Introduction
The protection of employees from illnesses, injuries, and diseases related to work creates part of the responsibilities of the International Labor Organization (ILO). Injuries and illnesses are not associated with the work or job nor can poverty defend ignorance for employees’ health and safety. The ILO focus is on upholding the chances for both men and women to get good and fruitful jobs or works in equal, safe, free, and dignified conditions. Currently, the development within the technology field and the great competitive demands lead to dynamic changes in the working environment, organization, and work procedures. Governments, employees, and employers have now identified or recognized the positive effects of establishing occupational safety and health (OSH) management systems within the company or organizational level. These positive effects include risks and hazards reduction and an increase in productivity (International Labor Conference 1998, p.12).
Any work-related injury or disease is not something to be happy about especially if the application of the right measures can control it. More than 200 individuals die annually in the working places in Britain. Moreover, approximately 150,000 people are injured annually and about two million get sick from work-related diseases or are left handicapped (Health and Safety Executive 2008, p.1). The worst mistake that someone can make is to think that these fatal issues occur in highly unexpected situations, which never happen in the workplace. This is not true.
This paper explores the use of amalgam in dentistry. Dental amalgam is used to repair damaged forms of teeth restoring its function thereof. Many people have damaged teeth due to infection from dental carries: a process whereby the teeth undergo mineralization and demineralization reversibly because of fluoride and dental plague respectively (Health and Safety Executive 2008, p.1). In the past years, dentists have used amalgam to restore damaged teeth. However, as time passed by, fears that mercury might be hazardous kept on mounting and people started to withdraw from its use slowly by slowly. This paper analyses the use of amalgam and explores the credibility of the fears that dental amalgam is not health-friendly. The paper will include statistical data explaining the prevalence of injury or illnesses associated with amalgam use in dentistry. The paper also addresses epidemiological evidence and offers appropriate recommendations that would reduce risks associated with amalgam use if any.
Background information about Amalgam
According to Sullivan and Krieger (2001), there are about 400,000 dental specialized personnel employed in dental laboratories, offices, hospitals, outpatient care facilities, and nursing homes. Of the above dentists, 105,248 are full-time and 29,998 in part-time practicing privately. About 92 percent of the dentists hire at least one secondary individual like laboratory technicians, hygienists, clerical personnel, and chairside assistants (p. 510). Although dentists are subjected to physical, biological, and chemical agents, the level of subjection is mostly within the standards set by the Occupational Safety and Health Administration (OSHA). However, Sullivan and Krieger (2001) posit that there are undesirable exposures and hazards like excessive quantities of mercury waste and poisonous gases in the surroundings of several dental hospitals and offices
Medical care in Canada and British Columbia has improved drastically over the last decennium and more improvement is expected. The rise in demand for medical services is largely due to a drastic increase in the proportion of the aging population, general growth in population as well as improvements in treatment diagnosis technology. Dentists’ employment is projected to increase at a yearly rate of 1.5 percent. About 1,020 dentists’ jobs will be accessible between 2001 and 2011. Some of the factors that lead to the increased number of dentists’ jobs are population growth particularly; a large number of growing baby boomers shows that more persons need dental care. In addition, as the population ages, it implies that more people are growing old. Given the inherent health complications that come with old age, there is an urgent need to improve adult dental care. Moreover, most the people have recognized the significance of maintaining their teeth for a longer period. In addition, the rise in income for many people has led to more affordable preventive dental care and this might persist in the future (Vancouver Public Library 2009, para.1).
The most frequently utilized dental recuperative substance in dental fillings is dental amalgam. Dental amalgam was first established in the early 1800s in France. It is made up of mercury with several components of metal. It has been in use for many years as a recuperative material for it is cheap, strong and durable, easy to apply, and has bacteriostatic effects. Nevertheless, despite the numerous advantages associated with amalgam in dentistry, there has been declining use of the same in dentistry. Some of the reasons that have contributed to this decline in the recent past include a persistent concern for aesthetic values, environmental pollution, and detrimental or harmful health effects. Aesthetic properties raise concerns mainly due to the realization that the color shade of the natural tooth does not match well with the bright metallic color of the used material. This becomes a concern mostly when the metallic color is used on the front tooth or teeth, though it can be tackled by the use of other dental materials. Environmental concerns arise from the fact that there are emissions of mercury in the process of preparation or grounding as well as from amalgam waste during cremation or incineration of the deceased people (Cahalane n., p. 26). Compositions of dental amalgam include 43 to 54 percent mercury, the rest material or powder is composed of Zinc (2 percent), cooper (10 percent), and silver (20-35 percent) (Ferrancane n.d, p.3).
