Dental amalgam yanga ichishandiswa kudzorera meno kweanoda kusvika mazana maviri emakore, uye kusahadzika pamusoro pekupokana kupokana kwekupa basa rekuchengetedza hutano nechinhu chine mercury chakaramba chiripo nguva yese. Pakagara paine undercurrent mukati mehunyanzvi hwemazino hwekurwisa-amalgam manzwiro, "mercury-isina" kufamba. Nepo kutaura kwemanzwiro aya kwakura mumakore achangopfuura sezvazvinove nyore kuita zvakanaka kudzoreredza kwemazino pamwe nemisanganiswa, maitiro akajairika evanachiremba vemazino kune amalgam anogona kupfupikiswa sekuti "hapana chakaipa nazvo pasainzi, isu hatisi kungoishandisa zvakanyanya zvakare. ”

Kuti ubvunze kana paine chero chinhu kana chisina kusayendisiti chakashata ne amalgam, mumwe anofanirwa kutarisa kune yakakura mabhuku pamusoro pekuratidzwa, chepfu uye kuongororwa kwenjodzi ye mercury. Mazhinji acho akarara kunze kwenzvimbo dzeruzivo vanachiremba vemazino vanowanzo kufumurwa. Kunyangwe akawanda emabhuku ari pamekisheni kuburitswa kubva amalgam aripo kunze kwemazino magazini. Kuongororwa kweichi chakawedzerwa chinyorwa kunogona kujekesa pane fungidziro dzakaitwa nemazino nezvekuchengetedza amalgam, uye kunogona kubatsira kutsanangura kuti nei vamwe vanachiremba vemazino vakaramba vachishora kushandiswa kwemalgam mune ekurapa mazino.

Hakuna munhu zvino anopokana kuti mazino amalgam anoburitsa metallic mercury munzvimbo yayo pane imwe nhanho, uye zvichave zvinonakidza kupfupisa muchidimbu humwe humbowo hwekuratidzwa uku. Iyo toxicology ye mercury yakafara kwazvo chidzidzo chechinyorwa chipfupi, uye inonyatso kuongororwa kumwe kunhu. Nyaya yekuongororwa kwenjodzi, zvisinei, inoenda yakananga pamoyo wekupokana pamusoro pekuti amalgam yakachengeteka here, kana kwete, yekushandisa zvisina kudzivirirwa muhuwandu hwevanhu.

Ndeupi Mhando Yesimbi iri muDental Amalgam?

Nekuti iwo musanganiswa unotonhora, amalgam haigone kusangana netsananguro yealloy, iyo inofanirwa kuve musanganiswa wesimbi yakaumbwa mune yakanyungudutswa mamiriro. Kana iyo haigone kusangana netsananguro yeiyoni yakakomberedzwa semunyu, iyo inofanirwa kuve nekuchinjana kwemaerekitironi zvichikonzera lattice yeiyoni dzakabhadharwa. Iyo inonyatso kusangana netsananguro yeiyo yepakati-yesimbi colloid, kana yakasimba emulsion, umo matrix zvinhu zvisingaitwe zvizere, uye zvinogona kupora. Mufananidzo 1 inoratidza micrograph yespolished metallurgia sampuro yemazino amalgam iyo yakange yafadzwa neyakaongororwa microscopic. Panzvimbo yega yega yekumanikidza, madonhwe emvura mercury anosvinwa kunze. ¹

Haley (2007)² kuyerwa mu-vitro kuburitswa kwemekyuri kubva kune imwechete-spill sampuli yeTytin®, Dispersalloy®, uye Valiant®, imwe neimwe iine nzvimbo yepamusoro ye1 cm2. Mushure memazuva makumi mapfumbamwe ekuchengetera kubvumidza maitiro ekutanga ekugadzika kuti ave akakwana, iwo masampuli akaiswa mumvura yakasvibiswa mukamuri yekushisa, 23˚C, uye isina kushatirwa. Mvura yakasvibiswa yakachinjwa uye kuongororwa zuva nezuva kwemazuva makumi maviri nemashanu, uchishandisa Nippon Direct Mercury Analyzer. Mercury yakaburitswa pasi pemamiriro aya pachiyero che25-4.5 micrograms zuva rega rega, pasentimita imwe chete. Chew (22)³ yakataura kuti mercury yakanyunguduka kubva amalgam ikaita mvura yakadonhedzwa pa37˚C pachiyero chinosvika kumakumi mana nemakumi matatu emakirogiramu pazuva, nepo Gross naHarrison (43)⁴ yakataura 37.5 micrograms pazuva mumhinduro yaRinger.

