to quantify the amount of mercury entering the sewage system from this source
B to identify and encourage the use of mercury-free alternatives and other suitable technologies
within the field
B to develop materials and other outreach initiatives specifically designed for the dental profession.
The DWSD has compiled a survey of over 2,000 dentists and conducted site surveys as well. They have also
convened a task force that will explore ways of reducing mercury pollution from dental facilities, make
recommendations for future legislation, regulation, and enforcement, and develop prevention strategies.
ALTERNATIVES TO MERCURY AMALGAM FILLINGS
(from M2P2)
Alternatives to mercury amalgam
differences in strength durability,
and dietary modifications. This
include gold, ceramic, porcelain,
ease-of-placement, an the lower
results in fewer fillings removed
polymers, composites and glass
cost between mercury amalgam
from patients. In fact, in the
ionomers. The cold silver and
and alternatives. Amalgams resist
United States, from 1979 to 1990,
gallium techniques are among the
dissolution and wear better, require
a 38 percent reduction in the use
most promising currently in the
a less precise technique during
of dental amalgam for restorative
developmental phase.
placement, and are lower in cost.
procedures has been observed.
However, 0.6 percent of the
Some people are predicting that
However, while alternatives exist
population may have some risk to
technological advances will allow
for mercury amalgam, they have
mercury amalgams due to a
amalgam substitutes to become
limited uses. Some of the variables
mercury sensitivity. (research from
competitive and replace amalgam
effecting the choice of material
canadian dental association on
fillings in the next couple of
are the location of the defect in the
dental amalgam, published in
decades. However, because a
tooth, the extensiveness of the
journal of american dental
large segment of the population
defect, the location of the afflicted
association, Vol 122, August 1991,
currently has mercury amalgam
tooth in the mouth, the amount of
pg. 54)
fillings, the proper handling of this
stress placed on the filling, and the
waste will be a relevant issue for
probability for contact with
Mercury use by the dental
some time to come.
moisture during placement of the
profession decreases each year
filling material. Amalgam use is
due to fluorides, sealant use,
favored over composite resins by
improved oral hygiene practices
260 DRAFT WISCONSIN MERCURY SOURCEBOOK: DENTISTS
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Dental Amalgam Use and Alternatives
Adopted from Dental Amalgam: A Scientific Review and Recommended Public Health Service Strategy for Research, Education, and
Regulation, Dept. HHS, January 1993. As appeared in Mercury Pollution Prevention In Michigan, April, 1996
Critical
Amalgam
Composite
Glass
Gold Foil
Gold Alloy
Metal-
Parameters
Ionomer
(Cast)
Ceramic
in Evaluating
Crowns
Posterior
Restorative
Materials
Median
8 to 12 years
6 to 8 years
No data1: 5
No data: 10 to
12 to 18 years
12 to 18 years
Longevity
years predicted
15 years
Estimate
estimated
Relative
Wears slightly
Excessive wear
Excessive wear
Excessive wear
Wears similar
Porcelain
Surface Wear faster than
in
in
in
to enamel
surface may
enamel
stress-bearing
stress-bearing
stress-bearing
wear opposing
situations
situations
situations
tooth
Resistance to Fair to
Poor to
Poor
Fair to good
Excellent
Excellent
Fracture
excellent
excellent
Marginal
fair to excellent Poor to
Poor to
Poor to
Fair to good
Poor to
Integrity
(self-sealing
excellent
excellent
excellent
(depends on fit
excellent
(leakage)
through
(polymerizatio
and type of
(depends on fit
corrosion
shrinkage can
buting agent
and type of
products)
cause poor
used)
buting agent
margins)
used)
Conservation Good
Excellent
Excellent if
Good
Poor
Poor
of Tooth
initial
Structure
restoration,
not if
replacement
Esthetics
Poor
Excellent
Good
Poor
Poor
Excellent
Indications:
Age range
All ages
All ages
All ages
Adult
Adult
Adult
Occlusal
Moderate stress Low-stress
Adult-class V
Class III and V High-stress
High-stress
Stress
bearing
and low-stress
and Crown
areas
areas
primary teeth
repair
Extent of
Incipient to
Incipient to
Class I and II
Incipient to
Severe tooth
Severe tooth
caries
moderate size
moderate size
child incipient
moderate size
destruction
destruction or
cavity
cavity
to moderate
cavity
aesthetic
size cavity
considerations
Cost to
1X
1.5X
1.4X
4X
3X + gold
8X
patient2
1 Longevity estimates reflect from published studies, however, under different clinical situations many restorations will last longer. For
materials that have emerged in the last decade and gold foil, estimates are speculative.
2 Relative cost to patient, in relation to amalgam (1X). There may also be considerable geographic variation.
DRAFT WISCONSIN MERCURY SOURCEBOOK: DENTISTS 261
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WHAT ABOUT THE HEALTH EFFECTS OF MERCURY-
AMALGAM FILLINGS?
The focus of this analysis revolves around the proper disposal of amalgam filling waste, and not the potential
health effects of its use as a restorative material. However, because this issue frequently comes up when
discussing the use of mercury amalgams, we have provided a brief discussion of the issue and a list of paper
abstracts on the subject. (The abstracts appear in the appendix.)
In general, the american dental community regards mercury-amalgam fillings as safe. The U.S. Public Health
Service issued a report in 1993 stating that there is no health reason not to use amalgam, except in the
extremely rare case of the patient who is allergic to a component of amalgam. This stance has been echoed by
the Food and Drug Administration, the National Institutes of Health Technology Assessment Conference, and
the National Institutes of Dental Research, all who support dental amalgam as a safe and effective restorative
material.
Nonetheless, the issue is certainly under debate. There are two sections of articles included in the appendix
about this issue.
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What we can do as a State
Following Michigan’s lead, Wisconsin can implement some practical initiatives to help reduce mercury
entering waste water treatment plants from dental offices. Here are some ideas from the Michigan
Dental Association and the Michigan Mercury Pollution Prevention Task Force:
x
Encourage the development and use of mercury amalgam alternatives
x
Recommend the elimination of bulk mercury and bulk amalgam alloy; recommend the use of
precapsulated amalgam alloy only
x
Participate in a bulk mercury collection program
x
Develop and distribute a pamphlet on amalgam waste reduction and recycling
x
Provide a Health and Hazard Regulation Traveling Seminar on all phases of mercury hygiene in
dental offices. (These seminars are part of a continuing education program that is mandatory for all
Michigan licensed dentists.)
x
Include articles in Dental Association Journals
x
Speak at local dental society meetings
x
Research particle size distribution on the latest in amalgam separators
x
Form a Dental Task Force on Mercury Minimization
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262 DRAFT WISCONSIN MERCURY SOURCEBOOK: DENTISTS
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DENTAL USE OF population, although a small
AMALGAM:
percentage of the population has
allergic hypersensitivity to mercury
Sweden
ACTIVITIES IN
that could be triggered by
Recently obtained information
exposure through amalgam.
OTHER
from Sweden indicates that use of
amalgams in children has been
COUNTRIES
The study also developed a
discontinued and use in adults is to
tolerable daily intake (TDI) value
be discontinued as of Jan. 1, 1997.
Info from John Gilkeson
for mercury (something that
This decision has been made on
Health Canada does not endorse).
the basis that there is simply too
This is a level of mercury
much mercury in the environment
exposure considered to be safe—
already, and amalgam use is halted
Canada
with a safety factor of 100. Most
like nearly all other uses. They
people’s exposure are below this
have stayed away from the health
Canadian Ministry of Health has a
TDI, although people who have
issue because it is contentious and
web site. Access this site through
seven or more amalgam fillings
currently unresolved, due to the
http://hpb1.hwc.ca/datahpb/
would have exposures in excess of
lack of research that can be
dataehd/ Then click on
the TDI. Because of the safety
agreed to resolve the question.
“English.” When you get the next
factor, it is still unlikely that such
screen, click on “Medical
people are at risk of health effects.
Devices.” Next screen, click on
“Research and Surveillance.” The
Health Canada’s position
“Health Canada Position
statement says that neither a ban
Statement on Dental Amalgams”
on amalgam nor removal of sound
and “The Safety of Dental
amalgam fillings from healthy
Amalgams” provide a summary of
patients is justified. However, it
Health Canada’s take on the issue
recommends use of non-mercury
and of a recent Health Canada-
materials in the primary teeth of
sponsored study of amalgam
children, when “suitable,” and
safety.
recommends against the using
amalgam with pregnant women
This study that found that for the
(due to exposures during the filling
average Canadian, 50 percent of
procedure) and with patients who
daily exposure to mercury (50
have impaired kidney function.
percent of the amount absorbed by
the body) is attributable to releases
from amalgam fillings. That
makes amalgam the most
significant single source of
mercury exposure for the average
Canadian. [Please note: The
summary of the report doesn’t
distinguish between forms of
mercury—exposures to
methylmercury in fish may still
cause greater health risk.]
However, the report concluded
that exposures at this level do not
cause illness in the general
DRAFT WISCONSIN MERCURY SOURCEBOOK: DENTISTS 263
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OTHER MERCURY-CONTAINING PRODUCTS THAT
MAY BE FOUND IN A DENTAL OFFICE
Mercury Product
Focus: Detergents
and Cleaners
“Other Sources of Mercury”
Information from the Massachusetts Water Resources Authority/MASCO
The Massachusetts Water
Product
Mercury Content
Resources Authority (MWRA), in
(ppb)
conjunction with MASCO (a
consortium of Longwood Medical
Ajax Powder
0.17
and Academic Area Institutions),
has been working with their area
Comet Cleaner
0.15
hospitals and academic institutions
to identify and address the problem
Lysol Direct
<0.011
of mercury contamination in
Soft Scrub
<0.013
hospital and medical waste
streams. As part of this process,
Kodak Fixer
6.9; 3.7
the MWRA group also worked to
identify “other sources” of
Kodak Developer
2.65; 6.0
mercury contaminants. These are
common products, such as bleach,
Alconox Soap
0.004 mg/kg
alcohol, laboratory lids, not
0.005 mg/kg
otherwise thought to be of
<0.0025 mg/kg
significant importance or concern,
that might contain low levels of
Derma Scrub
<5.0
mercury. Thus far, a total of 118
<2.5
products has been identified by this
team. This information is
Dove Soap
0.0027
applicable in a variety of settings.
Ivory Dishwashing
0.061
Included among their findings:
Liquid
Joy Dishwashing
<0.01
B At least four (4) cleaners, nine
Liquid
(9) soaps, embedding tissues
and other miscellaneous items
Murphy’s Oil Soap
<0.012
such as photoprocessing fixer
and developer solutions each
Soft Cide Soap (Baxter)
8.1
contain significant levels of
Sparkleen Detergent
0.0086
mercury.
Sunlight Dishwashing
<0.011
Detergent
264 DRAFT WISCONSIN MERCURY SOURCEBOOK: DENTISTS
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Mercury Product There are a number of electric these lamps is emitted into the
Focus: Lamps
lamps that use mercury as an
atmosphere when the lamps are
intrinsic part of their functioning.
broken, disposed of in landfills, or
fluorescent
These lamps include fluorescent,
incinerated.