The first or earliest occasion when amalgam was used as a dental recuperative material cannot be well traced. However, it has been recorded or reported that in the early 659 A.D, the silver paste was utilized in China to repair a tooth. Filling materials such as stone chips, resin, gum, cork, led, gold leaf, turpentine, and cork just to mention a few were utilized in restoring and repairing teeth before the discovery of dental amalgam. In the year 1603, Tobias Kreilius, a German, explained the procedure of making a dental amalgam filling by mixing copper sulfide with acids and later adding mercury. After mixing the three substances, they would boil and then one could pour onto someone’s tooth (Greener 1979, pp 24-25).
After many years, a combination of different types of metals like platinum, antimony, cadmium, and bismuth came to trial for purposes of filling destroyed teeth. In the year 1895, G. Black came up with a dental amalgam formula, which gave the best clinically suitable performance and over the next 70 years it remained unchanged (Anderson & McCoy 1993, p.45). Dr. Wilmer Eames in 1959, proposed a modification or alteration to the ratio of mercury to amalgam, suggesting that the ratio be reduced from 8:5 to 1:1 (Earnes 1959, p.76). In the year 1963, the formula was altered when a superior or better amalgam involving high copper distribution alloy was established. Although people thought that, the superiority or supremacy was because of dispersion intensification of the amalgam, people came to realize that the enhanced amalgam’s strength was due to its combination with copper that formed the copper-tin phase. This phase was less prone to corrosion or oxidation when compared to the tin-mercury phase in the first amalgam (Innes & Youdelis 1963, pp. 587-930). The union or combination of tin-mercury, which is currently referred to as the gamma-2 phase, leads to failure or disappointment and is preferably permitted to rise or increase during amalgam condensation when it is being poured onto a tooth. Gamma-2 phase is later removed when the amalgam is carved to obtain appropriate functional occlusion and structural anatomy (Asgar 1971, p. 56).
Classification of Hazards
When dental amalgam is used as a restorative material, there are waste materials that need to be disposed of and managed properly for the proper health and safety of the people. The United Nations (UN) classification system of hazards is internationally recognized and utilized universally by all organizations. The UN classification system involves nine classes of dangerous materials. These classes are as follows; class 1; explosives hazard, class 2; gases, class 3; flammable and combustible liquid and gases, class 4; flammable solids, class 5; oxidizers and organic peroxides, class 6; poisons, class 7; radioactive, class 8; corrosives and class 9; miscellaneous (ORM) (Global Security 2006, para.1). The main aim of classifying hazards is to recognize the hazardous intrinsic characteristics of the materials. In addition, the classifications of materials help in knowing the adverse effects related to the intrinsic characteristics of a substance. This can be done by utilization of tests and assessing the outcomes of the tests against the set criteria or standards. Chemicals are said to be hazardous when the intrinsic characteristics meet the standards.
In the dentistry industry, hazards are classified as follows: physical, biological, chemical, environmental, and psychological hazards. Most dental health practitioners are prone to risks due to occupational exposure to a wide range of hazardous chemicals and circumstances. Lack of adequate information on the possible hazards in the workplace makes dentists more susceptible to work-related diseases and injuries. For instance, concerning ergonomics issues, medical dentistry is tiring since there is a lot of physical demand in some ways. Hence, some of the body parts like necks, wrists, shoulders, backs, and hands are susceptible to injury due to stress, position, repetitive motion, and leisure activities (American Dental Association 2005, par.1).
Dental amalgam is a chemical hazard since its components are metallic like mercury, which is known to cause some health effects. Mercury enters the body from increased grinding, temperature, electrical current, and tooth brushing. Once in the body, it enters the blood through several systems in the body. Moreover, people may inhale mercury vapor, which enters through the lungs. Therefore, the mercury vapor levels released by dental amalgam, range from six to 50 micrograms per cubic meter (Gammel 1995, par. 5). Researchers have established ways through which mercury can affect one’s body. For instance, in the nervous system, mercury causes memory loss, sleeplessness, hand tremors, and in some cases ‘Mad hatter’s disease.’ In the digestive system, mercury causes, inflammation of the digestive system, vomiting, nausea, diarrhea, and abdominal pains. In the respiratory system, there may be respiratory failure, coughing out blood, inflamed, and impaired lungs. Mercury also affects the kidney by causing increase blood and blood and protein intake and kidney failure that may be accompanied by increased heart rate.
