DENTAL AMALGAM MERCURY SOLUTIONS www.flcv.com/dams.html
DAMS 12164 Whitehouse Rd, Tallahassee, Fl 32317
THE ENVIRONMENTAL EFFECTS OF AMALGAM FILLINGS AFFECT EVERYONE
THE FOLLOWING FINDINGS ARE DOCUMENTED IN THIS Review Paper:
1. Human excretion into sewers by those with amalgam dental fillings along with dental office amalgam waste have been documented to be the largest source of mercury into sewers and septic tanks in most areas. Much of the mercury is organic mercury, due to bacterial actions that methylate inorganic mercury to organic.
2. All sewer plants in the U.S. have high levels of mercury and all sewer sludge has dangerous levels of mercury (generally 1 to 3 ppm).
3. Dental amalgam fillings are a major source of mercury going into rivers, lakes, and bays, both from dental offices and human wastes in home and office sewers. Dentistry is the third largest use of mercury in the U.S. using 45 tons per year most of which ends up in the environment.
4. Mercury pollution is widespread in U.S. rivers, lakes, and bays; with dangerous amounts of mercury commonly found in freshwater and saltwater fish. Over 50% of Florida’s rivers and lakes have warnings regarding eating the fish and most bays. Over 33% of all U.S. lakes have fish consumption warnings, 15% of all U.S. river miles, 90% of Atlantic coastal miles, and 100% of all Gulf coastal miles. Most Gulf Coast salt water predator fish species have high levels of mercury (above EPA/FDA warning level)
5. Mercury is the most toxic substance commonly encountered, and is adversely affecting the health of millions of people in the U.S.
6. If sewer sludge is incinerated, most of the mercury goes into emissions.
7. Crops grown on land using sewer sludge pick up high levels of mercury. Soil bacteria in landfills and land spread sludge areas methylate mercury to methyl mercury, which is released in methane and landfill gas in high levels.
High levels of mercury are being found in rain all over the U.S.
8. Dental Amalgam fillings are the largest source of mercury in most people and levels of mercury exposure from amalgam commonly exceeds Government Health Guidelines, with high levels in human excretion wastes documented.
9. The level of mercury in most sewer plants in the U.S. exceeds the U.S. Environmental Protection Agency (EPA’s) proposed mercury limit for mercury in water due to the large amount from amalgam in sewers from dental offices, homes, and businesses.
10. Crematoria emissions commonly violate mercury air emission standards and are a significant source of mercury emissions due to mercury in amalgam fillings. Amalgam related air emissions exceed coal plant emissions in UK.
11. Due to the high mercury releases from dental offices, most European countries require amalgam separators in dental offices but the U.S. still has no regulations on this source of mercury. Due to the major environmental effects of mercury from amalgam fillings, plus the additional known adverse health effects, most Japanese Dental Schools no longer teach the use of mercury amalgam fillings and several other countries have voted to ban amalgam use or issued warnings regarding its use, as have several U.S. states.
Mercury is one of the most toxic substances commonly encountered, and according to Government agencies causes adverse health effects in large numbers of people in the U.S. [1,20,34] Some of the mercury excreted by people and dental offices is organic mercury since bacteria in people and sewers methylate inorganic mercury to organic mercury (4,20). The extreme toxicity of mercury can be seen from documented effects on wildlife by very low levels of mercury exposure. The amount of mercury in the marine environment is increasing 4.8% per year, doubling every 16 years (16). Some Florida panthers that eat birds and animals that eat fish containing very low levels of mercury (about 1 part per million) have died from chronic mercury poisoning (17). Since mercury is an estrogenic chemical and reproductive toxin, the majority of the rest cannot reproduce. The average male Florida panther has higher estrogen levels than females, due to the estrogenic properties of mercury (17). Similar is true of some other animals at the top of the food chain like polar bears, beluga whales, and alligators, which are affected by mercury and other hormone disrupting chemicals (16,25,29,20). Mercury in whale meat has been found to be high enough to cause acute toxicity from one meal. Several liver samples contained over 1000 ppm mercury, over 2000 times the Japanese health standard. Muscle samples contained 2.5 to 25 times the health standard (25). The Japanese government's limit for mercury contamination, 0.4 micrograms per gram (25). According to the U.S. EPA, the maximum advisable concentration of methylmercury in fish and shellfish tissue to protect consumers among the general population is 0.3 ppm(25b). Several European countries including Sweden have banned use of amalgam fillings, with the environmental releases being a major factor(5b,34).