-
general purpose
mercury vapor, metal halide, and
straight, U-bent,
high pressure sodium lamps. These Fluorescent lamps are still a good
circline, compact
lamps may be used indoors or
option. They last longer and cost
-
high output
outdoors in heat lamps, film
less to run than incandescent lights
projection, photography, dental
because they use up to 50 percent
exams, photochemistry, water
less electricity. This energy
germicidal lamps
purification, or street lighting.
savings helps reduce mercury
-
cold cathode
emissions because small amounts
-
hot cathode
Fluorescent lamps contain mercury of mercury are present in coal that
-
slimline
in a vapor form. The electric
is burned in power plants. The less
current of the lamp “excites” the
energy we use, the less mercury
metal halide
mercury atoms, which then give
will be released into the
high pressure sodium
off invisible ultraviolet light. The
environment when coal is burned.
ultraviolet light then “excites” a
powdery phosphorus coating inside
the tube that emits visible light.
The mercury that is contained in
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New Low Mercury Fluorescent Lamp
Phillips Electronics has developed a long-life fluorescent that contains so little mercury it is no longer
considered a hazardous waste. “Typically fluorescent lamps have an overabundance of mercury
because mercury loses its effectiveness due to physical and chemical reactions. So manufacturers
put in an overdose of mercury to compensate for these reactions,” said George Preston, a scientist at
Philips Lighting Co. Currently, a four-foot lamp contains about 22.8 milligrams of mercury, down
from 38.4 milligrams in 1990. Philips’s new lamp contains less than 10 milligrams of mercury. The
new lamp, named ALTO™, relies on a “buffering mechanism” that blocks the physical and chemical
reactions that cause the mercury to lose its effectiveness over time. The lamp also uses a new form
of phosphorus patented by Philips.
- From “Philips Unveils a Fluorescent Lamp With Less Mercury and a Long Life,” Wall Street Journal, June 9, 1995
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DRAFT WISCONSIN MERCURY SOURCEBOOK: DENTISTS 265
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Recycling Your Fluorescent Lamps
Several Wisconsin companies are
new lamps and thermometers.
informational handout, “Recycling
in the business of recycling
Your Fluorescent Lamps,” in the
fluorescent lamps and
State hazardous waste regulations
“Resources” section of this
incandescent bulbs. The copper
prohibit businesses from disposing
sourcebook.
coils, and aluminum or brass end
of waste lamps and light bulbs in
pieces are smelted and reused as
sanitary landfills if those lamps and
raw materials for non-food
bulbs contain levels of heavy
products. The glass can be purified
metals that exceed hazardous
and used to make fiberglass. The
waste limits. For information on the
mercury is distilled from the
storage, collection, and transport of
phosphor powder and reused in
fluorescent lamps, please see the
Types of Bulbs and Lamps that Contain Mercury
x
Fluorescent Lamps - the tube-style were first used as overhead lighting in
offices, now they also come in compact globe shapes for a variety of home and
office uses
x
Mercury Vapor Lamps - the first high intensity discharge (HID) lamps with
blue-white light, originally used as farmyard lights
x
Metal Halide Lamps - newer, more efficient HID lights found in homes and
offices
x
High-Pressure Sodium Vapor Lamps - white-yellow HID lights used for
street lamps and outdoor security lighting
x
Neon Lamps - brightly colored lamps typically used in advertising; most colors
contain mercury except red, orange, and pink
- From the Wisconsin Recycling Markets Directory
266 DRAFT WISCONSIN MERCURY SOURCEBOOK: DENTISTS
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Mercury Product space heaters. If a mechanical
Focus: Switches
switch is not visible in these items,
a mercury switch is probably being
used.
Tilt switches
Mercury tilt switches have been
used in thermostats for more than
silent light switches (single
40 years. According to Honeywell,
pole and three way;
Inc., a major manufacturer of
discontinued in 1991)
thermostats, more than 50 million
mercury-containing thermostats
fire alarm box switch
have been sold since the 1950s for
temperature control (mounted
use in homes and offices. Mercury
on bimetal coil or attached to
in these thermostats provide
bulb device)
accurate and reliable temperature
control, require little maintenance,
thermostats
and do not need a power source.
·
room temperature
However, each mercury switch in
control
a thermostat contains about 3
grams of mercury. (There may be
·
refrigerators
one or more of these switches in a
single thermostat, each switch in a
Another source of mercury that
sealed glass bulb.) Alternatives to
dental facilities may encounter is
these products include electronic
mercury switches. A small
thermostats, which can be
electrical switch may contain 3,500
programmed to set room
milligrams of mercury; industrial
temperatures at predetermined
switches may contain as much as
times. (blue brochure: the waste
eight pounds of mercury. Mercury
connection)
is used in temperature-sensitive
switches and in mechanical
Float control switches may be
switches. The mechanical (tilt)
used in septic tank and sump
switches are activated by a
pumps to turn the equipment on
change from a vertical to a
and off when water is at a certain
horizontal position. These are used
level. Often, these switches are
in products like thermostats and
visible. Temperature-sensitive
silent switches. Mercury-
switches may be used in
containing tilt-switches may also
thermostats. Yet another type of
be present in or under the lids of
mercury switch, the plunger or
clothes washers and chest
displacement relay, is used in high
freezers - they stop the spin cycle
current, high voltage applications
or turn on a light. Mercury tilt
that could include lighting,
switches are also found in motion-
resistance heating, or power
sensitive and position sensitive
supply switching (M2P2).
safety switches in clothes irons or
DRAFT WISCONSIN MERCURY SOURCEBOOK: DENTISTS 267
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Reduction Works!
Honeywell Corporation has been
for all the wholesalers who are
contractor assistance or with
running a free take-back program
participating as a consolidation
contractors who are not currently
in Minnesota to collect any brand
point for the thermostats. HVAC
participating in the Honeywell
of used mercury-containing
wholesalers contact their
program may recycle their
thermostat through either a
Honeywell customer service
thermostats through the free
reverse distribution system or a
representatives to order containers
recycle-by-mail system. These
recycle by-mail system.
for used thermostats, and
individuals can call a toll-free
Honeywell sends the wholesaler a
number to receive a free postage
Honeywell works with heating,
plastic container with an attached
paid thermostat mailer.
ventilating, and air-conditioning
lid that holds 100 thermostats.
(HVAC) wholesalers who sell
their products. Honeywell has one
Homeowners who replace their
license (called a network license)
own thermostats without
Mercury Switches in Electrical Applications
Source: Michigan Mercury Pollution Prevention Task Force, 1996
Switch
Quantity of
Available Alternatives
Mercury
Tilt Switch
· Thermostats
3,000 - 6,000 mg
Electronic type and snap switches
· Float Control
?
Magnetic dry reed switch, optic sensor, or
(septic tank and sump pumps)
mechanical switch
· Freezer Light
2,000 mg
Mechanical switch
· Washing Machine
2,000 mg
Mechanical switch
(power shut off)
· Silent Switches
2,600 mg
Mechanical switch
(light switches prior to 1991)
Thermo-Electrical Applications
· Accustat
~ 1,000 mg
?
(“mercury in glass thermostat,” a
calibrated device resembling a
thermometer is used to provide
precise temperature control for
specialized applications)
· Flame Sensor
2,500 mg
Hot surface ignition system for devices or
(used in residential and commercial
products that have electrical connections.
gas ranges, mercury is in capillary
tube when heated mercury
vaporizes and opens gas valve or
operates switch. Used for both
electrical or mechanical output.)
268 DRAFT WISCONSIN MERCURY SOURCEBOOK: DENTISTS
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MERCURY SPILLS
Handle Mercury
Safely!
As a dentist, you will probably continue to encounter mercury for some
time to come. Therefore, it is essential to handle mercury, especially
bulk mercury, safely. Small droplets of spilled mercury may lodge in
Use mercury only in
uncarpeted, well-ventilated
cracks and sinks, mix with dust, accumulate on work surfaces, and
areas. Provide troughs on
adhere to knit fabrics, shoe soles, watches, gold, and other jewelry. This
smooth surfaced tables and
allows for mercury to potentially be transported to other locations,
benches to collect mercury
homes, or businesses.
spills. Reserve the room for
mercury use only; restrict
traffic in the area.
The Costs of Mercury Spills
Ask workers to remove all
Mercury spills can be expensive for a number of reasons. Here are
watches and other jewelry -
some examples:
especially gold jewelry since
mercury readily combines with
The Cost of Clean-up
gold - and have them wear a
x
A mercury-containing sphygmomanometer broken on a carpeted
mercury vapor respirator and
floor at Butterworth Hospital cost $2000 to clean up.
protective clothing: gloves,
disposable gowns, and shoe
coverings.
Labor costs
Prohibit smoking, eating, and
x
It took Riverside Hospital 8 to 16 hours to clean up a mercury
drinking in the area.
spill (the mercury had fallen in tile crevices).
Train all workers to understand
the properties and hazards of
Facility Down-Time
mercury and to carry out safe
x
The room in which a mercury spill occurs will be unavailable for
handling procedures and
use until the site is decontaminated. Riverside Hospital found
specific policies related to
that their room was out of service for at least one day.
mercury disposal.
Clean and calibrate all mercury-
Equipment Loss
containing equipment
according to the manufacturer’s
x
A mercury-containing switch in an oven in a University of
recommended handling
Michigan Hospital cafeteria exploded. It cost $3500 to clean up
procedures and the formal
the spill. The oven, a $25,000 piece of equipment, was
procedures posed by your
irreparably damaged.
communications or safety
program supervisors.
Training Time
Ask your safety supply vendor
x
Continuing to use mercury containing items can be expensive for
for a mercury vacuum sweeper
your facility because of the needed staff training for spill
and spill cleanup kit. Having
response plans. However, if you are still using mercury-
the right equipment on hand
will limit the amount of mercury
containing products, don’t neglect this important step! An
released into the atmosphere.
improperly handled spill can end up costing even more to
decontaminate.
- From “The Case Against Mercury: Rx
for Pollution Prevention,” The Terrane
Institute
DRAFT WISCONSIN MERCURY SOURCEBOOK: DENTISTS 269
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ACTION IDEAS FOR DENTISTS TO CONSIDER
Eliminate the use of bulk mercury and bulk amalgam alloy in your practice; use precapsulated
amalgam alloy only
Use a chair-side trap or other capture device to collect your waste amalgam. Educate staff on how to
effectively use the equipment .
Recycle the waste amalgam you collect in your traps. Never throw it in the garbage or in the medical
waste red bags!
Continue to educate yourself and your colleagues about amalgam alternatives
Continue to use fluorescent lamps! Even though fluorescent lamps contain mercury, they are a good
choice because they use much less energy than regular bulbs.
Establish a lamp recycling program for your business. Try not to break these lamps because some of
the mercury will escape into the air.
When remodeling or replacing old equipment, replace thermostats containing mercury switches with
thermostats containing electronic type and snap switches, and replace “silent” light switches with
mechanical light switches.
Clean or flush the traps, sumps, and pipes in your sewer lines to rid your facility of historical uses of
mercury. See excerpts from the MWRA/MASCO Infrastructure Subcommittee Maintenance
Guidebook that appear in the “Resources” section of this sourcebook for more information.
270 DRAFT WISCONSIN MERCURY SOURCEBOOK: DENTISTS
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SAMPLE PROCLAMATION
Your dental clinic may wish to formally declare your commitment to mercury reduction. You may use the
proclamation below, or adopt it to suit your needs.
