Man's mercury loading from a dental amalgam

The release of mercury from an amalgam surface in natural saliva during cyclic loading, as well as under static conditions, simulating the clinical conditions of chewing and rest, has been studied using a nuclear tracer technique. Cyclic loading strongly promoted degradation of the amalgam surface in the saliva environment. Corrosion products were found to be loosely bound on the amalgam surface and could be removed by brushing similar to toothbrushing. Most of the mercury released from the surface was present in amalgam particles, produced during the cyclic loading procedure. The daily release of ionic mercury was estimated to be approximately 3 micrograms/cm2, according to the model experiment. Extrapolating the present findings to clinical conditions, man's ionic mercury intake from dental restorations may be at the same level as the total mercury intake from food and drink.     

Mercury recovery in situ of four different dental amalgam separators

Amalgam separators are used to physically remove dental amalgam from waste water in dental clinics. They are thereby supposed to reduce mercury (Hg) emissions to the municipal waste water system to acceptable levels. We here present results from a comparative study in situ of three amalgam separators available on the market, all with a claimed efficiency of 99% according to Danish and ISO protocols, and using sedimentation as the principle of separation. We also present corresponding data for an investigational prototype of an improved separator. The obtained efficiency of the three commercial separators is far below what is stated by the manufacturer and by authorities assumed to be the efficiency in clinical conditions. They reduced Hg emissions by 79 - 91%, leaving an average Hg content in outgoing waste water of 1.5 mg L(-1). However, the prototype separator participating in this study retained 99.9% of the waste water Hg emissions, leaving an average Hg content in outgoing waste water of 0.004 mg L(-1). Physical restrictions prohibit sedimentary type separators to recover the Hg fractions causing the largest damages in wastewater treatment plants. This fraction is not considered in the ISO protocol for testing amalgam separators, which therefore needs to be revised. Abolishing the use of dental amalgam and cleaning the tubing systems is the most efficient long-term solution to reduce Hg emissions from dental clinics. Until then, Hg emissions originating from placing, polishing or removing existing amalgam fillings, should be counteracted by the use of low-emission amalgam separators, already on the market or presently being developed for use alone or together with sedimentary type amalgam separators.     

The relationship between mercury from dental amalgam and the cardiovascular system

The findings presented here suggest that mercury poisoning from dental amalgam may play a role in the etiology of cardiovascular disorders. Comparisons between subjects with and without amalgam showed amalgam-bearing subjects had significantly higher blood pressure, lower heart rate, lower hemoglobin, and lower hematocrit. Hemoglobin, hematocrit, and red blood cells were significantly lower when correlated to increased levels of urine mercury. The amalgam subjects had a greater incidence of chest pains, tachycardia, anemia, fatigue, tiring easily, and being tired in the morning. The data suggest that inorganic mercury poisoning from dental amalgam does affect the cardiovascular system.     

Release of mercury from dental amalgam and its influence on salivary antioxidant activity

Dental amalgam fillings are known to release significant amounts of mercury (Hg) in saliva which could represent a continuous source of oxidative damage to mouth tissues. The present investigation was aimed at verifying this hypothesis by determining a possible correlation between salivary Hg levels and salivary total antioxidant activity (TAA), which is used as an index of oxidative stress. Samples of saliva from 34 healthy donors were analyzed for Hg content, by vapor atomic absorption spectrometry, and for TAA, by determining the ferric reducing ability ('FRAP' method). A significant correlation between Hg and the number of amalgam restorations or total amalgam surface was evident in both the male and female subjects. A significant negative correlation between TAA and Hg levels or number of amalgam restorations or amalgam surface was evident in females, indicating that small increases in salivary Hg were sufficient to produce a decrease in salivary TAA. On the other hand, no significant correlation was found in the males. The present study provides, for the first time, evidence of a pro-oxidant role of the amalgam Hg chronically released in saliva.     

