Mercury, ranked as the third most hazardous chemical, has been reported in many regions and places far from its source of emission. It has become a growing issue of global concern because of its adverse environmental and health impacts. The Minamata Convention on Mercury has been signed by 120 countries (including Pakistan and other Asian countries) and ratified by six. Its main objective is to safeguard public health and protect the environment by phasing out mercury use and emission/releases.

Studies have shown that dental sites (dental teaching institutions, dental clinics and hospitals) employing mercury amalgam for dental healthcare have high levels of mercury vapors, both indoors and outdoors (Khwaja et al. 2014). Low levels of inhaled mercury to highly contaminated or chronic exposure to low level contamination in the breathing zone can result in mercury poisoning, which among other issues may damage the nervous system, lungs, and kidneys. Exposure to mercury of vulnerable population (dental professionals, healthcare workers, children, pregnant women and elderly) is of particular concern. To support the Minamata Convention on Mercury, Sustainable Development Policy Institute (SDPI) submitted a timely motion at the IUCN Global Conservation Congress (GCC 2012) which was supported by 92 organisations/networks in 41countries and was adopted by the Congress with 88% votes.

Very few investigations on mercury amalgam use in the dentistry sector have been carried out in South Asia and there is little data reported on mercury contamination of indoor/outdoor air at dental sites. This paper will focus on the findings of two recent studies carried out by SDPI to investigate the health threats and challenges due to mercury amalgam use in dental healthcare in Pakistan. The first study, conducted in May 2013, reported mercury air monitoring results at 34 dental sites (dental teaching institutions = 17, general hospitals = 7 & dental clinics = 10) in five main cities (Peshawar, Abbottabad, Rawalpindi, Islamabad and Lahore) of Pakistan. Highly alarming levels of mercury vapors in the air, injurious to public health in general and healthcare workers in particular, were observed due to unawareness of dental professionals and undergraduate students regarding health hazards due to mercury exposure, inappropriate handling of mercury/mercury amalgam, inadequate ventilation systems, lack of best environmental practices for mercury emission/ releases and no environmentally sound system for mercury contaminated waste disposal (Khwaja and Abbasi 2014). A follow-up study in April 2014 was carried out to review and evaluate the Doctor of Dental Surgery (BDS) curriculum to see whether or not it provides information about the serious aspects of mercury amalgam use in dentistry to students of dental teaching institutions in the country. For comparison and guidance, BDS curriculum offered at dental institutions in neighboring Bangladesh and India were also reviewed.  The survey carried out at 38 dental teaching institutions in Pakistan indicated that the BDS curriculum currently being taught does not effectively guide outgoing dental professionals and does not provide them adequate knowledge and training about mercury/mercury amalgam human health related issues. Majority respondents supported the recommendation of reviewing and revising Pakistan’s dental curriculum at the earliest (Khwaja and Nawaz 2014).

References

Khwaja, M.A. Abbasi, M.S. Mahmood, F. and Jahangir, S. 2014, ‘Study of High Levels Indoor Air Mercury Contamination from Mercury Use in Dentistry’, Journal of Science, Technology and Development, Pakistan Council for Science and Technology, vol.33, no. 2, pp.94-106.

Khwaja, M.A. and Abbasi, M.S. 2014, ‘Mercury Poisoning Dentistry’, Reviews on Environment Health,  New York Academy of Sciences,  vol. 29, nos.1/2, pp.29 – 31.

Khwaja, M.A. and Nawaz, S. 2014, ‘Toxic Mercury and Mercury Amalgam Use in Dentistry – The Need to Review and Revise Current BDS Curriculum at Dental Teaching Institutions’,  SDPI Policy Brief Series # 43, Sustainable Development Policy Institute, Islamabad, Pakistan.