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Safety of dental amalgam—an update
,W
A
ASSOCIATION
REPORTS
Safety of dental amalgam—an update
Council on Dental Materials, Instruments, and Equipment Council on Dental Therapeutics
h e C o u n c il o n D e n ta l M a te ria ls, Instrum ents, a n d E q u ip m e n t a n d the C o u n c il o n D e n ta l T h e r a p e u tic s r e p o rte d in 19831 th a t b a se d o n sc ie n tific in fo rm a tio n a m a lg am is safe. T h e cou n cils fu rth er em phasized that, except in individuals a lle rg ic to m ercury, there is no reason why a p a ti e n t s h o u ld seek to h a v e a m a lg a m r e s to r a tio n s re m o v e d . T h e c o u n c ils a ls o reported in 19842 th at the need for patch tests for allerg y is a p ro fessio n al ju d g m e n t, a n d w h en p a tc h tests are indicated, they sh o u ld be p e rfo rm e d by a p ro fe s s io n a l tra in e d in the a d m in istratio n and interpretation of these tests. Referral to physicians such as allergists o r d e r m a to lo g is ts , w h o sp e c ia liz e in th is testing, is strongly recom m ended. I n v e s tig a tio n s of m e rc u ry v a p o r fro m a m a lg a m 3-9 a n d m ercu ry c o n c e n tra tio n s in b l o o d ,5,6,10 u r i n e , 10,11 a n d o th e r b io lo g ic a l specim ens12-15 (such as nerve tissues of subjects w ith am alg am restorations), report that sm all q u a n ti t ie s of m e rc u ry a re re le a se d fro m am algam s. Q u a n tifica tio n of in vivo m ercury vapor release from am algam based on direct m easurem ent w ith a m ercury vapor analyzer is q u e s tio n a b le a n d a v a rie ty of a n a ly tic te c h n iq u e s a n d in te r p r e t a ti o n s h a v e b e e n reported.9 Nevertheless, the quan tities reported are sm all in com parison w ith m ercury from o th e r sources su c h as diet, a n d are far less th an the q u a n titie s required to induce sym p tom s of m ercury p o is o n in g .16 D ental h e alth care w orkers h a v in g o c c u p a tio n a l e x p o su re to m erc u ry v a p o r have h ig h e r m ean values of m erc u ry in b lo o d 17,18 a n d u rin e 19,20 th a n the general p o p u latio n ; however, these levels have n o t been show n to cause sym ptom s of m e rc u ry p o i s o n i n g in d e n ta l h e a lth c are w o rk e rs w h o p ra c tic e g o o d h ygiene in use of dental m ercury. A llergic reactions to am algam restorations are extrem ely rare. W hen such reactions do occur, they are m ost frequently characterized by sig n s a n d sy m p to m s th a t are sim ila r to those seen in o ther contact allergies such
T
204 ■ JADA, Vol. 119, July 1989
as derm atitis, urticaria, erythem a, and edema. O ra l sy m p to m s a re u s u a lly d e sc rib e d as g in g iv o s to m a titis .21 In som e cases w h e re allergy to m ercury was determ ined, previous exposures to o th e r sources of m ercury such as M e rc u ro c h ro m e o r s k in c o n ta c t w ith m e ta llic m ercury were noted. O c cu p a tio n a l exposure to m ercury is know n to cause contact derm atitis; how ever, case reports of m ercury a lle rg y a m o n g d e n ta l h e a lth c are w o rk e rs are also extrem ely rare.22 T h e m e th o d fo r c o n f ir m in g a lle rg y to m ercury involves the p ro p e r use a n d in te r p re ta tio n of a p a tc h test.2 M any difficulties are a sso c ia te d w ith th e use o f p a tc h tests, in clu d in g the fact th a t m any of the com pounds use d for te s tin g are ir r ita n ts o r have been used in excessive c o n ce n tra tio n s, p ro d u c in g false-positive results.23 It should also be noted th a t a lle rg y to c e rta in m e rc u ry -c o n ta in in g c o m p o u n d s does n o t n ecessarily in d ic a te a tru e allergy to