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Advisory Committee on Mercury PollutionMeeting #52: Thursday, May 13, 2004 MINUTES Members Present: The Committee members and interested parties gathered in the Large Conference Room in Community Public Health at the Vermont Department of Health. Rich Phillips called the meeting to order. Agenda Item 1- Liljan Smith Aandahl introduced herself and advised the Committee that she has held her current position for one year. She has a master's degree in dental public health. Ms. Aandah began by presenting to the Committee an overview of the process involved in creating the Norwegian "National Clinical Guideline for the Use of Dental Filling Materials" The process began in 1998 and was the result of two reports, which were sent to Karen Knaebel, state mercury education and reduction coordinator, for distribution to the Committee. Until recently, the document was only in Norwegian, but there is now an English translation available at the Norwegian Directorate for Health and Social Welfare's website at: http://www.shdir.no/index.db2?id=11566. The previous document released to the Committee was a summary, which was an unofficial translation. Development of the final guidelines took several years to complete and involved a number of steps. The Norwegian Federal Health Agency issued its first report in 1998, entitled "Use of Dental Filling Materials in Norway. The 1998 report was 25 chapters including toxicology, environment, patients' aspects and the report was more or less summarized in what was sent to Karen this morning. The conclusion was that Health Authorities should develop recommendations that would result in less amalgam use. The guideline set procedure and after reviewing research came to two conclusions, which were in direct, conflict with each other.
The lifetime perspective is to save as much tooth tissue as possible and that amalgam is not the most desirable in the long run. The Norwegian guidelines will be presented at the International Conference on Mercury as a Global Pollutant in Slovenia in late June. The Norwegian legal system has two important principals: the public health perspective and the environmental perspective. They are also required by the Norwegian Control Act to observe the Principal of Substitution, which would promote the least amount of health affects or environmental damage. The Director of Environmental Affairs stated that this principal applied to amalgam because of the high concentrations of mercury. It was determined that:
The guidelines address both of these area by first reducing the use and subsequent environmental release of dental mercury and second, by reducing mercury exposure in patients. One of the more problematic issues is the total exposure to mercury contributed to sensitive populations. For a long time, it was thought that not much mercury is released from amalgam. However, over the last decade it was noted that releases of mercury into the body, due to amalgam fillings, are much higher than previously believed. Primary studies have indicated that mercury was detected in the mother's milk and in the fetus. Therefore, it is important to have this population's exposure to mercury at the lowest possible levels. It was decided that there must be a discontinuation
of the use of amalgam as much as possible. There were also some undesirable effects of the new replacement restoration materials but there was not
much documentation to substantiate the findings.
Questions by Committee:
Ms. Aandahl stated that the initial review process actually began much before the 1998 recommendation with the prior recommendation in 1991 for pregnant women to avoid amalgam placement. There was also considerable comment from members of the public saying they were becoming ill from amalgam fillings. In the late 1980s there was a also lot of discussions.
It was determined that the recommendation would be extended regarding all filling therapy for pregnant women. Because alternative-filling material contains Bisphenel "A", (hormone mimicking) it has adverse affects on cell cultures similar to estrogen. It is unknown how much is released and how long it is release and it was felt that this could possible cause adverse affects on the fetus. Question:
Agenda Item 2- Greg Lutchko and Gary Gulka gave the Committee an overview of the Amalgam Separator Project as follows: In November 2002 the Committee looked at dental as a release source of mercury through wastewater. A sub-committee was formed to determine what types of units were on the market, their performance, and what recommendations should the Committee make. Field testing was already available for amalgam separator units and there was no requirement for installation in Vermont. Several states and municipal districts now require separators but there is no first hand testing on how these units perform over a period of time or if there are any maintenance issues. This project began in May 2003. There are approximately ten commercial units on the market. The idea was that the vendors would donate the units for the pilot and DEC would arrange for installation of the units by licensed plumbers that were mostly paid for by the vendors. Six different types of units were installed at 17 installation sites. DEC visited the dental offices about four times through March of 2004 asking dentists about such things as any loss of suction in the vacuum system, observations about accumulation in the separator units, etc. Each of these units is ISO certified for a 95% or greater removal rate for particulate mercury. One important issue was the maintenance of these units including cleaning the lines at the end of each day. DEC tried to match separators with types of offices. There were wet and dry vacuum system variations and space issues. The Committee was given a draft overview of the separators used and findings. Handouts were provided to the Committee that were excerpts of the draft report and included: (1) a chart of separators in the pilot describing unit specifications, costs, maintenance, etc.; (2) diagrams of separator installations and field observations on each type of separator in the pilot, and (3) recommendations on choosing an amalgam separator. Comments from committee:
Agenda Item 3- This discussion moved to next meeting due to time constraints. Agenda Item 4- March minutes were accepted with no changes.
The next meeting is scheduled for Friday, June 4, 2004 to be held from 9:00 to 11:30 in the Environmental Assistance Office (EAO) Conference Room
at the Waterbury State Complex, Waterbury, Vermont. The agenda will be a discussion of dental brochures, and updates on: 1) outreach to sensitive
populations, 2) lamp outreach efforts, 3) mercury legislation, 4) NESCAM meeting and 5) New England Fish Forum. If the amalgam separator draft report
is available, the Committee will be given a copy at the next meeting for review.
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