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Licensed Unlicensed Requires Authentication Published by De Gruyter January 20, 2016

Mercury exposure in the work place and human health: dental amalgam use in dentistry at dental teaching institutions and private dental clinics in selected cities of Pakistan

  • Mahmood A. Khwaja EMAIL logo , Sadaf Nawaz and Saeed Waqar Ali


During the past two decades, mercury has come under increasing scrutiny with regard to its safety both in the general population and in occupationally exposed groups. It’s a growing issue of global concern because of its adverse environmental and health impacts. 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. According to an earlier SDPI study, reported in 2013, alarmingly high mercury levels were observed in air (indoor as well as outdoor) at 11 of the 34 visited dental sites (17 dental teaching institutions, 7 general hospitals & 10 dental clinics) in five main cities of Pakistan. 88% of the sites indicated indoor mercury levels in air above the USA EPA reference level of 300 ng/m3. According to our study, carried out at 38 dental teaching institutions in 12 main cities (in Khyber Pakhtunkhwa, Punjab and Sindh provinces) of Pakistan, respondents were of the opinion that the currently offered BDS curriculum does not effectively guide outgoing dental professionals and does not provide them adequate knowledge and training about mercury/mercury amalgam and other mercury related human health and mercury waste issues. 90% of respondents supported the review and revision of the present dental curriculum offered at dental teaching institutions in the country, at the earliest. A study has also been conducted to assess the status of mercury amalgam use in private dental clinics in Gilgit, Hunza, Peshawar, Rawalpindi and Islamabad. More than 90 private dental clinics were visited and dental professionals/private clinics in-charge were interviewed during June–July, 2015. The focus areas of the study were Hg amalgam toxicity, its waste management practices and safety measures practiced among the dental practitioners. In the light of the findings described and discussed in this brief report, to safeguard public health and for the protection of environment, it is strongly recommended that since mercury amalgam use cannot be banned immediately in the country, its use may be regularized and allowed subject to use of “Amalgam Separators,” “Capsulated Mercury” and “Mechanized Mixing,” use of mercury amalgam be banned for children (below 12 years age) and pregnant women. The curriculum currently being taught at medical and dental colleges in the country be reviewed and revised, to ensure adequate training towards minimizing mercury exposure.

Corresponding author: Dr. Mahmood A. Khwaja, Sustainable Development Policy Institute (SDPI), 38, Main Embassy Road, G-6/3, Islamabad, Pakistan, Phone: +0092 51 2278134/36, E-mail:


The valuable contribution and support of SDPI mercury air monitoring team and Mr. Adnan Hassan (MIS), is gratefully acknowledged by the authors, with many appreciative thanks.


1. (ATSDR): Agency for toxic substances and diseases registry. Detailed Data table for priority list of hazardous substances. 2011. Available at: in Google Scholar

2. Duruibe JO, Ogwuegbu MO, Egwurugwu JN. Heavy metal pollution and human biotoxic effects. Int J Phys Sci 2007;2(5):112–8.Search in Google Scholar

3. Office for Public Health, Information for health care professionals Mercury exposure and toxicity, Louisiana Department of Public Health and Hospitals. 2008. Available at: in Google Scholar

4. Spencer AJ. Dental amalgam and mercury in dentistry. Aust Dent J 2000;45(4):224–34.10.1111/j.1834-7819.2000.tb00256.xSearch in Google Scholar PubMed

5. Weinberg J. An NGO introduction to mercury pollution. International POPs Elimination Network (IPEN) Publication, 2010. Available at: in Google Scholar

6. Arvidson B, Arvidsson J, Johansson K. Mercury de-posits in neurons of the trigeminal ganglia after insertion of dental amalgam in rats. Biometals 1994;7:261–3.10.1007/BF00149557Search in Google Scholar PubMed

7. Kirby A, Leva R, Valentin Y, Christy C, Otto S. Mercury – Time to Act. United Nations Environment Program (UNEP) Publication, 2013;23. Available at: in Google Scholar

8. Pamphlett R, Coote P. Entry of low doses of mercury vapors into the nervous system. Neurotoxicology 1998;19:39–48.Search in Google Scholar

9. Preliminary report on Mercury Inventory in Pakistan. Islamabad: Government of Pakistan/UNEP Chemical Branch, Ministry of Environment, 2000.Search in Google Scholar

10. Rubina M, Khan AA, Noor N, Humayun. Amalgam Use and Waste Management by Pak. Dentist EMHU 2010;16:334–9.Search in Google Scholar

11. Iqbal KI, Maria Z, Majid J, Sana M, Afreen M, et al. Dental Amalgam effects of alloy/mercury mixing uses and waste management. J Ayub Med College, Abottabad 2011;23:43–5.Search in Google Scholar

12. Gul, Niab, Ph.D. Thesis, Mercury exposure and Health Effects on Occupational Workers, Dental Amalgam and Whitening Cream Users. Department of Environmental Sciences, University of Peshawar, Pakistan, 2015.Search in Google Scholar

13. Khwaja MA, Abbasi MS, Mahmood F, Jahangir S. 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 2014;33(2):94–106.Search in Google Scholar

14. Khwaja MA, Abbasi MS. Mercury poisoning dentistry. Rev Environ Health 2014;29(1/2):29–31.10.1515/reveh-2014-0010Search in Google Scholar PubMed

15. Khwaja MA, Nawaz S. 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, 2014.Search in Google Scholar

16. Khwaja MA, Ali SW. SDPI project report. Sustainable Development Policy Institute (SDPI), Islamabad, Pakistan, 2015.Search in Google Scholar

17. HEC: Higher Education Commission. Curriculum of Bachelor of Dental Surgery (BDS) Five Years Program. 2011. Available at in Google Scholar

Received: 2015-10-20
Accepted: 2015-10-21
Published Online: 2016-01-20
Published in Print: 2016-03-01

©2016 by De Gruyter

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