Comparison of chlorine and chloramine in the release of mercury from dental amalgam

The purpose of this project was to compare the ability of chlorine (HOCl/OCl⁻) and monochloramine (NH₂Cl) to mobilize mercury from dental amalgam. Two types of amalgam were used in this investigation: laboratory-prepared amalgam and samples obtained from dental-unit wastewater. For disinfectant exposure simulations, 0.5 g of either the laboratory-generated or clinically obtained amalgam waste was added to 250 mL amber bottles. The amalgam samples were agitated by end-over-end rotation at 30 rpm in the presence of 1 mg/L chlorine, 10 mg/L chlorine, 1 mg/L monochloramine, 10 mg/L monochloramine, or deionized water for intervals of 0 h, 2 h, 4 h, 8 h, and 24 h for the clinically obtained amalgam waste samples and 4 h and 24 h for the laboratory-prepared samples. Chlorine and monochloramine concentrations were measured with a spectrophotometer. Samples were filtered through a 0.45 µm membrane filter and analyzed for mercury with USEPA standard method 245.7. When the two sample types were combined, the mean mercury level in the 1 mg/L chlorine group was 0.020 mg/L (n = 25, SD = 0.008). The 10 mg/L chlorine group had a mean mercury concentration of 0.59 mg/L (n = 25, SD = 1.06). The 1 mg/L chloramine group had a mean mercury level of 0.023 mg/L (n = 25, SD = 0.010). The 10 mg/L chloramine group had a mean mercury level of 0.024 mg/L (n = 25, SD = 0.011). Independent samples t-tests showed that there was a significant difference between the natural log mercury measurements of 10 mg/L chlorine compared to those of 1 mg/L and 10 mg/L chloramine. Changing from chlorine to chloramine disinfection at water treatment plants would not be expected to produce substantial increases in dissolved mercury levels in dental-unit wastewater.     

Blood mercury following DMPS administration to subjects with and without dental amalgam

The use of DMPS as a diagnostic tool in patients with symptoms allegedly caused by mercury from dental amalgam fillings is disputed. We have previously shown that the mercury concentrations in urine cannot be used in such a way. In the present study, we wished to evaluate the effect on blood mercury levels (B-Hg) following intravenously injected DMPS in four groups of subjects: 19 controls without amalgam experience; 21 healthy controls with amalgam fillings; 20 patients with self-reported symptoms from existing dental amalgams; and 20 patients who had removed amalgam fillings. A single dose of DMPS (2 mg/kg) was injected. Blood samples were collected prior to the injection and after 15, 30, 120 min, and after 24 h, and mercury was analyzed by cold vapor atomic absorption spectrophotometry. All groups showed an initial drop of 24 to 30% in the blood levels, approaching baseline values (2.5-5.5 microg/l) after 2 h. The subjects with no amalgam experience had the lowest mercury values. There was no significant difference between the three groups with such experience. There were no significant differences between the two groups with amalgam fillings present. Patients with symptoms allegedly caused by amalgam were not different from the control groups. There were indications that part of the urinary mercury excreted during the first 30 min originated from blood.     

Modelling of mercury emissions from background soils

Emissions of volatile mercury species from natural soils are believed to be a significant contributor to the atmospheric burden of mercury, but only order-of-magnitude estimates of emissions from these sources are available. The scaling-up of mercury flux measurements to regional or global scales is confounded by a limited understanding of the physical, chemical and biochemical processes that occur in the soil, a complex environmental matrix. This study is a first step toward the development of an air-surface exchange model for mercury (known as the mercury emission model (MEM)). The objective of the study is to model the partitioning and movement of inorganic Hg(II) and Hg(0) in open field soils, and to use MEM to interpret published data on mercury emissions to the atmosphere. MEM is a multi-layered, dynamic finite-element soil and atmospheric surface-layer model that simulates the exchange of heat, moisture and mercury between soils and the atmosphere. The model includes a simple formulation of the reduction of inorganic Hg(II) to Hg(0). Good agreement was found between the meteorological dependence of observed mercury emission fluxes, and hourly modelled fluxes, and it is concluded that MEM is able to simulate well the soil and atmospheric processes influencing the emission of Hg(0) to the atmosphere. The heretofore unexplained close correlation between soil temperature and mercury emission flux is fully modelled by MEM and is attributed to the temperature dependence of the Hg(0) Henry's Law coefficient and the control of the volumetric soil-air fraction on the diffusion of Hg(0) near the surface. The observed correlation between solar radiation intensity and mercury flux, appears in part to be due to the surface-energy balance between radiation, and sensible and latent heat fluxes which determines the soil temperature. The modelled results imply that empirical correlations that are based only on flux chamber data, may not extend to the open atmosphere for all weather scenarios.     