WHEREAS mercury is an elemental substance, that once released into the environment, easily and rapidly
changes forms to several organic and inorganic states that transfer from soil to air to water and back again;
WHEREAS the organic form of mercury, methylmercury, bioaccumulates in aquatic ecosystems to magnify
concentrations in animal tissue in increasing degrees up to 250,000 times;
WHEREAS methylmercury, the most toxic form of mercury, can affect the reproductive efforts of top
predators in aquatic environments such as loons, otters, mink, and panthers;
WHEREAS the neurotoxic effects of high levels of methylmercury poisoning in humans has been established,
and low-level doses of methylmercury consumption can potentially effect human health, especially that of a
fetus;
WHEREAS elemental mercury is a highly toxic substance which can vaporize easily and cause both acute and
chronic health effects including severe respiratory irritation and damage to the central nervous system;
WHEREAS mercury has been identified internationally as a toxic substance of concern, and mercury
contamination has led to fish consumption advisories for more than 235 lakes and 350 miles of rivers in
Wisconsin;
WHEREAS the majority of mercury entering Wisconsin comes from anthropogenic sources, and one-quarter
of these emissions are the result of the purposeful use of mercury;
WHEREAS mercury is used widely in consumer and industrial products, where, in most cases, alternative,
mercury-free products are available;
WHEREAS pollution prevention or product substitution is a progressive approach to protecting the
environment that eliminates or minimizes the generation of mercury-bearing waste, making it one of the most
favorable strategies for maintaining a clean environment;
WHEREAS pollution prevention for mercury can help environmental conditions, as well as protect the health
and safety of workers;
WHEREAS recognizing mercury minimization as an active opportunity to improve the environment of
Wisconsin and the environment of our business, we, the undersigned, do hereby declare our business to be a
mercury minimization participant;
DRAFT WISCONSIN MERCURY SOURCEBOOK: DENTISTS 271
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WE commit to research the following mercury minimization opportunities in our facility and implement those
we find most feasible:
x Continue education about amalgam alternatives
x Use a chair-side trap or other capture device to collect waste amalgam. Educate staff on how to use
effectively use the equipment .
x Recycle the waste amalgam collected in the traps.
x Eliminate the use of bulk mercury and bulk amalgam alloy; use precapsulated amalgam alloy only
x Recycle any bulk mercury still at facility
x Use safe, non-mercury cleaners and degreasers in labs, housekeeping departments, and maintenance
areas
x Replace mercury-containing thermostats and switches with mercury-free alternatives when
remodeling or replacing old equipment
x Recycle fluorescent lamps
x Establish effective spill response measures to ensure the mercury already in your facility is handled in
a safe and proper manner.
_________________________________________
Facility
_________________________________________ ________________________
Name
Date Signed
272 DRAFT WISCONSIN MERCURY SOURCEBOOK: DENTISTS
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BIBLIOGRAPHY
The information included in the pamphlet is essentially a compilation of the best mercury pollution
prevention work to date. Information was gathered from the documents below; some material may have
been quoted directly from these sources:
“A Guide for Dentists: How to Manage Waste from Your Dental Practice,” Western Lake Superior Sanitary
District, 1993
“A Guide for Dentists: How to Manage Waste from Your Dental Practice,” University of Wisconsin-Extension
Solid and Hazardous Waste Education Center, 1996
“At the Source,” Great Lakes Pollution Prevention Centre, Fall 1995
“Best Management Practices for Hospitals and Medical Facilities,” Palo Alto Regional Water Quality Control
Plant, September 1994
“Business Waste Reduction and Recycling: A Guide For The Workplace,” Wisconsin DNR, 1995
“DNR Briefing Paper: How to Handle Your Waste Fluorescent Lamps and Incandescent Bulbs,” Wisconsin
DNR 1995
“Dental Amalgam-Environmental Aspects,” D. Arenholt-Binslev, Adv Dent Res 6:125-130, September, 1992
“Facts About Amalgam/Mercury,” Detroit Waster and Sewerage Department
“Hospital Mercury Work Group Operations Subcommittee Final Report,” Massachusetts Water Resources
Authority (MWRA) and MASCO Mercury Work Group, August 21, 1995
“Hospital Success Stories” (presentation), Jennifer Carver, University of Michigan Hospitals, presented at
“Mercury Pollution Prevention: Healthcare Providers Protecting People and the Great Lakes,” Novi, Michigan
October 4, 1996
“Household Fluorescent Lights: A Household Hazardous Waste Fact Sheet,” MPCA, August 1994
“How to Design and Administer a Hospital Mercury Reduction Plan” (presentation), David Smith, Riverside
Hospital, presented at “Mercury Pollution Prevention: Healthcare Providers Protecting People and the Great
Lakes,” Novi, Michigan October 4, 1996
“June Update, WLSSD Mercury Zero Discharge Project,” Western Lake Superior Sanitary District, June
1996
“MDA Initiatives on Mercury Pollution Prevention”
“Medical Waste Pollution Prevention: Keep Mercury Out of the Wastewater Stream,” USEPA Region 5,
September 1995
DRAFT WISCONSIN MERCURY SOURCEBOOK: DENTISTS 273
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“Mercury Elimination and Reduction,” Pollution Probe, 1997
“Mercury in Minnesota Slide Show Script,” Western Lake Superior Sanitary District, November 1995
“Mercury Pollution Prevention Measures in Michigan Health Care Institutions,” Liz Krug and Guy Williams,
The National Wildlife Federation
“Mercury Products Study,” John Gilkeson, Minnesota Pollution Control Agency, May 1996
“Mercury Pollution Prevention in Michigan,” A Report by the Michigan Mercury Pollution Prevention Task
Force, April, 1996
“Mercury, Power Plants and the Environment: Basic Facts about Mercury and Coal-fired Power Plants, the
Environment, Fish and Wildlife, and Human Health,” compiled by Steven Ugoretz, WDNR
“Mercury in Medical Waste,” fact sheets 1-3, USEPA Region 5, September 1995
“Mercury Pollution Prevention in the Health Care System,” conference notes compiled by Emily Moore,
MPCA, April 1996
“Mercury in the Environment: The Waste Connection,” MPCA, MDEQ, WDNR
“Philips Unveils a Fluorescent Lamp With Less Mercury and a Long Life,” Wall Street Journal, June 9, 1995
“Preventing Mercury Waste Generation Through Comprehensive Environmental Management within the
Healthcare Industry,” Steering Committee Meeting Summary Notes, April 1996
“Sources of Mercury in Healthcare Business,” Detroit Water and Sewerage Department, July 1995
“Summary of the June 13, 1995 Meeting,” Detroit Waster and Sewerage Department Task Force for Mercury
Minimization from Dental Facilities
“Supplement to Annual Reports and Resolutions,” American Dental Association Board of Trustees, 1994
“Strategies for Mercury Control in Minnesota,” MPCA Mercury Task Force, July 1994
“The Case Against Mercury: Rx for Pollution Prevention,” The Terrane Institute
“The Concern Over Mercury and Wastewater,” Journal of the Michigan Dental Association, John Hughes and
Beverly J. Ingram, April/May 1995
“The Hunt for Quicksilver,” presented at AERB’s Wastewater Discharge Compliance Conference, November
17, 1992 by Frank Altmayer, Scientific Control Labs, Inc.
“The Use and Disposal of Amalgam (Mercury) In The Dental Office,” HHR Update, Michigan Dental
Association, Connie M. Verhagen, D.D.S., M.S., June 1995
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“Waste Management and Recycling for the Michigan Dental Office,” HHR Update, Michigan Dental
Association, March 1996
“Wisconsin Recycling Markets Directory,” Wisconsin DNR, May 1995
Current Mercury Work – Dentists
Specific Outreach/Research
Project:
Lake Superior Pollution Prevention Pilot
Description:
A focus area of dentist and hospital outreach and product education/collection was
targeted for 1996 projects
Agencies working on this project:
WDNR
Project:
MercAlert
Description:
Mercury education and waste reduction program, focusing on dentists and the general
public
Agencies working on this project:
WLSSD
Project:
Targeted Initiative: Dentists
Description:
Outreach effort and study of recycling/disposal procedures; best management practice
document
Agencies working on this project:
WLSSD
Project:
Lake Superior Implementation Plan Team
Description:
A focus area of dentist and hospital outreach was targeted for 1996 projects
Agencies working on this project:
MPCA/OEA
WDNR
Project:
Study of Dentist Mercury Use and Alternatives
Description:
A section of the M2P2 Task Force examined sources and alternatives for mercury use
in dental settings. Includes a table of amalgam alternatives, collection of bulk mercury
from dentist offices, and research
Agencies working on this project:
MDEQ
Project:
Mercury Minimization from Dental Facilities
Description:
As part of Detroit’s Mercury Minimization Program, DWSD is establishing collaborative
voluntary efforts with the ADA, the MDA, and the Detroit District Dental Society. Task
Force of 20 members. Bulk mercury collection.
Agencies working on this project:
Detroit Water and Sewerage Department
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MERCURY AMALGAM LITERATURE
1. Adamkus, Valdus V., Great Lakes National Program Manager - EPA, Memorandum: Sale of Mercury by the
Federal Government, August 2, 1994.
2. American Dental Association, Dental Office Wastewater Position Paper, October, 1994.
3. Arenholt-Bindsley, D., Dental Amalgam - Environmental Aspects, September, 1992.
4. California Water Pollution Control Association, City and County of San Francisco, Dental Related Facilities -
Heavy Metals Loadings, The Bulletin, Fall, 1993.
5. Citizens for a Better Environment, LA Gear - Putting Profits Over People.
6. City of Detroit Water and Sewerage Department, Waste Reduction Sewers, August, 1984.
7. City and County of San Francisco Department of Public Works, Bureau of Environmental Regulation and
Management, Water Pollution Prevention Program, Dental Related Metals Inventory, January, 1993.
8. Clinical Research Associates Newsletter, Silver Amalgam & Its Alternatives - 1991, Volume 15, Issue 2 - February,
1991.
9. Darlin, Damon, Mercurial Sales, Forbes, Page 12, June 20, 1994.
10. Expert Panel on Mercury Atmospheric Processes, Mercury Atmospheric Processes: A Synthesis Report,
September, 1994.
11. FDI World, The Amalgam Story Continues, Page 13-16, July/August, 1994.
12. Fan, P.L. Chang, S.B., Siew. C., Environmental Hazard Evaluation of Amalgam Scrap, Dental Materials, November,
1992.
13. Flanders, Raymond A., D.D.S., MPH, Mercury in Dental Amalgam - A Public Health Concern?, Public Health
Dent, Page 303-311 Fall, 1992
14. Gaines, Dr., Amalgam Waste Water Research Needed, ADS Says, ADA News, October 17, 1994.
15. Huggins, Hal A. D.D.S., Mercury & Other Toxic Metals in Humans: Proceedings of the First International
Conference on Biocompatibility of Materials.
16. Journal of Environmental Health, New Dental Amalgam Will Eliminate Mercury Content, December, 1993.
17. Kodak Dentel Radiography Series, Waste Management Guidelines, June 1994.
18. Lake Superior Partnership-Western Lake Superior Sanitary District, Dental Mercury Pollution Prevention Program.
19. Lawrence, David F., Memo - Dental Amalgam Survey Update, September 6, 1994.
20. Leinfelder, Karl F., D.D.S., M.S., After Amalgam, What Other Materials Fall Short?, JADA, May 1994.
21. Mason, R.P., Pitzgerald, W.F. and Morel, F.M.M., The Biogeochemical Cycling of Elemental Mercury:
Anthropogenic Influences.
22. Mercury and the Environment, Natural Sources.
23. METASYS; 1994, Amalgam Seperation - What You Should Know; Superior System; Amalgam Separator -
Multi System Type 1, Floor Model Description and Technical Data; Green & Clean M2 - The Dual Hygiene
System.
