Why we must start early implementation
Mercury is the most toxic non-radio active element known to man and has been identified as one of the top 10 global priority pollutants. In 2013, the United Nations Environmental Programme (UNEP) concluded the Minamata Convention on Mercury Treaty. The treaty was named after the first globally recognized mercury catastrophe in Minamata, Japan where the Chisso plant had been dumping mercury waste into Minamata Bay. This mass mercury contamination, resulted in a long cycle of poisoning of not only the fish and animals, but also all of the inhabitants. The name Minamata disease was created upon the discovery of the source of the poisoning that the victims were suffering from. The treaty was named to honor the memory of all of the victims 1.
Since 2013, there have been 128 signatories and 32 countries that have ratified the Minamata Convention on Mercury treaty2. Chile was a stakeholder in these negotiations and like many developing countries, expressed major concerns of mercury contamination from Artisanal Small Scale Gold Mining (ASGM). Since the rise in gold prices globally, ASGM has become one of the most significant sources of mercury pollution. According to the United Nations Environmental Programme, the sector with the highest demand for mercury is ASGM. Mercury used in ASGM is not only creating local contamination, but also the burning of mercury in the gold extraction process is part of the global air transport of mercury. Those who live near these mining sites are also being exposed to mercury through fish consumption. Mercury exposure can cause many serious health effects including neurological damage, kidney damage, vision disorders, tremors, sleep disorders, autoimmune dysfunction, and other adverse health problems 3.
In 1991 the World Health Organization (WHO) deemed that the first route of human exposure to mercury is through mercury dental amalgams, often referred to as “silver” fillings, even though these fillings are approximately 48-54% mercury4. Dental mercury amalgam is a product on the phase down list of the Minamata Convention. Dental mercury is often diverted for sale on the black market for ASGM purposes 5.
The International Academy of Oral Medicine and Toxicology, a Non-Governmental Organization (IAOMT-NGO), is a global leader in the field of biological dentistry. IAOMT was an active stakeholder during the negotiations of the treaty, and provided delegates with information on mercury free/mercury safe dentistry. IAOMT developed the Technical Assistance Programme (TAP) during the treaty, in order to educate countries on how to safely remove mercury from patients, which is critical for minimizing additional exposure to the patient, dental workers and the environment. The first TAP was held in Brasil 6. This is extremely important because the UNEP is asking all participants to start early implementation of the treaty. It is particularly significant to eliminate the use of dental mercury because it will stop the flow into ASGM. An important alternative to dental mercury is Atraumatic Restorative Treatment (ART), which was developed to provide dental care in remote areas where only hand instruments are used. This has been considered a viable solution to treat dental caries in developing countries7. For many decades other alternatives to dental mercury restorations have been successfully used such as composite resins or glass ionomer fillings. These alternatives should be utilized to preserve the healthy tooth structure, since they are less invasive than dental mercury that not only requires destruction of the good tooth, but also expands and contracts, which can destroy the tooth 8.
A report titled Dentist the Menace, published in 2002 showed that the largest contributor of mercury to the wastewater came from the dental sector 9. What is often overlooked are the pathways in which humans are continuously contributing to the global mercury problem when mercury is present in their teeth. Human contributions to mercury contamination are through burial or cremation, human waste, going to the dentist, or simply breathing.
Cartes-Velasquez reported that there has been an exponential growth of dental schools in Chile. In fact, from 1997 to 2011 the number of schools grew from 5 to 34. As of 2012, there were approximately 17,000 dentists in Chile 10. As the dental industry grows in Chile, the continued use of mercury in dentistry will create even more long-term environmental problems. Norway, Denmark, and Sweden have banned the use of mercury in the dental sector. Other countries like Germany, Spain and Italy have restrictions or guidelines in place 11. This is also a social justice problem, since many dental patients in developed countries have a clear choice for dental materials; while developing countries are continuing to expose dental patients to mercury fillings. The Minamata Convention on Mercury Treaty is clearly a wakeup call to the world that all uses of mercury must be eliminated. There can be no more excuses for dental mercury’s continued use, since there are viable non-mercury alternatives. It is no longer a question of if we will stop its use, but when.