m ercury, a n d a p a tie n t w ith allergy to one form of m ercury may or may n o t cross-react to o th er form s of m ercury.22 A p a tc h test is judged positive on the basis o f th e e v a lu a tio n of c u ta n e o u s sig n s su c h as e ry th e m a , edem a, vesicles, a n d p a p u le s, a n d n o t o n system ic changes, such as pulse rate a n d blood pressure.24'25 G a lv an ic c u rren ts have been show n to be of s im ila r m a g n itu d e a n d d i s t r ib u t i o n in patients w ith a n d w ith o u t sym ptom s attributed to g a lv a n ic c o rro sio n in the m o u th .26 T h e clinical recording of electrochem ical variables such as potentials, currents, or charge transfers c a n n o t be a cc o m p lish e d by u s in g c o m m o n in stru m e n ts.26 Even w ith special m ea su rin g instrum ents of the type constructed a n d used in w e ll-c o n tro lle d stu d ie s , th e m a g n itu d e of the recorded values has n o t been related to th e p re se n c e o r se v e rity o f sy m p to m s a lle g e d ly c a u s e d by g a lv a n ic c o rro s io n in th e m o u th . T h e s e k in d s of m e a su re m e n ts sh o u ld n o t be the sole basis for a decisio n re g a r d in g th e s u b s ti t u ti o n o f o n e ty p e of restorative m aterial for another. T here is no
b a sis for th e use of g a lv a n ic c u r re n t m e a surem ents as diagnostic tools for neither allergy nor toxicity. T h e re are several review s of lite ra tu re o n m ercury a n d a m a lg a m .16,22,27-31 O n the basis of th ese review s a n d c u r re n t i n f o r m a tio n , am alg am is safe for p atien ts n o t allerg ic to m ercury, and the occurrence of m ercury allergy is extrem ely rare. T h e long history of am algam su c c essfu lly used for m o re th a n 150 years, a n d th e n u m b e r of a m a lg a m r e s to r a tio n s placed w ith n o docum ented toxicity su p p o rt th e safety o f a m a lg a m . T h e c o u n c ils have review ed e x ta n t sc ie n tific in fo rm a tio n a n d re a f firm th e A s s o c ia tio n ’s32 p o s i t io n th a t am alg am is safe for p a tie n ts n o t a llerg ic to m e rc u ry . T h e r e is n o re a s o n , b a se d on toxicological consideration, w hy a nonallergic p a ti e n t s h o u ld seek to h a v e s e rv ic e a b le a m a lg a m r e s to r a tio n s re m o v e d . T h e r e is in s u ffic ie n t evidence to ju stify c la im s th a t m ercury from am a lg am re sto ra tio n s has a n adverse effect o n the health of the patients.
J!£OA T h is report was approved by the councils in A pril 1989. A ddress requests for re p rin ts to the C o u n cil on D ental M aterials, Instrum ents, an d E q u ip m en t. 1. C ouncil on D ental M aterials, Instrum ents, and E q u ip m e n t a n d C o u n cil o n D e n tal T h e ra p e u tic s. Safety of d ental am algam . JADA 1983;106:319-20. 2. C ouncil on D ental M aterials, Instrum ents, and E q u ip m e n t a n d C o u n cil o n D e n tal T h e ra p e u tic s. P a tc h te sts fo r s e n s itiv ity to m e rc u ry o r n ic k e l. JAD A 1984; 108:381. 3. G a y D D, C ox R D , R e in h a r d t JW . C h e w in g releases m ercury from fillings. Lancet 1979;8123:985-
6. 4. Svare CW, et al. T h e effect of d e n ta l am algam s o n m e rc u ry lev els in e x p ire d a ir. J D e n t R es 1981;60:1668-71. 5. O tt K H R , et al. M ercury bu rd en due to am algam fillings. D tsch Zahnarztl Z 1984;39:199-205. 6. A braham JE , Svare CW , F rank CW . T h e effect