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24. METRO; King County Department of Metropolitan Services, Draft Regulation of the Discharge of Amalgam
Waste Products from Dental Offices, October, 1994.
25. METRO, Municipality of Metropolitan Seattle, Dental office Waste Stream Characterization Study, September,
1991.
26. Michigan Department of Natural Resources, Implementaiton of MESB Mercury Report Recumn, November,
1993.
27. Michigan Department of Natural Resources, Lake Superior Pollution Prevention Strategy, October, 1993.
28. Michigan Department of Natural Resources, Mercury in Michigan’s Environment: Causes and Extent of the
Problem and Strategy for Abatement, March 12, 1992.
29. Michigan Environmental Science Board, Mercury in Michigan’s Environment: Environmental and Human
Health Concerns, (A Science Report to Governor John Engler), April, 1993.
30. Minnesota Pollution Control Agency Mercury Task Force, Strategies for Mercury Control in Minnesota, 1994.
31. Municipality of Metropolitan Seattle, METRO, Waste Management guidelines for Kine County Dental Offices.
Published by METRO as a Service of the Local Hazardous Waste Management Program, July, 1993.
32. National Wildlife Federation, Great Lakes Natural Resources Center; Prospectus for Prevention & Minimizing
Mercury Loadings to the Detroit Water & Sewerage [District Treatment Plant], August, 1994.
33. Poulson, David, U.S. Defense Department Halts Mercury Sales, Booth Newshouse Newspapers, July 7, 1994.
34. Radian Corporation, Mercury Control Technologies and Coast Report Prepared for Office of Air Quality
Planning and Standards, September 30, 1993.
35. Research Triangle Institute, Mercury Control Technologies and Costing of Activated Carbon injection for the
Electric Utility Industry, Prepared for Emissions Standards Division.
36. Rochester Series on Environmental Toxicity, Advances in Mercury Toxicology.
37. Rogers, Kenneth D., M.D., Status of Scrap (Recyclable) Dental Amalgams ad Environmental Health Hazards
or Toxic Substances, JADA, July, 1989.
38. Ross and Associates, Mercury Sources and Regulations, Background Information for the Virtual Elimination
Pilot Project, Prepared for U.S. EPA Gret Lakes National Program Office, September 12, 1994.
39. Rourke, Daniel, City and County of San Francisco - Dental Related Facilities, Heavy Metals Loadings, California
Water Pollution Control Association Bulletin, Page 10, 12 and 14, Fall, 1993.
40. Rowe, Nathaniel H., D.D.S., M.H.D., & Chadzynski, R.S., M.P.H., A Study of the Waste Management of One
Regulated Infectius Medical Waste: Shartp Disposal, October, 1993.
41. Sills, Robert, Great Lakes and Environmental Assessment Section Surface Water Quality Division, Mercury in
Michigan’s Environment (Causes and Extent of the Problem, June 24, 1992.
42. Sources of Human and Environmental Exposure.
43. Suzuki, Tsuguyoshi; Imura, Nobumasa; Clarkson, Thomas W., Rochester Serioes on Environmental Toxicity,
Advances in Mercury Toxicology, 1991.
44. Swedish Environmental Protection Agency, Waste Management in Sweden for Mercury Containing Waste
Products, 1994.
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45. Taylor, Joyal, D.D.S., The Complete Guide to Mercury Toxicity from Dental Fillings - How to Find Out If
Your Silver Dental Fillings Are Poisoning You and What You Can Do About It, 1988.
46. United States Department of Interior, Bureau of Mines, Mercury in 1992, July, 1993.
47. United States Department of Interior, Bureau of Mines, Mineral Industry Surveys, July 27, 1993.
48. Unites States Environmental Protection Agency, Guides to Pollution Prevention - Selected Hospital Waste
Streams, June, 1990.
49. United States Environmental Protection Agency, The EPA Great Waters Program: An Introduction to the
Issues and the Ecosystems, April, 1994.
50. Washington State Dental Association, WSDA News, May, 1994.
51. Welland, Cynthia (Metro Chemist), Dental Office Waste Stream Characterization Study, September, 1991/
Reprinted November, 1993.
52. The Western lake Superior Sanitary District, A Guide for Dentist - How to Manage Waste From Your Dental
Practice, March 1993.
53. The Wester Lake Superior, Sanitary District, Mercury, July, 1994.
54. World Health Organization, International Programme on Chemical Safety.
55. Yuen, Stephen, Dr., California Requires Use of Universal Precautions, ADA News, October 17, 1994.
56. Zapp, John S., D.D.S., Executive Director, American Dental Association, Memo: ADA Assistance with Dental
Office Waste Issues, June 6, 1994.
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MORE ARTICLES ABOUT MERCURY-AMALGAM
FILLINGS
The following is a list of abstracts of articles about the mercury- amalgam health-field. Please note that
this is a very subjective selection by Leif Hedegard. Updated 8 April 1996.
give web address
Ahlqwist M, Bengtsson C, Lapidus L, Lindstedt G & Lissner L. Concentrations of blood, serum and urine
components in relation to number of amalgam tooth fillings in Swedish women. Comm Dent Oral Epidem
23(4):217-221 (1995)
ABSTRACT: “ Altogether 1462 women aged 38, 46, 50, 54 and 60 yr were examined in 1968/69 in a
combined medical and dental population study in Gothenburg, Sweden. Number of tooth surfaces restored with
amalgam fillings was assessed. The examination was repeated in 1980/81 including a new dental examination.
The results from a number of biochemical analyses of blood, serum and urine were analyzed for a possible
statistical relationship to number of dental amalgam fillings. As emphasis has been put in the literature on
special influence from amalgam on kidney function and on the immunological system, special attention was
paid to variables which might reflect these functions in our analyses. When potential confounders were taken
into consideration, no significant correlations remained which seemed to be of clinical importance. Specifically,
amalgam fillings were not found to be associated with impairment of the kidney function or the immunological
status.”
Bjorkman L, Pedersen N & Lichtenstein P. Physical and mental health related to dental amalgam fillings in
Swedish twins. Submitted for publication 1995. This article can be found in: Bjorkman L. Studies on Dental
Amalgam and Mercury. Exposure, Accumulation and Effects. Thesis, Institute of Environmental Medicine.
Karolinska Institutet, Stockholm Sweden 1995 (ISBN 91-628-1507-5)
ABSTRACT: “In the past years increasing attention has been paid to possible adverse health effects
associated to mercury exposure from dental amalgam fillings. To evaluate possible health effects from
amalgam fillings, dental status, registered by specially trained nurses, was obtained from 587 male and female
twins included in the ongoing Swedish Adoption/Twin Study of Aging (SATSA). Data on physical and mental
health were collected and memory function tested. Mean age was 66 years (SD 9, range 46-89). In the entire
material, 25 % of the individuals had no own teeth and in the group with own teeth the median number of teeth
surfaces filled with dental amalgam was 15 (range 0-65). Analyses of associations between dental amalgam
and a number of scales estimating somatic and mental health and memory functions were performed both
using the entire group and after excluding individuals with less than 12 teeth. Regardless of the sample no
negative effects on physical or mental health were found from amount of dental amalgam. On the contrary, a
positive correlation between performance in the memory tests and number of teeth surfaces filled with dental
amalgam was found. After controlling for age, gender, education and number of remaining teeth this
association generally disappeared. When using a co-twin control design with twin pairs discordant for amalgam
exposure, no negative health effects associated with dental amalgam were detected. This study does not
indicate any negative effects from dental amalgam on physical or mental health or memory functions in the
general population over 50 years of age.”
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Borjesson J, Barregard L, Sallsten G, Schutz A, Jonson R, Alpsten M & Mattsson S. In vivo XRF analysis of
mercury: the relation between concentrations in the kidney and the urine. Phys Med Biol (P6J) 40(3):413-426
(1995)
ABSTRACT: “The objective of this study was to determine the concentrations of mercury in organs of
occupationally exposed workers using in vivo x-ray fluorescence analysis. Twenty mercury exposed workers
and twelve occupationally unexposed referents participated in the study. Their mercury levels in kidney, liver
and thyroid were measured using a technique based on excitation with partly plane polarized photons. The
mercury levels in blood and urine were determined using atomic absorption spectrophotometry. The detection
limit for mercury in the kidney was exceeded in nine of the exposed workers, but in none of the referents. The
mean kidney mercury concentration (including estimates below the detection limits) was 24 micrograms g-1 in
the exposed workers, and 1 microgram g-1 in the referents. The association between mercury in the kidney
and in urine was statistically significant, but it was unclear whether the relation was linear. The measurements
on liver (n = 10) and thyroid (n = 8) in the exposed workers showed mercury levels below the detection limit.
The study shows that it is now possible to measure the mercury concentrations in kidneys of occupationally
exposed persons, using in vivo x-ray fluorescence. The estimated concentrations are in reasonable agreement
with the limited human autopsy data, and the results of animal studies.”
Cavalleri A, Belotti L, Gobba FM, Luzzana G, Rosa P & Seghizzi P. Colour vision loss in workers exposed to
elemental mercury vapour. Toxicology Letters 77(1-3):351-356 (1995)
ABSTRACT: “We evaluated colour vision in 33 workers exposed to elemental mercury (Hg) vapour and in
33 referents matched for sex age, alcohol consumption and cigarette smoking. The results were expressed as
colour confusion index (CCI). In the workers urinary excretion of Hg (HgU) ranged from 28 to 287 ug/g
creatinine. Subclinical colour vision loss, mainly in the blue-yellow range, was observed in the workers. This
effect was related to exposure, as indicated by the correlation between HgU and CCI (r=0.488, P<0.001). In
the workers whose HgU exceeded 50 ug/g creatinine, mean CCI was significantly increased compared to the
matched referents. The results suggest that exposure to elemental Hg inducing HgU values exceeding 50 ug/g
creatinine can induce a dose-related colour vision loss.”
Echeverria D, Heyer NJ, Martin MD, Naleway CA, Woods JS & Bittner AC jr. Behavioral Effects of Low-
Level Exposure to Hg0 Among Dentists. Neurotoxicol Teratol 17(2):161-168 (1995)
ABSTRACT: “Exposure thresholds for health effects associated with elemental mercury (Hg0) exposure
were examined by comparing behavioral test scores of 19 exposed (mean urinary Hg = 36 micrograms/l) with
those of 20 unexposed dentists. Thirty-six micrograms Hg/l is 7 times greater than the 5 micrograms Hg/l
mean level measured in a national sample of dentists. To improve the distinction between recent and
cumulative effects, the study also evaluated porphyrin concentrations in urine, which are correlated with renal
Hg content (a measure of cumulative body burden). Subjects provided an on-site spot urine sample, were
administered a l-h assessment consisting of a consent form, the Profile of Mood Scales, a symptom and
medical questionnaire, and 6 behavioral tests: digit-span, symbol-digit substituion, simple reaction time, the
ability to switch between tasks, vocabulary, and the One Hole Test. Multivariate regression techniques were
used to evaluate dose-effects controlling for the effects of age, race, gender and alcohol consumption. A dose-
effect was considered statistically significant below a p value of 0.05. Significant urinary Hg dose-effects
were found for poor mental concentration, emotional lability, somatosensory irritation, and mood scores.
