Overview
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Key numbers
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- Dental amalgam was conducted using blood (n = 3), urine (n = 7) and hair samples (n = 2). Most studies
- Aziza Menouni: http://orcid.org/0000-0001-9738-8301 about 6% of total global mercury consumption.3 Accordingly,
- Health Program found that 84% of the 80 countries surveyed design (PECOS) framework: (P) dental health workers; (E)
- in up to 36% of LMICs versus only 9% in high-income countries. care professionals, (O) mercury levels of dental health work-
- 40% and 23% of low-income and lower-middle-income coun- ers assessed through biomarkers of exposure in human
- dations. Specifically, we will (1) report on the range of concen- ronment), mercury exposure levels (biomonitoring data
- analysis and reported on the instrument’s performance in the remaining four studies.17,19,21 The highest mean mer-
- reported all measured outcomes (both primary and second- study with a mean of 42.27 § 14.48 mg/g Cr.18 One study25
- (range: 0.060-1.628) in exposed individuals and 0.23 mg/g
- (n = 6),17,19-21,23,24 while two were carried out in African monitoring of mercury in the air was performed every trimes-
- countries,18,25 and only one in Europe22 (Table 1). Most of the ter of pregnancy.18 The highest mean environmental mercury
- cury,17-19,21,22,24,25 while blood (n = 3)17,20,24 and hair (n = 2)22,23 mg/m3 for the third trimester. In India, air monitoring was
- markers were used to evaluate oxidative stress (n = 3),17,18,24 3.88 mg/m3.21 Measurements taken in dental clinics’ treat-
- renal function (n = 2),17,24 liver function (n = 1)17 and immune ment rooms were higher than the control sample.
- response (n = 1).19 Other health outcomes studied included Jamil et al.20 assessed the contribution of dental amalgam
- pregnancy outcomes (n = 1)18 and self-perceived health out- in environmental contamination with mercury and found all
- comes (n = 1).21 wastewater samples collected in Pakistani dental practices to
- blood.17,20,24 Jamil et al.20 reported the highest mean concen-
- trations of mercury in blood, with 29.83 § 20.10 mg/L in den- Regarding mercury levels in the blood, Jamil et al.20 found a
- tists and 22.80 § 10.71 mg/L in dental assistants. In contrast, significant association with age, occupation (dentists vs. den-
- 1.24 § 0.71 mg/L in the blood of dentists.17 All three studies per day, number of amalgam fillings placed per week, and
- service in dentistry, the number of amalgam restorations car- Four studies reported on biomarkers of effects (Table 2).17-19,24
- Jamil et al.20 Pakistan Cross-sectional 98 B-Hg/ Plasma ICP-OES Dentists: 29.83 3.28 (1.46) mg/L Mean (SD) (mg/L) Not reported Elevated blood mer-
- Al-Zubaidi et al.17 Cross-sectional 35 U-Hg/ Urine CVAAS 4.30 (2.79) 0.57 (0.58) mg/L Mean (Se) (mg/m3) Increased levels of Exposure of dental
- B-Hg/ Serum Direct Mercury 1.24 (0.71) 0.19 (0.27) mg/L
- Cohort 124 U-Hg/ Urine CVAAS 42.27 (14.48) 6.53 (3.80) mg/g Cr Highest mean envi- Pregnant dental staff Pregnant dental staff
- Table 1. (Continued)
- Yazdanian et al.24 Cross-sectional 57 B-Hg/ Total blood HG-AAS 6.03 (2.22) 4.23 (2.04) mg/L Not performed Significant reduction Using dental amal-
- U-Hg/ Urine HG-AAS 5.7 (3.32) 3.60 (2.16) mg/L
- cek et al.22 Czech Cross-sectional 50 U-Hg/ Urine AAS Mean (min.-max.) Mean (min.-max.) mg/g Cr Not performed Not reported Current dental expo-
- Girgin et al.19 Turkey Cross-sectional 300 U-Hg/ Urine ICP-MS 3.60 (1.74) Not reported mg/L Not performed Positive correlation Lower neopterin and
- Zebbiche et al.25 Cross-sectional 42 U-Hg/ Urine ICP-MS Geometric mean NA mg/g Cr Not performed Not reported Reduction in occupa-
- 14 dental assistants (<LOQ, 14.05) sure is due to a shift
- Mawari et al.21 India Cross-sectional 93 U-Hg/ Urine ICP-MS 0.51 (1.4) 0.29 (0.28) mg/L Air sampling: 3.56 Significant correlation While mercury expo-
- 32 controls Time range: 227.18 and confusion, forget- the TLV, a significant
- Table 2 – Summary of studies reporting on biomarkers of effects.
- Microalbumin Turbidimetry 6.28 (2.82) 76.68 (290.89) mg/L
- decrease in amalgam for direct restorations from 52.3% in to assessing exposure determinants.
- 1998 to 7.1% in 2017.27 Similarly, the overall rate of dental Findings from environmental monitoring studies indicate
- declined from 21.8% in 2017 to 4.1% in 2023 in the United exceed recommended safety limits. Measurements taken in
- by 36.9% of dentists in Turkey,29 41.6% of dentists in Paki- above ACGIH recommended threshold limit value (TLV) of
- stan,30 and accounted for 57.5% of dental restorations placed 0.025 mg/m3 averaged over an 8-hour workshift.17,34 In con-
Methods (brief)
- Lode Godderis b,e, Samir El Jaa^fari a, Younes Filali-Zegzouti a
- Dental amalgam was conducted using blood (n = 3), urine (n = 7) and hair samples (n = 2). Most studies
- Lode Godderis: http://orcid.org/0000-0003-4764-8835 Article 4 of the Minamata Convention supports the
- ers to mercury, focusing on biomonitoring levels considering sample size, sampling period), population characteristics for
- three used air samples,17,18,21 and one used wastewater
- Overview of included studies samples.20
- renal function (n = 2),17,24 liver function (n = 1)17 and immune ment rooms were higher than the control sample.
- comes (n = 1).21 wastewater samples collected in Pakistani dental practices to
- Reference Study design Sample size Exposure measurement Health outcomes Main conclusions
- Jamil et al.20 Pakistan Cross-sectional 98 B-Hg/ Plasma ICP-OES Dentists: 29.83 3.28 (1.46) mg/L Mean (SD) (mg/L) Not reported Elevated blood mer-
- 37 dentists (20.10) Samples collected cury in older and
- Samples collected mercury vapours.
- dental chairs: wastewater samples
- Al-Zubaidi et al.17 Cross-sectional 35 U-Hg/ Urine CVAAS 4.30 (2.79) 0.57 (0.58) mg/L Mean (Se) (mg/m3) Increased levels of Exposure of dental
- Cohort 124 U-Hg/ Urine CVAAS 42.27 (14.48) 6.53 (3.80) mg/g Cr Highest mean envi- Pregnant dental staff Pregnant dental staff
- Reference Study design Sample size Exposure measurement Health outcomes Main conclusions
- Cross-sectional 100 H-Hg/ Hair FS-AAS 5.36 (2.64) 3.1 (1.99) ng/mL Not performed Not reported No occupational haz-
- Yazdanian et al.24 Cross-sectional 57 B-Hg/ Total blood HG-AAS 6.03 (2.22) 4.23 (2.04) mg/L Not performed Significant reduction Using dental amal-
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