Mano amalum agwiritsidwa ntchito kubwezeretsa mano kwa zaka pafupifupi mazana awiri, ndipo kukayikira zakutsutsana komwe kumapereka chithandizo chamankhwala ndi zinthu zomwe zili ndi mercury kwakhalapobe nthawi yonseyi. Pakhala pali vuto lililonse mkati mwaukadaulo wamano wotsutsana ndi amalgam, gulu "lopanda mercury". Pomwe malingaliro amtunduwu akula mzaka zaposachedwa chifukwa zimakhala zosavuta kukwaniritsa mano opatsirana obwezeretsa ndi zophatikizika, malingaliro onse a madotolo pama amalgam atha kufotokozedwa mwachidule kuti "palibe cholakwika ndi sayansi, sitikugwiritsa ntchito kwambiri panonso. ”

Kuti mufunse ngati chilichonse chikulakwika kapena sicholakwika mwasayansi ndi amalgam, munthu ayenera kuyang'ana m'mabuku ambiri owonetsa, poizoni komanso kuwunika kwa mercury. Ambiri mwa iwo amakhala kunja kwa magwero azidziwitso a mano omwe amapezeka nthawi zambiri. Ngakhale zambiri mwazolemba za mercury zomwe zimachokera ku amalgam zilipo kunja kwa magazini amano. Kuwunika kwa mabuku owonjezeraku kungatithandizire kudziwa zomwe madokotala apanga ponena za chitetezo cha amalgam, ndipo zitha kuthandiza kufotokoza chifukwa chomwe madokotala ena amatsutsira kugwiritsa ntchito amalgam mu mano obwezeretsa.

Palibe amene akutsutsa kuti amalgam wamazinyo amatulutsa chitsulo cha mercury m'malo ake pamlingo wina, ndipo zidzakhala zosangalatsa kufotokozera mwachidule zina mwa maumboni owonekera. Mankhwala oopsa a mercury ndi otakata kwambiri ngati nkhani yochepa, ndipo amawunikiridwa bwino kwina kulikonse. Nkhani yowunika zoopsa, komabe, imafika pamtima pakutsutsana kuti amalgam ndi yotetezeka, kapena ayi, pakugwiritsa ntchito mopanda malire kwa anthu onse.

Kodi Ndi Chitsulo Chotani Chimene Chimakhala mu Dental Amalgam?

Chifukwa ndi kusakaniza kozizira, amalgam silingakwaniritse tanthauzo la aloyi, yomwe iyenera kukhala chisakanizo chachitsulo chopangidwa ndi nthaka yosungunuka. Komanso sichingakwaniritse tanthauzo la gawo la ionic ngati mchere, womwe umayenera kusinthana ndi ma elekitironi omwe amabweretsa ma latoni a ayoni omwe amalipira. Zimakwaniritsa tanthauzo la colloid yapakatikati pazitsulo, kapena emulsion yolimba, momwe zinthu za matrix sizimachitidwa kwathunthu, ndipo zimatha kupezanso. Chithunzi 1 chikuwonetsa chojambula chazitsulo chopukutira mano cha amalgam chomwe chidachita chidwi ndi kafukufuku wocheperako. Nthawi iliyonse yamavuto, madontho a mercury amadzulidwa. ¹

Haley (2007)² kuyeza mu-vitro kutulutsidwa kwa mercury kuchokera pamitundu imodzi yotayika ya Tytin®, Dispersalloy®, ndi Valiant®, iliyonse yokhala ndi 1 cm2. Pambuyo posungira masiku makumi asanu ndi anayi kuti alole kuti mawonekedwe am'mbuyomu akwaniritsidwe, zidazo zidayikidwa m'madzi osungunuka kutentha, 23˚C, osachita phokoso. Madzi osungunulidwa adasinthidwa ndikuwunikidwa tsiku lililonse kwa masiku 25, pogwiritsa ntchito Nippon Direct Mercury Analyzer. Mercury idatulutsidwa pansi pazikhalidwezi pamlingo wama 4.5-22 ma micrograms tsiku lililonse, pa sentimita imodzi. Kutafuna (1991)³ adanenanso kuti mercury idasungunuka kuchokera ku amalgam kupita m'madzi osungunuka ku 37˚C pamlingo wokwana mpaka ma 43 micrograms patsiku, pomwe Gross ndi Harrison (1989)⁴ adatinso ma micrograms 37.5 patsiku mu yankho la Ringer.

Kugawa kwa Mano Mercury Kuzungulira Thupi

Kafukufuku wambiri, kuphatikiza maphunziro a autopsy, awonetsa kuchuluka kwa mercury m'matumba a anthu omwe ali ndi ma amalgam kujaza, mosiyana ndi omwe sanawululidwe chimodzimodzi. Kuchulukitsa katundu wa amalgam kumalumikizidwa ndi kuchuluka kwa mercury mumlengalenga; malovu; magazi; ndowe; mkodzo; Matenda osiyanasiyana kuphatikiza chiwindi, impso, chifuwa cha ubongo, ubongo, ndi zina; amniotic madzimadzi, chingwe magazi, latuluka ndi zimakhala fetal; colostrum ndi mkaka wa m'mawere.⁵