Kugoverwa kweDental Mercury Yakakomberedza Muviri

Ongororo dzakawanda, kusanganisira ongororo dzezvitunha, dzakaratidza huwandu hwepamusoro hwemekiyuri munyama dzevanhu dzine amalgam zadza, kupesana neavo vasina kufumurwa zvakafanana. Kuwedzera amalgam mutoro kunosanganisirwa nekuwedzera mamekiyuri musanganiswa mumhepo mweya; mate; ropa; mutsvina; weti; akasiyana matishu anosanganisira chiropa, itsvo, pituitary gland, huropi, nezvimwe; amniotic fluid, tambo yeropa, placenta uye fetus tishu; colostrum uye mukaka wemuzamu.⁵

Iyo yakajeka, yechinyakare kuyedza kunoratidza mu-vivo kugoverwa kwemekyuri kubva kune amalgam mafillings yaive ine mukurumbira "makwai netsoko zvidzidzo" zvaHahn, et. al. (1989 na1990).^6,7 Gwai raive nepamuviri rakapihwa gumi nemaviri occlusal amalgam mafillings aive akaiswa radioactive ²⁰³Hg, chinhu chisipo mumasikirwo, uye chine hafu yeupenyu hwemazuva makumi mana nemana. Kuzadza kwacho kwakavezwa kunze kwekuvharirwa, uye muromo wemhuka wakachengetwa wakarongedzwa uye wakashambidzwa kudzivirira kumedza zvinhu zvakawandisa panguva yekushanda. Mushure memazuva makumi matatu, chakabairwa. Radioactive mercury yakaiswa mukati mechiropa, itsvo, nzira yekugaya uye shaya, asi zvese zvinyama, kusanganisira fetal tishu, zvakagamuchirwa kuyerwa. Autoradiogram yemhuka yese, mushure mekubviswa kwemeno, inoratidzwa mumufananidzo 46.

Kuedza kwemakwai kwakashoropodzwa nekushandisa mhuka yaidya nekutsenga neimwe nzira yakatosiyana nevanhu, saka boka rakadzokorora kuyedza richishandisa tsoko, nemhedzisiro yakafanana.

25 Skare I, Engqvist A. Kufumurwa kwevanhu kune mercury uye sirivheri yakaburitswa kubva kumazino amalgam kudzoreredzwa. Arch Environ Hutano 1994; 49 (5): 384-94.

Basa reKuongorora Njodzi 

Humbowo hwekuratidzwa chinhu chimwe chete, asi kana "iyo dosi ichigadzira iyo chepfu," sezvatakanzwa kazhinji zvine chekuita nekubuditswa kwemekyuri kubva mazino amalgam, kutsunga kweiyo mwero wekuratidzira une chepfu uye kune iro dunhu rine njodzi kuongorora. Kuongorora njodzi seti yemaitiro akarongeka anoshandisa dhata iripo mune yesainzi zvinyorwa, kupa pfungwa nhanho dzekuburitsa dzinogona kugamuchirwa pasi pemamiriro akapiwa, kuzviremera zvinotarisira kutarisira ngozi. Iyo nzira inowanzo shandiswa muinjiniya, se, semuenzaniso, iyo yeruzhinji inoshanda dhipatimendi inoda kuziva mukana webhiriji kutadza pasi pemutoro usati waisa muyero wehuremu pairi.

Kune akatiwandei emahofisi anoona nezve kudzora kuratidzwa kwevanhu kune zvine chepfu, FDA, EPA, uye OSHA, pakati pavo. Ivo vese vanovimba nemaitiro ekuongorora njodzi kuisa mitsara inosarudzika yemakemikari, kusanganisira mercury, muhove nezvimwe zvekudya zvatinodya, mvura yatinonwa uye nemweya watinofema. Aya masangano anozoisa miganho inomanikidzirwa zviri pamutemo pakuburitswa kwevanhu kunoratidzwa nemazita akasiyana siyana, akadai seanogadziriswa ekuratidzira muganho (REL), rezita rezita (RfD), rejereisheni yekufungidzira (RfC), inoganhurika zuva nezuva muganho (TDL), nezvimwe, zvese izvi zvinoreva chinhu chimwe chete: kuwanda kupi kubvumidzwa kwekutendera pasi pemamiriro ezvinhu iro agency rinotarisira. Iyi nhanho inobvumidzwa inofanirwa kuve iyo pane pane kutarisira kwe hapana mhedzisiro yakaipa yehutano mukati mehuwandu hwakafukidzwa pasi pemutemo.

