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“Silver amalgam alloy has been used as a dental restorative material since the beginnings of restorative dentistry. It rose as an easily manipulated and low cost material in comparison to other restorative techniques of the time, but it had poor dimensional stability and clinical behavior. Successive research led to the standardization of both its composition and some aspects of its mechanical properties, which have contributed to its widespread acceptance. Nevertheless, the risk of environmental toxicity generated by mercury and its poor esthetics have given rise to the search for alternative and more promising materials. This article endeavors to give a brief historical description of the main events which have led to development of modern silver amalgam alloys.

SIGNIFICANCE:

It is concluded that extensive knowledge of the use of silver amalgam alloy has made it the most widely used restorative material for the posterior oral cavity. However, in recent years its preponderance has been brought into question even though some innovative ideas have been suggested which could help improve this material in the future.”

“OBJECTIVE:

The objective of this investigation was to carry out residual mercury (Hg) determinations and toxicity characteristic leaching procedure (TCLP) analysis of used amalgam capsules.

METHODS:

For residual Hg analysis, 25 capsules (20 capsules for one brand) from each of 10 different brands of amalgam were analyzed. Total residual Hg levels per capsule were determined using United States Environmental Protection Agency (USEPA) Method 7471. For TCLP analysis, 25 amalgam capsules for each of 10 brands were extracted using a modification of USEPA Method 1311. Hg analysis of the TCLP extracts was done with USEPA Method 7470A. Analysis of silver (Ag) concentrations in the TCLP extract was done with USEPA Method 6010B.

RESULTS:

Analysis of the residual Hg data resulted in the segregation of brands into three groups: Dispersalloy capsules, Group A, retained the most Hg (1.225 mg/capsule). These capsules were the only ones to include a pestle. Group B capsules, Valliant PhD, Optaloy II, Megalloy and Valliant Snap Set, retained the next highest amount of Hg (0.534-0.770 mg/capsule), and were characterized by a groove in the inside of the capsule. Group C, Tytin regular set double-spill, Tytin FC, Contour, Sybraloy regular set, and Tytin regular set single-spill retained the least amount of Hg (0.125-0.266 mg/capsule). TCLP analysis of the triturated capsules showed Sybraloy and Contour leached Hg at greater than the 0.2 mg/l Resource Conservation and Recovery Act (RCRA) limit.

SIGNIFICANCE:

This study demonstrated that residual mercury may be related to capsule design features and that TCLP extracts from these capsules could, in some brands, exceed RCRA Hg limits, making their disposal problematic. At current RCRA limits, the leaching of Ag is not a problem.”

“We determined levels of inorganic mercury (I-Hg) and methylmercury in placentas from 119 Swedish women, not selected with respect to high exposure of mercury. Our objective was to relate placental Hg species with maternal and fetal blood concentrations and to evaluate possible associations with selenium. We performed the analyses using automated alkaline solubilization/reduction and cold-vapor atomic fluorescence spectrophotometry. I-Hg levels in placenta increased with an increasing number of maternal dental amalgam fillings (p < 0.001). Despite placental accumulation (median, 1.3 microg/kg; range, 0.18-6.7 microg/kg wet weight), a substantial fraction of maternal blood I-Hg, probably as Hg(0), reached the fetus. Although MeHg transferred easily to the fetus, it also accumulated in the placenta. On average, 60% of placental Hg was in the form of MeHg. The median concentration was 1.8 microg/kg (range, 0-6.2 microg/kg wet weight), more than twice the maternal blood concentration. We found significant associations between MeHg and selenium in both maternal and umbilical cord blood but not in the placenta. The associations were particularly obvious in freshwater fish consumers, probably reflecting that fish is a source of both MeHg and selenium. We found no correlations between I-Hg and selenium. This study increases the understanding of Hg, in its different forms, in human placenta and how they are related to maternal and fetal exposure.”

“The results of a polycentric study to assess the reference values of urinary mercury (U-Hg) in four Italian cities are presented. A total of 383 subjects were selected on the basis of standardised criteria by a questionnaire on personal habits, lifestyle, occupational or non-occupational exposure to Hg, medical history, number and area of dental amalgams. U-Hg was determined by hydride generation atomic absorption method (HG-AAS), with a detection limit of 0.5 microg/l and by flow injection (FI) inductively coupled plasma mass spectrometry (ICP-MS), with a detection limit of 0.03 microg/l. The median value of U-Hg, determined by HG-AAS, was 0.78 microg/g creatinine (0.75 for males and 0.83 for females), with 5 degrees and 95 degrees percentiles, respectively, of 0.17 and 3.66 microg/g creatinine. When determined by FI ICP-MS, the median value was 0.79 microg/g creatinine (0.77 for males and 0.79 for females) with 5 degrees and 95 degrees percentiles of, respectively, 0.12 and 5.02 microg/g creatinine. Among the independent variables, city of origin, area of dental amalgams, fish intake and tobacco smoking significantly influenced the U-Hg levels. The U-Hg reference values from this survey are lower than those from other recent investigations, probably due to characteristics and selection of the examined individuals and to the strict control of pre-analytical and analytical factors of variability.”

“…removal of amalgam restorations from the non-allergic patient solely for the alleged purpose of removing toxic substances from the body, when such treatment is performed at the recommendation or suggestion of the dentist, is improper and unethical.”

OBJECTIVE:

To determine the amount of amalgam entering the waste stream during removal of dental amalgam restorations.

METHODS:

Dental amalgam restorations were removed from anatomic replica teeth and natural teeth by means of a tungsten carbide bur, a high-speed handpiece and a conventional suction system. The weight of amalgam particles trapped in the primary and secondary solids separators was determined. Amalgam particles were filtered from wastewater with 15-microm filter paper and weighed. The concentration of total mercury in the effluent collected (by instantaneous flow-through) during the removal of amalgams, with and without an ISO-certified separator, was measured by means of cold-vapour atomic absorption spectrophotometry.