Mercury has been found to be so toxic that the drinking water standard for mercury is 2 parts per billion(ppb). But U.S. EPA have found that because mercury bioaccumulates in the environment and fish, in order to protect from accumulation in fish and wildlife and human health even lower standards appear to be needed and lower standards have been proposed or adopted in many areas (14). The Great Lakes Initiative Wildlife Criteria calculated needed to prevent accumulation in fish and wildlife is 1.3 nanagrams per Liter(ng/L) while the GLI Human Health Criteria is 3.1 ng/L(parts per trillion). The EPA Fish Tissue Methyl Mercury-based Criteria for rivers is 7.8 ng/L and for lakes is 3.5 ng/L. The California Toxics Rule Saltwater Criteria is 25 ng/L (14,33). The EEU limit on mercury in sewers is 50 micrograms per liter (31).
The average amalgam filling is 50% mercury and has more than ˝ gram of mercury; and has been documented to continuously leak mercury into the body of those with amalgam fillings due to the low mercury vapor pressure and galvanic current induced by mixed metals in the mouth (2,19,20,34). Amalgam has been well documented to be the number one source of mercury in most people (19,20) and to commonly cause serious adverse health effects (20, etc.). Amalgam has also been documented to be the largest source of methyl mercury in most people with several amalgam fillings, since mercury vapor and inorganic mercury have been shown to be methylated to methyl mercury in the mouth and intestines by bacteria, yeasts and other methyl donors (2,19,20). Mercury has also been found to be methylated in dental office disposal and sewer systems at levels orders of magnitude higher than in lakes and rain(4d,19,27,29,34). The World Health Organization confirmed that mercury contained in dental amalgam is the greatest source of mercury vapor in non-industrialized settings, exposing the concerned population to mercury levels significantly exceeding those set for food and for air (34,19). Mercury from dental amalgams are discharged to the sewer, atmosphere or land, with another some sent for recycling or disposed with the clinical waste stream (34). Together, mercury contained in dental amalgam and in laboratory and medical devices, account for about 53% of the total mercury emissions in the UK. (34)
Health-care facilities are one of
the main sources of mercury release into the atmosphere because
of emissions from the incineration of medical waste. The Environment
Minister of the Canadian province of Ontario declared on December 2002 that
emissions from incinerators were the fourth-largest source of mercury.
In the United States, according to US Environmental Protection Agency (EPA) in a 1997 report, medical waste incinerators may have been responsible for as much as 10% of all mercury air releases. (34)
Dental offices and health-care facilities are also responsible for mercury pollution taking place in water bodies from the release of untreated wastewater. According to a 1999 report, health-care facilities may also have been responsible for as much as 5% of all mercury releases in wastewater. Environment Canada estimates that more than one-third of the mercury load in sewage systems is due to dental practice. (34)
The most common potential mode of occupational exposure to mercury is via inhalation of metallic liquid mercury vapor. If not cleaned up properly, spills of even small amounts of elemental mercury, such as from breakage of thermometers or dental waste, can contaminate indoor air above recommended limits and lead to serious health consequences. Since mercury vapor is odorless and colorless, people can breathe mercury vapor and not know it. For liquid metallic mercury such as in thermometers or as used for dental amalgams, inhalation of vapor is the route of exposure that poses the greatest health risk. (30,20)
Because of the extreme toxicity of mercury, only ˝ gram is required to contaminate the ecosystem and fish of a 10 acre lake to the extent that a health warning would be issued by the government to not eat the fish . Over half the rivers and lakes along with most bays in Florida have such health warnings (3) banning or limiting eating of fish, and most other states and 4 Canadian provinces have similar health warnings (16,29). Wisconsin has fish consumption warnings for over 250 lakes and rivers(5b) and Minnesota even more, as part of the total of over 50,000 such lakes with warnings (16) (over 33% of all significant U.S. lakes) and 15% of all U.S. river miles. All Great Lakes as well as most coastal bays and estuaries and large numbers of salt water fish carry similar health warnings, with 90% of Atlantic coastal miles and 100% of Gulf coastal miles covered by fish mercury warnings.