AS S OCI ATI ON REPORTS of d e n ta l a m a lg a m re sto ra tio n s o n b lo o d m ercury levels. J D ent Res 1984;63:71-3. 7. Vim y M J, Lorscheider FL . In tra-o ral m ercury re le a se d fro m d e n ta l a m a lg a m s . J D e n t R es 1985;64:1069-71. 8. P a tte r s o n J E , W e issb e rg B G , D e n n iso n P J . M ercury in h u m a n b re a th fro m d e n tal am alg am s. B ull E nviron C o n tam T o x ico l 1985;34:459-68. 9. B erglund A. D eterm in atio n of the rate of release of in tra-o ra l m ercury vap o r from am algam . J D ent Res 1988;67:1235-42. 10. K roncke A, e t al. U b er d ie q u e ck silb e rk o n z e n tra tio n e n in b lu t u n d u r in v o n p e rs o n e n m it u n d o h n e a m a lg a m f u llu n g e n . D tsch Z a h n a rz tl Z 1981;36:69-74. 11. O lstad M L, et al. C o rrelatio n between am alg am re s to ra tio n s a n d m ercu ry c o n c e n tra tio n s in u rin e. J D ent Res 1987;66:1179-82. 12. N iln e r K, A kerm an S, Klinze B. Effect of dental a m a lg a m re s to ra tio n s o n th e m e rc u ry c o n te n t o f nerve tissues. Acta O d o n to l Scand 1985;43:303-7. 13. F r ib e r g L , e t a l. K v ic k siv le r i c e n tr a la n e rv s y ste m e t i r e la tio n till a m a lg a m f y llin in g a r. L a k a rtid n in g e n 1986;83:519-22. 14. N y la n d e r M, F r ib e r g L , L in d B. M e rc u ry c o n c e n tr a tio n s in th e h u m a n b r a in a n d k id n e y s in re la tio n to exp o su re from d ental am alg am from
d e n tal am alg am fillings. Sw ed D ent J 1987; 11:17987. 15. E g g e lsto n DW , N y la n d e r M. C o rre la tio n of d e n ta l a m a lg a m w ith m e rc u ry in b r a in tissu e . J P ro sth et D ent 1987;58:704-7. 16. E ley BM , C o x SW . M e rc u ry fro m d e n ta l am alg am fillin g s in p atients. Br D ent J 1987;163:221-
6. 17. C h a n g SB, Siew C, G ru n in g e r SE. E x am in atio n of b lo o d levels of m ercurials in p ra c tic in g dentists u s in g co ld -v a p o r a to m ic a b so rp tio n spectrom etry. J A nal T o x ico l 1987;11:149-53. 18. Siew C, C h an g SB, G ru n in g e r S. A dditional threat? CDA J 1987;15:18-21. 19. N alew ay C, et al. U rin a ry m ercury levels in US dentists, 1975-1983: review of h e alth assessm ent p ro g ram . JAD A 1985;111:37-42. 20. L a n g a n DC, Steffek A J, N alew ay CA. M ercury hygiene practices. CDA J 1987;15:24-9. 21. V ernon C, H ild e b ra n d H F, M artin P. A m algam es dentaires et allergie. J Biol Buccale 1986; 14:83-
100. 22. L a n g a n DC, Fan P L , H oos AA. T h e use of m ercury in dentistry: a critical review of the recent literatu re. JADA 1987;115:867-80. 23. B urrow s D. H ypersensitivity to m ercury, nickel, an d ch ro m iu m in relatio n to d e ntal m aterials. Int
D ent J 1986;36:30-4. 24. M ackert JR . H ypersensitivity to m ercury from d e n ta l am algam . J A m Acad D erm atol 1985; 12:87780. 25. F ish e r AA. T h e m isu se of th e p a tc h test to d e te rm in e “h y p e rsen sitiv ity ” to m e rc u ry a m a lg a m d e n ta l fillings. C ertis 1985;35:110, 112, 117. 26. C o u n c il o n D e n ta l M a te ria ls , I n s tru m e n ts , a n d E qu ip m en t. A m erican D ental A ssociation status re p o rt o n the o ccu rren ce of g a lv a n ic c o rro s io n in th e m o u th a n d its p o te n tia l effe c ts. JA D A 1987;115:783-7. 27. M jor IA. T h e safe a n d effective use of d e ntal am algam . In t D ent J 1987;37:147-51. 28. E n w o n w u C O . P o te n tia l h e a l th h a z a rd of use o f m ercu ry in d entistry: c ritic a l review of the literature. E n v iro n m en tal Res 1987;42:257-74. 29. Ely BM, C ox SW. ‘M ercury p o is o n in g ’ from d e n ta l a m a lg a m —a n e v a lu a tio n o f th e e v id e n ce . J D ent 1988;16:90-5. 30. D odes JE . A m algam toxicity: a review of the literature. O per D ent 1988;13:32-6. 31. R e in h a r d t JW . R isk a sse ssm e n t of m e rc u ry ex p o su re from d e n ta l am alg am s. J P u b lic H e a lth D ent 1988;48:172-7. 32. A m erican D ental A ssociation. T ra n s 1986;53637.
