An yi amfani da amalgam na hakori don dawo da hakora kusan shekara ɗari biyu, kuma shakku game da sabani da ake samu na samar da sabis na kiwon lafiya tare da kayan da ke ƙunshe da sinadarin mercury sun ci gaba duk tsawon lokacin. Ya kasance akwai wani abu mai raɗaɗi a cikin ƙwararrun hakora na ƙin yarda da amalgam, motsi "maras nauyi" Duk da yake maganganun wannan ra'ayi sun karu a cikin 'yan shekarun nan saboda ya zama da sauki a kammala aikin gyara hakorar hakora masu kyau tare da wadanda ake hadawa, za a iya takaita halayyar likitocin hakora game da amalgam a matsayin "babu wani abu da ya dace da shi a kimiyyance, kawai ba mu yin amfani da shi sosai babu kuma. ”

Don tambaya ko wani abu ya kasance ko ba daidai ba a kimiyance game da haɗakarwa, dole ne mutum ya kalli manyan wallafe-wallafen akan fallasa, toxicology da kimanta haɗarin Mercury. Mafi yawansu ba su da tushe a wajen tushen likitocin hakora. Ko da yawancin wallafe-wallafen kan tasirin mercury daga amalgam sun wanzu a waje da mujallu na hakori. Nazarin wannan ingantaccen wallafe-wallafen na iya ba da haske game da zaton da likitan hakori ya yi game da amalgam aminci, kuma zai iya taimakawa wajen bayyana dalilin da ya sa wasu likitocin hakora suka ci gaba da ƙin yarda da amalgam a cikin likitan hakori.

Babu wanda yanzu yake jayayya cewa amalgam ɗin haƙori yana fitar da daddaren ƙarfe zuwa yanayinsa da wani ɗan kuɗi kaɗan, kuma zai zama mai ban sha'awa a taƙaice taƙaita wasu daga cikin shaidun da ke nuna hakan. Magungunan toxicology na Mercury suna da faɗi sosai don gajeren labarin, kuma ana yin nazarin su sosai a wani wuri. Batun kimanta haɗari, duk da haka, ya tafi kai tsaye zuwa ga mahawarar game da ko amalgam yana da aminci, ko a'a, don amfani da shi ba tare da iyakancewa ba a cikin jama'a.

Wani Irin Karfe ne a Dental Amalgam?

Saboda cakuda ne mai sanyi, amalgam ba zai iya haduwa da ma'anar wani abu mai hade da allo ba, wanda dole ne ya kasance hadadden karafa ne wanda aka samar dashi cikin narkakken yanayi. Hakanan bazai iya haɗuwa da ma'anar mahaɗin ionic kamar gishiri, wanda dole ne ya sami musayar electrons wanda zai haifar da lattice of ions caji. Zai fi dacewa da ma'anar colloid mai ƙarfe-ƙarfe, ko emulsion mai ƙarfi, wanda ba a amsar kayan matrix gaba ɗaya, kuma za'a iya dawo dashi. Hoto na 1 yana nuna micrograph na samfurin goge na hakoran amalgam wanda binciken kwayar halitta ya burge shi. A kowane matsi na matsi, ana fitar da diga-digon ruwan mercury. ¹

Haley (2007)² auna fitowar in-vitro na mercury daga samfuran zube guda daya na Tytin®, Dispersalloy®, da Valiant®, kowannensu yana da filin 1 cm2. Bayan ajiyar kwanaki casa'in don ba da damar halayen saitin farko su kasance cikakke, an saka samfuran a cikin ruwa mai narkewa a zafin jiki na ɗaki, 23˚C, kuma ba damuwa ba. Ruwan daskararwar an canza shi kuma ana nazarin shi yau da kullun tsawon kwanaki 25, ta amfani da Nippon Direct Mercury Analyzer. An saki Mercury a ƙarƙashin waɗannan sharuɗɗan a kan kimar microgram 4.5-22 a kowace rana, a kowane santimita square. Tauna (1991)³ ya ruwaito cewa Mercury ya narke daga amalgam zuwa cikin ruwa mai narkewa a 37˚C akan kudi har zuwa microgram 43 kowace rana, yayin da Gross da Harrison (1989)⁴ ya ruwaito microgram 37.5 kowace rana a cikin maganin Ringer.