Nationwide the dental industry is the third largest user of mercury, using over 45 tons of mercury per year (26,14,34), and most of this mercury eventually ends up in the environment. Amalgam from dental offices is by far the largest contributor of mercury (over 35% of total) into sewers and sewer plants(4,13b,14,26,34), with mercury from replaced amalgam fillings and crown bases the largest source. When amalgam fillings are removed by standard practice methods using primary and secondary solids collectors, approximately 60% of the amalgam metals by weight end up in sewer effluent(28b). As much as 10% of prepared new amalgam becomes waste. This mercury also accumulates in building sewer pipes and septic tanks or drain fields where used, creating toxic liabilities. Unlike Canada and most European countries such as Germany, Sweden, Switzerland, and Denmark which have much more stringent regulation of mercury that requires amalgam separators in dental offices (26,28,22), the U.S. does not and most dental offices do not have them, but new more stringent regulations are set to go into effect in 2020(33). The discharge into sewers at a dental office per dentist using amalgam without amalgam separators is between 56 milligrams per day (14) and 270 milligrams per day (2,4,14,26). (some studies found much higher levels for some offices) For the U.S. with approximately 170,000 dentists working with amalgam (26), this would be from 2500 kg/yr to 12,000 kg/yr (between 3 to 13 tons/year of mercury into sewers and thus into streams, lakes, bays, and sewer sludge. In Canada the annual amount discharged is about 2 tons per year (28), with portions ending up in waters/fish, some in landfills and cropland, and in air emissions. The recently enacted regulations on dental office waste in Canada are expected to reduce emissions by at least 63% by 2005, compared to 2000(28).
Studies in Michigan, California, and Washington estimated that dental mercury is responsible for approximately 12 to14 % of mercury discharged to streams (5). An EPA study (13) found that dental office waste were responsible for similar levels of mercury in lakes, bays, and streams in other areas throughout the U.S. A Canadian study found similar levels of mercury contribution from dental offices into lakes and streams, and surveys of dental office disposal practices found the majority violated disposal regulations, and dangerous levels of mercury are accumulating in pipes and septic tanks from many offices (14,21,26). Dental amalgam mercury has been documented to be highly bioavailable in water (30).
The total discharge into sewers from dental amalgam at individual homes and businesses
is second only to that from dental offices (2,14), since the average person with amalgam fillings excretes in body waste approximately 40 micrograms per day of mercury(6,7,8,20,31a). This has also been confirmed by medical labs(13c), such as Doctors Data Lab in Chicago and Biospectron in Sweden, which do thousands of stool tests per year and is consistent with studies measuring levels in residential sewers by municipalities(13b). In a Finnish study, over 20 % of those with amalgam excrete so much to home sewers that the EEU standard for mercury in sewers (50 ug/L) is exceeded (31). The amount of mercury excreted on average doubled for each additional 10 amalgam surfaces. The AMSA study adopted the conservative estimate of 28 micrograms per day for the average person with amalgam and 17 micrograms for the average of all those with and without amalgam. In the U.S. this would amount to approximately 2800 to 5500 kilograms per year into sewers or from 3 to 6 tons per year. Over 3 tons of mercury flows into the Chesapeake Bay annually from sewer plants, with numerous resulting fish consumption advisories for that area and similar for other areas (16). Thus, the amount of mercury being excreted from dental amalgam is more than enough to cause dangerous levels of mercury in fish in most U.S. streams into which sewers empty. Studies by Oak Ridge National Laboratory (U.S. Dept. of Energy) (22,23) and other studies (14) have confirmed high levels of mercury in sewers and sewer sludge (generally 1 to 3 ppm in biosolids). Public Owned Treatment Works (POTWs) do not have equipment to remove mercury in sewers other than any pretreatment requirements imposed by sewer districts. Mercury wastes are incompatible and must be removed at the source. In general, POTWs are not equipped to remove or treat toxic chemicals.
