Use of mercury-containing dental restorations (dental amalgam) in Pakistan
Feroze Ali Kalhoro*
Mercury is being used in dentistry for restoration of decayed teeth since 1833. Due to its alloying nature, it is mixed with other metals like silver and tin to make the material commonly known as Dental Amalgam. Since its use in dentistry, the mercury-related problem of dental amalgam remains a source of great controversy. The contribution of mercury derived from dental amalgam to the overall body burden may be relatively low, but its handling during mixing with silver or during removal of old fillings and management of unused and recovered material in dental hospitals needs proper protocol.

This paper will highlight the use of dental amalgam as filling material in Pakistan, awareness of dentists and students regarding the potential risks of mercury, method of handling and mixing of mercury with silver alloy and its waste management.

There are almost 40 dental institutes in both public and private sector in Pakistan where thousands of fillings are being done with dental amalgam. A survey questionnaire was designed to extract information regarding the use of amalgam restorations in all 40 institutes. The survey was conducted from 15 August 2014 to 30 September 2014.  The survey found that on average 25 amalgam restorations are being performed daily in public sector institutes; and 15 restorations in private sector institutes by undergraduate students, post graduate students and dental surgeons. Amalgam restorations were found to be the most frequently used restorations than others like resin composite; and it is being taught as a primary restoration component for posterior teeth. The most commonly used dispensing method was found to be hand mixing by undergraduates; and amalgamator by postgraduate and dental surgeons.  Whereas, the methods used of disposing amalgam wastage in these institutes were the trash bin and sink.  In majority of the institutes, the protocol for handling and disposing of mercury was not being followed.

Amalgam restorations are safe as far as mercury issue is concerned. There is negligible amount of mercury release from set amalgam which does not pose harm for the general health, but mixing mercury with amalgam alloy; and amalgam wastage may cause severe health problems due to exposure to mercury vapors. So the proper guidelines for mixing of amalgam and disposing of amalgam wastage should be followed as suggested by the World Health Oragnization (WHO) and the American Dental Association (ADA) and those should be included in the curriculum of Bachelor of Dental Surgery (BDS) as well. A workshop should be conducted to train undergraduates, postgraduates and general dental practioners in this regard.
* Dr. Feroze Ali Kalhoro is Associate Professor and Principal of Institute of Dentistry at the Liaquat University of Medical Health and Sciences in Jamshoro, Sindh, Pakistan. He has been associated with dental education, teaching and research for the past ten years. He did FCPS in Operative Dentistry in 2006.