ANSI/ADA specification no. 66* for dental glass ionomer cements Council on Dental Materials, Instruments, and Equipment
m e ric a n D e n ta l A sso c ia tio n s p e c if i cation no. 66 for dental glass ionom er . c e m e n ts h a s b e e n a p p ro v e d by th e C o u n c il o n D e n ta l M a terials, In stru m e n ts, a n d E q u ip m e n t of th e A m e ric a n D e n ta l A sso c ia tio n . T h is a n d o th e r sp e c ific a tio n s for dental m aterials, instrum ents, and e q u ip m ent are being form ulated by subcom m ittees of the Accredited Standards C om m ittee MD156 for D ental M aterials, Instrum ents, and E q u ip m e n t. T h e c o u n c il a cts as a d m in is tr a tiv e sp o n s o r of th a t c o m m ittee, w h ic h has re p re sen ta tio n from a ll interests in the U n ited S tates in th e s ta n d a rd iz a tio n of m a te ria ls , instrum ents, a n d e q u ip m e n t in dentistry. T h e council has adopted the specifications, show in g professional re cognition of th eir usefulness in dentistry, a n d has forw arded them to the A m erican N a tio n a l S tandards In stitu te w ith a recom m endation th a t the specifications be a p p ro v e d as A m erican N a tio n a l S tandards. A pproval of ADA specification no. 66 as an A m erican N atio n al S tandard was granted by the A m e ric an N a tio n a l S ta n d a rd s In s titu te o n J a n 25, 1989. T h is s ta n d a r d becom es effective J a n 25, 1990. T h e c o u n c il th a n k s th e su b c o m m itte e
A
m em bers and organizations w ith w hich they were a ffiliated a t the tim e the specificatio n was developed: J o h n M. Pow ers (chairm an), U niversity of M ichigan, A nn Arbor; B. Keith M oore (secretary), In d ia n a U niversity, In d i a n a p o lis; E m ery D o u g h e rty , D e n tsp ly In ti, York, PA; R ichard N orm an, S outhern Illinois U niversity, Alton; and V. B. D h u ru , M arquette U niversity, M ilwaukee. T h is sta n d a rd specifies re q u ire m e n ts for d e n ta l glass io n o m e r cem ents p ro d u c e d by the reaction betw een a pow der of acid-soluble, alum inosilicate glass a n d a n aqueous solution of a polym er (alkenoic acid). G lass ionom er cem en ts p re p a re d by the a d d itio n of w ater to a m ixture of dry acid a n d alum inosilicate glass are also covered by this standard. T h e glass ionom er cem ents covered by this standard m ay be used as lu tin g cem ents, re sto ra tiv e m aterials, or as p it and fissure fillers or sealers. T h is standard does not cover glass ionom er cem ents used as liners or bases. T h e desirable p ro p e rtie s to be tested for lin e rs a n d bases a re b e in g in v e s tig a te d a t th is tim e . W h en s u ita b le test m eth o d s h ave b e en d e v elo p ed a n d verified, this classification w ill be added as a revision o r addendum .
T h is sp e c ific a tio n is e sse n tia lly id e n tic a l to ISO S ta n d a rd 7489, d e n ta l g lass p o ly a lk e n o a te c e m e n ts, p r e p a re d by te c h n ic a l c o m m itte e , I S O /T C I O 6 , d e n tis tr y , o f th e In tern atio n al O rganization for S tandardization (ISO). In accordance w ith the desire to have ISO a n d A N SI/A D A specifications as sim ilar as possible, this ISO standard was circulated to th e ASC M D156 su b c o m m itte e for g lass ionom er cem ents for acceptance as the A N S I/ ADA specification no. 66. T h e subcom m ittee approved the ISO standard w ith one exception, th e sp e c ific a tio n d iffers fro m IS O 7489 in reference to the nam e of dental glass polyalkenoate cem ents. T h e specification title a n d all references m ade w ith in the body refer to d e n ta l glass p o ly alk e n o ate cem ents as glass ionom er cements. * A N S I/A D A s p e c if ic a tio n n o . 66-1989. A pproved J a n 25, 1989.
C opies of this and o th e r A N SI/A D A specifications are available from the A m erican N a tio n a l Standards In stitu te, 1430 Broadw ay, New York, 10018.