Zojambula zowoneka bwino kwambiri, zowonetsa mu-vivo kugawa kwa mercury kuchokera ku amalgam fillings anali odziwika bwino "maphunziro a nkhosa ndi nyani" a Hahn, et. al. (1989 ndi 1990).^6,7 Nkhosa yapakati idapatsidwa zodzazidwa khumi ndi ziwiri zamagulu omwe anali ndi ma radioactive ²⁰³Hg, chinthu chomwe kulibe m'chilengedwe, ndipo chili ndi theka la masiku 46. Zodzazidwazo zidapangidwa kuchokera pakubisala, ndipo pakamwa pa nyama panali kusungidwa ndi kutsukidwa kuti zipewe kumeza zakuthupi pochita opareshoni. Pambuyo masiku makumi atatu, idaperekedwa. Magetsi a mercury anali okhudzana ndi chiwindi, impso, kagayidwe kake kagaya ndi nsagwada, koma minofu iliyonse, kuphatikiza ziwalo za fetal, imawonekera. Autoradiogram yanyama yonseyo, mano atachotsedwa, ikuwonetsedwa chithunzi 2.

Kuyesa kwa nkhosa kunatsutsidwa chifukwa chogwiritsa ntchito nyama yomwe idadya ndikutafuna mwanjira yosiyana kwambiri ndi anthu, chifukwa chake gululo lidabwereza kuyesa pogwiritsa ntchito nyani, zotsatira zake zomwezo.

25 Skare I, Engqvist A. Kuwonetsedwa kwaumunthu kwa mercury ndi siliva kutulutsidwa m'mano obwezeretsa mano. Arch Environ Health 1994; 49 (5): 384-94. (Adasankhidwa)

Udindo Wowunika Zowopsa 

Umboni wokhudzana ndi chiwonetsero ndi chinthu chimodzi, koma ngati "mlingowo umapangitsa poizoni," monga takhala tikumva pafupipafupi pokhudzana ndi kutulutsa kwa mercury kuchokera kumankhwala a mano, kutsimikiza kuti kuwonekera kotani kuli ndi poyizoni komanso kuti chigawo chake chili pachiwopsezo kuwunika. Kuyesa kwa ngozi ndi njira zovomerezeka zomwe zimagwiritsa ntchito zopezeka m'mabuku asayansi, kuti apange malingaliro owonekera omwe angavomerezedwe munthawi zina, kwa omwe akutsogolera kukonza ngozi. Ndi njira yomwe imagwiritsidwa ntchito popanga uinjiniya, mwachitsanzo, dipatimenti yogwira ntchito zaboma iyenera kudziwa kuthekera kwa mlatho womwe ukulephera pansi musanakhazikitse malire.

Pali mabungwe angapo omwe amayang'anira kuwonetsedwa kwa anthu ndi mankhwala owopsa, FDA, EPA, ndi OSHA, pakati pawo. Onse amadalira njira zowunika zoopsa kuti akhazikitse zotsalira zotsalira zamankhwala, kuphatikiza mercury, nsomba ndi zakudya zina zomwe timadya, madzi omwe timamwa komanso mpweya womwe timapuma. Mabungwewa kenako amakhazikitsa malire okakamiza kuwonekera kwa anthu omwe amafotokozedwa ndi mayina osiyanasiyana, monga malire owunikira (REL), reference dose (RfD), reference concentration (RfC), malire olekerera tsiku lililonse (TDL), ndi zina zambiri, zonsezi zikutanthauza chinthu chomwecho: kuchuluka kwakanthawi kololeza malinga ndi zomwe bungweli likuyang'anira. Mulingo wovomerezeka uwu uyenera kukhala umodzi pomwe pali chiyembekezo palibe zotsatira zoyipa zaumoyo mwa anthu okhala ndi malamulo.

Kukhazikitsa ma REL

Kuti tigwiritse ntchito njira zowunika zoopsa za mankhwala a mercury kuchokera ku mano a mano, tiyenera kudziwa mlingo wa mercury womwe anthu amadzazidwa nawo, ndikuyerekeza ndi miyezo yachitetezo cha mtundu womwewo. Mankhwala oopsa a mercury amazindikira kuti zotsatira zake m'thupi zimadalira kwambiri mitundu ya mankhwala yomwe ikukhudzidwa, komanso njira yowonekera. Pafupifupi ntchito yonse ya amalgam kawopsedwe amaganiza kuti mitundu yayikulu ya poizoni yomwe ikukhudzidwa ndi metallic mercury vapor (Hg˚) yomwe imatulutsidwa ndi kudzazidwa, kupumira m'mapapu ndikuyamwa pamlingo wa 80%. Mitundu ina ndi njira zina zimadziwika kuti zimakhudzidwa, kuphatikizapo metallic mercury yomwe imasungunuka ndi malovu, ma abraded tinthu ndi zinthu zam'mimba zomwe zimamezedwa, kapena methyl mercury yopangidwa kuchokera ku Hg˚ ndi mabakiteriya am'matumbo. Njira zowoneka bwino kwambiri zadziwika, monga kuyamwa kwa Hg˚ muubongo kudzera mu epithelium yolfactory, kapena kubwezeretsanso mayendedwe amiyala ya mercury kuchokera ku nsagwada kupita muubongo. Zowonekera izi mwina ndi zosadziwika, kapena zimaganiziridwa kuti ndizocheperako kuposa kupumira pakamwa, chifukwa chake kafukufuku wochuluka wa amalgam mercury wafika pamenepo.