Kugadzira RELs

Kuti tishandise nzira dzekuongorora njodzi kune inogona kuitika mercury chepfu kubva kumazino amalgam, isu tinofanirwa kuona muyero wemekiyuri uyo vanhu vanowanikwa nawo kubva pakuzadza kwavo, uye toenzanisa izvo kune yakasimbiswa chengetedzo zvimiro zveiyo mhando yekuratidzwa. Iyo toxicology yemekyuri inoziva kuti mhedzisiro yayo pamuviri inotsamira zvakanyanya pamakemikari marudzi anobatanidzwa, uye nzira yekuratidzwa. Rinenge rese basa pane amalgam chepfu inofungidzira kuti iyo mikuru chepfu mhando inosanganisirwa nesimbi mercury vapor (Hg˚) inoburitswa nokuzadza, inhaled mumapapu uye inonwiwa pamwero we80%. Dzimwe mhando nemigwagwa zvinozivikanwa kuve zvinobatanidzwa, zvinosanganisira metallic mercury yakanyungudutswa mumate, abraded zvimedu uye ngura zvigadzirwa zvinomedzwa, kana methyl mercury inogadzirwa kubva kuHg˚ nemukati mabhakitiriya. Kunyangwe dzimwe nzira dzekunze dzakatarwa, senge kuiswa kweHg˚ muuropi kuburikidza neolfactory epithelium, kana kudzoreredza axonal kutakura kwemekiyuri kubva kumajaya kuenda muuropi. Izvi zvinofumurwa zvingave zvehuwandu husingazivikanwe, kana zvinofungidzirwa kuve zvehukuru hwakaderera pane hwemuromo inhalation, saka hukuru hukuru hwekutsvagisa nezve amalgam mercury hwakatarisana ipapo.

Iyo yepakati tsinga system inofungidzirwa kuti ndiyo inonyanya kunzwisiswa nhengo ye mercury vapor exposure. Zvakasimbiswa zvakashata zvinokanganisa paitsvo nemapapu zvinofungidzirwa kuva nehurefu hwekuratidzira. Mhedzisiro inokonzeresa hypersensitivity, autoimmunity uye mamwe maakirogiki erudzi maitiro haakwanise kuverengerwa nemazamu-ekupindura mamodheru, (ayo anokumbira mubvunzo, kushomeka kwakadii kusagadzikana kune mercury, chaizvo?) Naizvozvo, vaongorori nemasangano ari kutsvaga kumisikidza maRELs ezasi. Chikamu chisingaperi Hg˚ kuratidzwa vakatarisa matanho akasiyana siyana eCNS mhedzisiro. Zvishoma zvidzidzo zvakakosha (zvakapfupikiswa mutafura 1) zvakaburitswa pamusoro pemakore izvo zvinobatanidza huwandu hweemekiyuri kusvibiswa kwemhepo nezviratidzo zvinoyerwa zveCSS kusagadzikana. Izvi ndizvo zvidzidzo zvakaongororwa nesainzi.

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Tafura 1. Zvidzidzo zvakakosha zvange zvichishandiswa kuverenga kutarisisa kweye metallic mercury vapor, inoratidzwa se micrograms pa cubic mita yemhepo. Asterix * inoreva kuwanda kwemweya kwakatorwa nekushandura kukosha kweropa kana weti kune yakaenzana nemhepo zvinoenderana nekutendeuka kubva kuna Roels et al (1987).

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Muitiro wekuongororwa kwenjodzi unoziva kuti kuburitswa uye dhizaini inounganidzwa kune vanhu vakuru, zvinokatyamadza murume, vashandi munzvimbo dzebasa havagone kushandiswa mune yavo yakasvibirira fomu senge inoratidza mwero wakachengeteka kune wese munhu. Kune akawanda marudzi ekusava nechokwadi mune iyo data:

• LOAEL vs. NOAER. Hapana imwe ye data rekuratidzira rakaunganidzwa muzvidzidzo zvakakosha zvataurwa nenzira inoratidza yakajeka dhizaini-yekupindura curve yemhedzisiro yeCSS yakayerwa. Nekudaro, ivo havaratidze chaiyo chaiyo chikumbaridzo chemazamu ekutanga kwemhedzisiro. Mune mamwe mazwi, hapana kutsunga kwe "Kwete-Inocherechedzwa-Yakashata-Inokanganisa-Chikamu" (NOAEL). Zvidzidzo zvega zvega zvinonongedzera ku "Yakadzika-Yakacherechedzwa-Yakashata-Mhedzisiro-Chikamu" (LOAEL), iyo isingatariswe seyakajeka.
• Kusiyana kwevanhu. Kune akawanda akanyanyisa kusanzwisisa mapoka evanhu muhuwandu hwevazhinji: vacheche uye vana vane hunyanzvi hwekuvandudza masisitimu ehuremu uye huremu hwemuviri hwakaderera vanhu vane hutano hwekurapa; vanhu vane majini akatsunga kuwedzera kunzwisisika; vakadzi vezera rekubereka uye mamwe mitezo ine chekuita nevakadzi. vakwegura, kungodoma vashoma. Misiyano yehukama iyo isina kuverengerwa mu data inogadzira kusava nechokwadi.
• Dhata rekubereka uye rekuvandudza. Mamwe masangano, akadai seCalifornia EPA, anoisa zvakanyanya kusimbisa pane data rekubereka uye rekuvandudza, uye vhara imwe nhanho yekusava nechokwadi mukuverenga kwavo painenge ichishaikwa.
• Inter-zvipenyu data. Kushandura dhata rekutsvagurudza mhuka kuchiitiko chevanhu hakuna kumbobvira kwajeka, asi kufunga kwechinhu ichi hakushande mune ino chiitiko, nekuti zvidzidzo zvakakosha zvataurwa pano zvese zvine chekuita nenyaya dzevanhu.

Yakaburitswa maREL ekurarama kusingaperi kwemekiyuri mhute inowanikwa muhuwandu hwevanhu yakapfupikiswa muTafura 2. RELs inorehwa kudzora kufumurwa kwehuwandu hwevanhu inoverengerwa kuvimbisa kuti hakungave netarisiro inonzwisisika yemhedzisiro inokanganisa hutano kune chero munhu, saka kubvumidzwa kunobvumidzwa kwakaderedzwa kubva iyo yakacherechedzwa yakaderera mhedzisiro nhanho ne arithmetic "kusava nechokwadi zvinhu" (UF). Kusanzwisisika zvinhu hazvifungidzwe nemitemo yakaoma uye inokurumidza, asi nemutemo - chenjedzo sei inodzora agency inoda kuve, uye kuvimba kwavo mune data.

Panyaya yeUS EPA, semuenzaniso, danho rekuita (9 µg-Hg / cubic mita yemhepo) inoderedzwa nechinhu che3 nekuda kwekuvimba neLOAEL, uye nechinhu chegumi chekuzvidavirira mukusiyana kwevanhu, kweUF izere makumi matatu. Izvi zvinogumira muganho unobvumidzwa we10 µg-Hg / cubic mita yemhepo. ⁸

ICalifornia EPA yakawedzera imwe UF yegumi nekushaikwa kwedata rekubereka nekusimudzira reHg10, zvichiita kuti muganho wavo uve gumi, 0 µg Hg / cubic mita yemhepo. ⁹

Richardson (2009) akaona iyo Ngim et al kudzidza¹⁰ seyakakodzera kwazvo kukudziridza REL, sezvo yakaratidza vese vanhurume nevanhukadzi vanachiremba vemazino muSingapore, zvinogara zvichionekwa kumazinga akaderera emekiyuri mhute pasina kuvapo kweklorini gasi (ona pazasi). Akashandisa UF yegumi pane yechitatu yeiyo LOAEL, achipokana kuti vacheche nevana vane hushamwari zvakanyanya kupfuura chinhu che10 vanogona kuzvidavirira. Kuisa UF ye3 yekusiyana kwevanhu, kweUF izere zana, akakurudzira kuti Health Canada igadzire REL yavo yekusingaperi mercury vapor pa3 µg Hg / cubic mita yemhepo.¹¹

Lettmeier et al (2010) yakawana yakanyanya kuwanda chinangwa (ataxia yegedhi) uye kuzviisa pasi (kusuwa) mhedzisiro mune vadiki vegoridhe vanochera mu Africa, vanoshandisa mercury kupatsanura goridhe kubva kune yakapwanyika ore, pakunyanyisa kudzikira mazinga, 3 µg Hg / cubic mita yemhepo. Ichitevera iyo US EPA, vakashandisa UF huwandu hwe30-50, uye vakakurudzira REL pakati pe0.1 ne0.07 µg Hg / cubic mita yemhepo.¹²

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Tafura 2. Yakabudiswa RELs yekuratidzwa kune yakaderera chikamu, chisingaperi Hg0 vapor muhuwandu hwevanhu, pasina basa rekuratidzira. * Shanduko yekuita muyero, µg Hg / kg-zuva, kubva kuRichardson (2011).