JADA, Vol. 119, July 1989 ■ 205
A
ASSOCIATION
REPORTS
Safety of dental amalgam—an update
Council on Dental Materials, Instruments, and Equipment Council on Dental Therapeutics
h e C o u n c il o n D e n ta l M a te ria ls, Instrum ents, a n d E q u ip m e n t a n d the C o u n c il o n D e n ta l T h e r a p e u tic s r e p o rte d in 19831 th a t b a se d o n sc ie n tific in fo rm a tio n a m a lg am is safe. T h e cou n cils fu rth er em phasized that, except in individuals a lle rg ic to m ercury, there is no reason why a p a ti e n t s h o u ld seek to h a v e a m a lg a m r e s to r a tio n s re m o v e d . T h e c o u n c ils a ls o reported in 19842 th at the need for patch tests for allerg y is a p ro fessio n al ju d g m e n t, a n d w h en p a tc h tests are indicated, they sh o u ld be p e rfo rm e d by a p ro fe s s io n a l tra in e d in the a d m in istratio n and interpretation of these tests. Referral to physicians such as allergists o r d e r m a to lo g is ts , w h o sp e c ia liz e in th is testing, is strongly recom m ended. I n v e s tig a tio n s of m e rc u ry v a p o r fro m a m a lg a m 3-9 a n d m ercu ry c o n c e n tra tio n s in b l o o d ,5,6,10 u r i n e , 10,11 a n d o th e r b io lo g ic a l specim ens12-15 (such as nerve tissues of subjects w ith am alg am restorations), report that sm all q u a n ti t ie s of m e rc u ry a re re le a se d fro m am algam s. Q u a n tifica tio n of in vivo m ercury vapor release from am algam based on direct m easurem ent w ith a m ercury vapor analyzer is q u e s tio n a b le a n d a v a rie ty of a n a ly tic te c h n iq u e s a n d in te r p r e t a ti o n s h a v e b e e n reported.9 Nevertheless, the quan tities reported are sm all in com parison w ith m ercury from o th e r sources su c h as diet, a n d are far less th an the q u a n titie s required to induce sym p tom s of m ercury p o is o n in g .16 D ental h e alth care w orkers h a v in g o c c u p a tio n a l e x p o su re to m erc u ry v a p o r have h ig h e r m ean values of m erc u ry in b lo o d 17,18 a n d u rin e 19,20 th a n the general p o p u latio n ; however, these levels have n o t been show n to cause sym ptom s of m e rc u ry p o i s o n i n g in d e n ta l h e a lth c are w o rk e rs w h o p ra c tic e g o o d h ygiene in use of dental m ercury. A llergic reactions to am algam restorations are extrem ely rare. W hen such reactions do occur, they are m ost frequently characterized by sig n s a n d sy m p to m s th a t are sim ila r to those seen in o ther contact allergies such
T
204 ■ JADA, Vol. 119, July 1989
as derm atitis, urticaria, erythem a, and edema. O ra l sy m p to m s a re u s u a lly d e sc rib e d as g in g iv o s to m a titis .21 In som e cases w h e re allergy to m ercury was determ ined, previous exposures to o th e r sources of m ercury such as M e rc u ro c h ro m e o r s k in c o n ta c t w ith m e ta llic m ercury were noted. O c cu p a tio n a l exposure to m ercury is know n to cause contact derm atitis; how ever, case reports of m ercury a lle rg y a m o n g d e n ta l h e a lth c are w o rk e rs are also extrem ely rare.22 T h e m e th o d fo r c o n f ir m in g a lle rg y to m ercury involves the p ro p e r use a n d in te r p re ta tio n of a p a tc h test.2 M any difficulties are a sso c ia te d w ith th e use o f p a tc h tests, in clu d in g the fact th a t m any of the com pounds use d for te s tin g are ir r ita n ts o r have been used in excessive c o n ce n tra tio n s, p ro d u c in g false-positive results.23 It should also be noted th a t a lle rg y to c e rta in m e rc u ry -c o n ta in in g c o m p o u n d s does n o t n ecessarily in d ic a te a tru e allergy to m ercury, a n d a p a tie n t w ith