Dongosolo lamanjenje lamkati limaganiziridwa kuti ndiye chida chofunikira kwambiri pakudziwitsa mpweya wa mercury. Zomwe zimayambitsa poizoni pa impso ndi mapapo zimaganiziridwa kuti zimakhala ndizowonekera kwambiri. Zotsatira chifukwa cha hypersensitivity, autoimmunity ndi njira zina zosagwirizana sizingayankhidwe ndi mitundu ya mayankho amiyeso, (yomwe imapempha funso, ndizosowa bwanji kwa mercury, zoona?) Chifukwa chake, ofufuza ndi mabungwe omwe akufuna kukhazikitsa ma REL otsika Kuwonetsedwa kwakanthawi kwa Hg˚ kwatengera njira zosiyanasiyana za zotsatira za CNS. Kafukufuku wocheperako (wofupikitsidwa pa tebulo 1) adasindikizidwa pazaka zomwe zimalumikiza kuchuluka kwa kutulutsa kwa mpweya wa mercury ndi zizindikilo zowoneka za CNS kukanika. Awa ndi maphunziro omwe asayansi adalira pakuwunika pachiwopsezo.

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Gulu 1. Kafukufuku wofunikira omwe agwiritsidwa ntchito powerengera kuchuluka kwa mpweya wa metallic metallic, wofotokozedwa ngati ma micrograms pa mita imodzi ya kiyubiki yamlengalenga. Anterix * amatanthauza kuchuluka kwa mpweya komwe kwatengedwa ndikusintha kwamwazi kapena mkodzo kukhala wofanana ndi mpweya malinga ndi kutembenuka kwa Roels et al (1987).

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Kuyeserera kwa chiopsezo kumazindikira kuti kuwonetsa komanso kuwunika kwa deta yomwe imasonkhanitsidwa kwa achikulire, amuna mwamphamvu kwambiri, ogwira ntchito m'malo ogwirira ntchito sangathe kugwiritsidwa ntchito mu mawonekedwe awo osawoneka ngati njira yosungira aliyense. Pali mitundu yambiri yosatsimikizika mu data:

• LOAEL motsutsana ndi NOAEL. Palibe chidziwitso chazambiri zomwe zapezeka m'maphunziro ofunikira omwe adanenedwa m'njira yomwe imawonetsa kuyankha kwamiyeso yomveka pazotsatira za CNS. Mwakutero, samawonetsa malire olondola azoyambira pazotsatira. Mwanjira ina, palibe kutsimikiza kwa "No-Observed-Adverse-Effect-Level" (NOAEL). Kafukufuku aliyense amatchula za "Lowest-Observed-Adverse-Effect-Level" (LOAEL), yomwe siziwoneka ngati yotsimikizika.
• Kusiyanasiyana kwa anthu. Pali magulu ambiri ovuta pakati pa anthu: makanda ndi ana omwe ali ndi vuto lamanjenje lomwe limayamba kuchepa kwamthupi; anthu omwe ali ndi zovuta zachipatala; anthu omwe ali ndi chibadwa chodziwika akuwonjezeka chidwi; azimayi azaka zobereka ndi zosiyana zina zokhudzana ndi jenda; okalamba, kungotchulapo ochepa. Kusiyanitsa pakati pa anthu komwe sikupezeka mu deta kumapangitsa kuti pakhale kusatsimikizika.
• Zambiri zobereka ndi chitukuko. Mabungwe ena, monga California EPA, amagogomezera kwambiri za kubereka ndi chitukuko, ndikuyika kusatsimikizika kowonjezera pakuwunika kwawo ikasowa.
• Zambiri zamitundu yapakati. Kusintha kuchuluka kwa kafukufuku wazinyama kumachitidwe aumunthu sikowongoka konse, koma kulingalira izi sikugwira ntchito panthawiyi, popeza maphunziro ofunikira omwe atchulidwa pano onse amaphatikizapo maphunziro aanthu.

Ma REL osindikizidwa omwe amatulutsidwa ndi nthenda yotentha ya mercury m'chiwerengero cha anthu afotokozedwa mwachidule mu Table 2. Ma REL omwe amatanthauza kuwongolera kuwonekera kwa anthu onse amawerengedwa kuti atsimikizire kuti sipangakhale chiyembekezo chokwanira cha zovuta zaumoyo kwa aliyense, kotero kuwonekera kovomerezeka kumachepetsedwa kuchokera zotsatira zotsika kwambiri zowerengeka mwa masamu "zinthu zosatsimikizika" (UF). Zinthu zosatsimikizika sizimasankhidwa ndi malamulo okhwima komanso achangu, koma ndi mfundo - momwe bungwe loyang'anira likufunira kukhala osamala, ndikudzidalira kwawo pazambiri.