Rarraba Dental Mercury A Kewayen Jiki

Yawancin karatu, gami da nazarin autopsy, sun nuna matakan mercury mafi girma a cikin kyallen takarda na mutane tare da cikewar amalgam, sabanin waɗanda ba a fallasa su ba. Loadara yawan kayan amalgam yana da alaƙa da haɓaka haɓakar mercury a cikin iska mai iska; yau; jini; najasa; fitsari; kyallen takarda daban-daban da suka hada da hanta, koda, gland, pituitary, gland, da sauransu; ruwan ciki, jinin igiyar ciki, mahaifa da kayan tayi; man gishiri da nono.⁵

Mafi kyawun zane-zane, gwaje-gwajen gargajiya da ke nuna in-vivo rarraba Mercury daga cikewar amalgam sune mashahurin “karatun tumaki da biri” na Hahn, et. al. (1989 da 1990).^6,7 An ba rago mai ciki cikon amalgam cika goma sha biyu wanda aka yiwa alama tare da rediyoaktif ²⁰³Hg, wani abu ne wanda baya wanzu a yanayi, kuma yana da rabin rai na kwanaki 46. An sassaka abubuwan ne daga ɓoyewa, kuma an kiyaye bakin dabbar a cushe an kurkure ta don hana haɗiyar abubuwan da suka wuce gona da iri yayin aikin. Bayan kwana talatin, aka yanka. Rediyon radiyo mai tasiri ya kasance cikin hanta, kodoji, sashin narkewa da kasusuwa, amma kowane nama, gami da ƙwayoyin tayi, sun sami muguwar magana. A autoradiogram na duk dabba, bayan an cire hakora, an nuna a cikin hoto 2.

An soki gwajin ragunan ne saboda amfani da dabba wacce ta ci ta tauna ta hanyar da ta bambanta da ta mutane, don haka kungiyar ta maimaita gwajin ta hanyar amfani da biri, da sakamako iri daya.

25 Skare I, Engqvist A. Bayyanar ɗan adam zuwa mercury da azurfa wanda aka sake shi daga maidowar amalgam. Arch kewaye da Lafiya 1994; 49 (5): 384-94.

Matsayin Bincike Mai Hadari 

Shaida kamuwa da cuta abu daya ne, amma idan “maganin ya sanya guba,” kamar yadda muka ji sau da yawa dangane da yaduwar sinadarin mercury daga amalgam na hakori, tabbatar da wane irin matakin kamuwa da cutar ne mai guba kuma ga wanene lardin haɗarin kima. Kiman hadari tsari ne na yau da kullun wanda ke amfani da bayanan da ke cikin adabin kimiyya, don gabatar da matakan bayyanar da zai iya karbuwa a karkashin yanayin da aka bayar, ga hukumomin da ke da alhakin hadarin hadarin. Hanya ce da aka saba amfani da ita a cikin aikin injiniya, kamar yadda, misali, sashen ayyukan jama'a yana buƙatar sanin yuwuwar gadar da za ta faɗi ƙasa da ɗorawa kafin saita iyakan nauyi a kai.

Akwai hukumomi da dama da ke da alhakin tsara yadda dan adam ke yada abubuwa masu guba, FDA, EPA, da OSHA, daga cikinsu. Dukansu sun dogara da hanyoyin tantance haɗarin don saita iyakokin saura na yarda da sinadarai, gami da mercury, a cikin kifi da sauran abincin da muke ci, da ruwan da muke sha da kuma cikin iska da muke shaƙa. Waɗannan hukumomin sa'annan suka sanya iyakokin da doka za ta iya tilastawa kan bayyanar da ɗan adam wanda ake bayyana su da sunaye iri-iri, kamar iyakantaccen tsarin bayyanarwa (REL), ƙididdigar bayani (RfD), ƙididdigar tunani (RfC), iyakancewar yau da kullum (TDL), da sauransu, duk waɗannan ma'anar abu ɗaya ne: yadda yawan fallasa don ba da izini a ƙarƙashin yanayin da hukumar ke da alhakin sa. Wannan matakin da aka yarda dashi dole ne ya zama ya kasance wanda ake tsammanin hakan babu mummunan sakamako na kiwon lafiya a tsakanin jama'ar da ke ƙarƙashin dokar.

Kafa REL

Don amfani da hanyoyin tantance hatsarin ga yiwuwar cutar ta sinadarin mercury daga hakoran amalgam, dole ne mu tantance irin sinadarin mercury din da mutane ke haduwa da shi daga abubuwan da suke cikewa, kuma mu gwada hakan da matsayin matakan kariya na irin wannan yanayin. Toxicology na mercury ya gane cewa tasirinsa a jiki ya dogara ne ƙwarai akan nau'in ƙwayoyin sunadaran da ke ciki, da kuma hanyar fallasa su. Kusan duk aikin da ake yi akan cutar guba ta amalgam ya tabbatar da cewa manyan jinsunan dake dauke da sinadarin sunadaran ƙarfe ne na haya (Hg˚) wanda yake cikewa ta iska, ana shaƙar huhu a cikin huhu kuma ana ɗaukar shi cikin ƙimar 80%. Sauran nau'ikan halittu da hanyoyi an san su da hannu, ciki har da ƙarfe melakla wanda aka narkar da shi a cikin miyau, abubuwan da aka ɓarke ​​da kayayyakin lalata waɗanda ake haɗiye su, ko methyl mercury da ake samu daga Hg˚ ta ƙwayoyin cuta na hanji. Har ma an gano wasu hanyoyi masu ban mamaki, kamar su shan Hg˚ a cikin kwakwalwa ta hanyar epithelium mai kamshi, ko kuma dawo da jigilar sinadarin mercury daga kashin kashin cikin kwakwalwa. Wadannan baje kolin ba su san adadinsu ba, ko kuma ana zaton sunada girma sosai fiye da shakar baka, saboda haka babban binciken da akayi akan amalgam mercury ya maida hankali acan.

