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QASSIM UNIVERSITY
Pricipales of Dental Toxicology
Iyad Abou Rabii DDS, OMFS, MRes, PhD
Dental Toxicology
Study of poisons and their effects, particularly on living systems.
Forensic toxicology (the use of toxicology and other disciplines such as analytical
chemistry, pharmacology and clinical chemistry to aid medical or legal
investigation of death)
Mercury
Facts
Mercury is the most toxic substance that people are exposed to.
• Potential health risks associated with mercury amalgams include:
• Mercury inhibits sulfhydryl (-SH) group containing enzymes
• Mercury's links to neurological diseases like Alzheimer's disease and autism
• Harm to unborn babies
• Vulnerability to toxicity, particularly among vulnerable pregnant women
and young children
• Greater exposure to the effects of mercury due to chewing and drinking
beverages
• Interaction with other metals and dental materials that increases risks
Mercury Types
There is three types of Mercury
• Inorganic
• Organic: Especially in fishes leaving Lakes and rivers are also contaminated
when there is a direct discharge of mercury industrial
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• Mercury vapor.
Pharmacodynamics
Mercury can pass the skin barrier, blood-brain and the placental barrier and
thus cause devastating effects on the functioning and growth of the brain
and the growing foetus.
• The most likely routes of exposure are inhalation of inorganic mercury
vapour after a spill or during a manufacturing process, or ingestion of
methyl mercury from contaminated fish, absorption through skin.
• Ditribution
• According to Mercury type
• Vapor : The most dangerous form absorbed in the lungs and stored in the
CNS
1
• Oraganic Mercury : Lipophile absorbed in the intestin, most of it excerted
with feces
• Inorganic : Accumulate in the blood, plasma, and kidney (scereted in the
urine)
• Mercury plasmatic half-life is about 60-70 days
Mecury in dentistry
Mercury is a component of the amalgam used for "silver" fillings. The other
major ingredients are silver, tin, copper, and zinc. When mixed, these
elements bond to form a strong, stable substance.
• Mercury vapour from amalgam is the most dangerous form of mercury,
most rapidly crossing the blood-brain barrier and mother’s placenta, and
ensuring adverse developmental effects at lower levels than other forms.
• The mercury-free dentists cite the potential for excess exposure to mercury
when removing amalgam fillings as a serious concern for dental
practitioners, some of whom have devised various strategies for reducing
the amount of mercury exposure for both patients and dental staff during
the removal of mercury fillings.
Arsenic
Arsenic is a poisonous chemical often used in herbicides and pesticides and is classified as a Class
1 carcinogen, meaning it is highly toxic to humans.
“arsenic has been linked to cancer of the bladder, lungs, skin, kidney, nasal passages, liver, and
prostate”. Other side effects of consuming arsenic can include nausea, vomiting, diarrhea, partial
paralysis and blindness.
Lead
Lead is a toxic element existed in the dental clinic (amalgam fillings, Xray
shields, Xray films), once in the body lead can
• Inhibit heme biosynthesis Heme is the essential structural component of
hemoglobin, myoglobin and cytochromes.
• Binds to sulfhydryl groups (-SH groups) of proteins (including a lot of
important metabolic enzymes)
Pharmacodynamique
Absorbtion
• Skin: alkyl lead compounds, because of lipid solubility (methyl and
tetraethyl lead)
2
• Inhalation: up to 90% depending upon particle size
• GI: adults 5 to 10%, children 40%
Distribution
Initially carried in red cells and distributed to soft tissues (kidney and liver);
redistributed to bone, teeth and hair mostly as a phosphate salt. Rates of
absorption and distribution are greatly influenced by dietary intake and
body stores of phosphate, calcium and iron relative to lead
• high PO4, Pb storage in bone
• high Vitamin D, Pb storage in soft tissue
• low PO4, Pb sequestered in soft tissue
• high Ca++, Pb sequestered in soft tissue
• Half life in blood 30-60 days, bone 20-30 years
Source of exposure
# GI - paint, pottery,amalgam
# Inhalation - metal fumes, amalgam dust
# Skin -tetraethyl lead in gasoline
3
Current clinical recommendations for preventive F measures are
1) to determine total F intake per day from all sources in order to assess over or
under F exposure
2) determine caries risk
3) institute a regimen commensurate with individual caries risk status which
emphasizes bioavailability of post-eruptive topical F (e.g. regular use of F
dentifrice and other home products if indicated)
4) administer professional topical F treatments, the timing of which should also
be gauged to caries risk (This may not be needed in low risk individuals) and
5) administer systemic topical F if indicated. (The latter is currently under review.
Present Academy of Pediatric Dentistry recommendations are presented below.
Dignosis
1. History of exposure
2. Biological fluids analysis (blood mercury, whole blood lead level, arsenic
blood and urinary levels)
Treatment
Remove from exposure
• Chelating agents
• 1.Lead: Calcium disodium EDTA (IV). 2, 3-dimercaptosuccinic acid (Succimer)
(Oral). 2, 3-dimercaptoproponol (BAL, Dimercaprol) (IM). Penicillamine
(Oral)
•
• Mercury: 2, 3-dimercaptosuccinic acid (Succimer) (Oral). 2, 3-
dimercaptoproponol (BAL, Dimercaprol) (IM). Penicillamine (Oral). N-acetyl-
penicillamine (Oral)
• Arsenic: N-acetyl-penicillamine (Oral). Penicillamine (Oral)
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