MCES found that dental offices were responsible for over 40% of Mineapolis sewer mercury and excretion from those with amalgam responsible for over 80% of domestic mercury (4). According to an EPA study the majority of U.S. sewerage plants cannot meet the new EPA guideline for mercury discharge into waterways that was designed to prevent bioaccumulation in fish and wildlife due to household sewer mercury levels(15,13). The EPA discharge rule had been reduced due to a National Academy of Sciences report of July 2000 that found that even small levels of mercury in fish result in unacceptable risks of birth defects and developmental effects in infants (18).
ORNL studies have found that crops grown on land using land spread sewer sludge pick up high levels of mercury, and soil bacteria methylate inorganic mercury into methyl mercury, which is released into the air or landfill gas at high levels(22,23a). Sixty percent of the 5.6 million tons of sewage sludge generated each year are used for land application (27). The ORNL studies estimate that emissions of mercury from sludge amended soil amounts to from 5 to 6 tons of mercury per year(23a). Most dental amalgam waste from dental offices either goes into landfills or is incinerated (26). Much of the sewer sludge is also incinerated. Most of the mercury in materials that are incinerated goes out in the emissions, as most incinerators have no controls to remove mercury. High levels of mercury including the very toxic organic forms are being measured in rainfall throughout the U.S. (24). High levels of the extremely toxic dimethyl and methylmercury forms of mercury are being found in landfill gas coming from landfills and appear to be a significant source of some of this (22,24). Bacteria in landfills have been found to be methylating elemental and inorganic mercury to the organic forms(22a,23a). Dental amalgam waste and mercury from human sewer sludge are major sources of mercury in some landfills and sludge is also used in landspreading on farms and other areas. Health Canada has also documented similar information on mercury emissions from amalgam and sewer sludge to waterways, crops, and air(28,29).
Additionally, cremation of those
with amalgam fillings adds to air emissions and deposition onto land and
lakes. A study in Switzerland found that in that small country,
cremation released over 65 kilograms of mercury per year as emissions, often
exceeding site air mercury standards (9), while another Swiss study found
mercury levels during cremation of a person with amalgam fillings as high as
200 micrograms per cubic meter (considerably higher than U.S. mercury
standards). The amount of mercury in the mouth of a person
with fillings was on average 2.5 grams, enough to contaminate 5 ten-acre lakes
to the extent there would be dangerous levels in fish (2,20). A
Japanese study estimated mercury emissions from a small crematorium there as 26
grams per day (10). A study in Sweden found significant
occupational and environmental exposures at crematoria, and since the
requirement to install selenium filters mercury emission levels in crematoria
have been reduced 85% (11). For the 70% of people in Britain who die and
end up with their bodies being cremated, the mercury escapes into the atmosphere and
contaminates waterways, soil, wildlife and food. Crematoria now contribute
16% of all the mercury released by industry and power plants in
Britain (32), with levels projected to soon exceed emissions by
power/industrial plants(32b). The 440,000 people cremated in Britain every year
are estimated to discharge 1300kg of mercury. (12) A study of
assessing hair mercury in a group of staff at some of the 238 British
crematoriums found that the groups hair mercury were
significantly greater than that of controls (12). Government guidance
calls on them to introduce new flue cleaning measures to help achieve a
statutory target of a 50 per cent reduction by 2012.