Pankhani ya US EPA, mwachitsanzo, kuchuluka kwa mphamvu (9 µg-Hg / cubic mita air) kumachepetsedwa ndi chinthu china chifukwa chodalira LOAEL, komanso chifukwa cha 3 yowerengera kusiyanasiyana kwa anthu, kwa UF wathunthu wa 10. Izi zimabweretsa malire ololeza a mpweya wa 30 µg-Hg / cubic mita. ⁸

California EPA idawonjezeranso UF ya 10 chifukwa chosowa chidziwitso cha kubereka ndi chitukuko cha Hg0, ndikupangitsa malire awo kukhala okhwima kwambiri, mpweya wa 0.03 µg Hg / cubic mita. ⁹

Richardson (2009) adazindikira kafukufuku wa Ngim et al¹⁰ monga yoyenera kwambiri pakupanga REL, popeza idapereka madokotala a mano amuna ndi akazi ku Singapore, omwe amakhala ndi mpweya wambiri wa mercury popanda mafuta a chlorine (onani m'munsimu). Adagwiritsa ntchito UF ya 10 osati 3 ya LOAEL, ponena kuti makanda ndi ana amakhala ovuta kwambiri kuposa momwe chiwerengero cha 3 chingawerengere. Pogwiritsa ntchito UF ya 10 pakusintha kwa anthu, pa UF yonse ya 100, adalimbikitsa kuti Health Canada ikhazikitse REL yawo yanthawi zonse ya mercury vapor pa 0.06 µg Hg / cubic mita air.¹¹

Lettmeier et al (2010) adapeza cholinga chofunikira kwambiri (ataxia ya chipata) komanso zotsatira zake (zachisoni) kwa omwe amagulitsa golide ang'onoang'ono ku Africa, omwe amagwiritsa ntchito mercury kupatula golide ndi miyala yosweka, ngakhale pang'ono kutsika, 3 µg Hg / kiyubiki mita mpweya. Kutsatira US EPA, adagwiritsa ntchito UF ya 30-50, ndikupangira REL pakati pa 0.1 ndi 0.07 µg Hg / cubic mita mpweya.¹²

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Gulu 2. Ma REL osindikizidwa kuti athe kupezeka pamiyeso yotsika, nthunzi ya Hg0 yosawerengeka mwa anthu onse, osawonekera pantchito. * Kutembenuka kuti muyambe kumwa, µg Hg / kg-day, kuchokera ku Richardson (2011).

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Mavuto ndi ma REL

US EPA idasinthiratu nthunzi yawo ya mercury REL (0.3 Hg Hg / cubic mita air) mu 1995, ndipo ngakhale adatsimikiziranso mu 2007, avomereza kuti mapepala atsopano asindikizidwa omwe angawathandize kukonzanso REL pansi. Mapepala akale a Fawer et al (1983) ¹³ ndi Piikivi, et al (1989 a, b, c)^{14, 15, 16}, zimadalira kwakukulu pamiyeso ya kuwonekera kwa mercury ndi zotsatira za CNS mwa ogwira ntchito ku chloralkali. Chloralkali ndi njira yazogulitsa zamankhwala yazaka za zana la khumi ndi chisanu ndi chinayi momwe mchere wamchere umayandama mopyapyala kwambiri wamadzi a mercury, ndipo amapangidwa ndi hydrolyzed ndimagetsi amagetsi kuti apange sodium hypochlorite, sodium hydroxide, sodium chlorate, mpweya wa chlorine, ndi zinthu zina. Mercury imakhala ngati imodzi mwa ma elekitirodi. Ogwira ntchito m'malo oterewa samangololedwa ndi mercury mlengalenga, komanso mpweya wa chlorine.

Kutulutsa komweko kwa nthunzi ya mercury ndi gasi ya klorini kumasintha momwe anthu amaonekera. Hg˚ imadzazidwa pang'ono ndi klorini m'mlengalenga kupita ku Hg²⁺, kapena HgCl₂, yomwe imachepetsa kufalikira kwake m'mapapu, ndikusintha kwambiri kugawa kwake mthupi. Makamaka, HgCl₂ otengeka kuchokera kumpweya kudzera m'mapapu samalowa m'maselo, kapena kudzera pachotchinga cha magazi-ubongo, mosavuta monga Hg˚. Mwachitsanzo, Suzuki et al (1976)¹⁷ adawonetsa kuti ogwira ntchito omwe adapezeka ndi Hg˚ yekha anali ndi kuchuluka kwa Hg m'maselo ofiira am'magazi ndi plasma ya 1.5 -2.0 mpaka 1, pomwe ogwira ntchito ku chloralkali omwe amapezeka ndi mercury ndi chlorine anali ndi kuchuluka kwa Hg mu RBCs ndi plasma ya 0.02 mpaka 1, pafupifupi kutsika zana m'kati mwa maselo. Chodabwitsa ichi chingapangitse kuti mercury igawike kwambiri ku impso kuposa ubongo. Chizindikiro chowonekera, mkodzo wa mercury, chikanakhala chofanana kwa mitundu yonse ya ogwira ntchito, koma ogwira ntchito ku chloralkali sangakhale ndi zotsatira zochepa za CNS. Pofufuza makamaka anthu ogwira ntchito ku chloralkali, chidwi cha CNS pakuwonekera kwa mercury sichingaganizidwe, ndipo ma REL kutengera maphunzirowa angakwezedwe.