Tsarin kulawa na tsakiya shine ɗayan ɓangaren da aka fi dacewa mai saurin haɗuwa don bayyanar ƙarancin mercury. Tabbataccen tasirin mai guba akan kodan da huhu ana tsammanin yana da ƙofar faɗakarwa mafi girma. Ba za a iya lissafin abubuwan da ke faruwa saboda yawan jijiyoyin jiki, rashin karfin jiki da sauran nau'ikan nau'ikan abubuwan rashin lafiyan ta hanyar samfurin amsa-kashi, (wanda ya haifar da tambaya, yaya ba kasafai ake samun cutar ta Mercury ba, da gaske?) Saboda haka, masu bincike da hukumomin da ke neman kafa RELs na low Matsayi na yau da kullun Hg˚ ya kalli matakai daban-daban na tasirin CNS. Fewan mahimman mahimman bayanai (an taƙaita su a cikin tebur na 1) an wallafa su a cikin shekarun da suka haɗu da yawawan haɗarin iskar mercury tare da alamun da za a iya aunawa na rashin aikin CNS. Waɗannan su ne binciken da masana kimiyya masu tantance haɗari suka dogara da shi.

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Tebur 1. Karatuttukan karatu waɗanda aka yi amfani dasu don ƙididdige ƙididdigar abubuwan da ke tattare da tururin mercury na ƙarfe, wanda aka bayyana azaman microgram a kowace mita mai siffar sukari. Asterix * yana nuna ƙididdigar iska wanda aka samo ta ta hanyar canza jini ko ƙimar fitsari zuwa iska kwatankwacin abubuwan juyawa daga Roels et al (1987).

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Aikin tantance haɗarin ya fahimci cewa tonawa da tasirin bayanan da aka tattara don manya, galibi maza, ma'aikata a cikin saitunan aiki ba za a iya amfani da su cikin ɗanyensu kamar yadda yake nuna matakan lafiya ga kowa da kowa. Akwai nau'ikan rashin tabbas a cikin bayanan:

• LOAEL da NOAEL. Babu ɗayan bayanan fallasa da aka tattara a cikin mahimman karatun da aka ruwaito a cikin hanyar da ke nuna madaidaiciyar ƙimar amsa-amsa don tasirin CNS da aka auna. Kamar wannan, ba su nuna tabbataccen ƙofar shiga don farawar tasirin. A wasu kalmomin, babu ƙaddara game da "Matakan da ba a Lura ba-Sakamakon-Matsayi-Inganci" (NOAEL). Karatuttukan da kowannensu ke nunawa shine "Matsakaicin-Lura-Rarraba-Tasiri-Mataki" (LOAEL), wanda ba'a ɗauka azaman tabbatacce.
• Bambancin mutum. Akwai ƙungiyoyin mutane da yawa da ke da ƙima a cikin yawancin jama'a: jarirai da yara waɗanda ke da ƙwarewar tsarin juyayi da ƙananan nauyin jiki; mutanen da ke da sassaucin magani; mutanen da ke da ƙaddarar halittar gado suka ƙaru ƙwarewa; mata masu haihuwa da sauran bambancin jinsi; tsofaffi, ga wasu kaɗan. Bambance-bambance tsakanin mutane waɗanda ba a lissafin su a cikin bayanan suna haifar da rashin tabbas.
• Haihuwa da ci gaban bayanai. Wasu hukumomi, kamar California EPA, suna ba da fifiko sosai kan bayanan haihuwa da na ci gaba, kuma suna ƙara ƙarin matakin rashin tabbas a cikin lissafinsu lokacin da aka rasa.
• Bayanin tsakanin jinsunan. Canza bayanan binciken dabba zuwa ga kwarewar mutum ba madaidaiciya ba ce, amma yin la'akari da wannan lamarin ba ya aiki a wannan misalin, tunda mahimman karatun da aka ambata a nan duk sun shafi batutuwan ɗan adam.

RELs da aka buga don bayyanar da tururin mercury na yau da kullun a cikin yawancin jama'a an taƙaita a cikin Table 2. RELs da aka tsara don tsara tasirin ga yawan jama'a ana lasafta su don tabbatar da cewa ba za a sami kyakkyawan tsammanin mummunan tasirin lafiyar kowa ba, don haka an ba da izinin bazuwar daga matakan da aka lura da mafi ƙarancin sakamako ta hanyar ilimin lissafi "abubuwan rashin tabbas" (UF). Abubuwa marasa tabbas ba'a yanke hukunci ta hanyar dokoki masu wuya da sauri ba, amma ta hanyar siyasa - yadda taka tsantsan hukumar tsara ke son zama, da kuma yadda suke da kwarin gwiwa akan bayanan.