(1) ATSDR/EPA : Top 20 Hazardous Substances, Agency for Toxic Substances and Disease Registry,U.S. Department of Health and Human Services, & U.S. EPA (Environmental Protection Agency), 2018, "Integrated Risk Information System, ,
(3) Florida Department of Health, Bureau of Environmental Toxicology, Health Advisories for Mercury in Florida Fish 1997; 10-15; & B.Windham, and effects on people,
(4) Arenholt‑Bindslev, D.; Larsen, A.H. "Mercury Levels and Discharge in Waste Water from Dental Clinics" Water Air Soil Pollution, 86(1‑4):93‑9, (1996); & (b)Assoc. of Metropolitan Sewerage Agencies(AMSA), Evaluation of Domestic Sources of Mercury , Aug 2000, ; &(c) Metropoliton Council Environmental Services (MCES), “Controlling Dental Facility Discharges in Wastewater”, Twin Cities, Minnesota, 1999; ; &
(d) Stone ME, Cohen ME, Liang L, Pang P. Determination of Methylmercury in dental-unit wastewater; Dent Mater.,2003, 19(7):675-679;
&(e) Characterization of methyl mercury in dental wastewater and correlation with sulfate-reducing bacterial DNA. Zhao X et al; 2008 Apr 15;42(8):2780-6.; & (f) Review, Dental Amalgam Facts: ;
(5) Rowe NH; Sidhu KS; Chadzynski L; Babcock RF. School of Dentistry, University of Michigan, Ann Arbor,
USA. J Mich Dent Assoc 1996 Feb;78(2):32‑6; &(b) Wisconsin Mercury Sourcebook: Dentists, p262, http://www.epa.gov/glnpo/bnsdocs/hgsbook/dentist.pdf
(6)Skare I; Engqvist A. National Istitute of Occupational Health, Human exposure to mercury and silver released from dental amalgam restorations. Arch Environ Health 1994 Sep‑Oct;49(5):384‑9.
(7)Bjorkman L; Sandborgh‑Englund G; Ekstrand J. Mercury in saliva and feces after removal of amalgam fillings.
Toxicol Appl Pharmacol 1997 May;144(1):156‑62
(8) Ekstrand J; Bjorkman L; Edlund C; Sandborgh‑Englund G. Toxicological aspects on the release and systemic uptake of mercury from dental amalgam. Eur J Oral Sci 1998 Apr;106(2 Pt 2):678‑86
(9) Rivola J, Krejci I, Imfeld T, Lutz F. Cremation and the environmental mercury burden. Schweiz Monatsschr Zahnmed1990;100(11):1299‑303; & Matter‑Grutter C, Baillod R, Imfeld T, Lutz F. Mercury emission measurements in a crematorium. The dentistry aspects. Schweiz Monatsschr Zahnmed 1995;105(8):1023‑8
(10) Yoshida M; Kishimoto T; Yamamura Y; Tabuse M; Akama Y; Satoh H. Amount of mercury from dental amalgam filling released into the atmosphere by cremation. Nippon Koshu Eisei Zasshi 1994 Jul;41(7):618‑24.
(11) Reese Km. Mercury emissions from crematoria. Chem & Engin News, 12-7-98, p80-81; & Lancet 1998; 352, 1602.
