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MERCURY TOXICITY
- 1. MERCURY TOXICITY PRESENTED BY- DR. DHANASHREEGUNJAL MDS, CONSERVATIVE DENTISTRY AND ENDODONTICS.
- 2. Introduction History Chemical Forms OfMercury Sources Of Mercury Exposure Pathways Side effects of mercury Mercury Hygiene Safe Mercury Amalgam Removal Technique (SMART) CONTENT DR. DHANASHREE GUNJAL 2
- 3. Introduction Mercury is aknown toxic, bio-accumulative substance. It often finds its way into the body through dental amalgam, which is used to restore cavitated tooth. Mercury release in body and shows negative affect on the lungs, nervous system, kidney etc. DR. DHANASHREE GUNJAL 3
- 4. Definitions An amalgam isan alloy that contains mercury as one of its constituents. PHILLIP’S SCIENCE OF DENTAL MATREIALS 11TH EDITION Dental amalgam is an alloy made by mixing mercury with a silver-tin dental amalgam alloy. STURDEVANT’S ART AND SCIENCE OF OPERATIVE DENTISTRY 5TH EDITION DR. DHANASHREE GUNJAL 4
- 5. Amalgam Wars • In1841, the American Society of Dental Surgeons declared that “the use of amalgam constitutes malpractice” • Amalgam use declined SECOND AMALGAM WAR FIRST AMALGAM WAR THIRD AMALGAM WAR • In mid 1920's a German dentist, Professor A. Stock started the "second amalgam war". • He claimed to have evidence showing that mercury could be absorbed from dental amalgam, which leads to serious health problems. • In 1981, the Neurobiologist Mats Hanson, Assosiate professor in physiology in Sweden started the war. • He was convinced that mercury released from dental amalgam was responsible for human diseases affecting the cardiovascular system and nervous system DR. DHANASHREE GUNJAL 5
- 6. CHEMICAL FORMS OF MERCURY ELEMENTALMERCURY Most volatile Exist in liquid/vapor form- Inhaled and absorbed into lungs (80%) and GIT (0.01%) Most common form amalgam restoration. Exposure to this form can occur due to accidental spillage of mercury in dental office DR. DHANASHREE GUNJAL 6
- 7. Relative Sources OfMercury Exposure DR. DHANASHREE GUNJAL 7
- 8. Sources Of MercuryExposure In Dental Clinic • Amalgam raw material being stored in use • During trituration , insertion & condensation • Amalgam scrap • During finishing & polishing • Removal of old restoration • Hg concentration in whole blood is ↓10 μg/L, • 20 μg/L / ↓ is normal. • Blood Hg concentration can rise to 35 μg/L after long-term exposure to mercury vapor DR. DHANASHREE GUNJAL 8
- 9. Hg released from amalgam& inhaled with 80% uptake in the lung Hg distributes throughout cell and tissue By peroxidase oxidation Hg breaks down to inorganic mercury Hg accumulates in the nervous system, GIT, liver and kidney Hg excreted through urine and faeces. DR. DHANASHREE GUNJAL 9
- 10. Mechanism of mercurytoxicity in the cell DR. DHANASHREE GUNJAL 10
- 11.
- 12. Amount of Hgvapor released • Trituration = 1-2 µg • Condensation = 6-8 µg • Dry polishing = 44 µg • Wet polishing = 2-4 µg • Removal of amalgam restoration under water spray and high volume suction = 15-20µg Threshold Limit Value(TLV) of mercury vapor in workplace –50μg DR. DHANASHREE GUNJAL 12
- 13. SIDE EFFECTS OFMERCURY MERCURY ALLERGY MERCURY TOXICITY DR. DHANASHREE GUNJAL 13
- 14. Contact dermatitis orComb's type IV hypersensitivity reaction represents side effect to dental amalgam. Allergy responses represent an antigen-antibody reaction marked by itching, rashes, sneezing, erythematous lesions, severe burning and difficulty in breathing. MERCURY ALLERGY DR. DHANASHREE GUNJAL 14
- 15. Erythematous lesion onright buccal mucosa in vicinity of amalgam restorations. Rashes on vermillion border of lower lip, angle of mouth and cheek. DR. DHANASHREE GUNJAL 15
- 16. • Immediate Hsreaction associated with the mercury component of amalgam restoration induces an acute reaction. • Skin patch test results indicated a very strong positive reaction to mercury. • Amalgam restorations should be replaced with composite filling material. MERCURY ALLERGY DR. DHANASHREE GUNJAL 16
- 17. MERCURY TOXICITY TOXIC EFFECTSOF MERCURY DEPEND UPON Amount of exposure Length of exposure Length of mercury accumulation in body Amount of accumulated mercury Overall health of the patient (for detoxification) DR. DHANASHREE GUNJAL 17
- 18. LEVELS OF MERCURYTOXICITY DR. DHANASHREE GUNJAL 18
- 19. MERCURY SYMPTOMS ON ORAL CAVITY Tissue pigmentation Ulceration of gingiva,palate tongue Bleeding gums Alveolar bone loss Loosening of teeth Foul breath Metallic taste Stomatitis Burning sensation, with tingling of lips, face Excessive salivation DR. DHANASHREE GUNJAL 19
- 20.