Individual tests evaluating cognitive and motor function changed in the expected directions but were not
significantly associated with urinary Hg. However, the pooled sum of rank scores for combinations of tests
within domains were significantly associated with urinary Hg, providing evidence of subtle preclinical changes
in behavior associated with Hg exposure. Coproporphyrin, one of three urinary porphyrins altered by mercury
exposure, was significantly associated with deficits in digit span and simple reaction time. The prophyrin pooled
sums of rank scores were as sensitive as the urinary Hg analyses within the cognitive and motor domains but
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were less sensitive for the overall battery of tests. The reported effects were detected among dentists with a
mean urinary Hg level of 36 micrograms/l, which lies between the proposed biologic thresholds of 25 and 50
micrograms Hg/creatinine, suggesting the need for a more comprehensive study to determine the threshold of
adverse biologic effects.”
Ellingsen DG, Nordhagen HP & Thomassen Y. Urinary Selenium Excretion in Workers with Low Exposure to
Mercury Vapour. J Appl Toxicol 15(1):33-36 (1995)
ABSTRACT: “Urinary selenium excretion was studied in 21 mercury vapour (Hg0)-exposed workers
involved in the demolition of a chloralkali plant. The subjects had no known previous occupational exposure to
mercury. Their mean pre-exposure urinary mercury concentration, determined on average 1.2 days prior to the
exposure, was 0.8 nmol/mmol creatinine (range 0.3-1.9). Their last mean urinary mercury concentration,
determined on average after 51.4 days (range 19-103) of exposure, was 4.8 nmol/mmol creatinine (range 1.2-
10.0). The exposure ceased on average 4.1 days after the last determined urinary mercury concentration. The
corresponding concentrations of urinary selenium decreased from an average of 39.1 nmol/mmol creatinine
(range 13.9-89.5) to 29.0 nmol/mmol creatinine (range 10.1-52.9) (P=0.002). This finding may indicate that
even a low to moderate work-related exposure to Hg0 may reduce the urinary selenium concentration in
humans in a manner that is not yet fully known”
Enestrom S & Hultman P. Does Amalgam Affect the Immune System? A Controversial Issue. Int Arch
Allergy Immunol 106:180-203 (1995)
ABSTRACT: “Although in use for more than 150 years, dental amalgam has been questioned more or less
vigorously as a dental restoration material due to its alleged health hazards. Humans are exposed to mercury
and the other main dental amalgam metals (Ag, Sn, Cu, Zn) via vapour, corrosion products in swallowed saliva,
and direct absorption into the blood from the oral cavity. Dental amalgam fillings are the most important source
of mercury exposure in the general population. Local, and in some instances, systemic hypersensitivity
reactions to dental amalgam metals, especially mercury, occur at a low frequency among amalgam bearers.
Experimental and clinical data strongly indicate that these and other subclinical systemic adverse
immunological reactions to dental amalgam metals in humans will be linked to certain MHC genotypes, and
affect only a small number of the exposed individuals. These individuals will be very difficult to detect in a
mixed population of suspectible and resistant individuals, including persons with alleged symptoms due to dental
amalgam fillings, where many of the individuals are likely to suffer from conditions with no proven
immunological background such as multiple chemical sensitivity syndrome. Intensified studies should be
performed to identify such susceptible MHC genotypes, taking advantage of the reported cases of more
heavily metal-exposed humans with systemic autoimmune reactions. Further studies will also be needed to
ascertain whether the combined exposure to the metals in dental amalgam may lower the threshold for
adverse immunological reactions, since recent studies have shown that the metals in alloy, especially silver,
may induce autoimmunity in genetically susceptible mice.”
End of abstract. A quote follows:
“... Very recent results (Hultman et al., in prep) in genetically suspectible rats implanted with
conventional dental amalgam fillings in 4 teeth revealed a stimulation of B cells, measured as a
significant increase in serum IgE, followed by systemic immune complex deposits...”
Eti S, Weisman R, Hoffman R & Reidenberg. Slight Renal Effect of Mercury from Amalgam Fillings. Pharm
& Toxicol 76:47-49 (1995)
ABSTRACT: “The current study was to answer the question: Is enough mercury absorbed from dental
amalgam fillings to produce renal damage? One hundered healthy adults (18-44 years old) filled out health
questionnaries and voided urine samples. Urine mercury concentration and N-acetyl-beta-glukosaminidase
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(NAG) were measured. Subjects were grouped into those having amalgam fillings (N=66) and those without
(N=34). Median 95% Confidence Interval) urine mercury was 1 (1-2) and 0 (0-0.6) ng/ml (P<0.01) and
median urine NAG was 23 (18-27) and 16 (11-18) units (P<0.05) in the two groups respectively. People with
mercury amalgam fillings excreted slightly more mercury than people without them, and have a very small
increase in urinary NAG excretion that is probably of no clinical significance. This dose of mercury absorbed
from amalgam appears to be too little to be a health hazard for renal injury.”
Fuortes LJ, Weismann DN, Graeff ML, Bale JF, Tannous R & Peters C. Immune trombocytopenia and
elemental mercury poisoning. J Toxicol - Clin Toxicol 33(5):449-455 (1995)
ABSTRACT: “ Three cases of severe mercury toxicity occurring within a family are reported. Two cases of
thrombocytopenia occurred in this family and represent the second such report in the literature of an
association between elemental mercury toxicity and thrombocytopenia. Three of the children presented with a
combination of dermatologic and neurologic manifestations reminiscent of acrodynia or pink disease. Each of
the four children in this family were treated with dimercaptosuccinic acid. The hazard of vacuuming spilled
mercury and appropriate clean-up procedures are described.”
Gonzalez-Ramirez D, Maiorino RM, Zuniga-Charles M, Xu Z, Hurlbut KM, Junco-Munoz P, Aposhian MM;
Dart RC, Diaz Gama JH, Echeverria D et al. Sodium 2,3-dimercaptopropane-1-sulfonate challange test for
mercury in humans: II. Urinary mercury, porphyrins and neurobehavioral changes of dental workers in
Monterrey, Mexico. J Pharmacol Exp Ther 272(1):264-274 (1995)
ABSTRACT: “The sodium salt of 2,3-dimercaptopropane-1-sulfonic acid (DMPS) challange test (300 mg
p.o. after an 11-hr fast) was given in Monterrey, Mexico to dental and non-dental personnel. Urine samples
were collected and analyzed for total mercury. The mean mercury urinary excretion (+/- S.E.) for 6 hr before
and 6 hr after DMPS administration for 10 dental technicians, who formulate amalgam, was 4.84 micrograms
+/- 0.742 and 424.0 micrograms +/- 84.9; for 5 dentists, who use amalgam in their practice, 3.28 micrograms
+/- 1.11 and 162.0 micrograms +/- 51.2; and for 13 nondental personnel, 0.783 microgram +/- 0.189 and 27.3
micrograms +/- 3.19. The urinary coproporphyrin levels before DMPS administration, which are indicative of
renal mercury content, were quantitatively associated with the urinary mercury levels among the three study
groups after DMPS administration. This was not so if the urinary mercury level before DMPS administration
was compared with the urinary coproporphyrin concentration. The urinary mercury level after DMPS
administration is a better indicator of exposure and renal mercury burden than is the mercury level measured in
the urine before DMPS is given. Regression analysis showed that the coefficient of urinary mercury was
statistically and adversily associated with complex attention (switching task), the perceptual motor task
(symbol-digit substitution), symptoms and mood. The easily performed DMPS-mercury challenge test is useful
for monitoring dental personnel for mercury vapor exposure.”
Gothe CJ, Odont CM & Nilsson CG. The environmental somatization syndrome. Psychosomatics 36(1):1-11
(1995)
ABSTRACT: “Patients with environmental somatization syndrome (ESS) believe that their symptoms are
caused by exposure to tangible components of the external environment or by ergonomic stress at work. ESS
is distinguishable by mental contagiousness and by the patients’ focus on the external environment as cause of
the illness. The presentation is often polysymptomatic, and epidemic outbreaks may appear. The patients
usually refuse alternative explanations of their symptoms and discredit and reject any suggestion of a
psychogenic etiology. It is important to distinguish between hygienic problems and ESS problems, particularly
when poor and inadequate hygienic factors are present simultaneously with an ESS epidemic.”
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Grandjean P. Individual susceptibility in occupational and environmental toxicology. Toxicol Lett 77(1-3):105-108
(1995)
ABSTRACT: “By prudent interpretation of toxicological and epidemiological evidence, susceptibility could
become a very useful notion, both in a scientific sense and for prevention of adverse effects. Based on
presumed aetiology, susceptibility can often be separated into genetic, constitutional, and environmental
categories, although some overlapping between these groups will be apparent. Inherited factors seem to be
involved in determining many toxic effects of environmental chemicals, including carcinogenic responses,
although some of the evidence is equivocal. Among constitutional factors, sex, age and pregnancy are major
determinants of individual susceptibility. An individual’s resistance toward chemical toxicity may also be
affected by other environmental exposures, including those associated with diet and lifestyle. The mechanisms
involved are only partially known but are likely to include both toxicokinetic and toxicodynamic interactions.
Three major types can be recognised: (1) factors that increase the concentration of the biologically active
substance at the active site; (2) factors that augment the reaction of the chemical substance with target
molecules in the body, thereby initiating the response; and (3) factors that promote the sequence of events
between the initial reaction and the final manifestation of an adverse health effect. Specifically, a decrease in
the body’s reserve capacity may not be readily observable and may only reveal itself as a weakening of the
defence mechanisms. The causes of hypersusceptibility and its effects on toxic responses are little known and
deserve to be explored systematically.”
Guerrier P, Weber J-P, Cote R, Paul M & Rhainds M. The accelerated reduction and elimination of toxics in
Canada: the case of mercury-containing medical instruments in Quebec hospital centres. Water, air, and soil
pollution 80:1199-1202 (1995)
ABSTRACT: “In Canada, medical instruments containing mercury (Hg) are still widely used in hospitals.
These are mostly thermometers and sphygmomanometers. Mercury present in these instruments does not
itself consitute a risk of contamination since the metal is contained within a closed system. however, breakage,
inadequate maintenance and disposal of such instruments can expose workers and the public to this toxic
substance. In Quebec 80% of the 28 hospitals surveyed still use Hg sphygmomanometers and 45% Hg
thermometers. Besides, 35% do not have any recovery procedures in case of spillage and most mercury spills
are apparently not reported. Two main courses of action are recommended: the gradual replacement of these
medicla instruments by aneroid sphygmomanometers and electronic thermometers, and the establishment and
communication, in form of a handbook, of guidelines to handle and dispose of mercury safely.”
Gustafsson E. Swedish experiences of the ban on products containing mercury. Water, Air, and Soil Pollution
80:99-102 (1995)
ABSTRACT: “The Swedish Parliament has decided that the use of mercury (Hg) must cease. Risk reuction
measures are to be carried out with and without the support of legislation. According to decisions taken in May
1994 the aim is, with a few exemptions, to end the use of Hg in processes and products by the year 2000.
Special attention has been paid to products containing Hg. Most uses of Hg-containing measuring instruments
and electrical components have successively been phased out in Sweden. It can be concluded that most such
uses have reliable Hg-free alternatives.”
Liang L I & Brooks RJ. Mercury reactions in the human mouth with dental amalgams. Water, Air, and Soil
Pollution 80:103-107 (1995)
ABSTRACT: “This is a preliminary study of the reactions of mercury (Hg) in the human mouth with dental
amalgams. It was conducted by analysing saliva samples from subjects with amalgam fillings and control
subjects with no amalgams. Samples were collected both prior to and after cleaning the mouth. These samples
were analyzed for elemental mercury (Hg0), inorganic mercury (Hg2+) and methylmercury (MeHg). We
concluded that the concemntrations after cleaning represented the systemic concentrations. Hg2+ and MeHg
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were found in all systemic samples from both subjects and controls, while Hg0 was found only in the samples
from subjects with amalgams. In the control group, the concentrations found before and after cleaning the
mouth were equivalent. In the amalgam group, concentrations of Hg2+ found before cleaning the mouth were
10 to 40 times higher than those found after cleaning, suggesting that the oxidation reaction of Hg0 into Hg2+
takes place. For MeHg, a similar but less pronounced pattern as Hg2+ was found, supporting methylation in
the mouth.”
