DENTAL MERCURY, THE ENVIRONMENT,
AND SWEDEN’S SUCCESS STORY
By David Kennedy, DDS, MIAOMT, and Amanda Just
Mercury’s Damage to the Environment
Although human health risks related to mercury are of major concern, another main reason mercury regulations are being drafted and enforced is because mercury harms the environment. Mercury released into the air, soil, or water has devastating impacts on the ecosystem, including “land-degradation and river siltation and the associated deforestation, loss of organic soil, modification of hydrologic regimes and loss of aquatic habitat.”1 The pollution can also create “mercury hotspots that last for centuries.”2
The toxicity of fish from methylmercury, which is a form of the element transformed by certain bacteria, has resulted in advisories for pregnant women and children not to eat certain types of seafood.3,4,5
Dental Mercury and the Environment
It is well-known that the use of amalgam in dentistry causes mercury to be released to the environment. Consider for example that the United States Environmental Protection Agency (EPA) estimates dentistry accounts for 14% of the U.S. domestic usage of mercury annually.6 Also consider that approximately 40 tons of mercury are used each year to manufacture amalgam fillings.7
Research has shown that the primary source of mercury in municipal wastewater effluents generally originates from dental practices.8 In fact, according to the EPA, dental offices were found to have been the source of 50% of all mercury pollution entering publically-owned treatment works in 2003.9
Amalgam separators can successfully reduce the amount of mercury discharge in wastewater from dental offices10,11 and are essential in stopping mercury from entering the environment. However, it would be helpful to enforce maintenance requirements for amalgam separators, as the Royal College of Dental Surgeons has done in Ontario, Canada.12 It should also be remembered that amalgam separators only contribute to solving the problem of dental mercury in wastewater and not the additional burdens placed by amalgam fillings on the environment and human health.
Other burdens to the environment caused by amalgam include mercury released in human waste from patients with these fillings,13 improper disposal of amalgam at dental offices,14,15 mercury vapors given off of the fillings,16,17 and air discharges from central vacuum systems.18,19
Additionally, dental offices contribute to atmospheric releases of mercury from vapors given off during the cremation of individuals with amalgam fillings.20,21,22,23 Regarding this as a major source of air pollution is becoming more and more publicly accepted, a fact which is validated by lawsuits.24,25,26,27
For these reasons and more, a variety of environmental agencies have taken measures against dental mercury. The United Nations Environment Programme recently passed a worldwide mercury treaty, which includes working to phase-down dental mercury,28 and in the United States, many state environmental agencies, such as the Connecticut Department of Environmental Protection, have worked to educate dentists29 and consumers30 about pollution caused by amalgam and health risks from mercury.
The Example of Sweden
Sweden was one of the first countries to identify mercury as a persistent environmental biological toxin, and this initiated their evolution into one of the first mercury-free countries in the world. Some have mistakenly described Sweden’s approach to the mercury issue as recycling. Rather, according to the Nordic Council of Ministers, the Swedish government does not suggest recycling but does endorse appropriately handling mercury waste: “The Swedish government has proclaimed, that mercury should not be recycled and that mercury waste should be treated in a way, that makes it possible to store mercury appropriately in the long time perspective. The Swedish EPA recommends a deep mountain depot as the environmentally most safe disposal solution.”31
The Swedish EPA also trained dogs to sniff out residual mercury from abandoned buildings such as manufacturing plants and schools.32 With the dogs’ help, they identified hot spots and recovered and stored even more of this highly toxic metal. This dramatically cleaned up their country from the legacy of uncontrolled manufacturing.
Overall, there were very few difficulties in transitioning away from the mercury materials, and the oral health of Swedes did not collapse as the dire predictions had envisioned. Actually, the dental schools stopped teaching the use of mercury, and Sweden quickly became a healthier country for its environment, its citizens, and its future.
