Mercury Free Dentistry

World Alliance for Mercury Free Dentistry is dedicated to ending dental mercury use. Asian Center for Environmental Health, in collaboration with ESDO and the World Alliance for Mercury Free Dentistry, has been working diligently for a long time to phase out mercury dental amalgam from Asia.

As Bangladesh is a signatory country of the Minamata Convention, BDS together with ESDO made a call to the dental surgeons of Bangladesh to put an end to the use of mercury amalgam in the treatment of pregnant women, nursing mothers, and children in June, 2018. In accordance with that, they urged to the government to officially prohibit the use and export of mercury and mercury-containing products.

Dental amalgam is a widely used filling material for treating dental cavities containing mercury- a heavy metal which severely affects human and environmental health. Worldwide movement has already started against mercury amalgam. ESDO is the first organization in Bangladesh that took part in this global movement and is still fighting against this toxic mercury. The association of Bangladesh Dental Society – BDS is working hand to hand with ESDO from the very beginning of this movement.

A Memorandum of Understanding (MOU) was signed between ESDO and BDS in 2016 with a view to eliminating “Mercury Dental Amalgam” from Dentistry Sector in Bangladesh by 2018. One of the main components of dental amalgam filling is mercury which is very harmful for human health as well as for environment. It has been used for more than 150 years. Mercury vapor is emitted during food chewing and this mercury containing vapor enters into human body which causes many problems for human body as well as for the environment.

Major activities of Mercury Free Dentistry Movement

The World Alliance for Mercury Free Dentistry initiated its campaign in Bangladesh in 2010. Environment and Social Development – ESDO is the pioneer organization to deliberately work on this issue since the beginning. Under the umbrella of Asian Center, the campaign started to expand its magnitude. Incessant efforts in terms of awareness raising campaigns, policy advocacy and action based research brought some significant outcomes in Bangladesh.

• Bangladesh Dental Society declared a ban on mercury use in the treatment of pregnant women, nursing mother and children by June, 2018: ESDO in association with Bangladesh Dental Society organized a Press Briefing on March 10, 2018 where BDS declared “Mercury dental amalgam should not be used in the treatment of pregnant women, nursing mother and children after June, 2018”. The Press Briefing was held at the Dhaka Reporters Unity; BDS Secretary General Dr. Humayun Kabir Bulbul officially announced this decision.
• The BDS announced support for the phase out of dental amalgam use in Bangladesh by 2018: Earlier in 2017, BDS declared and set target to phase out dental mercury amalgam by 2018 in Bangladesh. On May 6, 2017 in a workshop entitled “Mercury-Free Dentistry: Way Forward” this declaration was made.
• Bangladesh Army Medical and Dental Core phased out dental amalgam use in their treatment: Before 2009, amalgam was supplied in Bangladesh army as alloy powder and liquid mercury form and it was mixed annually. After ESDO’s intervention in 2014 and initiative taken by Bangladesh Army Medical and Dental Core, they phased out dental amalgam from their treatment.
• BDS-ESDO Signed MOU to Eliminate Mercury Amalgam by 2018: A Memorandum of Understanding (MOU) signed between Environment and Social Development Organization-ESDO and Bangladesh Dental Society (BDS) to eliminate “Mercury Dental Amalgam” from Dentistry Sector in Bangladesh by 2018. The signing event took place on 26 April, 2016 at BDS. The MOU was signed with the purpose of promoting and policy advocacy for adaptation and institutional initiatives for “Mercury-Free Dentistry”. On behalf of two organizations MOU was signed by Dr. Humayun Kabir Bulbul, Secretary General of Bangladesh Dental Society and Siddika Sultana, Executive Director of ESDO.
• Use of mercury dental amalgam reduced up to 80% in Bangladesh: After ESDO’s some major initiatives such as dental chamber visit, mobile campaign, market campaign; the overall use of dental amalgam has been reduced by more than 80% as a result of the endeavor.
• Petition submission: ESDO’s another major success is submitted petition to the Honorable Minister of Ministry of Environment and Forests, Government of Bangladesh for complete ban of mercury amalgam trade in Bangladesh by 2020.
• More than 1000 dentists pledged themselves as mercury free dentists: A large number of dentists of different dental colleges and units are united and simultaneously running the mercury free dentistry movement in Bangladesh and pledged themselves as mercury free dentists.
• Pioneering approach in Bangladesh in the whole Asia to Identify and Recognize Mercury Amalgam free Dental chamber: Bangladesh is the first country in Asia to identify the mercury amalgam free dental chambers and recognize those by pasting ‘Mercury-Free Dental Chamber’ logo sticker.On 28 January, 2018 ESDO and BDS in collaboration with World Alliance for Mercury-Free Dentistry and Asian Center for Environmental Health inaugurated ‘Mercury Amalgam Free Dental Chamber Visit’ as a part of their vibrant campaign to ban mercury from dentistry in Bangladesh.