Does mercury from amalgam restorations constitute a health hazard?

Amalgam is the most extensively used implant material in dentistry. There have been no clinical trials of this substance and there are no epidemiological studies that allow any conclusions on the safety of amalgam fillings. Amalgam restorations continuously emit mercury vapour, which is absorbed in considerable quantities via the lungs. A comparison with dose-effect relationships, obtained in occupational studies, for certain effects on the kidneys and central nervous system (CNS), suggests that individuals with unusually high emission of mercury from amalgam fillings are at risk. It is unclear whether or not clinically significant effects could be expected. The limited sensitivity of available occupational studies, together with insufficient knowledge of possible host factors affecting resistance to mercury, implies that other more severe effects in susceptible individuals cannot be excluded. Information on long-term effects on organs other than brain or kidney is sparse. Animal studies suggest the possibility of immune system reactions to mercury, i.e. development of autoimmunity, that are not primarily dose-dependent, but rather depend on genetic susceptibility. From a toxicological point of view, amalgam is an unsuitable material for dental restorations.     

Steady-state transfer and depletion kinetics of mercury from amalgam fillings

In 29 volunteers with a low amalgam load, the number of amalgam-covered tooth surfaces and the occlusal area of the fillings were determined. Before and at select times after removal of all amalgams, concentrations of total mercury were measured by cold-vapor atomic absorption in plasma and erythrocytes as well as in urine together with the excretion rate. Absorbed daily doses were estimated from intraoral Hg emission by two separate methods. The transfer of Hg from the fillings via the oral cavity and blood to urinary excretion was evaluated according to the most representative combination of parameters. This consisted of occlusal area (1), absorbed dose (2), Hg concentration in plasma (3) and urinary excretion (4). Pairwise correlation coefficients were 0.49 for parameters 1 vs. 2, and 0.75 each for parameters 2 vs. 3 and 3 vs. 4. Within 9 days after removal of the fillings, a transient increase in Hg levels was observed in plasma only; in the group without a rubber dam, concentrations increased significantly above pre-removal values at days 1 and 3, whereas they decreased significantly below pre-removal values at day 30 in the rubber-dam group and at day 100 in both groups. Excretion rates decreased significantly at day 100 in the protected group. Peak plasma-Hg was 0.6 ng/ml on average at day 1 and decreased with halftimes of 3 and 43 days in subjects protected by a rubber dam. The results indicated that concentrations of total mercury in plasma responded rapidly to changes in the amalgam status and reflected the actual absorption most reliably. Notably, plasma-Hg levels were sensitive enough to detect a transient attenuation of the additional exposure after using a rubber dam during the removal of only a few fillings. However, being small in magnitude and lasting 100 days at best, the rubber-dam effect had minor toxicological relevance.     