allergy to one form of m ercury may or may n o t cross-react to o th er form s of m ercury.22 A p a tc h test is judged positive on the basis o f th e e v a lu a tio n of c u ta n e o u s sig n s su c h as e ry th e m a , edem a, vesicles, a n d p a p u le s, a n d n o t o n system ic changes, such as pulse rate a n d blood pressure.24'25 G a lv an ic c u rren ts have been show n to be of s im ila r m a g n itu d e a n d d i s t r ib u t i o n in patients w ith a n d w ith o u t sym ptom s attributed to g a lv a n ic c o rro sio n in the m o u th .26 T h e clinical recording of electrochem ical variables such as potentials, currents, or charge transfers c a n n o t be a cc o m p lish e d by u s in g c o m m o n in stru m e n ts.26 Even w ith special m ea su rin g instrum ents of the type constructed a n d used in w e ll-c o n tro lle d stu d ie s , th e m a g n itu d e of the recorded values has n o t been related to th e p re se n c e o r se v e rity o f sy m p to m s a lle g e d ly c a u s e d by g a lv a n ic c o rro s io n in th e m o u th . T h e s e k in d s of m e a su re m e n ts sh o u ld n o t be the sole basis for a decisio n re g a r d in g th e s u b s ti t u ti o n o f o n e ty p e of restorative m aterial for another. T here is no
b a sis for th e use of g a lv a n ic c u r re n t m e a surem ents as diagnostic tools for neither allergy nor toxicity. T h e re are several review s of lite ra tu re o n m ercury a n d a m a lg a m .16,22,27-31 O n the basis of th ese review s a n d c u r re n t i n f o r m a tio n , am alg am is safe for p atien ts n o t allerg ic to m ercury, and the occurrence of m ercury allergy is extrem ely rare. T h e long history of am algam su c c essfu lly used for m o re th a n 150 years, a n d th e n u m b e r of a m a lg a m r e s to r a tio n s placed w ith n o docum ented toxicity su p p o rt th e safety o f a m a lg a m . T h e c o u n c ils have review ed e x ta n t sc ie n tific in fo rm a tio n a n d re a f firm th e A s s o c ia tio n ’s32 p o s i t io n th a t am alg am is safe for p a tie n ts n o t a llerg ic to m e rc u ry . T h e r e is n o re a s o n , b a se d on toxicological consideration, w hy a nonallergic p a ti e n t s h o u ld seek to h a v e s e rv ic e a b le a m a lg a m r e s to r a tio n s re m o v e d . T h e r e is in s u ffic ie n t evidence to ju stify c la im s th a t m ercury from am a lg am re sto ra tio n s has a n adverse effect o n the health of the patients.
J!£OA T h is report was approved by the councils in A pril 1989. A ddress requests for re p rin ts to the C o u n cil on D ental M aterials, Instrum ents, an d E q u ip m en t. 1. C ouncil on D ental M aterials, Instrum ents, and E q u ip m e n t a n d C o u n cil o n D e n tal T h e ra p e u tic s. Safety of d ental am algam . JADA 1983;106:319-20. 2. C ouncil on D ental M aterials, Instrum ents, and E q u ip m e n t a n d C o u n cil o n D e n tal T h e ra p e u tic s. P a tc h te sts fo r s e n s itiv ity to m e rc u ry o r n ic k e l. JAD A 1984; 108:381. 3. G a y D D, C ox R D , R e in h a r d t JW . C h e w in g releases m ercury from fillings. Lancet 1979;8123:985-
6. 4. Svare CW, et al. T h e effect of d e n ta l am algam s o n m e rc u ry lev els in e x p ire d a ir. J D e n t R es 1981;60:1668-71. 5. O tt K H R , et al. M ercury bu rd en due to am algam fillings. D tsch Zahnarztl Z 1984;39:199-205. 6. A braham JE , Svare CW , F rank CW . T h e effect