RESULTS:

About 60% by weight of the amalgam removed was found in the effluent, about a third was retained in the primary solids separator and less than 10% was retained in the secondary solids separator. The ISO-compliant separator reduced the concentration of mercury in the instantaneous flow-through discharge by 99.4%, from 31.2973 mg/L to 0.1800 mg/L.

CONCLUSIONS:

About 60% of the waste generated during the removal of amalgams escaped the primary and secondary solids collectors and was released into the wastewater. An ISO-certified amalgam particle separator was effective in removing the amalgam from the wastewater.”

“The interaction between mercury and selenium may involve a variety of toxicologically and biochemically distinct processes. In this paper, the interaction between inorganic mercury and sodium selenite, the interaction most extensively studied, as well as the interaction between methylmercury (MeHg) and selenium, the interaction perhaps most significant for non-occupational human populations, will be discussed. It has been shown that the former interaction can be understood as a modification of the kinetic behavior of inorganic mercury by selenite, but this interaction may occur only under very limited conditions. On the other hand, the mechanism of the latter interaction is largely unknown, and kinetic modification appears to play only a minor role. An interaction between MeHg and seleno-proteins or a possible interaction between the inorganic mercury, resulting from the demethylation of MeHg, and the selenium may be important. Compared to the experimental findings, little evidence of the toxicological modification of MeHg by selenium was obtained in epidemiological studies.”

“It has been argued that the release of mercury from amalgam fillings is of toxicological relevance. The aim of the study was to determine the internal mercury exposure of two groups differing in their attitude towards possible health hazards by mercury from amalgam fillings. It was to be examined if the two groups differ with regard to the mercury concentration in different biological matrices and to compare the results with current reference values. Blood, urine and saliva samples were analyzed from 40 female subjects who claimed to suffer from serious health damage due to amalgam fillings (“amalgam sensitive subjects”). 43 female control subjects did not claim any association (“amalgam non-sensitive controls”). Mercury was determined by means of cold vapour atomic absorption spectrometry. Number and surfaces of amalgam fillings were determined by dentists for each subject. Median (range) mercury levels in blood were 2.35 (0.25-13.40) micrograms/l for “amalgam sensitive subjects” and 2.40 (0.25-10.50) micrograms/l for “amalgam non-sensitive controls”. In urine, the median mercury concentrations were 1.55 (0.06-14.70) micrograms/l and 1.88 (0.20-8.43) micrograms/g creatinine respectively. No significant differences could be found between the two groups. Mercury levels in blood and urine of the examined subjects were within the range of background levels in the general population including persons with amalgam fillings. Stimulated saliva contained 76.4 (6.7-406.0) micrograms mercury/l in “amalgam sensitive subjects” and 57.0 (2.8-559.0) micrograms mercury/l in controls (not significant). Mercury levels in saliva did not correlate with the concentrations in blood and urine, but merely with the number of amalgam fillings or of the filling surfaces. Mercury in saliva is therefore not recommended for a biological monitoring.”

“The aim of this study was to identify differences and similarities between the Nordic countries in dentists’ use of dental amalgam as a restorative material, and also their knowledge and attitudes about amalgam from health, environmental, ethical, economic and social points of view. Procedures for handling amalgam waste were also studied. A random sample of 250 dentists was drawn from the national registers of authorized dentists in each country in late autumn 1997. At the beginning of 1998, a questionnaire was sent to all the dentists in the study group. The response rate was 77.6% in Denmark, 73.2% in Finland, 78.8% in Norway, and 84.0% in Sweden. In Finland and Sweden the use of dental amalgam had almost ceased, particularly for younger patients, while in Norway and especially in Denmark it was still widely used. Dentists’ knowledge of the environmental effects of amalgam was confused, but most dentists had installed amalgam separators in their dental units by 1998. The majority of dentists in each country wanted to keep dental amalgam as a restorative material even in the future, and they did not want to ban the import of mercury to their home countries. Most dentists considered amalgam to be a health risk for at least some patients, and a great majority (from 76% in Sweden to 94% in Norway) considered composite as a possible odontological risk to patients. Since a majority of the dentists considered both amalgam and composites possibly harmful to patients, efforts to develop better alternatives to amalgam should continue.”

“The major source of thimerosal (ethyl mercury thiosalicylate) exposure is childhood vaccines. It is believed that the children are exposed to significant accumulative dosage of thimerosal during the first 2 years of life via immunization. Because of health-related concerns for exposure to mercury, we examined the effects of thimerosal on the biochemical and molecular steps of mitochondrial pathway of apoptosis in Jurkat T cells. Thimerosal and not thiosalcylic acid (non-mercury component of thimerosal), in a concentration-dependent manner, induced apoptosis in T cells as determined by TUNEL and propidium iodide assays, suggesting a role of mercury in T cell apoptosis. Apoptosis was associated with depolarization of mitochondrial membrane, release of cytochrome c and apoptosis inducing factor (AIF) from the mitochondria, and activation of caspase-9 and caspase-3, but not of caspase-8. In addition, thimerosal in a concentration-dependent manner inhibited the expression of XIAP, cIAP-1 but did not influence cIAP-2 expression. Furthermore, thimerosal enhanced intracellular reactive oxygen species and reduced intracellular glutathione (GSH). Finally, exogenous glutathione protected T cells from thimerosal-induced apoptosis by upregulation of XIAP and cIAP1 and by inhibiting activation of both caspase-9 and caspase-3. These data suggest that thimerosal induces apoptosis in T cells via mitochondrial pathway by inducing oxidative stress and depletion of GSH.”