; & ; & -2015
Resulting from the Cremation of Dental Amalgam in Minnesota -2015; & Maloney S. et al, Nene Univ. College, Northhampton, Crematoria staff face risk from mercury in tooth fillings. Brit Med Journal, 2000; & V. Mc Donald, health Corresponsdent, Daily Telegraph; & Department of the Environment, Transport, and the Regions (DETR)- London, & Rob Edwards, Environment Editor, Dublin Sunday Herald, Feb 11 2001,
(13) U.S. Environmental Protection Agency Mercury Sourcebook: a Guide to Help Your Community Identify and Reduce Releases of Elemental Mercury. Section III, Mercury Use: Dentists, p249-292. Great Lakes- & & ; & (b) Association of Metropolitan Sewerage Agencies (AMSA), Evaluation of Domestic Sources of Mercury , Aug 2000,
; & (c) Doctors Data Inc.; ; P.O.Box 111, West Chicago, Illinois, 60186-0111;
(14) Association of Metropolitan Sewerage Agencies (AMSA)/U.S. EPA, Mercury Source Control Program Evaluation, Larry Walker Associates, Final Report, March 2002, & (b) AMSA, Mercury Source Control/Pollution Prevention, Metropolitan Council Environmental Services, p5, p5,
& International , Volume XIII, Spring/Summer 2000; & (c) Dental office waste - public health and ecological risk. Muhamedagic B et al; 2009;21(1):35-8.
(15) Household mercury complicates EPA Rule, A. Huslin, Washington Post, Aug 26,2000, pg B2.
(17) C.F. Facemire et al, “Reproductive impairment in the Florida Panther”, Health Perspect,1995, 103 (Supp4):79-86; & ; M.Maretta et al, “Effect of mercury on the epithelium of the fowl testis”, Vet Hung 1995, 43(1):153-6; & T. Colborn (Ed.), Chemically Induced Atlerations in Functional Development, Princeton Scientific Press,1992;
(18) Toxicological Effects of Methylmercury (2000), pp. 304‑332: Risk Characterization and Public Health
Implications, Nat'l Academy Press 2000. www.nap.edu
(19) DAMS Fact Sheet, and Exposures from Amalgam Commonly Exceed Government Health Guidelines.
(20) and . Over 5000 medical study references (most in Medline) and approx. 60,000 clinical cases of amalgam replacement followed by doctors.
(21) News Release, April 7, 2000, MONTREAL URBAN COMMUNITY TO LEGISLATE RECYCLING OF MERCURY BY DENTAL CLINICS; APPROVED BY QUEBEC ENVIRONMENT MINISTER, contact: Dr. Pierre Larose (514) 747-4949
(b) City of Toronto, by-law No. 457-2000, To regulate the discharge of sewage and land drainage,
enacted by Council, July 6, 2000;
(22) (a) Lindberg, S.G., et al. Oak Ridge National Laboratory, 2001. Methylated mercury species in municipal waste landfill gas sampled in Florida, USA. Atmospheric Environment 35(Aug):4011-15.; & Lindberg, S.G. et al, Airborne Emissions of mercury from municipal solid waste: measurements from 3 Florida landfills, JAWMA, 2002; & (b)Janet Raloff, Landfill gas found to have high levels of highly toxic dimethyl form of mercury. Science News July 7, 2001; Vol. 160, No.1; & Study Says Landfill Bacteria Worsen Mercury Pollution, Solid Waste Report, Vol. 32 No. 28 July 12, 2001 Page 217; &(c) U.S. EPA, Air Emissions of landfill gas pollutants at Fresh Kills Landfill, Staten Island, NJ, December 1995, NTIS Order number PB97-500508INC 04/20/2001 [www.ntis.gov/fcpc/cpn7634.htm];