If other countries learn from the example of Sweden, the entire planet could benefit from a new level of health. However, since the world appears to have opted to gradually phase-down the use of dental mercury, this means that as a dental professional, you can wait to take action until you are told to do so, or you can protect the environment, your patients, and yourself immediately by not using amalgam in your practice. The Environmental Committee of the IAOMT has pioneered the safe and environmentally conscious dental practice and has encouraged and facilitated all members in bringing their practices into alignment with stringent protections for employees, the environment, as well as patients.
1.Pirrone, Nicola; Mason, Robert. Mercury Fate and Transport in the Global Atmosphere: Emissions, Measurements, and Models. (New York , 2009). http://books.google.com/books?id=mMVfbOQQeRMC&pg=PA166&lpg=PA166&dq=asgm+ecosystems&source=bl&ots=I1ZNKjc7r8&sig=AFNxft-Xe-c_VXeQUJjL_XbEE3E&hl=en&ei=t–cTunJO6Xq0gGhrr2hCQ&sa=X&oi=book_result&ct=result&resnum=1&ved=0CBoQ6AEwAA#v=onepage&q=asgm%20ecosystems&f=false
3.United States Environmental Protection Agency. Mercury: Human Exposure, October 2010, 1. http://www.epa.gov/hg/exposure.htm
4.State of Connecticut Department of Public Health. A Woman’s Guide to Eating Fish Safely: Special Advice for Pregnant Women & Young Children, 2010, http://www.ct.gov/dph/lib/dph/environmental_health/eoha/pdf/womans_guide_-english_2010.pdf
5.United States Food and Drug Administration. What You Need to Know about Mercury in Fish and Shellfish, 2009. http://www.fda.gov/Food/ResourcesForYou/Consumers/ucm110591.htm
7.Fischer R. Assessing State and Local Regulations to Reduce Dental Mercury Emissions. Domestic Policy Subcommittee Oversight and Government Reform Committee. July 8, 2008.
8.New York Academy of Sciences. Pollution Prevention and Management Strategies for Mercury in the NY/NJ Harbor. June 2002. http://www.nyas.org/Publications/Annals/Detail.aspx?cid=8454dd76-8998-4ee7-b7a2-5a97f68c790c
9.United States Environmental Protection Agency. Mercury in Dental Amalgam. August 5, 2011. http://www.epa.gov/mercury/dentalamalgam.html
10.Hylander, Lars D. et al. “Mercury recovery in situ of four different amalgam separators.” Science of the Total Environment. 2006. http://www.sciencedirect.com/science/article/pii/S0048969705004961
11.Arenholt-Bindslev, D., et al., Mercury Levels and Discharge in Waste Water from Dental Clinics, Water Air Soil Pollution, 86(1-4):93-9 (1996). Abstract available at http://www.springerlink.com/content/pp65v404t276p450/
12.Royal College of Dental Surgeons in Ontario. “Amalgam Waste Disposal.” Standard of Practice. November 2003. www.rcdso.org
13.United States Environmental Protection Agency. Mercury in Dental Amalgam. August 5, 2011. http://www.epa.gov/mercury/dentalamalgam.html
15.Bender, Michael. “Facing up to the hazards of mercury tooth fillings.” A Report to the U.S. House of Representatives; Government Oversight Committee on Domestic Policy: Assessing State and Local Regulations to Reduce Dental Mercury Emissions. (Washington, DC: July 8, 2008). Available online at http://www.non-au-mercure-dentaire.org/_fichiers/submission_mercury_policy_project.pdf
16.Health Canada. The Safety of Dental Amalgam. (Ottawa, Ontario: report, 1996), 4. http://www.hc-sc.gc.ca/dhp-mps/alt_formats/hpfb-dgpsa/pdf/md-im/dent_amalgam-eng.pdf
17.Richardson GM, R Wilson, D Allard, C Purtill, S Douma and J Gravière. 2011. Mercury exposure and risks from dental amalgam in the US population, post-2000. Science of the Total Environment, DOI 10.1016/j.scitotenv.2011.06.035, 22-JUL-2011. Abstract available at http://www.sciencedirect.com/science/article/pii/S0048969711006607
18.Stone, ME, Cohen, ME, Debban, BA, “Mercury vapor levels in exhaust air from dental vacuum systems,” Dental Materials, 23 (5): 527-532, May 2007. Abstract available at http://www.sciencedirect.com/science/article/pii/S0109564106000881
19.Rubin PG, Yu M-H, “Mercury vapor in amalgam waste discharged from the dental office vacuum units.” Arch Environ Health 51(4):335-7, 1996 Jul-Aug. http://www.tandfonline.com/doi/abs/10.1080/00039896.1996.9936036
20.Institute of Environmental Medicine (Sweden). Karolinska Institute Report. IMM 1/92.