Dangane da US EPA, alal misali, matakin sakamako (9 µg-Hg / iska mai nauyin cubic) an rage shi da kashi 3 saboda dogaro da LOAEL, kuma da kashi 10 don yin lissafin bambancin ɗan adam, don jimlar UF na 30. Wannan yana haifar da iyakar izinin 0.3 µg-Hg / cubic mita mai siffar sukari. ⁸

California EPA ta ƙara ƙarin UF na 10 don ƙarancin haihuwa da kuma bayanan ci gaba na Hg0, suna yin iyakokinsu sau goma a matsayin tsaurara, 0.03 µg Hg / cubic meters air. ⁹

Richardson (2009) ya gano binciken Ngim et al¹⁰ kamar yadda ya fi dacewa don haɓaka REL, tunda ya gabatar da likitocin haƙori maza da mata a Singapore, a bayyane yake ga ƙananan matakan tururin mercury ba tare da kasancewar iskar gas ta chlorine ba (duba ƙasa). Ya yi amfani da UF na 10 maimakon 3 don LOAEL, yana jayayya cewa jarirai da yara suna da hankali fiye da yadda 3 zai iya lissafawa. Aiwatar da UF na 10 don bambancin ɗan adam, a cikin duka UF na 100, ya ba da shawarar cewa Health Canada ta saita REL ɗin su don tururin mercury mai ɗorewa a iska mai nauyin 0.06 µg Hg / cubic.¹¹

Lettmeier et al (2010) ya sami mahimmin abu mai mahimmanci (ataxia na ƙofar) da kuma tasirin (baƙin ciki) a cikin ƙananan ƙananan masu hakar gwal a Afirka, waɗanda ke amfani da mercury don raba zinare daga murƙushe ma'adanin, har ma da ƙananan matakan ɗaukar hotuna, 3 Hg Hg / iska mai siffar sukari Bayan bin US EPA, sun yi amfani da kewayen UF na 30-50, kuma sun ba da shawarar REL tsakanin iska 0.1 da 0.07 µg Hg / cubic mita.¹²

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Tebur na 2. REL da aka buga don ɗaukar hoto zuwa ƙananan matakin, tururin Hg0 na yau da kullun a cikin yawancin jama'a, ba tare da ɗaukar aikin sana'a ba. * Canzawa don ɗaukar nauyin, Hg Hg / kg-day, daga Richardson (2011).

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Matsaloli tare da rel

EPA ta Amurka ta sake yin kwaskwarimar hayarsu ta RELEL (0.3 µg Hg / iska mai siffar sukari) a 1995, kuma kodayake sun sake tabbatar da hakan a 2007, sun yarda cewa an buga sabbin takardu da zasu iya shawo kansu su sake duba REL ɗin zuwa ƙasa. Tsoffin takardu na Fawer et al (1983) ¹³ da Piikivi, et al (1989 a, b, c)^{14, 15, 16}, ya dogara da babban sashi a kan ma'aunin tasirin mercury da tasirin CNS a cikin ma'aikatan chloralkali. Chloralkali shine tsarin masana'antar sinadarai na karni na goma sha tara wanda ake amfani da sinadarin gishiri a saman wani bakin ruwa mekuri, kuma ana hada shi da wutar lantarki domin samar da sodium hypochlorite, sodium hydroxide, sodium chlorate, gas chlorine, da sauran kayan. Mercury yana aiki azaman ɗayan wayoyin lantarki. Ma'aikata a cikin irin waɗannan tsire-tsire suna fuskantar ba kawai ga mercury a cikin iska ba, har ma da iskar gas ɗin chlorine.

Haɗuwa da haɗarin iskar mercury da iskar gas na chlorine yana canza tasirin tasirin ɗan adam. Hg˚ yana da sinadarin chlorine a cikin iska zuwa Hg²⁺, ko HgCl₂, wanda ke rage tasirinsa a cikin huhu, kuma yana canza yadda yake rarrabawa cikin jiki. Musamman, HgCl₂ sha daga iska ta cikin huhu baya shiga cikin sel, ko kuma ta hanyar shingen kwakwalwar jini, cikin sauki kamar Hg˚. Misali, Suzuki et al (1976)¹⁷ ya nuna cewa ma'aikatan da aka fallasa su Hg˚ kadai suna da rabo na Hg a cikin jajayen kwayoyin jini zuwa na jini na 1.5 -2.0 zuwa 1, yayin da ma'aikatan chloralkali da ke fuskantar duka mercury da chlorine suna da rabo na Hg a cikin RBCs zuwa plasma na 0.02 zuwa 1, kusan ƙasa da ɗari sau ƙasa a cikin ƙwayoyin. Wannan lamarin zai haifar da rabuwa sosai ga kodar fiye da kwakwalwa. Alamar nunawa, fitsari mekuri, zai kasance daidai ne ga nau'ikan ma'aikatan biyu, amma ma'aikatan chloralkali zasu yi tasirin CNS da yawa. Ta hanyar bincika yawancin batutuwa masu aiki na chloralkali, za a iya rage girman tasirin CNS zuwa tasirin mercury, kuma RELs da ke kan waɗannan karatun za a cika su da ƙari.