Pakati pa mapepala atsopano ndi ntchito ya Echeverria, et al, (2006)¹⁸ amene amapeza zotsatira zoyipa zamaubongo ndi ma neuropsychological kwa madokotala a mano ndi ogwira ntchito, pansipa 25 µg Hg / cubic mita mulingo wamlengalenga, pogwiritsa ntchito mayeso oyesedwa bwino. Apanso, palibe malire omwe adapezeka.

Kugwiritsa Ntchito Ma Mercury RELs ku Dental Amalgam

Pali kusiyana pakati pamabuku okhudzana ndi kuchuluka kwa kuchuluka kwa mankhwala a mercury kuchokera ku amalgam, koma pali mgwirizano pakati pa manambala omwe akukhudzidwa, omwe afotokozedwa mwachidule mu Table 3. Zimathandiza kukumbukira ziwerengerozi, monga olemba onse amazigwiritsira ntchito powerengera . Zimathandizanso kukumbukira kuti izi zowonetseratu izi ndizofanana ndi zomwe zimapezeka muubongo. Pali zambiri zokhudzana ndi zinyama komanso zomwe anthu amafa pambuyo pake, koma palibe mayendedwe amtundu wa mercury muubongo wa omwe akuchita nawo maphunzirowa.

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Gulu 3. maumboni:

• a- Mackert ndi Berglund (1997)
• b- Skare ndi Engkvist (1994)
• c- yowunikiridwa ku Richardson (2011)
• d-Roels, et al (1987)

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Pakati pa zaka za m'ma 1990 kudatulutsidwa njira ziwiri zowunikira za amalgam ndi chitetezo. Yemwe adakhudza kwambiri zokambirana m'mano adalembedwa ndi H. Rodway Mackert ndi Anders Berglund (1997)¹⁹, apulofesa a mano ku Medical College of Georgia, ndi University of Umea ku Sweden, motsatana. Ili ndiye pepala lomwe akuti akuti zingatenge malo 450 a amalgam kuti ayandikire mankhwala owopsa. Olembawa adatchula mapepala omwe amachepetsa mphamvu ya klorini pakumwetsa mpweya wa mercury, ndipo amagwiritsa ntchito malire owonekera pantchito, (omwe amachokera kwa amuna akulu omwe amawulula maola asanu ndi atatu patsiku, masiku asanu pa sabata), a 25 µg-Hg / cubic mita ya mpweya ngati REL-deo yawo de-facto. Iwo sanawone kusatsimikizika kwa chiwerengerochi momwe zingagwire ntchito kwa anthu onse, kuphatikiza ana, omwe angawululidwe maola 24, masiku asanu ndi awiri pa sabata.

Kuwerengetsa kumachitika motere: gawo lowoneka bwino kwambiri logwedezeka mwadala pakati pa abambo achimuna, makamaka ogwira ntchito ku chloralkali, anali 25 µg-Hg / cubic mita mpweya wofanana ndi mkodzo pafupifupi 30 µg-Hg / gr-creatinine. Kuwerengera mulingo woyambira wa mkodzo wa mercury womwe umapezeka mwa anthu osadzazidwa, ndikugawa 30 µg ndi chopereka chapamwamba pamkodzo wa mercury, 0.06 µg-Hg / gr-creatinine, zotsatira zake ndi malo pafupifupi 450 ofunikira kufikira mulingowo .

Pakadali pano, a G. Mark Richardson, akatswiri owunika zoopsa omwe amagwiritsidwa ntchito ndi Health Canada, ndi a Margaret Allan, mainjiniya owunikira, onse osadziwa udokotala wamano, adalamulidwa ndi bungweli kuti liwunikenso ngati ali amalgam mu 1995. Adabwera ku lingaliro losiyana kwambiri ndi Mackert ndi Berglund. Pogwiritsa ntchito zidziwitso zakudziwika komanso kusatsimikizika mogwirizana ndi zomwe tafotokozazi, adapempha Canada REL ya mercury vapor ya 0.014 µg Hg / kg-day. Poganiza kuti pali malo 2.5 pakudzaza, adawerengera kuchuluka kwakudzaza komwe sikungadutse kuchuluka kwa mibadwo isanu, kutengera kulemera kwa thupi: ana ang'ono, 0-1; ana, 0-1; achinyamata, 1-3; akuluakulu, 2-4; okalamba, 2-4. Kutengera manambalawa, Health Canada idapereka malingaliro angapo oletsa kugwiritsidwa ntchito kwa amalgam, omwe amanyalanyazidwa kwambiri pakuchita.^{20, 21}

Mu 2009, US Food and Drug Administration, pokakamizidwa ndi milandu ya nzika, idamaliza gulu lawo la pre-capsulated dental amalgam, njira yomwe idalamulidwa ndi Congress mu 1976.²² Amayika amalgam ngati chida cha Class II chokhala ndi zolemba zina, kutanthauza kuti apeza kuti ndi otetezeka kuti aliyense azigwiritsa ntchito mopanda malire. Kuwongolera zolembedwako kumayenera kukumbutsa madotolo kuti azigwiritsa ntchito chida chomwe chili ndi mercury, koma kunalibe lamulo loti akaperekeko kwa odwalawo.

