Toxic mercury/mercury amalgam use in dentistry: review and evaluation of curriculum in dental teaching institutions of Pakistan

Toxic mercury/mercury amalgam use in dentistry: review and evaluation of curriculum in dental teaching institutions of Pakistan

Keeping in view the toxicity and hazardousness of mercury and its various products, recently, under the United Nation Environmental Program (UNEP), “Minamata Convention on Mercury” has been in-acted by over 140 countries to reduce/phase out mercury use globally. It has been already signed by 94 countries (including Pakistan) in October 10th, 2013 at Kumamoto, Japan. In Minamata convention on mercury, annex 2 describes the provisions for mercury added products, like mercury amalgam. Among others, measures to be taken by a party to the Minamata convention include “Encouraging representative professional organisations and dental schools to educate and train dental professional and students on the use of mercury-free dental restoration alternatives and on promoting best management practices”.

Very few investigations on mercury related issues have been reported in Pakistan. According to preliminary reported data in 2009, the estimated maximum and minimum emission and transfer of mercury in Pakistan is about 36,900 and 10,800 kg per year, respectively. At present, there is no mercury specific legislation in the country.

In a recent study by the Sustainable Development Policy Institute, mercury monitoring in air was carried out at selected dental sites in five main cities of Pakistan. The study finds that:

  • an uneven education with serious omissions, regarding the use of mercury amalgam in operative dentistry is going on at dental teaching institutions in the country
  • offered curriculum does not address the main mercury related issues or the control measures, resulting from mercury/mercury amalgam use in dentistry, such as occupational health, safety, environment and mercury contaminated wastes
  • the present curriculum does not effectively lead outgoing future dental professionals and provide information, knowledge and training on these mercury/mercury amalgam related human health issues

To minimise the observed alarmingly very high mercury vapours contamination of air at dental sites due to mercury/mercury amalgam use and to prevent health hazards resulting from mercury exposure to public in general and health workers, children and pregnant women in particular, the study recommends that:

  • for adequate teaching and training of students, immediate review of the existing curriculum and inclusion of relevant contents in the revised curriculum, to provide information with emphasis to the following:
    • brief on the need, objectives and the relevant provisions of “Minamata Convention on Mercury,” regarding mercury in products (dental amalgam), health and environment
    • toxicity and health hazards resulting from mercury/mercury amalgam use, protection and control measures for the same, to minimise mercury exposure and guidelines for mercury contaminated waste management
    • cost and clinically effective mercury-free alternatives to mercury amalgam filling, such as composites and glass ionomers,; use of encapsulated mercury methodology and mechanised mixing
    • occupational health and safety; use of best in-house environmental practices at dental facilities, to reduce mercury exposure and releases to air, water and land
  • Minamata convention on mercury be signed and ratified by national governments including Pakistan (already signed) and accordingly, measures be taken by parties to the convention, to phase down the use of mercury/dental mercury amalgam in their respective countries, leading to its elimination at the earliest time possible
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