Daga cikin sabbin takardu akwai aikin Echeverria, et al, (2006)¹⁸ wanda ya sami tasirin ilimin neurobehavioral da neuropsychological a cikin likitocin hakora da ma'aikata, sosai a ƙasa da matakin 25 µg Hg / cubic mita na iska, ta amfani da ingantattun ingantattun gwaje-gwaje. Bugu da ƙari, ba a gano ƙofa ba.

Aiwatar da Mercury RELs zuwa Dental Amalgam

Akwai bambanci a cikin wallafe-wallafen game da yanayin yaduwar mercury daga amalgam, amma akwai yarjejeniya mai fa'ida kan wasu lambobin da abin ya shafa, wanda aka taƙaita a cikin Shafi na 3. Yana taimaka wajan kiyaye waɗannan ƙididdiga masu mahimmanci a zuciya, kamar yadda duk marubutan ke amfani da su a cikin lissafin su . Hakanan yana taimakawa wajen tuna gaskiyar cewa waɗannan bayanan da ake nunawa analog ne kawai na nunawa ga kwakwalwa. Akwai bayanan dabba da bayanan mutum bayan mutuwa, amma babu wani ainihin motsi na Mercury a cikin kwakwalwar ma'aikatan da ke cikin waɗannan karatun.

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Table 3. nassoshi:

• a- Mackert da Berglund (1997)
• b- Skare da Engkvist (1994)
• c- sake dubawa a cikin Richardson (2011)
• d-Roels, da al (1987)

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A tsakiyar 1990's an ga wallafe-wallafen ra'ayoyi biyu masu bambanci game da bayyanar amalgam da aminci. Wanda ya sami tasiri sosai kan tattaunawa tsakanin al'ummar hakora H. Rodway Mackert da Anders Berglund ne suka rubuta shi (1997)¹⁹, farfesoshin hakori a Kwalejin Kiwon Lafiya na Georgia, da Jami'ar Umea a Sweden, bi da bi. Wannan ita ce takardar da aka yi iƙirarin cewa zai ɗauki ɗakunan 450 na amalgam don kusanci kashi mai guba. Wadannan marubutan sun ambaci takardu wadanda suka rage tasirin sinadarin chlorine akan shakar mercury na yanayi, kuma sun yi amfani da iyakancewa na aiki, (wanda aka samo domin manya maza da aka fallasa awa takwas a kowace rana, kwana biyar a mako), na 25 µg-Hg / cubic mitir iska kamar yadda suke de-facto REL. Ba su yi la’akari da rashin tabbas a cikin wannan lambar ba saboda zai shafi dukan jama’a, gami da yara, waɗanda za a fallasa su awanni 24, kwana bakwai a mako.

Lissafin yana zuwa kamar haka: matakin mafi karancin sakamako na girgiza da gangan tsakanin mazan manya, musamman ma'aikatan chloralkali, ya kasance 25 µg-Hg / cubic mita wanda yayi daidai da matakin fitsari kimanin 30 µg-Hg / gr-creatinine. Ingididdiga don ƙananan matakin asalin fitsarin meerkury da aka samo a cikin mutane ba tare da cikawa ba, da kuma raba 30 µg ta gwargwadon gudummawar zuwa fitsarin mercury, 0.06 µg-Hg / gr-creatinine, sakamakon yana kusan saman 450 da ake buƙata don isa wannan matakin .

A halin yanzu, G. Mark Richardson, kwararren masanin kimanta hadari da Health Canada ya yi amfani da shi, da Margaret Allan, wani injiniya mai ba da shawara, dukkansu ba su da masaniya game da likitan hakora, wannan hukumar ce ta ba su aikin tantance hadari don hadewar a 1995. Sun zo wurin Kammalawa daban da Mackert da Berglund. Yin amfani da bayanan tasirin tasiri da abubuwan rashin tabbas dangane da waɗanda aka tattauna a sama, sun ba Kanada shawarar REL don tururin mercury na 0.014 µg Hg / kg-day. Idan aka yi la'akari da saman 2.5 a cike, sai suka kirga kewayon yawan adadin da ba zai wuce wancan matakin bayyanar ba na rukunin shekaru biyar daban-daban, gwargwadon nauyin jiki: yara, 0-1; yara, 0-1; matasa, 1-3; manya, 2-4; tsofaffi, 2-4. Dangane da waɗannan lambobin, Health Canada sun ba da jerin shawarwari don ƙuntata amfani da amalgam, waɗanda aka watsar da su a aikace.^{20, 21}

A cikin 2009, Hukumar Abinci da Magunguna ta Amurka, a matsin lamba daga karar 'yan ƙasa, ta kammala aikinta na haɗin amalgam na haƙori, tsarin da Majalisar ta ba da umarni tun asali a 1976.²² Sun rarraba amalgam azaman na'urar Class II tare da wasu takamaiman lakabi, ma'ana sun same shi lafiya ga amfani mara iyaka ga kowa. Ana yin amfani da alamun lakabin ne don tunatar da likitocin hakora cewa za su yi amfani da na'urar da ke dauke da sinadarin mercury, amma babu wani umarni na mika wannan bayanin ga marasa lafiya.