- 21. TOXIC EFFECT OFMERCURY ON THE BODY • Cramps • Inflamed colon • Diarrhea G.IT PROBLEMS • Weak pulse • Increase B.P • Chest pain/feeling of pressure. • In the chest area C.V.S PROMBLEMS • Weakness • Emphysema • Persistent cough RESPIRATORY PROMBLEMS NEUROLOGICAL PROBLEMS • Headaches • Vertigo • Tinnitus • Twitching DR. DHANASHREE GUNJAL 21
- 22. Hg damaged developmentof CNS in the foetus during prenatal period DR. DHANASHREE GUNJAL 22
- 23. Classic symptoms: tremor, gingivitis, Renal &CNS damage Minamata disease Mercury Poisoning Acute effect Chronic effect By ingestion: local corrosive effects nausea, vomiting, severe abdominal pain, chemical colitis, renal damage. By inhalation: chemical pneumonitis, pulmonary edema DR. DHANASHREE GUNJAL 23
- 24. • Erythema ofthe palms soles • Edema of hand and feet • Desquamating rash • Hair loss • Diaphoresis • Tachycardia • Photophobia • Irritability- Constipation/Diarrhea • Anorexia • Insomnia • Poor muscle tone ACRODYNIA (PINK DISEASE) DR. DHANASHREE GUNJAL 24
- 25. Caused by methylmercurypoisoning •Paraesthesia •Visual field constriction •Ataxia • Impaired hearing & speech. HUNTER RUSSELL SYNDROME DR. DHANASHREE GUNJAL 25
- 26. MINAMATA DISEASE DR. DHANASHREEGUNJAL 26
- 27. 1.Ataxic gait 2.Convulsions 3.Numbness inmouth & limbs 4.Constriction in the visual field 5.Difficulty in speaking. MINAMATA DISEASE DR. DHANASHREE GUNJAL 27
- 28. Ventilation Monitor office Monitor personnel Office design •Proper ventilation by having fresh air exchanges and periodic replacement of filters. • Monitor the Hg vapor level in the office periodically. • Monitor office by periodic analysis • Use proper work area design to facilitate spill containment and clean up. SAFE MERCURY AMALGAM REMOVAL TECHNIQUE DR. DHANASHREE GUNJAL 28
- 29. Pre-capsulated alloys Amalgamator cover Evacuation systems • Use pre-capsulatedAlloy. Eliminate the possibility of a bulk Hg Spill • Use an amalgamator fitted with a cover. Use high volume evacuation when finishing/ removing amalgam. It has the traps/ filter. DR. DHANASHREE GUNJAL 29
- 30. Masks Contaminated items Spills Select an appropriate alloy •Change mask as necessary when removing amalgam restoration. • Dispose in sealed bags according to applicable regulation • Clean up Hg properly by using bottle tapes. • To pick- up amalgam droplets use clean up kits. Proper Hg: alloy ratio to avoid the need to remove excess Hg before packing. DR. DHANASHREE GUNJAL 30
- 31. Recyling Clothing Avoid carpet/floor coverings indental office • store amalgam scrap under radiographic fixer solution in covered container. • Recycle amalgam scraps through refiners • Wear professional clothing only in dental operatory. • floor coverings should be easy to clean, nonabsorbent and seamless. Use rubber dam during insertion, condensation and polishing of amalgam DR. DHANASHREE GUNJAL 31
- 32.