Job description Associated with Use of Amalgam
According to Kennedy (2009), dentists and their assistants are at high risk of mercury poisoning. This is because these people carry out the process of placing amalgam onto patients and without taking the appropriate safety measures, individuals are most likely to have adverse effects from amalgam. Patients who receive the amalgam are even at higher risks of amalgam poisoning than anybody else. However, away from dentistry, mercury affects people in different jobs, different genders, and at different ages. For instance, people who consume fish regularly are at risk of getting mercury poisoning. Research indicates that fish may have some significant amounts of mercury. Mercury may find its way into oceans, seas, rivers, and ponds through spillage or disposal. This mercury then accumulates in the fish that people feed on eventually. There are different forms of mercury poisoning. For instance, occupational mercury exposure relates to people working in areas like fluorescent light manufacturing companies.
People may be exposed to mercury at home. This may result from broken fluorescent lights, thermometers, or from using household latex as an antifungal. A lot has been said about mercury and gender. Some people argue that mercury affects men mostly leading to autism. However, there is not enough data to support these theories (Kennedy, 2009). Even though it is true that boys are four times more likely to have autism than girls are, Kennedy (2009) posits that there is no clear information to explain this situation. There is evidence that age determines mercury exposure. Infants and fetuses are at high risk of adverse mercury effects. It is thus recommendable to keep pregnant mothers and infants away from mercury exposure.
Dental amalgam is a versatile and excellent recuperative material and dentists use it because of several reasons. Amalgam is cheap and relatively simple to utilize and manipulate or control especially during placement, it remains or stays soft for a short period, therefore, one can pack it to seal any uneven space and then make a hard compound. In addition, it lasts longer than other direct recuperative materials like resin-based composite. It has greater longevity because it is tolerant to a wide variety of medical placement circumstances or conditions and reasonably resistant to the presence of wetness during placement (Christensen 2005, p. 201-203).
In addition, mercury, which is used in dental amalgam, has features of the bacteriostatic agent while silver-based composite encourages or leads to the growth of microbes or microorganisms. The growth of microorganisms results in increased tooth decay since in the elemental composition of resin-based composites; there is nothing to deter the growth of microbes. Instead, TEGMA (trimethylene glycol methacrylate) and TEGDMA (triethylene glycol dimethacrylate) are the primary components of resin-based composites that support the growth of carries producing microbes (Leinfelder 2000, pp. 1186-1187).
Injury and illness Statistics
Though dental amalgam has been used for a long time because of the above-mentioned reasons, it has some consequences or health effects. According to WHO (World Health Organization), mercury, which is a component of dental amalgam, contributes to 5 percent of the total mercury produced, and together with mercury waste from clinical and laboratory devices, it totals up to 53 percent of mercury emissions (World Health Organization 2005, p.1). Medically, dental amalgam fillings subject an individual to a daily mercury dose though the degree and consequences of the chronic subjection remain contentious. Health effects resulting from allergy or hypersensitivity. Examples of the signs and symptoms related to mercury poisoning are memory loss, irritability, kidney failure, anorexia, irritability, insomnia, tremors, and poor physical coordination (Brunton & Duxbury 2004, p. 555).
Mercury behaves peculiarly and this has led to environmental concerns in the recent past. It has been observed that, after mercury gets into the environment, it does not degrade as expected. On the contrary, it accumulates to high levels. Therefore, if this accumulation is in water bodies, then fish contain significant amounts of it and this exposes human beings to mercury thereafter. These mercury levels in fish are significant to cause health complications in fish eaters like human beings.
Though mercury is a major ingredient in the manufacture of dental amalgam, it should not be disposed of as normal waste in sharps, garbage, or container. In addition, it ought not to be disposed into a drainage system where it will drain. Creating awareness is therefore important because some people dispose of medical wastes inappropriately. Some people will burn these wastes together with other wastes like sludge and this is dangerous. In case dental amalgam gets its way into one of the societies’ incinerators, mercury, which is a by-product, will be released or freed into the surroundings or environment because of the high temperatures utilized in the incineration procedures (American Dental Association 2004, p.2).