Takardun rarraba FDA shine takaddar shafi na 120 mai cikakken bayani wanda takaddamarsa ta dogara ne akan ƙimar haɗari, kwatanta amalgam Mercury zuwa EPA's 0.3 µg-Hg / cubic metric air standard. Koyaya, binciken na FDA yayi amfani ne kawai da ma'anar yawan jama'ar Amurka da ke tattare da haɗuwa, ba cikakken kewayo ba, kuma, abin lura, baiyi gyara ba don nauyin jikin mutum. Tana kula da yara kamar su manya. Wadannan maganganun an yi hamayya da su da karfi a cikin “koke-koke don sake dubawa” wanda dukkan ‘yan kasa da kungiyoyin kwararru suka gabatar ga hukumar ta FDA bayan an buga bayanan. Takardun karar sun kasance masu isasshen hankali ne daga jami'an hukumar ta FDA cewa hukumar ta dauki matakin da ba safai ba wajen kiran kwamitin kwararru don sake nazarin gaskiyar binciken da ta yi na hadari.

Da yawa daga cikin masu shigar da karar sun nemi Richardson, yanzu mai ba da shawara ne mai zaman kansa don sabunta kimantawarsa ta asali. Sabuwar binciken, ta amfani da cikakkun bayanai game da yawan haƙoran da suka cika a cikin jama'ar Amurka, shine cibiyar tattaunawa a taron ƙwararrun masana na FDA na Disamba, 2010. (Duba Richardson et al 2011⁵).

Bayanai game da yawan haƙoran da suka cika a cikin jama'ar Amurka sun fito ne daga binciken Nazarin Kiwon Lafiyar Kiwon Lafiyar Jama'a da na Nutrition, wani binciken da aka gudanar a ƙasar game da kusan mutane 12,000 masu shekaru 24 zuwa sama, wanda aka kammala shi a ƙarshe a shekara ta 2001-2004 ta Cibiyar forididdiga ta Kiwon Lafiya ta ,asa na Cibiyoyin Kula da Rigakafin Cututtuka. Bincike ne ingantacce wanda yake wakiltar dukkanin jama'ar Amurka.

Binciken ya tattara bayanai kan yawan saman hakorin da aka cika, amma ba akan kayan ciko ba. Don gyara ga wannan rashi ƙungiyar Richardson ta gabatar da yanayi guda uku, duk an ba da shawara ta hanyar adabin da ke akwai: 1) duk wuraren da aka cika sun kasance amalgam; 2) 50% na cike saman sun kasance amalgam; 3) 30% na batutuwa basu da amalgam, kuma 50% na sauran sun kasance amalgam. A karkashin labari na 3, wanda ke ɗaukar mafi ƙarancin abubuwan cikewar amalgam, ƙididdigar ma'anar ainihin yawan kuɗin yau da kullun shine:

Ananan yara 0.06 µg-Hg / kg-day
Yara 0.04
Matasa 0.04
Manya 0.06
Tsofaffi 0.07

Duk waɗannan matakan haɓakar yau da kullun suna haɗuwa ko ƙetare yawan kwayar Hg0 da ke haɗuwa da RELs da aka buga, kamar yadda aka gani a Table 2.

Adadin fuskokin amalgam da ba zai wuce REL na Amurka na 0.048 µg-Hg / kg-day ba, an kirga, don yara, yara da matasa matasa su zama saman 6. Ga tsofaffi matasa, manya da tsofaffi, saman 8 ne. Don kada ya wuce REL na California EPA, waɗannan lambobin za su kasance saman 0.6 da 0.8.

Koyaya, waɗannan matsakaitan bayanan ba su faɗin labarin duka, kuma ba sa nuna yadda mutane da yawa suka wuce ƙimar “lafiya”. Yayinda yake nazarin yawan adadin yawan haƙoran da ke cike a cikin jama'a, Richardson yayi lissafin cewa a halin yanzu za'a sami Amurkawa miliyan 67 waɗanda haɗuwar amalgam mercury ya wuce REL da US EPA ta aiwatar. Idan aka yi amfani da California REL mai tsananin ƙarfi, wannan adadin zai zama miliyan 122. Wannan ya bambanta da bincike na FDA na 2009, wanda yayi la'akari da matsakaicin adadin haƙoran hakora, don haka ƙyale yawan jama'a ya zama daidai a ƙarƙashin EPA REL na yanzu.