Chikalatacho cha FDA chinali pepala latsamba 120 lomwe mfundo zake zimadalira kwambiri pakuwunika zoopsa, kuyerekeza amalgam mercury kukhudzana ndi EPA's 0.3 µg-Hg / cubic mita air standard. Komabe, kuwunika kwa FDA kunangogwiritsa ntchito njira yokhayo yomwe anthu aku US amawonekera ku amalgam, osati uthunthu wonsewo, ndipo, modabwitsa, sanakonzekeretse kuchuluka kwa thupi. Amawachitira ana ngati kuti ndi achikulire. Mfundozi zidatsutsidwa mwamphamvu mu "zopempha zingapo kuti ziganizirenso" zoperekedwa ndi nzika zonse komanso magulu akatswiri ku FDA atatulutsa gulu. Zopemphazo zimawerengedwa kuti ndizovomerezeka mokwanira ndi oyang'anira a FDA kuti bungweli lidatenga njira yosavuta yoyitanitsa gulu la akatswiri kuti liwunikenso zowunika zake.

A Richardson, omwe tsopano ndi mlangizi wodziyimira pawokha, adapemphedwa ndi ambiri mwa omwe adapemphayo kuti awunikenso zoyeserera zake zoyambirira. Kuwunikaku kwatsopano, pogwiritsa ntchito chidziwitso chatsatanetsatane cha kuchuluka kwa mano odzaza mu anthu aku US, inali malo opangira zokambirana pamsonkhano wa akatswiri a FDA mu Disembala, 2010. (Onani Richardson Et al 2011⁵).

Zambiri pamanambala akudzaza anthu aku America adachokera ku National Health and Nutrition Examination Survey, kafukufuku wapadziko lonse wazaka pafupifupi 12,000 za anthu azaka 24 ndi kupitilira, omaliza kumaliza mu 2001-2004 ndi National Center for Health Statistics, gawo of the Centers for Disease Control and Prevention. Ndi kafukufuku wowerengeka woyimira anthu onse aku US.

Kafukufukuyu adatolera zambiri za kuchuluka kwa mano, koma osati pazodzazidwa. Pofuna kukonza izi, gulu la a Richardson lidapereka zochitika zitatu, zonse zomwe zidanenedwa ndimabuku omwe adalipo: 1) malo onse odzazidwa anali amalgam; 2) 50% yodzaza malo anali amalgam; 3) maphunziro 30% analibe amalgam, ndipo 50% ya ena onse anali amalgam. Pansi pa chochitika chachitatu, chomwe chimatenga kuchuluka kochepa kwambiri kwama amalgam, njira zowerengera zenizeni za mankhwala a mercury tsiku ndi tsiku zinali:

Ana 0.06 µg-Hg / kg-tsiku
Ana 0.04
Achinyamata 0.04
Akuluakulu 0.06
Okalamba 0.07

Zonsezi tsiku lililonse zimakwaniritsa kapena kupitirira kuchuluka kwa Hg0 komwe kumalumikizidwa ndi RELs, monga tawonera Gulu 2.

Chiwerengero cha malo ophatikizana omwe sangapitirire REL ya US EPA ya 0.048 µg-Hg / kg-day yawerengedwa, kuti ana ang'ono, ana ndi achinyamata akhale malo 6. Kwa achinyamata okalamba, achikulire ndi achikulire, ndi malo 8. Kuti asapitirire REL California EPA, manambalawo akhoza kukhala 0.6 ndi 0.8.

Komabe, zowonekera izi sizimafotokoza nkhani yonse, ndipo sizikuwonetsa kuchuluka kwa anthu opitilira muyeso "wotetezeka". Poyesa kuchuluka kwa manambala odzaza mano pakati pa anthu, Richardson adawerengetsa kuti pakadali pano padzakhala anthu aku America okwana 67 miliyoni omwe amalgam mercury adutsa kuposa REL yoyendetsedwa ndi US EPA. Ngati California REL yolimba ingagwiritsidwe, nambala imeneyo ikadakhala 122 miliyoni. Izi zikusiyana ndikuwunika kwa FDA kwa 2009, komwe kumangowerengera kuchuluka kwa mano odzaza, ndikupangitsa kuti kuchuluka kwa anthu kukhale koyenera pansi pa EPA REL yapano.

Pakukulitsa mfundoyi, Richardson (2003) adazindikira mapepala khumi ndi asanu ndi awiri m'mabuku omwe amafotokoza kuyerekezera kwamiyeso ya kuchuluka kwa mercury kuchokera pakudzazidwa kwa amalgam. ²³ Chithunzi 3 chikuwawonetsa, kuphatikiza zomwe adalemba mu pepala lake la 2011, zoyimira mawonekedwe owonekera kulemera kwa umboni. Mizere yofiira yofananira imafanana ndi kuchuluka kwa Mlingo wa California EPA's REL, malamulo okhwima kwambiri omwe amalembedwa kuti azitha kutentha kwa mercury, ndi REL ya US EPA, yomvera kwambiri. Zikuwonekeratu kuti ofufuza ambiri omwe mapepala awo akuyimiridwa pa Chithunzi 3 amatha kunena kuti kugwiritsa ntchito amalgam mopanda malire kungapangitse kuti mercury ayambe kuwonekera kwambiri.