Influence of the temperature, volume and type of solution in the mercury vaporization of dental amalgam residue

One of the qualitative methods for the identification of mercury vapor is what it occurs as a way of chemical reaction between palladium chloride and metallic mercury. Palladium chloride ribbons with yellowish coloration put in contact with the vaporized mercury of dental amalgam residue, liberates palladium and forms mercury chloride in your surface, and starts to have black coloration; this form identify the presence of the mercury vapor in the system. This work studies the influence of temperature, volume and type of barrier-solution in the vaporization of mercury during the period of storage of dental amalgam residues, aiming to establish the best conditions for storage of these residues. It was found that for all tested solutions, the longest storage times without any occurrence of mercury vaporization were obtained in the lowest temperatures tested and the largest solution volumes of barrier-solution. The radiographic effluent presented bigger efficacy in the reduction of the volatilization, increasing the period when the residue was stored, however the analysis of this solution after the vaporization test showed the presence of organic mercury. These results show that water is the most efficient barrier against the vaporization of mercury, since it did not result in organic mercury formation in the effluent solution from the storage process.     

Urinary mercury in people living near point sources of mercury emissions

As part of the European Mercury Emissions from Chlor Alkali Plants (EMECAP) project, we tested the hypothesis that contamination of ambient air with mercury around chlor alkali plants using mercury cells would increase the internal dose of mercury in people living close to the plants. Mercury in urine (U-Hg) was determined in 225 individuals living near a Swedish or an Italian chlor alkali plant, and in 256 age- and sex-matched individuals from two reference areas. Other factors possibly affecting mercury exposure were examined. Emissions and concentrations of total gaseous mercury (TGM) around the plants were measured and modeled. No increase in U-Hg could be demonstrated in the populations living close to the plants. This was the case also when the comparison was restricted to subjects with no dental amalgam and low fish consumption. The emissions of mercury to air doubled the background level, but contributed only about 2 ng/m(3) to long-term averages in the residential areas. The median U-Hg levels in subjects with dental amalgam were 1.2 microg/g creatinine (micro/gC) in Italy and 0.6 microg/gC in Sweden. In individuals without dental amalgam, the medians were 0.9 microg/gC and 0.2 microg/gC, respectively. The number of amalgam fillings, as well as chewing, fish consumption, and female sex were associated with higher U-Hg. The difference between the countries is probably due to higher fish consumption in Italy, demethylated methyl mercury (MeHg) being partly excreted in urine. Post hoc power calculations showed that if the background mercury exposure is low it may be possible to demonstrate an increase in U-Hg of as little as about 10 ng/m(3) as a contribution to ambient mercury from a point source.     

Assessment of atmospheric mercury emissions in Finland

This paper is part of the study of atmospheric emissions of heavy metals conducted by the Finnish Environment Institute in collaboration with the Technical Research Centre of Finland (VTT) under the umbrella of the Finnish Ministry of the Environment. The scope of our study is limited solely to anthropogenic mercury that is emitted directly to the atmosphere. This article addresses emission factors and trends of atmospheric mercury emissions during the 1990s and is based mainly on the database of the Finnish Environmental Administration. In addition, data based on the measurements taken by the VTT regarding emission factors have been used to estimate emissions of mercury from the incineration of waste. The study indicates that the total emission of mercury has decreased from 1140 kg in 1990 to 620 kg in 1997, while industrial and energy production have been on the increase simultaneously. The 45% emission reduction is due to improved gas cleaning equipment, process changes, automation, the installation of flue gas desulfurization process in coal-fired power plants and strict pollution control laws. In the past, some authors have estimated a higher mercury emission in Finland. In this study, it is also observed that there are no big changes in the quality of raw materials. Estimated emission factors can be of great help to management for estimating mercury emissions and also its risk assessment.     

