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PUBLISHED IN LONDON S cientists agree that dental amalgam fillings slowly re- lease mercury vapour into the mouth. But both the amount of mercury released and the question of whether this expo- sure presents a significant health risk remain controversial. Public health studies often make the assumption that mer- cury in urine (which is composed mostly of inorganic mercury) can be used to estimate exposure to mercury vapour from amal- gam fillings. These same studies often use mercury in hair (which is composed mostly of organic mercury) to estimate ex- posure to organic mercury from a person’s diet. ButaU-Mstudythatmeasured mercury isotopes in the hair and urine from 12 Michigan dentists found that their urine contained a mix of mercury from two sourc- es: the consumption of fish con- taining organic mercury and in- organic mercury vapour from the dentists’ own amalgam fillings. “These data suggest that in populations that eat fish but lack occupational exposure to mer- cury vapour, mercury concentra- tions in urine may overestimate exposure to mercury vapour from dental amalgams. This is an im- portant consideration for studies seeking to determine the health risks of mercury vapour inhala- tion from dental amalgams,” said U-M biogeochemist Joel D. Blum, a co-author of the paper. About 80 per cent of inhaled mercury vapour is absorbed into the bloodstream in the lungs and transported to the kidneys, where it is excreted in urine. Because the mercury found in urine is almost entirely inorganic, total mercury concentrations in urine are commonly used as an indica- tor, or biomarker, for exposure to inorganic mercury from dental amalgams. But the study by Sherman, Blum and their colleagues sug- gests that urine contains a mix of inorganic mercury from dental amalgams and methylmercury from fish that undergoes a type of chemical breakdown in the body called demethylation. The demethylated mercury from fish contributes significantly to the amount of inorganic mercury in the urine. Chief Executive of the Brit- ish Dental Health Foundation, Dr Nigel Carter OBE, commented: “Minute amounts of mercury from dental amalgam do escape from dental amalgam and are absorbed into the body, some of it into the central nervous system. Everyone has a small amount of mercury in their system, measurable through their blood and urine. On average a UK adult absorbs about nine millionths of a gram of mercury a day from all environmental sources – about a sixth of which comes from amalgam fillings. “Most people with dental amalgam fillings containing mer- cury show less than five micro- grams per litre of urine. Nearly all dentists have levels below 10 micrograms per litre. Compared with this, the maximum permit- ted level of exposure to mercury for industrial workers in the US will produce levels around 135 micrograms per litre, which is still considered safe by medical authorities. “Confirmed cases of aller- gic reaction to amalgam are ex- tremely rare – fewer than 100 cases have been reported world- wide. This is an extremely small number in relation to the many thousands of millions of amal- gam fillings that have been pro- vided to patients since the mate- rial was developed.” DT Test may overestimate mercury exposure from amalgam fillings A common test used to determine mercury exposure from amalgam fillings may significantly overestimate the amount of the metal released from fillings, according to University of Michigan (U-M) researchers April 1-7, 2013 VOL. 7 NO 8 Global initiative to combat fake medicines Combating the global scourge of fake medicines which threatens the health of millions of people is the focus of a land- mark agreement between IN- TERPOL and 29 of the world’s largest pharmaceutical com- panies. The three-year deal, worth 4.5 EUR, will see the creation of INTERPOL’s Phar- maceutical Crime Programme to further build on the work of its Medical Product Coun- terfeiting and Pharmaceuti- cal Crime (MPCPC) unit. This will enhance the law enforce- ment community’s response to pharmaceutical crime through stronger partnership develop- ment. The programme will focus on the prevention of all types of pharmaceutical crime including branded and generic drug counterfeiting as well as the identification and disman- tling of organised crime net- works linked to this illegal ac- tivity, which generates millions in illicit profits every year. NICE to assess value of medi- cines NICE will take responsibility for assessing the full value of medicines when new pricing arrangements are introduced in 2014 the Government has announced. The Government confirmed the plans in its offi- cial response to the Health Se- lect Committee’s report on the future role of NICE which has been published. The move will give NICE a crucial role in the future value-based pricing ar- rangements for branded medi- cines. It will allow the body to build on its current drug evaluation processes by giv- ing it broader scope to assess a medicine’s benefits and costs. The announcement comes as NICE is also preparing to take on other new responsibilities. From April, its remit will be extended to cover social care, as well as the NHS and public health. Streamline gives CODE members reason to smile Streamline, a provider of card payment processing in the UK and Europe, has today an- nounced a multi-year partner- ship with the Confederation of Dental Employers (CODE). With almost 1,000 members and 2,500 practices nationwide, CODE members can now use one of the UK’s most trusted and reliable card payments systems to accept the widest range of card types in the mar- ket. Under the partnership, Streamline will be CODE’s rec- ommended payments provider and CODE members who be- come Streamline customers are eligible for preferential terms. www.dental-tribune.co.uk One Shape Jerome Elias discusses safe root canal preparation CQC Jane Armitage on the CQC visit to her practice Planning for the future Richard Lishman talks finances News in Brief Practice ManagementMoney Matters Endo TribuneNews Child smokers 200,000 start smoking each year page 2 pages 18-20 page 24pages 9-10