Abstract
BackgroundThe ubiquitous use of dental amalgam for over 180 years has resulted in the exposure of millions of dental workers to mercury. Dental amalgam contains approximately 50% mercury. Dental workers, including dentists, dental assistants, and dental hygienists, have been shown to have increased levels of mercury and suffer more from health issues related to mercury exposure than the general public. Mercury is known to be absorbed via inhalation or through the skin. There are many routine dental procedures that require the removal of dental amalgam by using the dental high-speed drill, which we suspected generates an occupational mercury exposure that is not sufficiently recognized.ResultsWe showed that drilling dental amalgam generates particulate that volatilizes significant amounts of mercury vapor generally for more than an hour after removal. The levels of mercury vapor created by this procedure frequently exceed the safety thresholds of several jurisdictions and agencies.ConclusionsA significant, underrecognized source of localized exposure to mercury vapor was identified in this study. The vapor was created by microgram levels of particulate generated from dental amalgam removal with a high-speed dental drill, even when all feasible engineering controls were used to reduce mercury exposure. This exposure may explain why dental workers incur health effects when safety thresholds are not breached. The dispersion patterns for the particulate are not known, so the use of effective skin barriers and inhalation protection are required during amalgam removal to protect the dental worker from this form of occupational mercury exposure. Standard methodologies for occupational mercury exposure assessment appear to be inadequate when assessing mercury exposure during amalgam removal.
Highlights
The ubiquitous use of dental amalgam for over 180 years has resulted in the exposure of millions of dental workers to mercury
Amalgam particulate was collected in-vivo from 21 patients who were scheduled for amalgam removal in the dental offices of Dr David Warwick and Dr Matthew Young during a time period starting October 2016 and April 2018
The total mass of all the particulate collected in the 21 cases was 54,876 μg, which represents only about 10% of the mercury in an average sized filling and only about 3–4% of the average mercury content of the amalgams removed in a single session
Summary
The ubiquitous use of dental amalgam for over 180 years has resulted in the exposure of millions of dental workers to mercury. There are many routine dental procedures that require the removal of dental amalgam by using the dental high-speed drill, which we suspected generates an occupational mercury exposure that is not sufficiently recognized. We hypothesized that the action of drilling amalgam with a dental high-speed hand piece, even when using protocols and all feasible engineering controls to minimize mercury vapor, would still generate an aerosol of particles that would be heated sufficiently to produce increased mercury vapor. We designed the study to answer the following questions: What concentration of mercury vapor can be reached from particulate generated from the removal of dental amalgam restorations using a high-speed drill?. Does the amount of amalgam removed in each sample affect the mass of mercury in particulate collected?.
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