Mercury exposure and risks from dental amalgam in the US population, post-2000

Dental amalgam is 50% metallic mercury (Hg) by weight and Hg vapour continuously evolves from in-place dental amalgam, causing increased Hg content with increasing amalgam load in urine, faeces, exhaled breath, saliva, blood, and various organs and tissues including the kidney, pituitary gland, liver, and brain. The Hg content also increases with maternal amalgam load in amniotic fluid, placenta, cord blood, meconium, various foetal tissues including liver, kidney and brain, in colostrum and breast milk.Based on 2001 to 2004 population statistics, 181.1 million Americans carry a grand total of 1.46 billion restored teeth. Children as young as 26 months were recorded as having restored teeth. Past dental practice and recently available data indicate that the majority of these restorations are composed of dental amalgam.Employing recent US population-based statistics on body weight and the frequency of dentally restored tooth surfaces, and recent research on the incremental increase in urinary Hg concentration per amalgam-filled tooth surface, estimates of Hg exposure from amalgam fillings were determined for 5 age groups of the US population.Three specific exposure scenarios were considered, each scenario incrementally reducing the number of tooth surfaces assumed to be restored with amalgam. Based on the least conservative of the scenarios evaluated, it was estimated that some 67.2 million Americans would exceed the Hg dose associated with the reference exposure level (REL) of 0.3 μg/m³ established by the US Environmental Protection Agency; and 122.3 million Americans would exceed the dose associated with the REL of 0.03 μg/m³ established by the California Environmental Protection Agency.Exposure estimates are consistent with previous estimates presented by Health Canada in 1995, and amount to 0.2 to 0.4 μg/day per amalgam-filled tooth surface, or 0.5 to 1 μg/day/amalgam-filled tooth, depending on age and other factors.     

Binding and mobility of mercury in soils contaminated by emissions from chlor-alkali plants

Chlor-alkali plants are known to be an important source of Hg emissions to the atmosphere and related contamination of soils in their vicinity. In the present study, the results of Hg speciation and mobility of Hg in soils affected by Hg emissions from three chlor-alkali plants are compared. Solid phase mercury speciation analyses was carried out using a mercury-thermo-desorption technique with the aim of distinguishing elemental Hg [Hg(0)] from Hg(II)-binding forms. Mercury species in soil leachates were distinguished using an operationally defined method, which is based on the reactivity of soluble Hg compounds. Results show that the Hg(0) emitted from the plants could not be detected in any of the investigated soils. This indicates quantitative re-emission or oxidation of this Hg species in the atmosphere or soils. In most soils Hg was predominately bound to organic matter. Only in sandy soils deficient in organic matter was Hg, to a larger extent, sorbed onto mineral soil components. Leachable Hg in most soils occurred as non-reactive, soluble organic Hg complexes such as fulvic acid-bound Hg, and reach their highest values (90 microg kg(-1)) in soils rich in organic matter. Concentrations of reactive, soluble Hg compounds were highest in sandy soils where the content of organic matter was low. Leachability of Hg was found to be inhibited in soils with a high content of clayey soil components. The distribution of Hg in soil profiles suggests that migration of Hg to deeper soil layers (approx. 20 cm) is most effective if Hg is bound to soluble organic complexes, whereas reactive Hg or weak Hg complexes are effectively retained in the uppermost soil layer (5 cm) through sorption on mineral surfaces.     

Risk of respiratory exposure of dental personnel to amalgam alternatives

Although the use of alternatives to dental amalgam is increasing, the possible hazard associated with their occupational exposure has received inadequate attention. The purpose of this study is to use available toxicological and environmental information in a qualitative risk assessment to address potential health hazards associated with exposure to these materials by dental personnel. The members of dental profession should be aware of risk due to long-term exposure to dental materials.     

Sources and trends of environmental mercury emissions in Asia

This paper focuses on environmental mercury emissions in Asia and elaborates its probable trend in the future and associated implications given the anticipated socioeconomic outlook and other macro-environmental factors. Among the various regions, Asia has become the largest contributor of anthropogenic atmospheric Hg, responsible for over half of the global emission. In the next few decades, a significant increase in anthropogenic Hg emissions in Asia is likely owing to rapid economic and industrial development, unless drastic measures are taken. In particular, the dominance of Asia in some Hg-emitting industries, such as coal combustion, steel production and gold mining, provokes a serious environmental concern over their potential contributions of incidental Hg in the region. Moreover, the increasing prevalence of electrical and electronic manufacturing industry as a user and a contributor of Hg in Asia is also worrying. Specifically, disposal of obsolete electrical and electronic wastes represents a phenomenon increasingly encountered in Asia. In addition to escalating anthropogenic Hg emissions in Asia, associated environmental and health implications may also exacerbate in the region for the probable effects of a unique combination of climatic (e.g. subtropical climate), environmental (e.g. acid rain) and socioeconomic factors (e.g. high population density). Hence, much effort is still needed to understand the role of Asia in global Hg cycle and associated environmental and health effects in the region.     

