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Interview: 'Amalgam seperators must be mandatory'

DTI Group Editor Daniel Zimmermann (right) speaks to Assoc. Prof. Lars Hylander (left). (DTI/Photo Claudia Salwiczek)
Daniel Zimmermann & Claudia Salwiczek, DTI

Daniel Zimmermann & Claudia Salwiczek, DTI

Sun. 28 September 2008

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Mercury has been used for millennia in many applications, primarily in artisanal mining and as an electrode in the chlor–alkali industry. Today, for many people exposure to mercury results from their amalgam fillings. With new regulations on amalgam use in Europe and the United States, environmental aspects of the toxic metal have to be taken into consideration. DT editors Daniel Zimmermann and Claudia Salwiczek spoke with Lars Hylander, Associate Professor at the University of Uppsala, Sweden, about how amalgam waste affects the environment and how it could be prevented.

Daniel Zimmermann/Claudia Salwiczek: Dentists have been using amalgam as filling material for a long time, but it seems that they do not know that much about its effects on the environment.
Assoc. Prof. Lars Hylander: The problem with amalgam is that the metallic mercury, which is part of the filling, is transformed into methylmercury by bacteria in water. Methylmercury is a toxic substance that bioaccumulates in fish, especially those we like to eat such as tuna. Once the mercury is in our system, it can be transported to the brain, where it can result in mental conditions, especially in children, whose brains are still in development.

Severe mercury pollution occurred in Minamata in Japan, in the 1960s. Unfortunately, the children were the ones that were the most affected. Many were born crippled, blind, deaf, or paralysed, or had spasmodic cramps. A special hospital was built for the victims of this disaster. I met many of those patients during my time in Japan. Some of them have always been in a wheelchair, because they were born paralysed owing to the effects of methylmercury.

How much does amalgam contribute to the entire amount of mercury that is released into the environment?
About 300–500 kilograms of mercury from dental amalgam are released in Sweden per year. Exact numbers are hard to get, because a large amount of mercury from fillings goes into the air from crematoria and mixes up with mercury that is released into the air from other countries. Emissions from Sweden, for example, go to Finland and Russia, and we get many emissions from Germany.

Nowadays, dental offices and clinics are the top point contributors to mercury pollution of water. Previously, the main sources were the chlor-alkali industry and some other industries that use mercury in one form or another. On a global scale, fossil fuel is the main contributor. There are ways to limit the mercury emissions from crematoria and fossil fuel, but countries like China or even the United States find them much too expensive. Various attempts have been made to introduce regulations, but they haven’t been successful so far.

You recommend amalgam separators, but only a few countries in Europe require their installation. Should there be more political pressure to make this technology mandatory for dental offices?
It must be mandatory, otherwise people will not use it. I also recommend including the costs for amalgam separators and the cleaning costs at crematoria into the price for the amalgam fillings. In Sweden, for example, the taxpayers pay for the cleaning, and though we are quite a rich country, we find it too expensive to put cleaning devices on all crematoria. This is not very responsible.

Many varieties of amalgam- or mercury-free fillings are available today, and they are more expensive than amalgam, if aesthetical aspects, the risk of cracked teeth in large amalgam fillings and environmental costs are not considered.

Why isn’t this topic on the political agenda?
There is much lobbying to avoid bringing this topic into the political agenda. For example, I recently received a statement from the Swedish authorities stating that they will not admit to health problems caused by amalgam, because they fear that people will start to claim reimbursements from the government, because they once said it was safe.

I was also quite disappointed by the European Commission hearing last year on how to handle amalgam and whether it should be mandatory for all member states to have amalgam separators. There were two different committees—the Scientific Committee on Health and Environmental Risks and the Scientific Committee on Emerging and Newly Identified Health Risks—working on these matters and, in my opinion, both did a very poor job. They looked at the situation in Sweden, where amalgam separators are practically mandatory, and assumed this was the case for all countries in the European Union.

The conclusion was that no further legislation is needed. I was astonished when I saw that they made this decision without any proper scientific evaluation. Even the authorities here in Sweden got quite upset about it, but their protest was not given consideration.

The Federal Drug Administration in the United States has recently changed their position on the health effects of dental amalgam. Do you think that this will have an impact on how we look at the whole amalgam issue?
Definitely. I guess that with such a statement, the American Dental Association cannot continue with their pro-amalgam attitude, which they have proclaimed for more than 100 years. They didn’t even recommend amalgam separators, but only screens on the chair side that collect particles larger than 0.6 or 0.7 mm. However, due to the high-speed drills we use today, most of the particles are much smaller than that and settle in the tubing or the sewage system.

Norway enforced a ban on amalgam at the beginning of this year. Do you think that more countries are to follow?
Yes, more countries will follow. The question is, when? It is not reasonable to allow the emission of such a toxic metal that will always remain in the environment. To give you an example, mercury that is released into the air typically travels two or three times around the earth before it settles down.

One of the things that could be done by practically all countries is simply to remove amalgam fillings before bodies are burned in crematoria. But there are also alternatives, such as to freeze-dry bodies and then collect the fillings. The mercury-containing remains should be put in containers and securely stored, preferably in deep bedrock repositories, such as abandoned mines. Salt mines have been suggested because these mines typically have no humidity, an environment that excludes corrosion. However, their geologic characteristic does not guarantee their long-term stability. The abandoned mercury mine in Spain is a safer option for a sound, final disposal.

Others say that preventive measures are the solution because the better oral health status is, the fewer fillings will be needed.
That’s true. I remember when I went to the dentist for the first time. All doctors came to see me, because it was rare that a seven-year-old had teeth with no caries. Nowadays, the situation is the opposite. I have no statistics for seven-year-olds today, but it is known that in the adolescents group (18–19 years) about 30–45 per cent have no caries at all.

Preventive measures in Sweden have been quite successful, but we are experiencing a downward trend again. The amount of decay in youngsters is increasing because of soft drinks, sweets, and a lack of regular meals. There should clearly be more emphasis on preventive measures in developing countries, because people there are more exposed to soft drinks and sweets advertising.

What should we focus on: preventive measures or the use of separators?
The formula is quite simple: stop using amalgam, start using amalgam separators, and put more efforts into preventive measures.

Thank you very much for the interview.

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