A mercury spill inside a major government hospital in Manila prompted officials on Saturday to order a cleanup that required the transfer of least 40 patients from the pediatric ward—and raised questions on why it was still keeping a stock of a chemical supposedly banned from public health facilities since 2008.
Assistant Secretary Eric Tayag of the Department of Health (DOH) said a cleanup was underway at Dr. Jose Fabella Memorial Hospital in Sta. Cruz, after an initial assessment showed unacceptable mercury levels in several areas in and around the storage room.
“Forty patients from the pediatric ward adjacent to the area of the spill were already transferred to another ward in the hospital as a precautionary measure” after mercury spilled from a broken container in the storage room on Aug. 8, Tayag said in a DOH statement.
In a phone interview, Tayag said the mercury was already up for disposal but that the process would require supervision from the Department of Environment and Natural Resources (DENR).
“We are still looking for answers,” Tayag said. “What we know was that the dental amalgam spill was discovered in a building away from patient areas, where it was temporarily stored after the DOH-issued ban in 2008.”
The spilled mercury had apparently evaporated and could affect the brain and the central nervous system if inhaled, he said. “High exposures can cause respiratory difficulty and even death.”
Individuals believed to have been exposed were also being examined, the DOH said.
Toxic effects
Mercury is considered by the World Health Organization (WHO) as one of the Top 10 chemicals of major health concern. Small amounts of exposure can already cause serious health problems, including for a child in the womb.
Its toxic effects include damage to the brain, kidney and lungs, skin and eyes. Other symptoms of mercury poisoning include headaches, insomnia, memory loss, muscle weakness and impairment of speech, hearing and walking. At higher doses, it could cause kidney and respiratory failure.
Tayag said Fabella would continue to accept and care for patients “as the current assessments do not require any evacuation.”
Established in Sta. Cruz in the 1950s, the government hospital has earned a reputation as a “baby factory” for the sheer number of births recorded there, at 60 to 80 daily, reportedly the highest in any hospital in the country.
Tayag said a DOH response team was working with the Hazardous Material Unit of the Bureau of Fire Protection to determine the extent of the chemical spill and initiate remediation procedures.
“(Health) Secretary (Enrique) Ona laments that this incident happened and ordered a review of the proper and safe storage and disposal of harmful chemicals, particularly mercury, in all hospitals to prevent a similar incident from happening again,” Tayag said.
According to the DOH, Fabella was one of the health facilities that had discontinued the use of mercury-containing medical devices after the DOH ordered their phaseout in 2008.
“All health facilities were ordered to comply with the mercury ban by 2010,” Tayag said. With a report from Inquirer Research
For many years now, there has been much discussion of the mercury amalgam controversy. It is a known fact that mercury is one of the most toxic heavy metals there is, and maintains a liquid state at room temperature. It is mixed with other granulated metals and alloys as a binder in amalgam fillings, and continually gives off harmful vapors after it is placed in a tooth as a filling. These vapors are easily inhaled through the mouth and nose. In addition, mercury toxins combine with saliva, which is then swallowed and ingested into the body.
Mercury exposure from amalgam fillings may contribute to, among other things, heart disease, hearing loss, neurological problems, digestive problems, fatigue, depression, birth defects, and quite possibly most degenerative chronic diseases such as Alzheimer's, M.S., and Parkinson's. For this reason, the State of California passed Proposition 65, wherein dental patients are now required to be informed about the health hazards of mercury amalgam. Other states are now following suit with similar laws.
The mercury amalgam controversy is being perpetuated by the American Dental Association and its dentist members, which continues to deny that there is anything wrong with mercury amalgam. However, the ADA has a lot at stake, since they support the major amalgam manufacturers and the dentists who place the amalgams. Statistics continue to mount showing that mercury may indeed be a hazardous substance to have in the mouth, regardless of what ADA-funded studies may show.
The Federal Food and Drug Administration (FDA) has pretty much skirted the mercury amalgam controversy by saying its the individual dentist, not the amalgam manufacturers, who is responsible for how much mercury is in this type of filling, since it is the dentist that actually mixes the amalgam immediately prior to putting it into a tooth as a filling. At the same time, state and federal agencies strictly regulate and enforce the handling of mercury as a hazardous material. Dentists cannot leave unused mixed dental amalgam exposed in the office, yet no one can explain how this harmful substance suddenly and mysteriously becomes safe when it is placed in the mouth as a tooth filling.
Babies with two serious neural tube birth defects had higher levels of mercury in their placentas than babies without the birth defects, according to a study conducted in China.The infants with spina bifida and anencephaly were 12 times as likely to have higher-than-average mercury levels. The rural region studied has a high prevalence of neural tube defects and heavy pollution from coal-burning plants, a major source of mercury. However, the babies from this region did not have unusually high mercury exposures.
Neural tube defects affect about 3,000 pregnancies in the United States each year, according to the March of Dimes. The birth defects of the brain and spine are some of the most serious congenital disorders.
During the first month of human development, the neural tube starts as a tiny, flat ribbon and turns into a tube. This tube eventually becomes the brain and the spinal cord.
Neural tube defects result if the tube does not close completely. The two most common defects are spina bifida and anencephaly.
Spina bifida is one of the most common birth defects in the United States. The condition affects about 1,500 babies each year. Spina bifida can occur when the protective vertebrae bones that make up the spine do not close entirely. Part of the spinal cord can stick out. Surgery may fix the spine, but nerve damage, leg paralysis, and bladder and bowel control problems may result.
In anencephaly, much of the brain does not develop. The baby is either stillborn or dies shortly after birth. In the United States, about 1,000 babies each year are born with anencephaly.