Urine mercury levels and associated symptoms in dental personnel

Dental personnel are exposed to low concentrations of mercury vapor in their working environment and from their own amalgam fillings. This study included 505 occupationally exposed individuals working at 82 dental clinics in northern Sweden and 41 controls without occupational mercury exposure. The concentration of mercury in air was measured. Urine mercury was determined for all participants, who also answered a questionnaire focused on four symptoms known from the literature to be connected with mercury exposure, namely loss of appetite, tremor, insomnia and anxiety. The median value of mercury vapor in air in the dental surgeries was low compared with other investigations; 1.5 micrograms m-3 in public dental care and 3.6 micrograms m-3 in private dental care. The urine mercury concentrations (HgU) were low, and of the same order of magnitude as for the Swedish population as a whole. Median values among different groups of dental personnel ranged from 1.4 to 2.9 nmol Hg/mmol creatinine. For those occupationally exposed, the load from their own amalgam fillings was estimated to be of the same order of magnitude as from the working environment. The prevalence of any of the four symptoms investigated in the groups of exposed personnel and controls as low, less than or equal to 11%. In our study, which included mercury intakes up to twice the contribution from amalgam fillings, no increase in the prevalence of symptoms could be detected in relation to mercury concentrations in urine.     

Mercury (Hg) burden in children: the impact of dental amalgam

The risks and benefits of using mercury (Hg) in dental amalgam have long been debated. This study was designed to estimate Hg body burden and its association with dental amalgam fillings in 182 children (ages: 5-15 years) living in Taif City. Hg was measured in urine (UHg), hair (HHg) and toenails (NHg) by the Atomic Absorption Spectrophotometer with Vapor Generator Accessory system. Urinary Hg levels were calculated as both micrograms per gram creatinine (μg/g creatinine) and micrograms per liter (μg/L). We found that children with amalgam fillings (N = 106) had significantly higher UHg-C levels than children without (N = 76), with means of 3.763 μg/g creatinine versus 3.457 μg/g creatinine, respectively (P = 0.019). The results were similar for UHg (P = 0.01). A similar pattern was also seen for HHg, with means of 0.614 μg/g (N = 97) for children with amalgam versus 0.242 μg/g (N = 74) for those without amalgam fillings (P = 0). Although the mean NHg was higher in children without amalgam (0.222 μg/g, N = 61) versus those with (0.163 μg/g, N = 101), the relationship was not significant (P = 0.069). After adjusting for many confounders, the multiple logistic regression model revealed that the levels of UHg-C and HHg were 2.047 and 5.396 times higher, respectively, in children with dental amalgam compared to those without (P < 0.01). In contrast, a significant inverse relationship was seen between NHg levels and dental amalgam fillings (P = 0.003). Despite the controversy surrounding the health impact of dental amalgam, this study showed some evidence that amalgam-associated Hg exposure might be related with symptoms of oral health, such as aphthous ulcer, white patches, and a burning-mouth sensation. Further studies are needed to reproduce these findings. The present study showed that significant numbers of children with or without amalgam had Hg levels exceeding the acceptable reference limits. The detrimental neurobehavioral and/or nephrotoxic effects of such an increased Hg on children should be a cause of concern, and further investigation is warranted. Our results are alarming and indicate an urgent need for biomonitoring and assessment of exposure. Changes in dental practices involving amalgam, especially for children, are highly recommended in order to avoid unnecessary exposure to Hg.