Don fadada wannan batun, Richardson (2003) ya gano takardu goma sha bakwai a cikin wallafe-wallafen da suka gabatar da kimantawa game da yanayin yaduwar yaduwar mercury daga cikewar amalgam. ²³ Hoto na 3 yana nuna su, tare da bayanai daga takardarsa ta 2011, wakiltar a cikin zane mai nauyin nauyin shaidu. Lines masu ja a tsaye suna yin daidai da matsayin daidai na California EPA's REL, mafi tsauraran iyakokin ka'idojin da aka buga don fallasar tururin mercury, da US EPA's REL, mafi sassauci. Tabbatacce ne cewa yawancin masu binciken waɗanda aka wakilta takardun su a cikin Hoto na 3 zasu yanke shawarar cewa amfani da ƙayyadadden amalgam zai haifar da wuce gona da iri ga mercury.

Makomar Dental Amalgam

Har zuwa wannan rubutun, Yuni, 2012, FDA har yanzu ba ta sanar da kammalawa game da shawarwarin ta ba game da matsayin tsarin tsarin amalgam na hakori. Yana da wahala ka ga yadda hukumar za ta iya ba wa amalgam wani koren haske don amfani ba tare da takaitawa ba. A bayyane yake cewa amfani mara izini na iya bijirar da mutane ga Mercury fiye da na REL na EPA, daidai iyakokin da ake tilasta masana'antar wutar ƙona gawayi su bi, da kuma kashe biliyoyin daloli don yin hakan. EPA ya kiyasta cewa daga shekarar 2016, rage fitar da hayaki mai guba, tare da toka da iskar gas, zai adana dala biliyan 59 zuwa dala biliyan 140 a cikin farashin lafiya na shekara-shekara, yana hana mutuwar 17,000 na saurin mutuwa a shekara, tare da cututtuka da kuma ranakun aiki.

Bugu da ƙari, bambancin da ke tsakanin hanyar Mackert da Berglund game da amincin haɗuwa da kuma hanyar Richardson ya nuna sassaucin ra'ayi wanda ke nuna alamun "yaƙe-yaƙe amalgam" na tarihi. Ko dai mu ce “ba zai iya cutar da kowa ba,” ko “zai iya cutar da wani.” A wannan zamani mai kyau da resin-tushen gyarawa hakora, a lokacin da kara lambobi na likitan hakora suna aikatawa gaba ɗaya ba tare da amalgam, muna da sauki damar rayuwa ta hanyar rigakafin manufa. Lokaci ya yi daidai don ba da amalgam ɗin haƙori zuwa wurin girmamawa a tarihin haƙori, kuma a bar shi ya tafi. Dole ne mu ci gaba tare da ƙawancensa - don haɓaka hanyoyin don kare marasa lafiya da ma'aikatan haƙori daga mummunan fallasa lokacin da aka cire abubuwan cikawa; kare ma'aikata daga fitowar lokaci kaɗan, kamar abin da ke faruwa yayin ɓoye tarkon ɓoye.

Dental merkury na iya zama kawai ƙananan ƙananan matsalolin duniya na gurbatar yanayi, amma bangaren da muke likitocin hakora muke da alhaki kai tsaye. Dole ne mu ci gaba da kokarinmu na kare muhalli, don ware ruwan sha mai dauke da sinadarin mercury daga magudanar ruwa, duk da cewa mun daina amfani da shi don damuwar lafiyar dan adam.

Stephen M. Koral, DMD, GASKIYA

_________

Don ƙarin cikakkun bayanai kan wannan batun, duba "Nazarin Hadarin Amalgam 2010" da kuma "Nazarin Hadarin Amalgam 2005. "

A sigar karshe, an buga wannan labarin a watan Fabrairu, 2013 na “Compendium na Ci gaba da Ilimi a Ilimin hakora." 

Hakanan za'a iya karanta ƙarin tattaunawa akan ƙimar haɗari dangane da haɗakar haƙori a cikin "Takardar Matsayi na IAOM akan Dental Amalgam. "

References

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2 Haley BE 2007. Dangantakar cututtukan da ke tattare da cutar ta mercury zuwa tsananta yanayin lafiyar da aka sanya a matsayin cutar Alzheimer. Medical Veritas, 4: 1510-1524.

3 Chew CL, Soh G, Lee AS, Yeoh TS. 1991. Rushewar lokaci mai tsawo daga amalgam wanda baya sakin kansa. Prewararren Clinwararren ,wararraki, 13 (3): 5-7.

4 Babban, MJ, Harrison, JA 1989. Wasu siffofin wutan lantarki na cikin in vivo lalata amalgams na hakori. J. Shafi. Lantarki., 19: 301-310.

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6 Hahn LJ, Kloiber R, Vimy MJ, Takahashi Y, Lorscheider FL. 1989. Cikakken hakori na "azurfa": wani tushe ne na isar da sinadarin mercury wanda ya bayyana ta hanyar hoton jikin duka da kuma nazarin nama. FASEB J, 3 (14): 2641-6.

