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      Decreased trends of using dental amalgam filling for decayed teeth in Taiwan from 1997 to 2013

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          Abstract

          Background/purpose

          Mercury within dental amalgam has been criticized for the potential toxicity and environmental hazard. Phasing down the use of dental amalgam is the transition for amalgam free dentistry. However, little is known about dental amalgam filling (AMF) in Taiwan. In this study, time trends of AMF were measured by using National Health Insurance Research Database (NHIRD).

          Materials and methods

          A retrospective study was conducted to analyze the AMF data in registered database compiled by Taiwanese NHIRD from 1997 to 2013. The AMF data were further analyzed according to sex, age, and geographic location, respectively. Time trends of dental visits for AMF and medical expenses for AMF were also evaluated.

          Results

          The average annual AMF ratio was 8.965% of nationwide population in Taiwan. The prevalence of AMF was significantly decreased both in male and female from 1997 to 2013 ( P for trend <0.0001). The decreased pattern of AMF was found by the age stratification ( P for trend <0.0001). The significant fall of AMF was also displayed in six districts ( P for trend <0.0001). The number of dental visits were ranged from 821,749 in 1997 to 1,313,734 in 2013. However, time trends of dental visits for AMF were significantly decreased ( P for trend <0.0001). The medical expenses for AMF were simultaneous significantly decreased from 1997 to 2013 ( P for trend <0.0001).

          Conclusion

          Form the results of this nationwide population-based database, a significant decrease of AMF in Taiwan was observed during past 17 years.

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          Most cited references20

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          Mercury exposure and risks from dental amalgam in the US population, post-2000.

          Dental amalgam is 50% metallic mercury (Hg) by weight and Hg vapour continuously evolves from in-place dental amalgam, causing increased Hg content with increasing amalgam load in urine, faeces, exhaled breath, saliva, blood, and various organs and tissues including the kidney, pituitary gland, liver, and brain. The Hg content also increases with maternal amalgam load in amniotic fluid, placenta, cord blood, meconium, various foetal tissues including liver, kidney and brain, in colostrum and breast milk. Based on 2001 to 2004 population statistics, 181.1 million Americans carry a grand total of 1.46 billion restored teeth. Children as young as 26 months were recorded as having restored teeth. Past dental practice and recently available data indicate that the majority of these restorations are composed of dental amalgam. Employing recent US population-based statistics on body weight and the frequency of dentally restored tooth surfaces, and recent research on the incremental increase in urinary Hg concentration per amalgam-filled tooth surface, estimates of Hg exposure from amalgam fillings were determined for 5 age groups of the US population. Three specific exposure scenarios were considered, each scenario incrementally reducing the number of tooth surfaces assumed to be restored with amalgam. Based on the least conservative of the scenarios evaluated, it was estimated that some 67.2 million Americans would exceed the Hg dose associated with the reference exposure level (REL) of 0.3 μg/m(3) established by the US Environmental Protection Agency; and 122.3 million Americans would exceed the dose associated with the REL of 0.03 μg/m(3) established by the California Environmental Protection Agency. Exposure estimates are consistent with previous estimates presented by Health Canada in 1995, and amount to 0.2 to 0.4 μg/day per amalgam-filled tooth surface, or 0.5 to 1 μg/day/amalgam-filled tooth, depending on age and other factors. Copyright © 2011 Elsevier B.V. All rights reserved.
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            Is dental amalgam safe for humans? The opinion of the scientific committee of the European Commission

            It was claimed by the Scientific Committee on Emerging and Newly Identified Health Risks (SCENIHR)) in a report to the EU-Commission that "....no risks of adverse systemic effects exist and the current use of dental amalgam does not pose a risk of systemic disease..." [1, available from: http://ec.europa.eu/health/ph_risk/committees/04_scenihr/docs/scenihr_o_016.pdf]. SCENIHR disregarded the toxicology of mercury and did not include most important scientific studies in their review. But the real scientific data show that: (a) Dental amalgam is by far the main source of human total mercury body burden. This is proven by autopsy studies which found 2-12 times more mercury in body tissues of individuals with dental amalgam. Autopsy studies are the most valuable and most important studies for examining the amalgam-caused mercury body burden. (b) These autopsy studies have shown consistently that many individuals with amalgam have toxic levels of mercury in their brains or kidneys. (c) There is no correlation between mercury levels in blood or urine, and the levels in body tissues or the severity of clinical symptoms. SCENIHR only relied on levels in urine or blood. (d) The half-life of mercury in the brain can last from several years to decades, thus mercury accumulates over time of amalgam exposure in body tissues to toxic levels. However, SCENIHR state that the half-life of mercury in the body is only "20-90 days". (e) Mercury vapor is about ten times more toxic than lead on human neurons and with synergistic toxicity to other metals. (f) Most studies cited by SCENIHR which conclude that amalgam fillings are safe have severe methodical flaws.
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              Mercury exposure and health impacts in dental personnel

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                Author and article information

                Contributors
                Journal
                J Dent Sci
                J Dent Sci
                Journal of Dental Sciences
                Association for Dental Sciences of the Republic of China
                1991-7902
                2213-8862
                14 November 2022
                January 2023
                14 November 2022
                : 18
                : 1
                : 400-406
                Affiliations
                [a ]School of Dentistry, Chung Shan Medical University, Taichung, Taiwan
                [b ]Department of Dentistry, Chung Shan Medical University Hospital, Taichung, Taiwan
                [c ]Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan
                Author notes
                []Corresponding authorSchool of Dentistry, Chung Shan Medical University, 110, Sec.1, Chien-Kuo N. Rd., Taichung, 40201, Taiwan. cyc@ 123456csmu.edu.tw
                Article
                S1991-7902(22)00285-9
                10.1016/j.jds.2022.11.001
                9831824
                36643251
                7ac1c2ba-16ca-4a38-a20e-126106d3628a
                © 2022 Association for Dental Sciences of the Republic of China. Publishing services by Elsevier B.V.

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                : 5 October 2022
                : 31 October 2022
                Categories
                Original Article

                amalgam filling,decreased trends,taiwan,national health insurance research database

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