Louwerse ES, Buchet J-P, Van Dijk MA, de Jong VJMB & Lauwerys RR. Urinary excretion of lead and
mercury after oral administration of meso-2,3-dimercaptosuccinic acid in patients with motor neurone disease.
Int Arch Occup Environ Health 67:135-138 (1995)
ABSTRACT: “Amyotrophic lateral slerosis (ALS) and spinal muscular atrophy (SMA) are progressive
neurodegenerative disorders involving motor neurons. The aetiology of the non-familiar forms is still unknown
but it has been suggested that long-term exposure may play a role in the pathogenesis of these diseases. In 53
patients suffering from ALS (n=42) and SMA (n=9) the oral administration of dimercaptosuccinic acid
(DMSA, 20 mg/kg) did not result in a greater mobilization of lead and mercury from peripheral depots than in
control subjects. Although it can not be excluded that the amount of lead or mercury excreted after DMSA
administration may not be a reflection of the amount accumulated in the motor neurones, this study does not
provide support for the hypothesis that heavy metals play a significant role in the occurrence of motor neurone
diseases.”
Maretta M, Marettov:a E, Skrob:anek P & Lede:c M. Effect of mercury on the seminiferous epithelium of the
fowl testis. Acta Vet Hung 43(1):153-61 (1995)
ABSTRACT: “ Phenylmercuric chloride was applied in three doses (5 ppm, 30 ppm Hg, and 30 ppm Hg + 4
ppm Se) via the food for 60 days. The effect of Hg with an without Se was studied histologically and the data
of a shortened spermatogram were evaluated. Treatment with 30 ppm Hg resulted in hypospermia, occurrence
of abnormally maturing spermatozoa, reduction of the volume of semen, and decrease in the number of
spermatozoa. The dose of 5 ppm Hg only resulted in the appearance of abnormally developing cells and
decreased sperm motility. The addition of Se maintained spermatogenesis and the values of semen on the
control level.”
McCann. Intravenous gamma globulin (IVIG) treatment of autoimmune kidney disease associated with
mercury ( Hg++) toxicity. J Allergy Clin Immunol 95(1)(Pt 2):145 Abstract 18 (1995)
ABSTRACT: “Tiny amounts of Hg++ (10(-6)) regulary induce in Brown-Norway rats, but not in outbred
strains, autoimmune renal disease characterized by polyclonal activation of B-cells, hypergammaglobulinemia
with antibodies against a variety of antigens as well as autoreactive T cells directed against Class II molecules.
The same could occur in humans but only in those who are genetically susceptible. RS, a 31 yr old Finn,
developed fatigue and recurrent infections (aseptic meningitis, pneumonia, sinusitis, pseudomonas
pyelonephritis) beginning at age 9. He was heavily exposed to Hg++. Urine Hg = >800 ug/L. His illness
exaberated following simultaneous removal of 21 large Hg-amalgam fillings along with chelation therapy
(EDTA & DMPS). Over the next yr he had 70 lb wgt loss, gastroenteritis, monilial stomatitis, granulocytopenia
and proteinuria. IgG=14.6 gm/L, CD8 lymphocytes= 50% CD4/CD8=0.9, CD8 HLADR=20u/L(N=>149).
Antimyelin IgM antibody was pos. The only successful treatment was IVIG, 400 mg/kg/mo. Creatinine Cl, 60
ml/min increased to > 80 ml/min, proteinuria cleared and weight gain resumed. His illness resembled AIDS but
repeated HIV testing was neg. This case suggests that traditional toxicological thinking in which symptoms
should be dose related to total body Hg++ burden in all individuals in a group, needs to be changed to recognize
genetic variability.”
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Molin M, Berglund JR & Mackert Jr. Kinetics of mercury in blood and urine after amalgam removal. J Dent
Res 74:420 IADR Abstract 159 (1995)
ABSTRACT: “Even though a number of studies have not been able to reveal any correlation between
subjective symptoms and amalgam load there still are speculations wether patients with subjective symptoms
related by the patients themselves to their amalgam fillings could have a changed pattern of elimination of
mercury. The aim of the present investigation was to study the elimination half-time of mercury in plasma.
erythrocytes and urine over an extended period of time after amalgam removal in a group of 10 patients with
subjective symptoms by the patients themselves reffered to their amalgam fillings and a group of 8 healthy
subjects. The average number of occlusal and total amalgam surfaces in the patient group were 13.0 (range 4
- 20) and 44.4 (range 24 - 68), respectively. Corresponding figures in the control group were 12.9 (range 10 -
16) and 40.9 (range 24 - 63). The amalgam removal using rubberdam, water spray cutting and high volume
vacuum evacuator, was carried out at one and the same time. Blood and urine samples were collected at two
occasions before the amalgam removal, then blood was collected at thirthytwo occasions and urine at
forthythree occasions during the following year. The mercury content wasanalysed by CVAAS technique. The
measured P-, Ery- and U-Hg concentrations before amalgam removal were slightly higher in the control group
6.4+/-3.3 nmol/L, 19.4+/-6.6 nmol/L, and 2.7+/-1.3 nmol/mmol creatinine respectively than in the symptom
group 5.6+/-1.8 nmol/L, 14.8+/-8.8 nmol/L, and 1.6+/-0.9 nmol/mmol creatinine respectively. The Hg-
concentrations did not significantly increase in the two groups after amalgam removal. Six days after the
removal the plasma mean concentrationwas significantly decreased at p<0.05 level and ten days after the
decrease was at a permanent p<0.005 level. The mean Ery-Hg level was significantly decreased after eleven
days (p<0.05) a level that remainedstabel for the rest of the year. The mean U-Hg level was significantly
decreased one month after the removal and after six months the mean level was reduced with 80% compared
to the initial level in bothgroups. The conclusion to be drawn from the present study is that the symptom group
did not have a changed pattern of elimination of mercury compared to the healthy group.”
Moszczy:nski P, S:owi:nski S, Rutkowski J, Bem S & Jakus-Stoga D. Lymphocytes, T and NK cells, in men
occupationally exposed to mercury vapours. Int J Occup Med Environ Health 8(1):49-56 (1995)
ABSTRACT: “ Lymphocytes, T-cells (CD3+), T-helper (CD4+) and T-suppressor (CD8+) as well as NK-
cells (CD16+) counts were determined in the peripheral blood of 81 males occupationally exposed to metallic
mercury vapours and of 36 non-exposed males using monoclonal antibodies in indirect immunofluorescence
tests. Mean weighted mercury concentration in air accounted for 0.0028 mg x m-3. Urine mercury
concentrations ranged from 0 to 240 micrograms x 1(-1) and concentrations in the blood varied from 0 to 30
micrograms x 1(-1). Stimulation of T-lymphocytes manifested by an increased number of T-cells, T-helper and
T-suppressor was observed. Quantitative change in T-cells night be an immunological index of exposure to
mercury vapours as indicated by a positive correlation between the exposure duration and the number of these
cells.”
Nakagawa R. Concentration of mercury in hair of diseased people in Japan. Chemosphere 30(1):135-140
(1995)
ABSTRACT: “The purpose of this investigation was to estimate the total hair mercury of diseased people
(not including patients of mercury poisoning such as Minamata disease). Hair samples were collected from
133 diseased volunteers in Tokyo and the surrounding areas from Oct. 1992 to June 1993. The total mercury
concentrations in the hair of ordinary diseased people (atopic dermatitis, asthma, dementia, cerebral infarct,
osteoporosis, hypertension and diabetes) were from 2.08 ppm to 36.5 ppm. Those values were considerably
higher than that of healthy people of the same age groups. However, the uptake routes and the metabolic
mechanism of high hair mercury concentrations in diseased people are not clear.”
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Nuyts GD, Vanvlem E, Thys J, Deleersnijder D, Dhaese PC, Elseviers MM & Debroe ME. New
Occupational Risk Factors for Chronic Renal Failure. Lancet 346(8966):7-11 (1995)
ABSTRACT: “Occupational pollutants may have a role in development of chronic renal failure (CRF). Most
epidemiological studies have been cross-sectional, limited to certain renal diagnoses, or concentrated on early
transient renal effects. In a case-control study, we examined the association between CRF and occupational
exposure. Occupational histories of 272 men and women with CRF (of all types) were compared with those of
272 controls matched for age, sex, and region of residence. Exposures were assessed and degree and
frequency were scored independently by three industrial hygienists unaware of case/control status,
Significantly increased risk of CRF were found for exposure to lead (odds ratio 2.11 [95% CI 1.23-4.36]),
copper (2.54 [1.16-5.53]), chromium (2.77 [1.21-6.33]), tin (3.72 [1.22-11.3]), mercury (5.13 [1.02-25.7]),
welding fumes (2.06 [1.05-4.04]), silicon-containing compounds (2.51 [1.37-4.60]), grain dust (2.96 [1.24-
7.04]), and oxygenated hydrocarbons (5.45 [1.84-16.2]). The frequencies of various occupational exposures
were high among patients with diabetic nephropathy. This epidemiological study confirms previously identified
risk factors and suggests that additional occupational exposures, for which there is some other experimental
evidence, may be important in the development of CRF. The role of grain dust and the association between
occupational exposure and diabetic nephropathy merit further investigation.”
O’Carroll RE, Masterton G, Dougall N & Ebmeier KP. The neuropsychiatric sequelae of mercury poisoning.
The mad hatter’s disease revisited. Br J Psychiatry 167(1):95-98 (1995)
ABSTRACT: “BACKGROUND. the detailed effects of mercury poisoning on cognitive function, brain
anatomy and regional brain function are largely unknown. We report a case of a 38-year-old man who was
exposed to toxic levels of inorganic mercury. METHOD. Four years after exposure, the patient was assessed
using magnetic resonance imaging (MRI), single-photon emission computerised tomography (SPECT) and
detailed neuropsychological evaluation. RESULTS. The patient developed a myraid of physical and psychiatric
complaints, including stomatitis, muscle spasm, tremor, skin rash and the psychiatric syndrome known as
“erythism” (Mad Hatter’s disease). Neuropsychological evaluation revealed marked and significant deficits of
attention, concentration, particularly when under time pressure. The MRI scan was unremarkable; however,
SPECT revealed hypermetabolism of the posterior cingulate cortex. CONCLUSIONS. Mercury poisoning
appeared to result in a dysregulation of posterior cingulate cortex, which was associated with attention/
concentration deficits and marked anxiety/agitation.”
Oskarsson A, Palminger Hallen I & Sundberg J. Exposure to toxic elements via breast milk. Analyst
120(3):765-770 (1995)
ABSTRACT: “Breast milk is the ideal nutrient for the newborn, but unfortunately also a route of excretion
for some toxic substances. Very little attention has been paid to breast milk as a source of exposure to toxic
elements. The dose-dependent excretion in breast milk and the uptake in the neonate of inorganic mercury,
methylmercury and lead were studied in an experimental model for rats and mice. The transfer of mercury
from plasma to milk was found to be higher in darns exposed to inorganic mercury than to methylmercury. In
contrast, the uptake of mercury from milk was higher in the sucklings of dams exposed to methylmercury than
to inorganic mercury. Pre- acid postnatal exposure to methylmercury resulted in increased numbers and
altered proportions of the thymocyte subpopulation and increased lymphocyte activities in the offspring of mice
and also effects on the levels of noradrenaline and nerve growth factor in the developing brain of rats.