AS S OCI ATI ON REPORTS of d e n ta l a m a lg a m re sto ra tio n s o n b lo o d m ercury levels. J D ent Res 1984;63:71-3. 7. Vim y M J, Lorscheider FL . In tra-o ral m ercury re le a se d fro m d e n ta l a m a lg a m s . J D e n t R es 1985;64:1069-71. 8. P a tte r s o n J E , W e issb e rg B G , D e n n iso n P J . M ercury in h u m a n b re a th fro m d e n tal am alg am s. B ull E nviron C o n tam T o x ico l 1985;34:459-68. 9. B erglund A. D eterm in atio n of the rate of release of in tra-o ra l m ercury vap o r from am algam . J D ent Res 1988;67:1235-42. 10. K roncke A, e t al. U b er d ie q u e ck silb e rk o n z e n tra tio n e n in b lu t u n d u r in v o n p e rs o n e n m it u n d o h n e a m a lg a m f u llu n g e n . D tsch Z a h n a rz tl Z 1981;36:69-74. 11. O lstad M L, et al. C o rrelatio n between am alg am re s to ra tio n s a n d m ercu ry c o n c e n tra tio n s in u rin e. J D ent Res 1987;66:1179-82. 12. N iln e r K, A kerm an S, Klinze B. Effect of dental a m a lg a m re s to ra tio n s o n th e m e rc u ry c o n te n t o f nerve tissues. Acta O d o n to l Scand 1985;43:303-7. 13. F r ib e r g L , e t a l. K v ic k siv le r i c e n tr a la n e rv s y ste m e t i r e la tio n till a m a lg a m f y llin in g a r. L a k a rtid n in g e n 1986;83:519-22. 14. N y la n d e r M, F r ib e r g L , L in d B. M e rc u ry c o n c e n tr a tio n s in th e h u m a n b r a in a n d k id n e y s in re la tio n to exp o su re from d ental am alg am from
d e n tal am alg am fillings. Sw ed D ent J 1987; 11:17987. 15. E g g e lsto n DW , N y la n d e r M. C o rre la tio n of d e n ta l a m a lg a m w ith m e rc u ry in b r a in tissu e . J P ro sth et D ent 1987;58:704-7. 16. E ley BM , C o x SW . M e rc u ry fro m d e n ta l am alg am fillin g s in p atients. Br D ent J 1987;163:221-
6. 17. C h a n g SB, Siew C, G ru n in g e r SE. E x am in atio n of b lo o d levels of m ercurials in p ra c tic in g dentists u s in g co ld -v a p o r a to m ic a b so rp tio n spectrom etry. J A nal T o x ico l 1987;11:149-53. 18. Siew C, C h an g SB, G ru n in g e r S. A dditional threat? CDA J 1987;15:18-21. 19. N alew ay C, et al. U rin a ry m ercury levels in US dentists, 1975-1983: review of h e alth assessm ent p ro g ram . JAD A 1985;111:37-42. 20. L a n g a n DC, Steffek A J, N alew ay CA. M ercury hygiene practices. CDA J 1987;15:24-9. 21. V ernon C, H ild e b ra n d H F, M artin P. A m algam es dentaires et allergie. J Biol Buccale 1986; 14:83-
100. 22. L a n g a n DC, Fan P L , H oos AA. T h e use of m ercury in dentistry: a critical review of the recent literatu re. JADA 1987;115:867-80. 23. B urrow s D. H ypersensitivity to m ercury, nickel, an d ch ro m iu m in relatio n to d e ntal m aterials. Int
D ent J 1986;36:30-4. 24. M ackert JR . H ypersensitivity to m ercury from d e n ta l am algam . J A m Acad D erm atol 1985; 12:87780. 25. F ish e r AA. T h e m isu se of th e p a tc h test to d e te rm in e “h y p e rsen sitiv ity ” to m e rc u ry a m a lg a m d e n ta l fillings. C ertis 1985;35:110, 112, 117. 26. C o u n c il o n D e n ta l M a te ria ls , I n s tru m e n ts , a n d E qu ip m en t. A m erican D ental A ssociation status re p o rt o n the o ccu rren ce of g a lv a n ic c o rro s io n in th e m o u th a n d its p o te n tia l effe c ts. JA D A 1987;115:783-7. 27. M jor IA. T h e safe a n d effective use of d e ntal am algam . In t D ent J 1987;37:147-51. 28. E n w o n w u C O . P o te n tia l h e a l th h a z a rd of use o f m ercu ry in d entistry: c ritic a l review of the literature. E n v iro n m en tal Res 1987;42:257-74. 29. Ely BM, C ox SW. ‘M ercury p o is o n in g ’ from d e n ta l a m a lg a m —a n e v a lu a tio n o f th e e v id e n ce . J D ent 1988;16:90-5. 30. D odes JE . A m algam toxicity: a review of the literature. O per D ent 1988;13:32-6. 31. R e in h a r d t JW . R isk a sse ssm e n t of m e rc u ry ex p o su re from d e n ta l am alg am s. J P u b lic H e a lth D ent 1988;48:172-7. 32. A m erican D ental A ssociation. T ra n s 1986;53637.
