International Medical Journal Vol. 25, No. 1, pp. 36 - 38 , February 2018 DENTAL SCIENCES Do Dentists Practicing in Karachi Follow Mercury Hygiene Recommendations? Asaad Javaid Mirza 1) , Maaz Asad Javaid 2) , Ammar Ahmed Siddiqui 3) , Mohammad Khursheed Alam 4) , Hazza A Alhobeira 1) ABSTRACT Background: Dental amalgam is extensively used as a material of choice for posterior restorations and Mercury (Hg) is its essential component. Mercury is a toxic substance which can be harmful for a Dentists and clinic staff due to long term exposure to Hg vapors in the clinic atmosphere. To avoid adverse effects of Hg on health of clinic personnel, American Dental Association (ADA) has laid down recommendations to follow while handling Hg or amalgam. Majority of general dentists practicing in Karachi - a metropolitan city of Pakistan place amalgam restorations more than the restorations of any other material. Despite frequent use of amalgam and Hg, no much data is available to show level of safety precautions taken by these dentists. This study was planned to assess the Hg hygiene practices of general dentists who run their private dental clinics in Karachi. Methods: A questionnaire based study conducted among general dentists practicing in Karachi. Results: Except use of personnel protective equipment, prevalence of following other precautions recommended by ADA for Hg hygiene is not encouraging. Conclusion: Practicing general dentists work in Hg - rich environment and are at risk of jeopardizing their health. Moreover, they are persistent source of atmospheric pollution with Hg which requires strict monitoring. KEY WORDS dental mercury toxicity, mercury hygiene, ADA recommendations for Hg safety, mercury occupational hazards Received on December 19, 2016 and accepted on March 21, 2017 1) Department of Restorative Dentistry, College of Dentistry, University of Ha'il Saudi Arabia 2) Department of Periodontology, Dental College, Baqai Medical University Pakistan 3) Department of Dental Public Health, College of Dentistry, University of Ha'il Saudi Arabia 4) Orthodontic Department, College of Dentistry, Al Jouf Universit Sakaka, Saudi Arabia Correspondence to: Asaad Javaid Mirza (e-mail: asaadjmirza@gmail.com) 36 INTRODUCTION Mercury (Hg) in its purest form is an integral part of Dental Amalgam which is an alloy of many metals with Silver as its main con- stituent. The amalgam alloy is dispensed as powder which is triturated with Hg to give rise to a moldable mass. The mass is filled into a tooth cavity to restore the cariously lost tissue and sets rock hard with 50% Hg in it by weight 1) . Mercury is considered as highly toxic substance 2,3) that may result in numerous adverse effects on health of the individuals exposed to it 4) . Exposure to Hg is linked to a chronic inflammatory dis- ease of oral mucosa known as oral lichen planus 5) . Findings of a study show that Hg associated with dental amalgams seem to affect the immune system of an exposed- to- Hg person 6) . Exposure to the raised levels of mercury vapors may cause pulmonary damage, hypertension, skin rashes, nausea, vomiting, diarrhea 7) . Many studies have shown hos- tile effects of Hg exposure on central nervous system and cardiovascular system 8) . In mid- 70s an anti-amalgam campaign was launched with concoc- tion that Hg in dental amalgam is harmful for dentists as they are the most Hg-exposed health professionals 9) . The dentists occupational expo- sure to Hg vapors take place to a large amount during chair-side clinical work at the time of manipulation of amalgam for restoration, its polish- ing and removal of failed amalgam restorations. It was therefore demanded to discontinue the use of amalgam as a restorative material. Despite this controversy which later resolved in favor of dental amal- gam and it was declared as a safe material 10) . It remains the material of choice for posterior restorations 11) due to its longevity, low technique sensitivity and cost effectiveness 12) . Antibacterial activity of silver amal- gam especially against caries causing bacteria has been found better than other restorative materials 13,14) . Moreover, amalgam is a time-tested material efficaciously used by the dental clinicians for last two centu- ries 15) as compared to other relatively newer restoratives. On clinical use of amalgam, contemporary policy of World Health Organization (WHO) and International Dental Federation (FDI) states that "though amalgam is a safe material but a potential health risk to oral health personnel from Hg exposure exists if working conditions are not properly organized. The application of proper Hg hygienic require- ments together with monitoring of Hg vapors in the work environment in dental clinics will significantly reduce Hg exposure". 16) In 1999, American Dental association (ADA) issued Hg hygiene recommendations to provide guidance to dentists and their staff mem- bers for safe handling of mercury and dental amalgam 17) . These recom- mendations hold good for safety of dental personnel working all over the globe but they are not implemented and practiced properly 18) espe- cially in countries like Pakistan where no monitoring authority exists to C 2018 Japan Health Sciences University & Japan International Cultural Exchange Foundation