Mercury in blood and breast milk in lactating women in Sweden was studied in relation to the exposure to
mercury from fish and amalgam. Low levels were found; the mean levels were 0.6 ng g(-1) in milk and 2.3 ng
g(-1) in blood. There was a statistically significant correlation between mercury levels in blood and milk,
showing that milk levels were approximately 30% of the levels in blood. Inorganic mercury exposure from
amalgam was reflected in blood and milk mercury levels. Recent exposure to methylmercury from
consumption of fish was reflected in mercury levels in the blood but not in milk. A high lactational transfer of
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lead was found in rats and mice. A linear correlation was found in the dams between lead in plasma and milk
and between lead in milk and tissues of sucklings. It was also found that the bioavailability of lead in milk diets
is dependent on the casein content of milk. Thus, lead in human milk with a low casein content was absorbed
more rapidly and to a higher extent in the sucklings than lead in rat milk with a high casein content. The
excretion of lead in milk was also studied in cows after an episode of lead intoxication. A curvilinear
relationship between lead in blood and milk was found, with a sharp increase in lead levels in milk at blood lead
levels above 200-300 mu g kg(-1). Lead levels in human breast milk and blood were studied in Sweden. The
mean levels of lead were 0.8 mu g l(-1) in milk and 33 mu g l(-1) in blood. This can be compared with a
reported mean value of 62 mu g l(-1) in milk from women living close to a smelter in Mexico. There was no
correlation between lead levels in blood and milk in the Swedish study. However, significantly higher levels of
lead in milk were found in women living close to a metal smelter as compared with women from a control
area.”
Perlingeiro RCR & Queiroz MLS. Measurement of the respiratory burst and chemotaxis in polymorphonuclear
leukocytes from mercury-exposed workers. Human & Experim Toxicol 14:281-286 (1995)
ABSTRACT: “The chemotactic and nitroblue tetrazolium reducing activities of neutrophils from 48 mercury-
exposed workers were examined and compared with those of non-exposed, age- and sex-matched individuals.
At the time of testing, the exposed population had a mean (+/- s.d.) urinary mercury concentration of 24.0 +/-
20.1 ug/g creatinine and in 44 of these workers urinary mercury levels were below the accepted threshold
level (TLV) of 50 ug/g creatinine. The two neutrophil functions were significantly reduced in the mercury-
exposed workers compared with the controls. In 28 of these workers, chemotaxis was re-evaluated 6 months
later. During the intervening 6 months, the level of hygiene was improved throughout the plant and urinary
mercury concentrations were determined monthly in each worker. Des pite a significant reduction in urinary
mercury concentrations, neutrophil migration did not return to within the normal range. These results suggest
the “safe” level mercury exposure may lead to impairment of netrophil function.”
Ritchie KA, MacDonald EB, Hammersley R, McGowan DA, Dale IM & Wesnes K. Psychomotor testing of
dentists with chronic low level mercury exposure. J Dent Res 74:420 IADR Abstract 160 (1995)
ABSTRACT: “There is still widespread concern about possible ill effects of chronic low-level mercury
exposure on dentists, staff and patients. 20 experienced general practioners (mean age 41), and 19 first year
post-qualification dentists (mean age 23), were tested, as were a control group of 40 doctors, 20 “older” (mean
age 46) and 20 “younger” (mean age 28). A computerised battery of psychomotor tests developed for drug
studies by Cignitive Drug Research was used., along with a questionnaire on age, sex, alcohol consumption,
regular medication, general health (supplemented by the 12-question version of the General Health
Questionnaire), and some aspects of practice procedure, includingany recent mercury spillage. Their urine
samples were analysed by cold atomic absorption spectroscopy and related to creatinine content as a measure
of urine concentration. The robertson Institute for Biostatistics (University of Glasgow), analysed data from
the 42 measurements from the 8 tests along with results of the questionnaire and of the urine testing. The
median mercury / creatinine ratios (nmol/mmol) for older dentists were 3.65 (range 1.4 - 17.6), younger
dentists 1.8 (0.7 - 16.6), older controls 0.95 (0.2-15), and younger controls 1.25 (0.5 - 6.1). Three older and
one young dentist had levels above the 5 mg/mmol cretinine considered to be the normal background level.
Older dentists scored faster Mean Reaction Times, (t-test, p<0.02) and poorer Mean Immediate, (p<0.05), and
Mean Delayed, (p<0.05), Word Recall, than the other groups, but there were no differences in the tests of
Number Vigilance, Choice Reaction Time, Spatial Memory, Memory Scanning, or Word Recognition. No
differences were shown in GHQ responses. Older dentists had faster reaction times, perhaps due to
occupational experience, but impaired memory retrieval, which could not be related to any confounding factors,
and could be due to chronic low level mercury exposure. The CDR testing system is suitable for larger scale
studies of effectc of mercury exposure on dentists.”
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Salonen JT , Sepp:anen K, Nyyss:onen K, Korpela H, Kauhanen J, Kantola M , Tuomilehto J, Esterbauer H,
Tatzber F & Salonen R. Intake of mercury from fish, lipid peroxidation, and the risk of myocardial infarction
and coronary, cardiovascular, and any death in eastern Finnish men. Circ 91(3):645-655 (1955)
ABSTRACT: “ BACKGROUND: Even though previous studies have suggested an association between high
fish intake and reduced coronary heart disease (CHD) mortality, men in Eastern Finland, who have a high fish
intake, have an exceptionally high CHD mortality. We hypothesized that this paradox could be in part explained
by high mercury content in fish. METHODS AND RESULTS: We studied the relation of the dietary intake of
fish and mercury, as well as hair content and urinary excretion of mercury, to the risk of acute myocardial
infarction (AMI) and death from CHD, cardiovascular disease (CVD), and any cause in 1833 men aged 42 to
60 years who were free of clinical CHD, stroke, claudication, and cancer. Of these, 73 experienced an AMI in
2 to 7 years. Of the 78 decreased men, 18 died of CHD and 24 died of CVD. Men who had consumed local
nonfatty fish species had elevated hair mercury contents. In Cox models with the major cardiovascular risk
factors as covariates, dietary intakes of fish and mercury were associated with significantly increased risk of
AMI and death from CHD, CVD, and any death. Men in the highest tertile (> or = 2.0 micrograms/g) of hair
mercury content had a 2.0-fold (95% confidence interval, 1.2 to 3.1; P = .005) age- and CHD-adjusted risk of
AMI and a 2.9-fold (95% CI, 1.2 to 6.6; P = .014) adjusted risk of cardiovascular death compared with those
with a lower hair mercury content. In a nested case-control subsample, the 24-hour urinary mercury excretion
had a significant (P = .042) independent association with the risk of AMI. Both the hair and urinary mercury
associated significantly with titers of immune complexes containing oxidized LDL. CONCLUSIONS: These
data suggest that a high intake of mercury from nonfatty freshwater fish and the consequent accumulation of
mercury in the body are associated with an excess risk of AMI as well as death from CHD, CVD, and any
cause in Eastern Finnish men and this increased risk may be due to the promotion of lipid peroxidation by
mercury.”
Sato K, Kusaka Y, Yanagihara M , Ueda K, Mori T & Miyakoshi S. :An epidemiological study of factors
relating to mercury sensitization: Arerugi 44(2):86-92 (1995) (In Japanese with Engl abstr)
ABSTRACT: “We investigated factors relating to mercury sensitization in 156 medical students (mean age
22.7 +/- 2.4, mean +/- S.D., male 113, female 43). Their allergic symptoms, lifestyles and family histories were
studied by questionnaire. Patch tests were performed on them with HgCl2 (0.05%aq.), NiSO4 (5%aq.), PPD
(2%pet.) and urushiol (0.01%pet.). Anti-dermatophagoides and anti-cryptomeria pollen IgE antibodies in serum
were also measured. While the positive rates of urushiol, nickel and PPD were 11.1%, 5.1% and 2.6%,
respectively, that of mercury was as high as 12.8%. Each allergen specific antibody positivity and past
histories of allergic diseases were not associated with mercury sensitization (by the chi-square test). Mercury
sensitized students had significantly more frequently experienced eczema caused by cosmetics, shampoos,
soaps and haircreams (by the chi-square test, p < 0.005). They also had significantly more teeth treated with
metals compared to the controls (one-tailed t-test, p <0.05). And their urinary mercury concentrations were
significantly higher than those of the controls (one-tailed t-test, p < 0.05). These findings suggest that mercury
sensitization is associated with exposure to mercury in the living environment.”
Saxe SR, Snowdow DA, Wekstein MW, Schmitt FA & Wekstein DR. Amalgam and Elderly Mental Function.
J Dent Res 74:75 AADR Abstract 510 (1995)
ABSTRACT: “Dental amalgam restoration surfaces release mercury (Hg), a neurotox, when mildly abraded
such as from chewing. Possible neuropsychological effects of such Hg relese have been alluded to but have
not been well assessed. This study investigated whether a relationship exists between number and surface
area of occlusal amalgam restorations and cognitive function in older women. Catholic sisters (nuns) (n=122)
aged 75-102 years who lived in the same residential complex with an on-site dental office were given a
selected battery of 8 standarized neuropsychological tests. Number and surface area of occlusal amalgams
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were determined using bite registrations, an intra-oral video camera and a Kontron image analyzer computer
system. Of the 122 sisters, 22 were dentate but had no amalgam (Grp. I) who were compared to 27
edentulous (Grp.II), 43 with 1 to 99 sq. mm of occlusal amalgam surface (Grp III) and 30 with 100 or greater
sq. mm (Grp. IV). Age and education-adjusted differences in Word Recall outcome scores showed that
compared to Grp. I, Grp. II was 1.3 (95% CI -0.3,2.9) p=0.12; Grp. III was 0.6 (Cl -1.0,2.2) p=0.43; Grp. IV
was 1.1 (Cl -0.6,2.9) p=0.20. Remaining tests also showed no adverse effects in grps. II, III and IV. The older
women studied showed no difference in mental function testing regardsless of the presence and extent of
occlusal surface amalgam.”
Skare I. Mass Balance and Systemic Uptake of Mercury Released from Dental Amalgam Fillings. Water, air,
and soil pollution 80(1-4):59-67 (1995)
ABSTRACT: “The release of mercury (Hg) from dental amalgam fillings has been verified by several
authors. In this study, the emission rate of Hg0-vapor from the oral cavity (O-Hg) and the urinary Hg-
excretion rate (U-Hg) have been studied with 34 healthy individuals. In ten cases, the urinary excretions of
silver (U-Ag) and the fecal excretions of Hg and Ag (F-Hg, F-Ag) were also monitored. All variables, except
U-Ag, were significantly related to the load of amalgam. According to this study, an individual with a moderate
lode of amalgam, i.e. 30 restored surfaces, is predicted to exhibit the following emission rates: O-Hg=22, U-
Hg=3, F-Hg=60 and F-Ag=27 ug/d (d=24 hours), consistent with a gross mass balance for Hg of
approximately 60 ug/d. The corresponding systemic uptake of Hg was estimated to 12 ug/d based on external
data relating air Hg0-exposures to urinary Hg-excretions. The worst case individual showed a gross mass
balance of 200 ug Hg/d connected to a systemic uptake of 70 ug Hg/d. These values were compared to the
average intake of total-Hg by a Swedish diet (2 ug/d) and to the WHO’s tolerable value for intake of total Hg
by food (45 ug/d). Upscaled to the entire Swedish population (8 mill.), the data suggests a fecal/urinary
emission to the environment of 100 kg Hg yearly originating from a population load of amalgam fillings
containing 90,000 kg of Hg.”