• Dental colleges recognition: Four dental colleges named Mandy Dental Collage & Hospital, Dhanmondi, Dhaka; Pioneer Dental College, Baridhara, Dhaka; Update dental college, Uttara, Dhaka and Chattagram International Dental College & Hospital, Chadgaon, Chittagong have been recognized as mercury free dental college and declared them mercury free through pasting ESDO’s sticker. Apart from this, many dental units and chambers have also been recognized as mercury free through ESDO’s questionnaire survey.

Mercury Added products

Mercury is a naturally occurring element that is found in air, water, and soil. Because mercury is a heavy, liquid metal at room temperature and a good conductor of electricity, it has unique characteristics that have historically been utilized in a wide variety of products, including barometers, numerous types of industrial equipment, measuring devices, convenience light switches in cars , alkaline and other batteries, light bulbs, flow meters at sewage treatment plants, and such novelty items as games and jewelry.

Currently, various forms of mercury are used in many products. Such as: . . 1. Fluorescent and other lighting,
2. Button-cell batteries,
3. Laboratory equipment,
4. Certain switches and relays,
5. Dental amalgam,
6. Skin lightening cream
7. Thermometer
8. Jewelry
9. Chemical solutions, etc.
These mercury-added products are used in residential, commercial, as well as industrial environments. Additionally, elemental mercury is used in industrial processes, such as chlor-alkali production, artisanal gold mining, and certain religious and cultural ceremonies.

ESDO has been working on mercury added products, especially on skin lightening cream. Skin lightening creams containing mercury – a heavy metal and dangerous neurotoxin – are still widely available to purchase in shops and online, despite being banned by governments. That’s the finding of new research by a global alliance of NGOs, working to eliminate mercury pollution. 

Testing throughout 2019 revealed 95 of the 158 products purchased in the 12 sampling countries including Bangladesh exceeded the legal limit of 1 ppm (part per million), with mercury levels ranging from 40 ppm to over 130,000 ppm.

More than two-thirds (65 of the 95) of those were bought online from such internet marketers as Amazon , eBay, BidorBuy, Lazada, Daraz, Flipkart and Jumia. Amazon has already removed some products from sale after campaigners in the US showed the results of the research to the company ahead of the report’s launch.

In 2018, leading online retailers signed a ‘Product Safety Pledge’ to remove dangerous products. Many of the same brands were found to contain high mercury levels on several consecutive sampling occasions, in different years, and purchased from both physical shops and via e-commerce platforms. Most were manufactured in Asia, especially in Pakistan (62%), Thailand (19%) and China (13%), according to their packaging.

Products were tested in accredited laboratories in the EU and US and using a hand-held X-ray fluorescence (XRF) spectrometer or analyzer by two regional hubs: CASE in Côte d’Ivoire (for Africa), and Ban Toxics in the Philippines (for Asia). The study did not test products from Latin America. It tested in Africa, Asia, the EU and the USA.

Over 110 countries have committed to the Minamata Convention to phase out and limit mercury, including in cosmetics.  A meeting for parties to that convention is being held in Geneva this week.

Background

Mercury in waste, containing the free element and its compounds, and mercury containing-products continue to harm the environment of Bangladesh many years after they have been disposed of. Bangladesh has no specific guidelines regarding the management of mercury waste, or how to safely manage the uses of either products or equipment that contain mercury or mercury compounds.

    

The evaluation of mercury emission, therefore, is required to assess new, potential and existing sources, of the mercury emission as a result of the use of mercury and mercury-containing products. The calculations of mercury emission and release into the environment made in this report are based on surveys, guidelines, methods and other sources.

The international demand for the control of mercury emissions arose following the UNEP’s Governing Council’s 22nd session in February 2003. After considering the key findings of the Global Mercury Assessment Report, the governing Council decided that there was sufficient evidence of significant global adverse impacts from mercury to warrant further international action to reduce the risks to humans and wildlife from the release of mercury into to the environment. The Governing Council decided that national, regional and global actions should be initiated as soon as possible and urged all countries to adopt goals and take actions, as appropriate, to identify populations at risk and to reduce human-generated releases of mercury.