7 Hahn LJ, Kloiber R, Mai ba da layi RW, Vimy MJ, Lorscheider FL. 1990. Hotunan da aka rarraba na yaduwar sinadarin mercury wanda aka fitar daga kayan hakoran cikin kayan biri. FASEB J, 4 (14): 3256-60.

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9 CalEPA (Hukumar Kare Muhalli ta California). 2008. Mercury, Inorganic - Matsakaicin Bayanin Bayanai na Takaitawa da Takaitaccen Abincin Guba. Ofishin Nazarin Haɗarin Kiwon Lafiyar Muhalli, California EPA. Rana ta Disamba 2008. Takaitawa kan layi a: http://www.oehha.ca.gov/air/allrels.html; Ana samun cikakkun bayanai a: http://www.oehha.ca.gov/air/hot_spots/2008/AppendixD1_final.pdf#page=2

10 Ngim, CH., Foo, SC, Boey, KW et al. 1992. Hanyoyin cutar neurobehavioral na yau da kullun na likitan hakora. Br. J. Ind. Mad., 49 (11): 782-790

11 Richardson, GM, R Brecher, H Scobie, J Hamblen, K Phillips, J Samuelian da C Smith. 2009. uryarfin Mercury (Hg0): Ci gaba da rashin tabbas game da toxicological, da kafa matakin nuna ƙimar Kanada. Dokar Toxicology da Magunguna, 53: 32-38

12 Lettmeier B, Boese-O'Reilly S, Drasch G. 2010. Shawara don sake duba ƙididdigar tunani (RfC) don ƙarancin mercury a cikin manya. Sci Gaba ɗaya kewaye, 408: 3530-3535

13 Fawer, RF, de Ribaupeirre, Y., Buillemin, MP et al. 1983. Aunawar girgizar hannu da aka haifar ta hanyar fallasa masana'antu zuwa ƙarfe mercury. Br. J. Ind. Mad., 40: 204-208

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15 Piikivi, L., Hanninen, H., 1989b. Bayyanannun alamun cutar da aikin halayyar ma'aikata na chlorine-alkali. Scand. J. Aiki kewaye. Lafiya 15, 69-74.

16 Piikivi, L., Tolonen, U., 1989c. Binciken EEG a cikin ma'aikatan chlor-alkali wanda ya fuskanci ƙarancin lokaci mai tsawo ga tururin mercury. Br. J. Ind. Likita. 46, 370-375.

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18 Echeverria, D., Woods, JS, Heyer, NJ, Rohlman, D., Farin, FM, Li, T., Garabedian, CE, 2006. associationungiyar tsakanin kwayar halittar polymorphism na coproporphyrinogen oxidase, hawan mekuriyya mai nunawa da amsawar neurobehavioral a cikin mutane. Neurotoxicol. Teratol. 28, 39–48.

19 Mackert JR Jr. da Berglund A. 1997. Bayyanar da Mercury daga hakoran amalgam: kwayar da aka sha da kuma tasirin illa ga lafiya. Crit Rev Oral Biol Med 8 (4): 410-36

20 Richardson, GM 1995. Bincike game da yaduwar mercury da kasada daga amalgam na hakori. An shirya a madadin Ofishin na'urorin lafiya, reshen Kariyar Kiwan lafiya, Kiwan lafiya Kanada. 109p. Rana ta ranar 18 ga Agusta, 1995. A layi a: http://dsp-psd.communication.gc.ca/Collection/H46-1-36-1995E.pdf   or http://publications.gc.ca/collections/Collection/H46-1-36-1995E.pdf

21 Richardson, GM da M. Allan. 1996. A Monte Carlo ofimar Mercury Exposure da Hadarin daga Dental Amalgam. Nazarin Hadarin Dan Adam da Lafiyar Muhalli, 2 (4): 709-761.

22 US FDA. 2009. Dokar Karshe Ga Dental Amalgam. A layi a: http://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/DentalProducts/DentalAmalgam/ucm171115.htm.

23 An faɗaɗa daga: Richardson, GM 2003. Shaƙar ƙwaƙƙwarar ƙwayoyin cuta ta likitan hakora: haɗarin aikin da ba a kula da shi. Nazarin Hadarin Dan Adam da Muhalli, 9 (6): 1519 - 1531. Hoto da marubucin ya bayar ta hanyar sadarwa ta mutum.

24 Roels, H., Abdeladim, S., Ceulemans, E. et al. 1987. Dangantaka tsakanin abubuwan da ke tattare da sinadarin mercury a iska da jini ko fitsarin ma'aikatan da ke fuskantar tururin mercury. Ann. Zama. Hyg., 31 (2): 135-145.

25 Skare I, Engqvist A. Bayyanar ɗan adam zuwa mercury da azurfa wanda aka sake shi daga maidowar amalgam. Arch kewaye da Lafiya 1994; 49 (5): 384-94.