Tsogolo la Amalgam Wamano

Pakulemba uku, Juni, 2012, a FDA sanalengeze kumapeto kwa zokambirana zawo pamalamulo oyendetsera mano. Ndizovuta kuwona momwe bungweli lithandizira kupatsa amalgam kuwala kobiriwira kuti agwiritse ntchito mopanda malire. Zikuwonekeratu kuti kugwiritsa ntchito mopanda malire kumatha kuyika anthu ku mercury kupitilira REL ya EPA, malire omwewo omwe kampani yamphamvu yamagetsi imakakamizidwa kutsatira, ndikuwononga ndalama mabiliyoni kuti achite. EPA ikuyerekeza kuti pofika mu 2016, kutsitsa mpweya wa mercury, komanso mpweya wa soot ndi asidi, zitha kupulumutsa $ 59 biliyoni mpaka $ 140 biliyoni pachaka chazachuma, kupewa kufa kwa 17,000 asanakwane pachaka, komanso matenda ndi masiku otayika pantchito.

Kuphatikiza apo, kusiyana pakati pa njira ya Mackert ndi Berglund yokhudzana ndi chitetezo cha amalgam ndi njira ya Richardson kukuwunikira kuwonongeka komwe kwadziwika ndi "nkhondo za amalgam". Mwina tinganene kuti "sizingavulaze aliyense," kapena "sipweteka wina." M'badwo uno wamankhwala abwino obwezeretsa utomoni, pomwe madotolo ochulukirachulukira akuchita mwamphamvu popanda mgwirizano, tili ndi mwayi wosavuta kutsatira mfundo zodzitetezera. Nthawi ndiyofunika kutumiza amalgam a mano kumalo ake olemekezeka m'mbiri yamano, ndikusiya. Tiyenera kupita patsogolo ndikudzikongoletsa kwake - kupanga njira zotetezera odwala ndi ogwira ntchito mano kuti asawonongeke kwambiri akadzazidwa; tetezani ogwira ntchito kuwonetseredwa kwakanthawi, monga kumachitika mukamatulutsa misampha yamagulu.

Mercury wamano atha kukhala gawo laling'ono chabe pamavuto apadziko lonse lapansi a kuwonongeka kwa mercury, koma ndi gawo lomwe ife madokotala a mano timayang'anira. Tiyenera kupitilizabe kuyesetsa kuteteza zachilengedwe, kupatula madzi onyansa a mercury mumtsinje wa zimbudzi, ngakhale timaleka kugwiritsa ntchito nkhawa zaumoyo wa anthu.

Stephen M. Koral, DMD, ZOKHUDZA

_________

Kuti mumve zambiri pankhaniyi, onani "Kafukufuku Wowopsa wa Amalgam 2010" ndi "Kafukufuku Wowopsa wa Amalgam 2005. "

Pomaliza, nkhaniyi idasindikizidwa mu kope la "February, 2013 la"Chiwerengero cha Kupitiliza Maphunziro mu Mano." 

Zokambirana zowonjezera pakuwunika zoopsa pokhudzana ndi mano a mano zitha kuwerengedwanso mu "IAOMT Position Paper yolimbana ndi Dental Amalgam. "

Zothandizira

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2 Haley BE 2007. Chiyanjano cha zotsatira za poizoni cha mercury pakukulitsa matenda omwe amadziwika kuti ndi matenda a Alzheimer's. Veritas ya Zamankhwala, 4: 1510-1524.

3 Chew CL, Soh G, Lee AS, Yeoh TS. 1991. Kutha kwakanthawi kwa mercury kuchokera ku amalgam yosatulutsa mercury. Clin Prev Dent, 13 (3): 5-7.

4 Gross, MJ, Harrison, JA 1989. Zina mwazinthu zamagetsi zamagetsi mu vivo dzimbiri la amalumikizidwe amano. J. Appl. Electrochem., 19: 301-310.

5 Richardson GM, R Wilson, D Allard, C Purtill, S Douma ndi J Gravière. 2011. Kuwonetsedwa kwa Mercury ndi zoopsa zake kuchokera kumalumikizano amano ku US, pambuyo pa 2000. Sayansi Yachilengedwe chonse, 409: 4257-4268.

6 Hahn LJ, Kloiber R, Vimy MJ, Takahashi Y, Lorscheider FL. 1989. Mano odzaza mano "siliva": gwero la kuwonekera kwa mercury kuwululidwa ndikuwunika thupi lonse ndikuwunika minofu. FASEB J, 3 (14): 2641-6.

7 Hahn LJ, Kloiber R, Wowonjezera RW, Vimy MJ, Lorscheider FL. 1990. Kulingalira thupi lonse kogawa mankhwala a mercury kotulutsidwa m'mano odzaza m'matumba a nyani. FASEB J, 4 (14): 3256-60.