This commitment to addressing the global adverse impacts of mercury pollution was reinforced by 27 Governments and regional economic integration organizations at the 23rd session of the Governing Council in February 2005. The Governing Council also requested UNEP, in cooperation and consultation with other relevant organizations, to facilitate and conduct technical assistance and capacity building activities to support the efforts of all countries to take action on mercury pollution.

In response to the Governing Council’s request, UNEP has established a mercury program within UNEP Chemicals (UNEP Division of Technology, Industry and Economics), with the immediate objective to encourage all countries to adopt goals and take actions, as appropriate, for the identification of mercury-exposed populations, for the minimization of mercury exposure through outreach efforts and for the reduction of anthropogenic mercury releases.

Environment and Social Development Organization-ESDO has also undertaken the project titled “Reduction of demand of mercury in mercury containing products in Bangladesh” in collaboration with UNEP to raise awareness and document mercury use and mercury added products in Bangladesh. This initiative also aims to support Bangladesh government towards ratification of Minamata convention.

Inventories of releases of priority hazardous substances constitute an important decision making tool in the process of mitigating environmental impacts from the pollutants in question. Such inventories are often vital in the communication with stakeholders like industry, trade, manufacturers and the public.

The information on mercury pollution contained in this report can be used to determine which sources of mercury should be addressed in Bangladesh for release reduction initiatives. Moreover, baseline inventories and related information can be used to set effective approaches and to draw further attention of the concerned government officials and stakeholders to take appropriate actions and measures.

Findings

This report is mainly focused on the preliminary field survey on mercury uses and releases, within Bangladesh territory. These surveys were undertaken during January-May, 2015 throughout Bangladesh by the ESDO team. The team followed the UNEP toolkit format in the design of the survey. Based on the preliminary data, the findings are as follows:

MERCURY TRADING: IMPORT-EXPORT

• Bangladesh does not produce mercury compounds nor does it engage in mercury mining.
• According to  the  source  of  NBR,  2015, around 3.73 MT Mercury is imported each year in Bangladesh.

• During the field survey ESDO found that in Bangladesh there are approximately 40 chemical importers and they import “mercury” chemicals mainly from China and India in recent Most of them import and sell two forms of mercury. These are: encapsulated and liquid forms.
• According to the survey it was found that around 58 MT mercury is imported by the importers (both legally and illegally, way through border belt areas).
• It was also found that annual storage of mercury (after supply or sell) for both the forms are 18600 kg or 18.6
• Therefore it has been found that in a year 4 MT mercury is normally sold to the following target customers. They are:
  • Dental colleges/chambers/ quacks o Dental assistants
  • Beauty product or cosmetics producers
  • Jewelry producers (used to re-collect gold from the waste)
  • Pharmaceutical companies
  • Pesticide/biocide companies
  • Laboratories (academic institutions/private sectors)

MERCURY USAGE INVENTORY IN PRODUCTS AND PROCESSES

• Major consumers of mercury are: the industrial sector (Chlor-alkali, paper and pulp, cement production), the healthcare sector (healthcare instruments, dental amalgam), the energy sector and processes, the electronic sector (electronic device, batteries, CFLs), the cosmetics sector, the jewelry sector and others.
  • Calculations based on existing Chlor-alkali plants, those using previous technology for producing chlorine (Cl2), suggest that, in total, 4.49 MT of mercury per year is being released.
  • Though 33 cement industries are present in Bangladesh, only 8 have clinker and cement manufacturing facilities. It is estimated that the release of mercury from the 8 cement factories of Bangladesh is 0.14 MT
  • Based on calculations of existing Aluminum production companies, total emission of mercury into air is 0.011 MT per
  • Based on same calculation it was found that 0.16 MT mercury is being emitted into air during steel production process per year.