(23) (a)Methyl Mercury Contamination and Emission to the Atmosphere from Soil Amended with Municipal Sewage Sludge, Anthony Carpi et al, U.S. Dept. of Energy Oak Ridge National Lab(ORNL), Journal Environ. Quality 26:1650-1655 (1997); & ORNL, Sunlight-mediated Emission of Elemental Mercury from Soil Amended with Sewerage Sludge, Env Sci& Tech, 31(7):2085-91; &Press Release: ORNL finds green plants fertilized by sewer sludge emit organic and inorganic mercury, www.ornl.gov/Press_Releases/archive/mr19960117‑01.html; & (b) National Research Council, NAS, Biosolids Applied to Land: Advancing Standards and Practices , www.nap.edu.; & (c) Maine Toxics Action Center, Toxic sludge: threatening farm lands and public health, Oct 2001. www.toxicsaction.org/tacsludgereport10_30_01.pdf; & Genetic Analysis of Drinking Water www.toxicsaction.org/tacsludgereport10_30_01.pdf;
(24) High mercury levels in rain throughout U.S., www.myflcv.com/rainhg.html
(25) Tetsuya Endo, Koichi Haraguchi and Masakatsu Sakata , Hokkaido Univeristy, High levels of mercury found in whalemeat, The Science of the Total Environment. 2002; & (b) ethylmercury fish tissue residue criterion, United States Environmental Protection Agency, Office of Water, 4304 EPA-823-F-01-001, January 2001,
(26) (a)Dentist the Menace: The Uncontrolled Release of Dental Mercury in the Environment, Mercury Policy Project and Healthcare Without Harm, June 2002, www.mercurypolicy.org/new/documents/DentistTheMenace.pdf
& Sustainable Hospitals Program, www.sustainablehospitals.org/HTMLSrc/IP_Merc_BMP_DentalAmalgam.html
& (b)S.M. Jasindki, U.S. Bureau of Mines, The Materials Flow of Mercury in the U.S. , Information Circular 9412, 1994; & (c)United Nations Environment Program, “Global Mercury Assessment-Appendix:Overview of Existing and Future National Actions, April 25 2002 Draft; & al-Shraideh M, al-Wahadni A, The mercury burden in waste water released from dental clinics in Jordan; SADJ 2002 Jun;57(6):213-5; &
(d) Mercury Speciation and Mobilization in a Wastewater-Contaminated Groundwater Plume. Environmental Science & Technology, 2013; 47 (23); Carl H. Lamborg, Doug B. Kent,et al, Woods Hole Oceanographic Institution, March 10, 2014
(27) National Research Council, National Academy of Sciences, Health risks of land-applying sewage sludge July 8, 2002
(28) Canada-wide Standards: A Pollution Prevention Program for Dental Amalgam Waste, J Can Dent Assoc 2001; 67:270-3 & (b) A.O. Adegbembo, P.A. Watson et al;
The weight of wastes generated by removal of dental amalgam restorations and the concentration of mercury in dental wastewater; J. Canadian Dental Assoc., 2002, 68(9): 553-8.
(29) Methylmercury in Canada, exposure of First Nations and Inuit residents to methylmercury in the environment, Health Canada, Volume 3, 1999.
(30) Christopher J. Kennedy, Uptake and accumulation of mercury from dental amalgam in the common goldfish, Carassiusauratus; Environmental Pollution, Volume 121, Issue 3, March 2003, Pages 321-326
(31)Leistevuo J, Leistevuo T, Tenovuo J. Mercury in saliva and the risk of exceeding limits for sewage in relation to exposure to amalgam fillings; Arch Environ Health 2002 Jul-Aug;57(4):366-70; &
Council of European Communities Directive 84/156/EEC.
(32) Department of Environment, Food and Rural Affairs, UK , Oct 2005
(b) Mercury emissions from crematoria, Defra/WAG/SE , July 2004,
UK Environment Agency’s Local Authority Unit, http://www.defra.gov.uk/corporate/consult/crematoria/index.htm
(33) EPA Dental Effluent Guidelines,
(34) World Health Organization, Mercury in Health Care, 2018; ;
& (b) WHO HealthCare Waste, ; & (c) : Health Affairs: Health Care Brief-2012, ; & (d) Healthcare Waste Management
(35) Electric Power Research Institute. Mercury in the Environment. Electric EPRI Journal 1990; April, p5; & EPRI Technical Brief: "Mercury in the Environment", 1993
Technical contact person: Bernard Windham
Research Coordinator, DAMS International
firstname.lastname@example.org ph: 850-878-9024