8 USEPA (United States Environmental Protection Agency). 1995. Mercury, woyamba (CASRN 7439-97-6). Njira Yophatikizira Zowopsa. Idasinthidwa komaliza pa June 1, 1995. Pa intaneti pa:  http://www.epa.gov/ncea/iris/subst/0370.htm

9 CalEPA (California Environmental Protection Agency). 2008. Mercury, Inorganic - Mulingo Wowonekera Wowonekera Pafupipafupi ndi Chidule cha Chowopsa Chowopsa. Ofesi ya Environmental Health Hazard Assessment, California EPA. Idasindikizidwa mu Disembala 2008. Chidule pamzere pa: http://www.oehha.ca.gov/air/allrels.html; Zambiri zopezeka pa: http://www.oehha.ca.gov/air/hot_spots/2008/AppendixD1_final.pdf#page=2

Ngim, CH., Foo, SC, Boey, KW neri n. 10. Matenda osachiritsika am'magazi a mano. Br. J. Ind. Med., 1992 (49): 11-782. (Adasankhidwa)

11 Richardson, GM, R Brecher, H Scobie, J Hamblen, K Phillips, J Samuelian ndi C Smith. 2009. Mpweya wa Mercury (Hg0): Kupitiliza kusatsimikizika kwa poizoni, ndikukhazikitsa gawo lowonekera ku Canada. Regulatory Toxicology ndi Pharmacology, 53: 32-38

12 Lettmeier B, Boese-O'Reilly S, Drasch G. 2010. Pempho lakukonzanso kosanthula (RfC) kwa nthunzi ya mercury mwa akulu. Sci Total Environ, 408: 3530-3535

13 Fawer, RF, de Ribaupeirre, Y., Buillemin, MP ndi al. 1983. Kuyeza kwa kunjenjemera kwa dzanja komwe kumayambitsidwa ndi kukhudzana ndi mafakitale ku mercury yachitsulo. Br. J. Ind. Med., 40: 204-208

14 Piikivi, L., 1989a. Maganizo a mtima ndi kuchepa kwanthawi yayitali kwa nthunzi ya mercury. Int. Chipilala. Gwiritsani ntchito. Zachilengedwe. Zaumoyo 61, 391-395.

15 Piikivi, L., Hanninen, H., 1989b. Zizindikiro zodalira komanso magwiridwe antchito am'magazi a chlorine-alkali. Sakanizani. J. Kugwira Ntchito. Zaumoyo 15, 69-74.

16 Piikivi, L., Tolonen, U., 1989c. (Adasankhidwa) Zotsatira za EEG mwa ogwira ntchito ku chlor-alkali zimakhalapo kwa nthawi yayitali ndi nthunzi ya mercury. Br. J. Ind. Med. 46, 370-375.

17 Suzuki, T., Shishido, S., Ishihara, N., 1976. Kuyanjana kwa zinthu zosagwirizana ndi organic mercury mu kagayidwe kake m'thupi la munthu. Int. Chipilala. Gwiritsani ntchito. Zaumoyo. 38, 103-113.

18 Echeverria, D., Woods, JS, Heyer, NJ, Rohlman, D., Farin, FM, Li, T., Garabedian, CE, 2006. Kuyanjana pakati pa majeremusi amtundu wa coproporphyrinogen oxidase, kutulutsa mano a mercury ndi kuyankha kwamitsempha yamagazi. mwa anthu. Neurotoxicol. Teratol. 28, 39-48.

19 Mackert JR Jr. ndi Berglund A. 1997. Kutulutsa kwa Mercury kuchokera kumazaza amadzimadzi amadzimadzi: kuchuluka kwa mankhwala ndi kuthekera kwakukumana ndi zovuta m'thupi. Crit Rev Oral Biol Med 8 (4): 410-36. (Adasankhidwa)

20 Richardson, GM 1995. Kuyesa kuwonetsedwa kwa mercury ndi zoopsa zake kuchokera pakulumata mano. Konzekerani m'malo mwa Bureau of Medical Devices, Health Protection Branch, Health Canada. 109p. Yolembedwa pa Ogasiti 18, 1995. Pa mzere pa: 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 ndi M. Allan. 1996. Kafukufuku wa Monte Carlo Wowonetsa Mercury ndi Zowopsa Zaku Dental Amalgam. Kuunika Kwawoopsa Kwaumunthu Komanso Zachilengedwe, 2 (4): 709-761.

22 US FDA. 2009. Lamulo Lotsiriza la Amalgam Wamano. Pa mzere pa: http://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/DentalProducts/DentalAmalgam/ucm171115.htm.

23 Kutambasulidwa kuchokera: Richardson, GM 2003. Kutulutsa mpweya wa mankhwala oopsa a mercury ndi madokotala a mano: chiopsezo chantchito. Kuunika Kwawoopsa Kwaumunthu ndi Zachilengedwe, 9 (6): 1519 - 1531. Chithunzi choperekedwa ndi wolemba kudzera pa kulumikizana kwachinsinsi.

[Adasankhidwa] 24 Roels H., Abdeladim S., Ceulemans E. et al. 1987. Maubwenzi apakati pa kuchuluka kwa mercury mumlengalenga komanso m'magazi kapena mkodzo wa ogwira ntchito omwe amapezeka ndi nthunzi ya mercury. Ann. Gwiritsani ntchito. Mpweya., 31 (2): 135-145.

25 Skare I, Engqvist A. Kuwonetsedwa kwaumunthu kwa mercury ndi siliva kutulutsidwa m'mano obwezeretsa mano. Arch Environ Health 1994; 49 (5): 384-94. (Adasankhidwa)