Experts are not sure what causes neural tube defects. Most likely it is a combination of genes and environmental factors, such as a lack of the B vitamin folic acid or exposure to organic solvents, pesticides and cigarette smoke.
Animal studies find pre-birth exposures to mercury, lead, arsenic and cadmium can affect spinal cord development. The limited number of human studies on the topic are inconclusive.
What did they do?
In this human case control study, scientists examined whether babies born with neural tube defects had more pre-birth exposure to mercury, lead, arsenic and cadmium than babies born without neural tube defects.
Researchers enrolled 36 cases of anencephaly, 44 cases of spina bifida and 50 healthy babies as controls from a rural region of Shanxi Province in northern China.
At delivery or pregnancy termination, scientists measured the levels of total mercury, lead, arsenic and cadmium in the placenta. Demographic information was collected in face-to-face interviews within a few weeks of delivery.
The region has a health surveillance system that regularly collects information on babies born with birth defects. This area of Shanxi Province has a high prevalence of neural tube defects and much pollution from burning coal.
What did they find?
Babies with anencephaly or spina bifida had higher placental mercury levels as compared to babies without these neural tube defects.
Median mercury levels were 2.25 nanograms per gram (ng/g) for neural tube defects, 2.19 ng/g for anencephaly and 2.44 ng/g for spina bifida. Median mercury concentration for the controls was 1.19 ng/g.
After accounting for other risk factors including previous history of birth defects and fever during early pregnancy, babies with neural tube defects were 12 times as likely to have above average levels of mercury as compared to babies without the birth defects.
There was little association between diagnosis with a neural tube defect and levels of the other metals.
For both the birth defect cases and the non-birth defect controls, the mercury levels in the placentas were about average when compared to other studies in locations with no known mercury contamination.
What does it mean?
Neural tube defects in newborns were associated with higher levels of mercury in the placenta when compared to levels from babies without the defects.
The Chinese study found the risk of spina bifida and anencephaly increased as the mercury concentrations increased.
This study agrees with some of the associations between metal exposure and neural tube defect previously observed in animals. In those studies, exposures to methylmercury early in development increased the risk of neural tube defects in mice and decreased the rate of neural tube cell growth in zebrafish.
The average mercury levels measured in this Chinese population were within ranges found in previous studies. They were similar to levels in areas with no known mercury sources. The concentrations were lower than levels reported in prior human studies from areas with known sources of mercury pollution.
However, the study has some limitations. First, the authors did not look for the sources of the mercury. Generally, human exposure occurs through food, water and air. Second, they also report only total levels of mercury, rather than the more harmful methyl mercury.
Neural tube defects are challenging to study in humans because the neural tube develops very early in pregnancy, often before a woman realizes she is pregnant.
This is an interesting compilation of videos surrounding the controversy of mercury amalgam fillings and the need to safely remove them.
Sunday, July 13, 2008
Chew on this: The fillings in your teeth might be hazardous to your health and that of the planet.
Millions of Americans have cavity fillings made of amalgam, a blend of about 50 percent mercury, a neurotoxin, plus tin, silver and other metals. (Fillings called "silver" are actually amalgam.) Although they've been widely used for more than 150 years, some people say amalgam fillings can emit mercury, causing damage to the brain, kidneys or nervous system.
Several studies published in medical journals have linked amalgam fillings to increased levels of bodily mercury. But not everyone is convinced: Matthew Messina, a spokesman for the American Dental Association and a practicing dentist in Ohio, says that "dental amalgam is a stable, solid compound."
A recently settled lawsuit, filed against the Food and Drug Administration by a group led by an organization called Moms Against Mercury, will require the FDA to complete its unfinished process of reviewing and possibly reclassifying amalgam fillings by next July. Now a Class I device, amalgam might be reclassified to Class II, which means that special controls would be issued governing its use. Those could be anything from simply requiring that patients be notified of the potential risks of mercury before receiving fillings to restricting amalgam's use in vulnerable populations such as pregnant women and small children.
The FDA's Web site recently changed its statement on amalgam. The site previously said that government agencies "have found no scientific studies that demonstrate dental amalgam harms children or adults." It now says that mercury in fillings "may have neurotoxic effects on the nervous systems of developing children and fetuses." It also states that "Pregnant women and persons who may have a health condition that makes them more sensitive to mercury exposure, including individuals with existing high levels of mercury bioburden, should not avoid seeking dental care, but should discuss options with their health practitioner."
The World Health Organization's policy paper on mercury released in 2007 states that "In 1991, the World Health Organization confirmed that dental amalgam is the greatest source of mercury vapour in non-industrial settings, exposing the concerned population to mercury levels significantly exceeding those set for food and air." It recommends that countries "support a ban on use of mercury-containing devices."
Should you avoid amalgam for new fillings? It's not a bad idea. Should you have your old ones taken out? It depends; the dental association doesn't recommend that. Many dentists will remove and replace fillings, but the removal must be done carefully, or the risk of exposure will be even greater than that of leaving them in. Mercury from amalgam going down the drain or into a landfill is another environmental issue. The dental association encourages, but does not require, dentists to recycle waste metals. It also suggests that dentists use amalgam separators, which prevent most mercury particles in water from reaching the sewer system and waterways. If you're having fillings removed, ask your dentist about exposure-prevention methods, and make sure the office uses an amalgam separator.
Regardless of whether amalgam fillings will be phased out altogether, the popularity of tooth-colored composite and porcelain fillings has skyrocketed. "That's not because they're green," Messina says, "but because they're white."
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