The mercury in your mouth (continued) BY JENNIFER LUNDEN

Here at home, Representative Diane Watson (D) of California has introduced a bill that would ban interstate commerce of mercury intended for use in dental fillings, effectively prohibiting mercury amalgams in the US. Maine’s Second District representative, Mike Michaud (D), is a cosponsor.

Other Maine citizens, like Pam Anderson, are working on the local level to outlaw mercury amalgams. Anderson describes her dentist husband, Dr. Tom Anderson, as an anti-amalgam pioneer. Pam is the office manager for his dental practice in Houlton, and she was motivated to agitate for changes in legislation after reading an article about a HoltraChem mercury leak in the Bangor Daily News. "I thought to myself, ‘My goodness, if a tablespoon’s released into the river and they’re making a big to-do of this, then what about how many tablespoons . . . Maine dentists [are] putting in the heads of people in the state of Maine every day?’ "

Anderson hopes that her efforts will end in a ban on mercury amalgams, at least in the state of Maine. She has drafted legislation to this effect, and intends to introduce it in the next legislative session.

Anderson’s first attempt to have mercury amalgams banned for use in children and women of childbearing age was defeated. But in 2001, then-governor Angus King signed a compromise bill, called "An Act to Address the Health Effects of Mercury Filling," which requires dentists to "provide each patient" with a brochure outlining the "potential advantages and disadvantages to oral health, overall human health, and the environment of using . . . mercury amalgam in dental procedures." Dentists must also display a poster "in the public waiting area" informing patients of the availability of the brochure. This was groundbreaking legislation, which is being used now as a model for other states seeking to address concerns about the risks of mercury amalgams.

But are Maine dentists following the law? One day, while I was in the midst of writing this story, my friend Patrick, an intelligent, health-conscious man, called me up to tell me he’d just had an amalgam placed in his tooth.

"Why’d you go and do a thing like that?" I said.

Patrick’s response? "I didn’t know I had a choice."

He was treated at Community Dental, in Portland, a clinic for low-income patients, and he said he didn’t see a poster or any brochures outlining his options.

So I went down to Community Dental and had a look around.

Nothing.

I asked Nicky Yattaw, Operations Manager, for help, but she was also unable to locate the brochure. She enlisted the help of a fellow worker, and after a brief scramble they came out from behind the locked door, brochure in hand.

They told me they keep the brochures in each operatory. When I asked if I could see the location, the staffers denied me entry, explaining that they were in the midst of a meeting.

Later, I spoke with Yattaw on the phone. She told me they hand a form to every patient which includes information about the brochure. As for the poster, "I need to look and see where [it] is."

In the meantime, people like Patrick, who may not read the fine print, are having mercury amalgams put in their mouths without knowing they have a choice, and without knowing the risks.

Last year, Governor John Baldacci signed another bill targeting amalgams, requiring Maine dentists to install amalgam separator systems in their offices. This device prevents dental amalgam from entering the waste stream. The Maine Dental Association (MDA) supported this legislation, although its executive director, Frances Miliano, is quick to qualify that support, asserting that "the Dental Association does not feel that dentists are a significant contributor to mercury in the waste stream."

But the Zero Mercury Campaign, an organization created to pressure New England state governments to fulfill their commitment to eliminate mercury emissions, maintains that 50 percent of mercury in water comes from dental amalgams. Some of that flows out of dentists’ offices; the rest is excreted in human waste. And the Bar Harbor Times reports that an average of one to two pounds of mercury flows every year from each of the 600 Maine dental offices. That adds up to 600 to 1200 pounds of mercury entering Maine’s wastewater.

One gram of mercury is all it takes to contaminate a lake the size of a football field, making fish unsafe for human consumption.

When I asked Dr. Zajkowski to explain how it is that mercury amalgams are considered to be a pollutant in the water but not in the mouth, he replied, "Just because I’m calling it a pollutant doesn’t mean that it’s a toxic substance." He likened it to dropping a titanium plate from a broken jaw, or a gold crown, into a lake. Litter. "Because we know the state is very environmentally conscious we supported that [amalgam separator legislation]. Even though it probably won’t make a difference in the environment at all."

While Dr. Zajkowski and the ADA assert that mercury amalgam is not a toxic substance, directions for use provided by Dispersalloy, an amalgam manufacturer, direct dentists to store amalgam scrap "in well sealed containers." And "Dental Mercury Hygiene Recommendations" provided by the ADA Council on Scientific Affairs, printed in the Journal of the American Dental Association (JADA), state that "amalgam scrap should not be stored in water."

Cronin, of DAMS, puts it bluntly: "In essence our mouths are mini–toxic dump sites . . . If it’s bad for the environment, it’s bad for us."

And few stop to wonder what happens to amalgams after people die. If the deceased is cremated, the mercury is incinerated into the air. The EPA has set no limits for mercury emissions from crematoria. A study of crematoria workers showed they had higher concentrations of mercury in their hair than a control group.

And what about the dentists who use mercury amalgams to fill their patients’ teeth? Are they at risk for higher levels of toxicity? Some say that just as milliners in the 19th century were made "mad as a hatter" by the mercury used to make felt hats, the high levels of depression and suicide in dentists may be related to their exposure to mercury. A study of 180 dentists in Scotland showed that dentists had up to four times the normal level of mercury in their urine and nails, and that dentists with higher levels of mercury in their bodies had more memory lapses and kidney problems than the general population.

As we reported in Part One of this series, 10 percent of US women — and 20 percent of Maine women — of childbearing age have enough mercury in their bodies to put a fetus at risk for permanent neurological damage. To date, these numbers are largely blamed on environmental pollution and fish consumption. But it’s possible that the amalgams in women’s teeth are a prime culprit. Mercury amalgams in pregnant women do impact the fetus, according to the US Agency for Toxic Substances and Disease Registry (ATSDR). Representative Dan Burton (R-IN) says that in 1999 the ATSDR published a report stating that mercury vapors are constantly emitted from amalgam, that they go first to the brain, and that children, because their brains are still developing, are most at risk of long-term damage. The report adds that mercury crosses the placenta to the developing fetus, and that it contaminates breast milk.

Consequently, the directions for use of the amalgam Dispersalloy contraindicate use in expectant mothers and children six and under. These considerations are not mentioned in the ADA’s official "Statement on Dental Amalgam." Nor is there legislation in place prohibiting such use. "That’s what we’re trying to do," says Anderson.