Despite the many dangers associated with amalgam, many people still have amalgam fillings. There is no conclusive report that links amalgam to any health risk. This leads to questioning the safety of amalgam use in filling teeth. What stand does a person take in the wake of differing opinions about the safety of amalgam? Some people argue that the amount of mercury exposure to people through teeth filling does not large enough to expose someone to health risks. There are claims that
Methods of Protection
Dental amalgam waste can be managed through recycling. Recycling is done to recover or extract mercury from amalgam waste through a process called distillation and it can be reutilized in new commodities or products to protect against environmental pollution (International Labor Organization, n.d.).The following steps are used in the recycling process of amalgam waste; put amalgam capsules in different sizes to reduce the quantity of amalgam waste produced. Secondly, mix amalgam waste with body fluid like saliva and in such practices, one should utilize PPE (personal protective clothing) like gloves, protective eyewear, and masks when handling it. Thirdly, ask an amalgam waste specialist or recycler about any particular needs, which may be found in an area for accumulating, storing, and transporting amalgam waste. The next step is that one should store amalgam waste in a container that is covered and labeled as ‘Amalgam for recycling’. Finally, one needs to look for a recycler who he or she will interrogate before carrying out the process (American Dental Association 2004, p.3).
Other practices that can be used to manage dental amalgam waste include; amalgam should not be disposed of in the toilet to drain instead, one should utilize line cleaners to reduce the dissolution of dental amalgam. In addition, one should use protective clothing when handling dental amalgam since it will be mixed with other body fluids like saliva. Dental amalgam waste should be stored in a lockable or covered container that should be labeled and various types of dental amalgam should be stored in different containers for recycling. Bulk elemental mercury should not be used in making amalgam capsules and disposable amalgam capsules should not be put in the garbage, infectious waste, and biohazard containers (the United States Environmental Protection Agency 2008, p.23).
For contact dental amalgam, one should recycle tooth or teeth, which consists of amalgam restorations after proving with the specialist or recycler that they will take removed teeth containing amalgam restorations. In addition, removed teeth, which have amalgam restorations, should not be disposed into the garbage, infectious waste, and sharp containers. Teeth that have been extracted and have amalgam restorations should be disinfected properly. In addition, one should utilize chair-side traps to preserve and recycle dental amalgam. The chair-side traps, which have amalgam, ought not to be rinsed in sinks or drains. The Chair-side and contents of the recyclable chair-side that are disposable should be placed in a gray or silver storage container, labeled and sealed (Carver 2008, p.64).
Worker protection used in the dental industry
Dentists are highly exposed to various types of pathogens found in the body fluids and blood of the patients. Because of infectious microbes found in their working environment, dentists can get infectious diseases. These diseases may include tuberculosis, hepatitis B virus, and acquired immunodeficiency syndrome (AIDS) among others. For dentists to protect themselves from bloodborne pathogens from the patient, they need to use proper preventive measures like hand washing with disinfectants after handling a patient. Dental care personnel is more susceptible to acquiring the hepatitis B virus when compared to the general population. Therefore, they should receive the hepatitis B vaccine (HBV). In addition, training is very crucial especially to the secondary workers employed by dentists to understand the importance of vaccinations (Occupational Safety & Health Administration n.d, par. 8).
Other protective materials include the PPE (personal protective equipment). Employers need to give their employees PPE with occupational exposure to eliminate or reduce the risk of contracting diseases due to getting in contact with infectious material with patients’ bodies. Appropriate PPE should not allow blood or any infectious material to get into the body or to get into the worker’s body like skin, eyes, undergarments, mucous membrane, and mouth in any normal circumstances (Occupational Safety & Health Administration n.d, par. 12).
Commonly used PPE in dentistry includes general protective wear like masks, face shields among other protective clothing like gloves. It is important to utilize these PPE materials for infection may result from slight mistakes. For instance, coming into contact with the body fluids of the patient may be very dangerous and this calls for use of gloves.
The dentists use a pair of gloves on each patient and later remove and dispose of them. Before handling another patient, the dentists have to wash, disinfect their hands and wear new gloves. Utility gloves are utilized in washing the environmental surfaces and equipment and can be recycled if disinfected. However, they must be disposed of if discolored, cracked, punctured, or indicating any signal of deterioration. The use of latex gloves among workers has been boosted by the stringent requirements for occupational protection. This has led to more cases of allergic reactions due to latex. Therefore, most gloves liners, as well as non-latex gloves, are more available to help stop such reactions. For the health and safety of the patient and dental team, dentists recommend latex-free surroundings or environments (Safety and Industrial Supplies 2009, para. 6).
Dentists need to develop a culture of putting on protective clothing always regardless of the type of exercise being undertaken. As aforementioned, the infection can result from unlikely conditions and this should be a warning to dentist practitioners not to assume anything but always to be cautious.
In addition, protective clothing ought to be put on anytime a dentist is to get into contact with any part of the body of the patient. The type of protective clothing will depend on the type of work the dentist is expected to perform (Safety and Industrial Supplies 2009, Para’s).
