Mercury (Hg), also known as quick silver, is an essential constituent of dental amalgam. It is a toxic substance of global concern. Children are more at risk from mercury poisoning which affects their neurological development and brain. In the past, a number of studies at dental sites in many countries have been carried out and reported. The present report briefly describes and discusses our recent investigations carried out at 34 dental sites (teaching institutions, hospitals and private clinics) in Pakistan. It is evident from the data that at many sites the indoor mercury vapor levels exceed far above the permissible limit recommended for safe physical and mental health. At these sites, public in general and the medical, paramedical staff and vulnerable population in particular, are at most serious risk to health resulting from exposure to toxic and hazardous mercury. To minimize such risk, some of the recommendations are, best in-house environmental practices for occupational health and safety, mercury contaminated waste reduction at source, mercury specific legislation and ratification of Minamata convention on mercury by Pakistan and other world governments at the earliest time possible.

During the past two decades, mercury has come under increasing scrutiny with regard to its safety both in the general population and in occupationally exposed groups. It’s a growing issue of global concern because of its adverse environmental and health impacts. Very few investigations on mercury amalgam use in the dentistry sector have been carried out in South Asia and there is little data reported on mercury contamination of indoor/outdoor air at dental sites. According to an earlier SDPI study, reported in 2013, alarmingly high mercury levels were observed in air (indoor as well as outdoor) at 11 of the 34 visited dental sites (17 dental teaching institutions, 7 general hospitals & 10 dental clinics) in five main cities of Pakistan. 88% of the sites indicated indoor mercury levels in air above the USA EPA reference level of 300 ng/m³. According to our study, carried out at 38 dental teaching institutions in 12 main cities (in Khyber Pakhtunkhwa, Punjab and Sindh provinces) of Pakistan, respondents were of the opinion that the currently offered BDS curriculum does not effectively guide outgoing dental professionals and does not provide them adequate knowledge and training about mercury/mercury amalgam and other mercury related human health and mercury waste issues. 90% of respondents supported the review and revision of the present dental curriculum offered at dental teaching institutions in the country, at the earliest. A study has also been conducted to assess the status of mercury amalgam use in private dental clinics in Gilgit, Hunza, Peshawar, Rawalpindi and Islamabad. More than 90 private dental clinics were visited and dental professionals/private clinics in-charge were interviewed during June–July, 2015. The focus areas of the study were Hg amalgam toxicity, its waste management practices and safety measures practiced among the dental practitioners. In the light of the findings described and discussed in this brief report, to safeguard public health and for the protection of environment, it is strongly recommended that since mercury amalgam use cannot be banned immediately in the country, its use may be regularized and allowed subject to use of “Amalgam Separators,” “Capsulated Mercury” and “Mechanized Mixing,” use of mercury amalgam be banned for children (below 12 years age) and pregnant women. The curriculum currently being taught at medical and dental colleges in the country be reviewed and revised, to ensure adequate training towards minimizing mercury exposure.

The production and disposal of hazardous waste remains a substantial problem in the Asian Pacific region. Remediation of waste disposal sites, including landfill sites, is attracting considerable research attention within the region. A recognition of the need for community engagement in this process is also growing. This article reviews the work presented in the Hazardous Waste sessions at the Pacific Basin Consortium for Environment and Health held in November 2009 in Perth.