Smart ER, Macleod RI & Lawrence CM. Resolution of lichen planus following removal of amalgam
restorations in patients with proven allergy to mercury salts: a pilot study. Br Dent J 178(3):108-112 (1995)
ABSTRACT: “Thirteen patients with symptomatic oral lichen planus had been shown by patch testing to be
allergic to ammoniated mercuric chloride. Replacement of amalgam restorations in these patients effected an
improvement in all but one case. In some cases the resolution of symptoms was dramatic following the
replacement of one or two fillings. The authors feel that the removal of all amalgam fillings need not be
necessary except in the most intractable case.”
Soederstroem S, Fredriksson A, Dencker L & Ebendal T. The effect of mercury vapour on cholinergic
neurons in the fetal brain: studies on the expression of nerve growth factor and its low- and high-affinity
receptors. Developmental Brain Research 85(1):96-108 (1995)
ABSTRACT: “The effects of mercury vapour on the production of nerve growth factor during development
have been examined. Pregnant rats were exposed to two different concentrations of mercury vapour during
either embryonic days E6-E11 (early) or E13-E18 (late) in pregnancy, increasing the postnatal concentration of
mercury in the brain from 1 ng/g tissue to 4 ng/g tissue (low-dose group) or 11 ng/g (high-dose group). The
effect of this exposure in offspring was determined by looking at the NGF concentration at postnatal days 21
and 60 and comparing these levels to age-matched controls from sham-treated mothers. Changes in the
expression of mRNA encoding NGF, the low- and hogh-affinity receptors for NGF (p75 and p140 trk,
respectively) and choline acetyltransferase (ChAT) were also determined. When rats were exposed to high
levels of mercury vapour during early embryonic development there was a significant (62%) increase in
hippocampal NGF levels at P21 accompanied by a 50% decrease of NGF in the basal forebrain. The
expression of NGF mRNA was found to be unaltered in the dentate gyrus. The expression of p75 mRNA was
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significantly decreased to 39% of control levels in the diagonal band of Broca (DB) and to 50% in the medial
septal nucleus (MS) whereas no alterations in the level of trk mRNA expression were detectable in the basal
forebrain. ChAT mRNA was slightly decreased in the DB and MS, significantly in the striatum. These findings
suggest that low levels of prenatal mercury vapour exposure can alter the levels of NGF and its receptors,
indicating neuronal damage and distributed trophic regulations during development.”
Stoz F, Aicham P, Janovic S, Steuer W & Mayer R. Ist ein generelles Amalgam-Verbot gerechtfertigt?
Untersuchungen an M:uttern und ihren Neugeborenen. (Is a generalized amalgam ban justified? Studies of
mothers and their newborn infants) Z Geburtshilfe Perinatol 199(1):35-41 (1995) (In German with Engl Abstr)
ABSTRACT: “To measure the Hg-contamination from amalgam as well as other exposures to mothers and
their newborns 185 women with tooth filling surfaces from 0 to 780 mm2 were examined. The Hg-values of
mother and child at a time showed a highly significant correlation with a median value from 0.4 resp. 0.5
microgram/Hg/l. Obviously, the placenta has a retention capability with up to 10 times higher Hg-values and a
low positive correlation to the amalgam surfaces. There was no relationship between the blood values of the
women and the children and the size of the surfaces of the amalgam fillings. Opposite to this a high
consumption of fish led to higher Hg-values in the umbilical cord blood, this even in children with mothers
without amalgam fillings. Other exposures through working conditions (i.e. dental assistant) or living
environment did not lead to higher values. Symptoms of diseases such as headaches, allergies, eczemas
appeared with those patients who had amalgam fillings as well as those in the group without amalgam fillings.
All women gave birth to healthy children. With all necessary caution concerning contamination with heavy
metals during pregnancy some of today’s panic inducing portrayals do not seem justified.”
Tandon L, Kasarskis EJ & Ehmann WD. Elemental imbalance studies by INAA on extraneural tissues from
amyotrophic lateral sclerosis patients. J Radioanal Nuclear Chem 195(1):13-19 (1995)
ABSTRACT: “Human kidney and liver tissues were studied for generalized elemental imbalances in
amyotrophic lateral sclerosis (ALS) by instrumental neutron activation analysis (INAA). Iron was significantly
increased (p < 0.05) in ALS kidneys and Co and Fe(marginal, p < 0.10) were increased in ALS liver compared
with their respective controls. Mercury values were almost two-fold higher for ALS kidney and 17% higher
for ALS liver as compared with their respective controls. However, the Hg data exhibited large variations and
ALS-control differences were not significant. Data from the present study are discussed with reference to the
role of metallothioneins (MT) in ALS, and a possible linkage between a free radical mediated mechanism and
degeneration of cells in ALS is also explored.”
Tibbling L, Thuomas K-A, Lenkei R & Stejskal V. Immunological and brain MRI changes in patients with
suspected metal intoxication. Int J Occup Med Toxicol 4(2):285-294 (1995)
ABSTRACT: “ Thirty-four patients with CNS and systemic symptoms suggestive of intoxication from dental
amalgam were examined with magnetic resonance imaging (MRI) of the brain (n=32) and with a Memory
Lymphocyte Immuno Stimulation Assay, MELISA, (n=17). Lymphocyte phenotype was analysed with flow
cytometry (FC) in 22 of the patients. One hundred twenty age-matched patients without CNS symptoms
served as controls for the MRI study, seventy-seven healthy subjects with dental amalgam fillings served as
controls for the MELISA test, and seventy-five clinically healthy subjects were controls for lymphocyte
phenotype determination. Pathological MRI findings were found in 81 % of the patients, most of them with
signs of degeneration in the basal ganglia, but in none of the controls. The lymphocyte phenotype determination
was pathological in 58 %. The MELISA showed pathological findings in 88 % of which 60 % with immune
reactions to mercuric chloride. 62 % of the patients had some kind of atopic disease. 35 % suffered from
levothyroxine-treated hypothyreosis. A high rate of immunopathies and objective signs of immunological
reactions in the majority of the patients with MRI changes in the brain suggests that immunological
mechanisms may play an important role in the development of the lesions.”
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Tulinius AV. Mercury-dental amalgam fillings and intellectual abilities in Inuit school children in Greenland. Arct
Med Res 54(2):78-81 (1995)
ABSTRACT: “The hair mercury concentration of 125 Greenland pupils aged 12 to 17 was recorded and
compared with the pupils’ marks in selected school subjects. Mercury values ranged from 0.2 to 15.9
microgram per gram (ug/g) and 20% of the pupils had more than 6 ug/g. There was no correlation between a
high mercury concentration score and poor results in school. Correlation of the number of dental amalgam
fillings with mercury concentration showed a weak but no significant relation. Eating habis were significantly
correlated with mercury concentration. Girls had a significantly higher number of amalgam fillings than boys,
and had a significantly higher mercury concentration. Modern Inuit and the mummified Qilaqitsoq Inuit from
the 15th century had largely identical levels of mercury in the hair irrespective of today’s higher exposure to
global environmental contamination. This is believed to result from a change in eating habits away from the
traditional Greenland food towards a more continental diet.”
Warfvinge K, Hansson H & Hultman P. Systemic autoimmunity due to mercury vapor exposure in genetically
susceptible mice: dose-response studies. Toxicol Appl Pharmacol 132(2):299-309 (1995)
ABSTRACT: “Six groups of genetically mercury-suspectible female SJL/N (H-2(5)) mice were exposed to
mercury vapor at a concentration of 0.3-1.0 mg Hg/m3 air for 0.5-19 hr/day 5 days a week for 10 weeks. The
absorbed doses calculated to be between 75 and 2365 ug Hg/week/kg body wt (ug Hg/week/kg). The
correlation between the dose and the concentration of Hg in Kidney, spleen, and thymus was significant (p
<0.0001; Spearman’s rank correlation test). The lowest observed adverse effect level (LOAEL) for serum
IgG antinuclear antibodies (ANoA) was 170 ug Hg/week/kg, corresponding to a renal mercury concentration
of 4.0+/-0.76 ug Hg/g wet wt. The correlation between the absorbed dose and the ANoA titer was highly
significant (p <0,0001; Spearmen’s rank correlation test), and all mice were ANoA-positive at a dose of 480 ug
Hg/week/kg. High-titer ANoA targeted the nucleolar 34-kDa protein fibrillarin. The LOAEL for B-cell
stimulation, measured as an increase in serum IgG2a and IgG1 concentrations, was 360 ug Hg/week/kg, but
the increase was fivefold higher and also included IgE at a dose of 690 to 2365 ug Hg/week/kg. The serum Ig
concentrations peaked after 2-4 weeks and then slowly declined but, except for IgE, remained significantly
increased during the entire exposure time. Glomerular, mesangial IgG immune complex (IC) deposits,
accompanied by systemic vessel wall IC deposits, were first detected at a dose of 480 ug Hg/week/kg, The
mesangium also showed increased titers of IgM IC deposits and complement factor C3c. The correlation
between the absorbed dose, and the individual titer of IgG, IgM, and C3c, was highly significant (p <0.0001;
Spearmen’s rank correlation test). In conclusion, mercury vapor efficiently induced an autoimmune syndrome
in genetically suceptible mice, and the LOAEL for adverse effects varied in the order ANoA < B-cell
stimulation < IC deposits. Comparing the body burden of mercury in mice at the LOAEL for autoantibodies
with the body burden in populations of occupationally exposed humans suggests that the safety margin may be
narrow for genetically suspectible individuals.”
Zaichick VYe, Tsyb AF & Vtyurin BM. Trace elements and thyroid cancer. Analyst 120(3):817-821 (1995)
ABSTRACT: “To evaluate the importance of trace amounts of elements in thyroid cancer etiology and
diagnostics, instrumental neutron activation analysis has been used to estimate Ag, Co, Cr, Fe, Hg, I,Rb, Sb, Sc,
Se, and Zn concentrations in malignant and benign thyroid nodules as well as in apparently intact paranodular
thyroid tissue. Resected material from 135 patients was obtained from operations. Forty-five cancer cases
were diagnosed and the rest were of benign nodules. The thyroid glands of 65 people, 53 male and 12 female,
who died and unexpected death or committed suicide, were used as a control group. Trace element contents of
the International Atomic Energy Agency reference material H-4 (animal muscle) were analysed simultaneously
with the thyroid tissue in order to evaluate the accuracy of the obtained data. No dependence of trace element
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contents on sex and age (14-80 years) was found for normal thyroids. In paranodular tissue, the Ag, Co, Hg, I
and Rb contents were much higher for malignant and benign nodules than they were for the standard. There was
also a slight deficiency of Se in the nodules compared with the standard. This result supports the hypothesis that
the direct toxic heavy metal influence on thyrocytes plays a major role in thyroid cancer etiology, provided that an
adequate level of the defence mechanisms is absent. Iodine concentrations are 15 times lower, on average, in
malignant compared with benign nodules. It is also shown that the radio between the iodine concentration in
nodular and paranodular tissue can be used for in vivo thyroid cancer diagnostics.”
