Mercury Exposure in Dentists: Three case reports

Öz

OBJECTİVE

Inorganic mercury is widely used in amalgams. Thus, dentists are chronically exposed to inorganic mercury.Chronic effects of mercury are mainly on central nervous system. Memory and concentration deficits, sleep andmood disturbances are commonly notified symptoms. We are reporting three dentists presenting with neurologicalfindings of mercury intoxication.

CASE 1

A 42 years-old man has been admitted to occupational health outpatient clinic with motor retardation and mooddisturbances. He had been working as a dentist and handling with amalgams for nineteen years. On neurologicalphysical examination intensional tremor was detected. Mercury levels in 24-hour urine testing were 44,2 μg/L(normal values <15 μg/L). Chelation therapy with DMPS was started, thereby declining Mercury to normal values.Neurological symptoms recovered and he was discharged.

CASE 2

A 43 years-old woman has been admitted with memory deficit and leg contractions. She had been working as adentist for eighteen years and using amalgam alloys for filling. MRI scan of brain revealed atrophic changes andpartially empty sella. Spot urine mercury level was 10.2 μg/L (normal value <10 μg/L). Substutition withcomposite fillings instead of amalgam fillings was recommended.

CASE 3

A 42 years-old woman has been admitted to occupational health outpatient clinic with memory deficit,distractibility, and extremity tremors. She had been handling with amalgam alloys for eighteen years as a dentist.Neurological examination revealed right-sided postural tremor. MRI scan of brain revealed mild atrophic changes.Spot urine mercury level was 8.3 μg/L (normal value <10 μg/L). After challenge test with DMPS, spot urinemercury raised to 15 μg/L. Chelation therapy with DMPS was started. By the end of 6 months, spot urine mercurylevel declined and neurological findings recovered.

RESULTS

Dentists are exposed to heavy metals through handling orthodontic materials. Dentists referred with

neuropsychiatric problems should be evaluated for mercury intoxication and mercury levels should be examined inbiological specimens. There is no known safe level and no limit to the effect of the mercury occurrence asunderstood from this case. Use of materials alternative to amalgam; proper ventilation in workplace; and use ofpersonal protective equipments may mitigate hazardous effects of toxic materials.

Anahtar Kelimeler

• Mercury Exposure in Dentists: Three case reports

Kaynakça

1. Meşide Gündüzöz (1), Zehra Nur Töreyin (2), Vugar Ali Türksoy (3), Lütfiye Tutkun (4), Sinan Karacabey (5), Hüseyin İlter (6) (1)Depertmant of Family Medicine, Ankara Occupational Diseases Hospital, Ankara, Turkey (2)Faculty of Medicine,Department of Public Health,EgeUniversity, İzmir, Turkey (3)Faculty of Medicine,Department of Public Health, Bozok University, Yozgat, Turkey (4)Faculty of Medicine, Department of Biochemstry, BozokUniversity, Yozgat, Turkey (5)Faculty of Medicine, Department of Emergency Medicine, Bozok University,Yozgat, Turkey (6)Public Health Institution of Turkey, Head of Environmental Health Department