21.Rivola J, Krejci I, Imfeld T, Lutz F. “Cremation and the Environmental Mercury Burden.” Schweiz Monatsschr Zahnmed 100(11):1299-303, 1990.
22.Fdn for Toxic Free Dentistry, Dental and Health Facts Newsletter, 5(3), Sept 1992.
23.Bender, Michael. “Facing up to the hazards of mercury tooth fillings.” A Report to the U.S. House of Representatives; Government Oversight Committee on Domestic Policy: Assessing State and Local Regulations to Reduce Dental Mercury Emissions. (Washington, DC: July 8, 2008). Available online at http://www.non-au-mercure-dentaire.org/_fichiers/submission_mercury_policy_project.pdf
24.Ray, Carla. “Bio-cremation: Going green.” Channel 2 NBC. (September 26, 2011). Available online at http://www.nbc-2.com/story/15552561/bio-cremation
25.Kelly, Tom. “Cremation costs to rise as tooth fillings poison the living.” Daily Mail U.K. (January 2007). Available online at http://www.dailymail.co.uk/news/article-427368/Cremation-costs-rise-tooth-fillings-poison-living.html
26.Cornell, DeeDee. “Mercury emissions fuel cremation fight.” Los Angeles Times. (December 30, 2007). Available online at http://www.boston.com/news/nation/articles/2007/12/30/mercury_emissions_fuel_cremation_fight/?page=full
27.Chea, Terence. “Cremation pollution?: Neighbors nervous.” MSNBC and Associated Press. (1/16/2007). Available online at http://www.msnbc.msn.com/id/16656749/ns/us_news-environment/t/cremation-pollution-neighbors-nervous/
28.United Nations Environment Programme. Minamata Convention on Mercury. Geneva, Switzerland: United Nations Environment Programme. 2013. p. 23. http://www.mercuryconvention.org/Portals/11/documents/conventionText/Minamata%20Convention%20on%20Mercury_e.pdf
29.Northeast Natural Resource Center of the National Wildlife Federation and State of Connecticut Department of Environmental Protection. The Environmentally Responsible Dental Office: A Guide to Proper Waste Management in Connecticut Dental Offices. June 2000. http://www.ct.gov/deep/lib/deep/mercury/gen_info/NWF-CTdentalreport.pdf
30.State of Connecticut Department of Environmental Protection. Fillings: The Choices You Have. Mercury Amalgam and Other Filling Materials. Hartford, CT: Departmend of Environmental Protection. Revised May 2011. http://www.csda.com/docs/default-source/regulations/amalgam.pdf?sfvrsn=0
31.Nordic Council of Ministers. Treatment and Disposal of Mercury Waste: Strategic Elements Proposed by a Nordic Tema Nord 1999: 544. Copenhagen, Denmark: Nordic Council of Ministers. p. 28.
32.Edie Newsroom. “SWEDEN: mercury sniffer dogs clean up Swedish schools.” Edie.net Web site. (April 16, 1999). http://www.edie.net/news/0/SWEDEN-mercury-sniffer-dogs-clean-up-Swedish-schools/1001/