• Health Care Sector

  • ESDO’s baseline survey on mercury containing products in 2015 found that 887472 thermometers are used yearly, and 37.8% of these thermometers break (552007.58). Similarly, yearly use of the number of sphygmomanometers is 305926 and 10% (275333.4) of the total sphygmomanometers
  • Standard thermometers contain 0.5g – 2.0g mercury and standard sphygmomanometers contain 80-160g
  • It is estimated that, in a year, approximately 0.69 tons of mercury is released into the environment and atmosphere due to thermometer breakage, and that 3.3 tons of mercury is released due to sphygmomanometer breakage.
  • During the preparation of dental amalgams, mercury vapor is released, and the amalgams are sources of exposure to mercury contamination. People associated with dental care such as dentists, students and health workers and, in some cases, patients, are exposed to mercury vapor during amalgam preparation through mercury spills, malfunctioning amalgamators, leaky amalgam capsules, trituration placement and condensation of amalgam, polishing and removal of amalgam and vaporization of mercury from other
  • Based on ESDO’s baseline survey it is estimated that a person during amalgam dental fillings inhales, on average, between 3 and 17 micrograms of mercury from its vapor into his or her blood each In a year it is 1095 mg to 6205 mg.
  • Based on the same ESDO survey, 09 MT  to 6.22 MT Mercury vapor is released from mercury amalgam fillings per year from the dental sector in Bangladesh.

Energy Sector & The Processes 

• In Bangladesh a major contributor of mercury emissions into to atmosphere in the near future will be coal burning in power plants. The processing of mineral oils, natural gas and fossil fuel extraction are also sources of mercury emission to the
• Based on ESDO’s country situation analysis, it is estimated that the potential mercury emissions from the energy sector (coal, gas, oil refining etc.) is 3058.158
• It is estimated that 11 kg mercury can be emitted into the air during aluminum production and 160 kg mercury emit from the by-product during pig iron and steel production.

Electronic Sector

• According to the report “Mercury Sources: Products and Hotspots in Bangladesh”, prepared by ESDO in 2012, it is estimated that fluorescent lamps represent approximately 80 percent of the total mercury used in
• Based on ESDOs baseline survey, the total CFL production in Bangladesh is 19,688,097.2 units in the period of 2012-2014 and the mercury released from CFL light bulbs is 0.118 MT.

• During the field survey of ESDO in 2015, it was found that each button cell battery may contain 1-2 ppm mercury as impurities in the salted
• Button cell batteries also contain mercury as impurities. According to the survey the total mercury release from button cell batteries in Bangladesh are estimated at 0.0179 MT per

Others

Based on ESDOs baseline survey on 2015;

• Mercury release from jewelry sector was estimated to be 4.1 MT
• Based on calculations, mercury release from measuring devices was 0.85
• According to the report of “Mercury Sources: Products and Hotspots in Bangladesh” prepared by ESDO in 2012, mercury concentration in beauty products ranges from 4653 ppm to 3361
• Mercury release from the chemicals, reagents, solvents use in laboratories is 538.263

Due to lack of information we were unable to obtain information for calculations including primary metal production, mercury in biocides and pesticides, paints, toys and related products, etc.

MERCURY WASTE  AND RELEASE INTO ENVIRONMENT

• Mercury has a very long life span, therefore, mercury in waste, sludge, and by products is not destroyed with disposal but rather continues to subsist in
• Based on focus group discussions and surveys, we found that the majority of users of mercury are not aware of the importance of proper disposal of mercury waste or mercury containing compounds. There are also no systems for the large-scale disposal of mercury in Bangladesh. Based on the ESDO baseline survey, it is estimated that 1.12 MT mercury waste is generated and released every year into environment through waste deposition, land filling and waste water treatment.
• Based on the same study, we found that annual mercury emission from cremation is 0.170 MT.

Recommendations

Bangladesh does not yet have any specific guidelines regarding the management of mercury release into the environment, or regarding how to safely manage the use of products/equipment that contain mercury, mercury compounds or other specific chemicals. The existing legislation generally focuses on the overall management of chemicals particularly related to pesticides (for agricultural purposes) and waste management (for the environmental purposes).

The absence of standardization and certification of the quality products and the high costs associated with these processes and products are some of the barriers of shifting from mercury to alternative healthcare instruments and dental amalgam. Absence of end-of-life management of discarded CFLs and other devices are also reasons for concern.

Bangladesh has limited strategies in place for identifying a site contaminated with mercury, as well as identifying and assessing the impact of mercury on environment and human health. The reason behind this is the lack of training, ability and capacity for knowledge sharing. Policy makers, regulators and the users of mercury containing goods are generally uninformed about the issue. There is also some lack of media awareness and the common mass is under informed of the toxicity of mercury.

Future recommendations to minimize mercury use and releases can be:

• Promoting alternatives of mercury added products
• Training on alternatives of mercury added products
• Government regulatory, and institutional framework programs
• Plan to minimize and eliminate the uses of mercury and mercury based products and practices

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