ANSI/ADA specification no. 66* for dental glass ionomer cements Council on Dental Materials, Instruments, and Equipment
m e ric a n D e n ta l A sso c ia tio n s p e c if i cation no. 66 for dental glass ionom er . c e m e n ts h a s b e e n a p p ro v e d by th e C o u n c il o n D e n ta l M a terials, In stru m e n ts, a n d E q u ip m e n t of th e A m e ric a n D e n ta l A sso c ia tio n . T h is a n d o th e r sp e c ific a tio n s for dental m aterials, instrum ents, and e q u ip m ent are being form ulated by subcom m ittees of the Accredited Standards C om m ittee MD156 for D ental M aterials, Instrum ents, and E q u ip m e n t. T h e c o u n c il a cts as a d m in is tr a tiv e sp o n s o r of th a t c o m m ittee, w h ic h has re p re sen ta tio n from a ll interests in the U n ited S tates in th e s ta n d a rd iz a tio n of m a te ria ls , instrum ents, a n d e q u ip m e n t in dentistry. T h e council has adopted the specifications, show in g professional re cognition of th eir usefulness in dentistry, a n d has forw arded them to the A m erican N a tio n a l S tandards In stitu te w ith a recom m endation th a t the specifications be a p p ro v e d as A m erican N a tio n a l S tandards. A pproval of ADA specification no. 66 as an A m erican N atio n al S tandard was granted by the A m e ric an N a tio n a l S ta n d a rd s In s titu te o n J a n 25, 1989. T h is s ta n d a r d becom es effective J a n 25, 1990. T h e c o u n c il th a n k s th e su b c o m m itte e
A
m em bers and organizations w ith w hich they were a ffiliated a t the tim e the specificatio n was developed: J o h n M. Pow ers (chairm an), U niversity of M ichigan, A nn Arbor; B. Keith M oore (secretary), In d ia n a U niversity, In d i a n a p o lis; E m ery D o u g h e rty , D e n tsp ly In ti, York, PA; R ichard N orm an, S outhern Illinois U niversity, Alton; and V. B. D h u ru , M arquette U niversity, M ilwaukee. T h is sta n d a rd specifies re q u ire m e n ts for d e n ta l glass io n o m e r cem ents p ro d u c e d by the reaction betw een a pow der of acid-soluble, alum inosilicate glass a n d a n aqueous solution of a polym er (alkenoic acid). G lass ionom er cem en ts p re p a re d by the a d d itio n of w ater to a m ixture of dry acid a n d alum inosilicate glass are also covered by this standard. T h e glass ionom er cem ents covered by this standard m ay be used as lu tin g cem ents, re sto ra tiv e m aterials, or as p it and fissure fillers or sealers. T h is standard does not cover glass ionom er cem ents used as liners or bases. T h e desirable p ro p e rtie s to be tested for lin e rs a n d bases a re b e in g in v e s tig a te d a t th is tim e . W h en s u ita b le test m eth o d s h ave b e en d e v elo p ed a n d verified, this classification w ill be added as a revision o r addendum .
T h is sp e c ific a tio n is e sse n tia lly id e n tic a l to ISO S ta n d a rd 7489, d e n ta l g lass p o ly a lk e n o a te c e m e n ts, p r e p a re d by te c h n ic a l c o m m itte e , I S O /T C I O 6 , d e n tis tr y , o f th e In tern atio n al O rganization for S tandardization (ISO). In accordance w ith the desire to have ISO a n d A N SI/A D A specifications as sim ilar as possible, this ISO standard was circulated to th e ASC M D156 su b c o m m itte e for g lass ionom er cem ents for acceptance as the A N S I/ ADA specification no. 66. T h e subcom m ittee approved the ISO standard w ith one exception, th e sp e c ific a tio n d iffers fro m IS O 7489 in reference to the nam e of dental glass polyalkenoate cem ents. T h e specification title a n d all references m ade w ith in the body refer to d e n ta l glass p o ly alk e n o ate cem ents as glass ionom er cements. * A N S I/A D A s p e c if ic a tio n n o . 66-1989. A pproved J a n 25, 1989.
C opies of this and o th e r A N SI/A D A specifications are available from the A m erican N a tio n a l Standards In stitu te, 1430 Broadw ay, New York, 10018.
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