- 33. Gallium based alloy:- Galliumwas discovered in 1875. It is metal with similar atomic structure and characteristics to mercury Melting temp of 29°C. By 1928, Puttkammer suggested Gallium as a substitute for mercury. It is available as 1. Gallium Alloy 2. Galloy Disadvatages: Handling characteristics of alloy not favourable High level of corrosion is seen which causes loss of strength marginal disintegration and marginal fracture in chunks. Poor biocompatibility. Costly. TO REDUCE MERCURY HAZARDS:MERCURY FREE ALLOYS DR. DHANASHREE GUNJAL 33
- 34. CHELATION THERAPY •Chelation therapyis the administration of chelating agents remove heavy metals from the body. • A chelating agent could be given orally, I.M, I.V • FDA approved use in children for treating Hg toxicity 2,3-dimercapto-1 propanesulfonicacid (DMPS) D-Pencillamine (DPCN) Dimercaprol (BAL) DR. DHANASHREE GUNJAL 34
- 35. • Phillips ScienceOf Dental Material 10th & 11th Edition • Sturdevant s The Art and Science of Operative Dentistry, Fifth Edition • Syed M, Chopra R, Sachdev V. Allergic Reactions to Dental Materials-A Systematic Review. J Clin Diagn Res. 2015 Oct;9(10):ZE04 • Ryo Sasaki DDS PhD, Sekiko Taneda, Toshihha, Gingival amalgam tattoo, CMAJ 2023 August 21;195:E1083-4. • Rhythm Bains1, Kapil Loomba1 and Anju Loomba, Allergy to Mercury from Dental Amalgam: A Case Report, Asian Journal of Oral Health & Allied Sciences 2012, Volume 2, Issue 2 • Dack K, Fell M, Taylor CM, Havdahl A, Lewis SJ. Prenatal Mercury Exposure and Neurodevelopment up to the Age of 5 Years: A Systematic Review. Int J Environ Res Public Health. 2022;19(4):1976. REFERENCES DR. DHANASHREE GUNJAL 35
Editor's Notes
- #6 1826 first dental amalgam used by Tavuea in USA and France 2. He also expressed concerns over health of dentists, stating that nearly all dentists had excess mercury in their urine 3. It began in 1980, through the seminars and writings of Dr.Huggins, a practicing dentist in Colorado. Also stated that patients claimed recoveries from multiple sclerosis, and other diseases as a result of removing their dental amalgam fillings.
- #8 Vaccines- rabies vaccine and influenza vaccine Sea food- tuna, shark, mackerel,swordfish.
- #11 sulfhydryl group
- #12 Amalgam remnants in dental clinic
- #16 A systemically healthy, non smoker, 23 year, female patient reported with the chief complaint of an ulceration on her right buccal mucosa and itching and rashes around the corner of her lips since two days. Clinical examination showed class I silver amalgam restorations on 47, 48.
- #17 Small percent age of people are allergic to mercury. silicone polymer, dimethaosne (Dermashield) can be applied over exposed areas of skin. Antihistaminics, topical glucocorticoids such as clobestol proprionate may be useful
- #18 Small percent age of people are allergic to mercury,
- #20 Small percent age of people are allergic to mercury,
- #21 73-year-old man with an amalgam tattoo black and blue-grey lesion along the gingiva adjacent to a porcelain tooth fused to a metal bridge 40 years . biopsy of the lesion showed black granules in the connective tissue. erbium-doped yttrium aluminum garnet laser is less invasive and easier than removal with free gingival grafts,
- #22 When mercury enters the body, it distributes to the soft tissues and then to the brain. Hg binds to hemoglobin and passes easily through the blood-brain barrier.
- #23 It also easily crosses the placental barrier in pregnant women and can pass through the breast milk. Image depicts to the neurons of a developing fetus when the mother consumes methylmercury affects growth cones of fetus. Cognitive thinking, fine motor and visual spatial skills hamper
- #25 Correcting fluid and electrolyte losses and rectifying any nutritional imbalances (vitamin-rich diet, B complex) chelating therapy Diaphoresis- excessive sweating due to an underlying health condition Anorexia- eating disorder that causes people to weigh less
- #26 The term Hunter-Russell syndrome derives from a study of mercury poisoning among workers in a seed packing factory in Norwich, England in the late 1930s who breathed methyl mercury that was being used as a seed disinfectant and preservative.
- #27 In 1952 Minamata Japan
- #28 1971 Iraq poison grain disaster was a mass methylmercury poisoning incident
- #29 International Academy of Oral Medicine and Toxicology protocol IAOMT Office- This may be done by using dosimeter badges & vapor analyzer
- #34 1971 Iraq poison grain disaster was a mass methylmercury poisoning incident