Civil Society Organizations signed “Dhaka Declaration,” A call for Asia to end dental amalgam by 2018

More than 137 Civil Society Organizations (CSOs), individuals and professionals from Bangladesh, India, Nepal, Sri Lanka, Pakistan and Thailand have signed a declaration calling for Asia to be the largest population on the planet to end the use of mercury in dental care.   Amalgam fillings are 50% mercury, a major neurotoxin. Its continuous use is not justified because alternatives are now affordable, effective, and available in Asia.  The restriction of its use is demanded worldwide in the Minamata Convention on Mercury, adopted by more than 140 governments and the EU in 2013, in Kumamoto, Japan. Signed by 128 nations and ratified by 8. The call is contained in the Civil Society Organizations (CSOs) declaration made in Dhaka in November 2014, and adapted by the CSOs and the individual in beginning   of January 2015 towards Mercury-Free Dentistry for Asia. The declaration advocates for Asia to become the largest and most densely populated continent to phase out dental amalgam. The declaration highlights that mercury, which is used in dental amalgam, is a restorative material that is approximately 50% elemental mercury  and is a notorious heavy metal of global concern that is known to be a potent poison of the human nervous system. By adapting this declaration South and Southeast Asian CSOs, professionals express their concern and said, “We are calling on Asia to end the use of mercury-based dentistry.  Asia is the most densely populated continent on the planet and therefore risks incredible harm to human health and the environment.” The CSOs say that the toxic trade in dental mercury, which pollutes waterways and food sources, needs to be ended.  The surest route is to have a ban on the use of dental amalgam in all countries of the continent, and have mercury-free dentistry. Mercury-free dentistry is growing in Asia. Recent studies in India and Pakistan show that, already, over 50% of dentists are using alternatives to dental amalgam in India, while in Pakistan 42.86% dental professionals strongly recommend to phase down the use of mercury/dental mercury amalgam. In Nepal and Bangladesh, the dental association and society of the dentist groups are also supporting the phase out of amalgam. Asian countries are requested to declare that the children of Asia — and all the people of Asia — have a basic human right to mercury-free dental care and a mercury-free environment. The request follows the existence of sound scientific evidences that mercury can damage children’s developing brains and nervous systems even before they are born.” In addition to the literature, the Minamata Convention on Mercury adopted in October 2013, noted that the world recognizes dental amalgam as a major environmental pollutant which requires each participating nation “to phase down the use of dental amalgam.” The CSOs concern is raised based on the fact that dental mercury accounts for 10% of annual global mercury consumption  and 260-340 metric tons of mercury pollution around the world each year. The dental amalgam mercury enters the environment via many pathways, polluting air via cremation, dental clinic releases, and sewage sludge incineration; water via human waste and dental clinic releases to septic systems and municipal wastewater; and soil via landfills, burials, and fertilizers. Once dental mercury is in the environment, bacteriain soils and sediments may convert it to methylmercury,  “a highly toxic form that builds up in fish, shellfish and animals that eat fish, thereby making fish and shellfish the main sources of methylmercury exposure to humans.
In the dental workplace, uncontrolled mercury vapours are a major occupational risk, especially to young women of childbearing age. The CSOs are also reminding Asian countries of their efforts during negotiations of the Minamata Convention. They worked very hard to make sure that reduction in dental amalgam use specifically be included in the treaty, forcefully arguing for the phase out of amalgam generally and for an end to amalgam in milk teeth specifically. The phase down is possible since Mercury-free dental restorative materials are far less expensive than dental amalgam when environmental and societal costs are factored in. The costs of using mercury-free options (including retreatment) is about half the cost of amalgam without retreatment, making this mercury-free technique significantly more affordable in low-income communities, particularly in areas without electricity or dental clinics. World Health Organization report Future Use of Materials for Dental Restoration,  says that “recent data suggest that RBCs

[resin-based composites]

perform equally well” as amalgam – and offer additional oral health benefits because “Adhesive resin materials allow for less tooth destruction and, as a result, a longer survival of the tooth itself. The CSOs call the Asian countries to work together and make Asia the first continent with mercury-free dentistry – considering that Asia is more densely populated than any other continent and the health and environmental costs will therefore be more significant. In addition, the CSOs call the countries to adopt effective amalgam phase down strategies that have been proven in nations that have already phased out or significantly reduced dental mercury use by raising awareness about dental mercury to parents, consumers, dental workers, health professionals, and educators and achieve the following priorities;
1.    Make it an immediate priority to stop the use of mercury amalgam in the treatment of children and pregnant women by 2015.
2.    Develop an alternative dental curriculum with a specific chapter on the dental restoration process of amalgam and its harm to dental staff, patients and the environment by 2015.
3.    Pass national regulation to ban the use, import and sale of mercury amalgam by 2016-2020 as per country situation.
4.    Promote alternative restoration materials and ensure they are affordable and accessible.
Furthermore, the CSOs call Asian countries to reject the double standard mentality which infers that Asians must accept toxic chemicals that the rest of the world is rejecting.

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