Conclusion and Recommendations
As a recuperative substance, dental amalgam has been beneficial and on the other hand, it has negative effects on the health of individuals, animals, and the environment. Possible environmental impacts associated with dental amalgam waste depend on the methods used to dispose of the waste as well as the mechanisms used in treatment. A lot of concern has been raised over the last decades concerning the effects of mercury, which is one of the components of dental amalgam. Dental amalgam has been known and accepted in clinical practices because of its durability, cost-effectiveness, and presence of bacteriostatic agents in its elemental composition. Although the medical acceptance of substitute of dental amalgam persists, it remains to be the most effective filling material. Therefore, environmental concerns or interests associated with dental amalgam waste ought to be tackled or addressed.
To some individuals, any substance that contains mercury is hazardous or harmful. Hence, appropriate differentiation or separation of mercury elements and dental amalgam needs to be addressed. In addition, amalgam is not mercury; therefore, waste management writings should not group amalgam as similar to mercury. Moreover, when amalgam waste is treated with very high temperatures, one of the by-products is mercury, therefore, it is not the existence or being of dental amalgam that leads to environmental pollution, but rather it is the entire treatment process. Hence, this clearly shows the difference between the pure or sources of mercury and mercury compound as in the case of dental amalgam waste.
To avoid mercury exposure, both employers and employees need to communicate in matters about occupational health and safety. Suggestions on the best methods to improve occupational health should constantly be sought to ensure no harm to the employees. Experts should also be constantly consulted as precautionary measures against unforeseen situations arising. It is advisable to have more elaborate research work to determine how amalgam is safe or not safe for people. As long as there is no conclusive report on the matter, some people will keep on using amalgam for teeth fillings while others will refrain from it. This does not change the effects of amalgam on people’s health. The most probable way to overcome the standing differences concerning this issue is through research.
Reference list
American Dental Association 2005. Ergonomics: Health and Wellness. Web.
American Dental Association 2004. Best Management Practices For Amalgam Waste. Web.
Anderson, M. & McCoy, B 1993. Dental amalgam. The state of the art and science. 3rd Ed., Philadelphia: Saunders.
Asgar, K 1971. Behavior of copper dispersion allows. J Dent Res, 50: 56.
Brunton, Y & Duxbury, G 2004. Healing of oral lichenoid lesions after replacing amalgam restorations: a systematic review. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 98(5):553-65.
Cahalane, D., n.d. Strategic Policy, Occupational Safety and Health Service. Department of Labor, Wellington (New Zealand).
Carver, D 2008. Environmental Protection Agency and Marquette University School of Dentistry. Draft Course Material; Presentation on Dental Amalgam Recycling: Pathways, Principles, and Practice.
Christensen, G., 2005. Longevity of posterior tooth dental restorations. JADA, 136:201-203.
Eames, W. 1959 Preparation and condensation of amalgam with low mercury alloy ratio. JADA, 58(4):78-83.
Ferracane, L., 2001. Materials in Dentistry: Principles and Applications. Lippincott Williams & Wilkins.
Gammel, R 1995. Mercury Amalgam fillings -potential health dangers. Web.
Global security, 2006. Hazard Classification Code. Web.
Greener, E., 1979. Amalgam–yesterday, today, and tomorrow. U.S. National Library Medicine National Institutes of Health, 4(1):24-35.
Health and Safety Executive, 2008. An introduction to health and safety. Web.
Innes, D. & Youdelis, W. 1963. Dispersion strengthened amalgam. J Can Dent Assoc, 29:587-93.
International Labor Conference, 1998. Declaration on Fundamental Principles and Rights at Work and its Follow-up. International Labor Conference at its 86th Session, Geneva.
International Labor Organization, n.d, Guidelines on occupational safety and health Management systems. Web.
Kennedy, R., 2009. Biological and Mercury-free Dentistry. The Doctors’ Medical Library. Web.
Leinfelder, F., 2000. Do Restorations Made Of Amalgam Outlast Those Made Of Resin-Based Composite? American Dental Association, 131(8):1186-1187. Web.
Occupational Safety & Health Administration, n.d. Toxic and Hazardous Substances- Blood borne pathogens. Occupational Safety and Health Standards. Web.
Safety and industrial supplies, 2009. Dental Industry Regulations. Web.
Sullivan, B. & Krieger, R. 2001. Dental health care hazards. Clinical environmental health and toxic exposures.
United States Environmental Protection Agency, 2008. Health Services Industry Detailed Study- Dental Amalgam. Web.
Vancouver Public Library, 2009. Working in the Dentists Industry. Guides to Occupations. Web.
World Health Organization, 2006. Mercury in Health Care. Department of Protection of the Human Environment.