Toxic Mercury and Mercury Amalgam Use in Dentistry - the need to review and revise current BDS curriculum at dental teaching institutions - (PB - 43)

Toxic Mercury and Mercury Amalgam Use in Dentistry - the need to review and revise current BDS curriculum at dental teaching institutions - (PB - 43)

Publication details

  • Thursday | 10 Jul, 2014
  • Mahmood A. Khwaja, Sadaf Nawaz
  • Policy Briefs/Papers
  • 22
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Dr. Mahmood A. Khwaja and Sadaf Nawaz


The extreme hazardousness and toxicity of the only known liquid element mercury is well established. Mercury has been ranked third in the list of toxic substances (ATSDR 2012).  Being assessed as a toxic substance to ecosystem, wildlife and human (UNEP 2002 & 2013),  it   affects nervous system and functioning of brain, especially of children. Short-term mercury exposure may cause damage to lungs, skin rashes and eyes irritation. Metallic mercury is an allergen that may cause eczema. Mercury amalgam use for teeth health care can lead to oral lichen (Jarup 2003; Martin & Griswold 2009; OPH 2008). In view of the adverse health impacts due to mercury exposure and its impacts on ecosystem and environment, in order to reduce and phase out global mercury use, “Minamata Convention on Mercury,” was in-acted by over 140 countries in early 2013 and till now 94 countries (including Pakistan) have already signed it (UNEP 2013).

In an earlier SDPI study carried out at 34 dental sites (including 17 dental teaching institutions) in five main cities of Pakistan, alarmingly high levels of mercury vapours were observed in outdoor/indoor air around these sites (Khwaja & Abbasi 2014; Khwaja et al. 2013). 88% of the sites indicated indoor mercury levels in air above the USA EPA reference level of 300ng/m3. SDPI study also indicated general unawareness among dental professionals regarding appropriate handling of mercury/mercury amalgam, poor management of mercury containing wastes, improper and inadequate ventilation system at the workplace, lack of awareness about hazards of mercury exposure to human health and its adverse impact on the environment. Use of liquid mercury for mercury amalgam making, non-mechanical mixing and very careless/care free use of mercury/mercury amalgam by the students at dental teaching institutions have been considered other main reasons for the above reported very high mercury vapour levels in the air at some of the monitored dental sites (Khwaja & Abbasi 2014; Khwaja et al. 2013).  

The present study was designed follow up to the above SDPI study report, with the following objectives:



  •      to know the present level of awareness and general practices regarding mercury/mercury amalgam use in operative dentistry in Pakistan
  •     to review BDS curriculum/syllabus, presently offered by national and professional bodies (including Pakistan Medical and Dental Council-PMDC) to the students of dental teaching institutions in the country.
  •     to assess and evaluate its contents with regard to mercury/mercury amalgam use and occupational health, safety & environment, best environmental practices/technologies employed and management of mercury containing waste related issues.
  •      to emphasize the need to revise the curriculum/syllabus at the earliest time possible, in the light of the above findings and to develop recommendations for additional needed relevant contents as part of the dental curriculum, for adequate knowledge and training of upcoming dental professionals towards minimizing mercury exposure, occupational health and safety of healthcare workers, mercury containing waste reduction at source and protection of environment.

For comparison and guidance, the curriculum offered by medical and dental councils of neighboring countries, Bangladesh and India and some teaching institutions in India and Pakistan were also reviewed.
Details of the above activities, collected data, findings/results and recommendations are briefly described and discussed in the foregoing pages.