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Zvinetso neRELs

IUS EPA yakapedzisira kugadziridza mercury vapor REL (0.3 µg Hg / cubic mita yemhepo) muna 1995, uye kunyangwe vakaisimbisazve muna 2007, vanobvuma kuti mapepa matsva aburitswa anogona kuvapa mukana wekudzokorora REL pasi. Mapepa ekare eFawer et al (1983) ¹³ uye Piikivi, et al (1989 a, b, c)^{14, 15, 16}, yaitsamira muchikamu chikuru pane zviyero zveiyo mercury exposure uye CNS mhedzisiro mu chloralkali vashandi. Chloralkali ndeyegumi nemapfumbamwe muzana indasitiri yemakemikari maitiro umo munyu brine unotenderedzwa pamusoro peutete hutete hwemvura ye mercury, uye hydrolyzed nemagetsi emagetsi kuburitsa sodium hypochlorite, sodium hydroxide, sodium chlorate, chlorine gasi, nezvimwe zvigadzirwa. Iyo mercury inoshanda seimwe yemagetsi. Vashandi muzvirimwa zvakadaro vanowoneswa kwete chete kune mercury iri mumhepo, asi neklorini gasi zvakare.

Kubuditsa pachena kwe mercury vapor uye chlorine gasi kunochinja simba rekuratidzwa kwevanhu. Hg˚ inosanganiswa pamwe neklorini mumhepo kuenda kuHg²⁺, kana HgCl₂, iyo inoderedza kukwana kwayo mumapapu, uye inoshandura zvinoshamisa kugoverwa kwayo mumuviri. Kunyanya, HgCl₂ inonwiwa kubva mumhepo kuburikidza nemapapu haipindi mumasero, kana kuburikidza neropa-uropi chipingaidzo, zviri nyore seHg˚. Semuenzaniso, Suzuki et al (1976)¹⁷ yakaratidza kuti vashandi vakafumurwa kuHg˚ voga vane chiyero cheHg mumasero matsvuku eropa ku plasma ye 1.5-2.0 kusvika ku1, nepo vashandi vekloralkali vakafumurwa kune ese mairi makemikari uye klorini yaive nechiyero cheHg muRBCs kune plasma ye0.02 kusvika 1, zvinoda kusvika zvakapetwa kazana mukati memasero. Ichi chiitiko chinokonzeresa iyo mercury kupatsanura zvakanyanya kune itsvo kupfuura huropi. Chiratidziro chekuratidzira, weti mercury, ingangove yakafanana kune ese marudzi evashandi, asi vashandi vechalkalkali vaizove nehana shoma yeCSS. Nekuongorora zvakanyanya kloralkali mushandi zvidzidzo, kunzwisisika kweCNS kune mercury kuratidzwa kwaizove kwakadzikiswa, uye maRELs akavakirwa pazvidzidzo izvi aizove akaverengerwa.

Pakati pemapepa matsva ibasa reEcheverria, et al, (2006)¹⁸ uyo anowana akakosha eurobehavioral uye neuropsychological mhedzisiro mune vanachiremba vemazino uye vashandi, zvakanyanyisa pazasi pe25 µg Hg / cubic mita yemhepo nhanho, vachishandisa zvakasimbiswa zvakasarudzika bvunzo. Zvakare, hapana chikumbaridzo chakawanikwa.

Kushandisa Mercury RELs kuDental Amalgam

Pane musiyano muzvinyorwa zvine chekuita nemuyero we mercury exposition kubva kune amalgam, asi pane kuwirirana kwakazara pane dzimwe nhamba dzakabatanidzwa, dzakapfupikiswa muTafura 3. Izvo zvinobatsira kuchengetedza izvi zvakakosha manhamba mupfungwa, sevanyori vese vanozvishandisa mukuverenga kwavo. . Izvo zvinobatsirawo kuchengeta mundangariro chokwadi chekuti idzi ruzivo rwekuburitsa anongova maanalogs ekuratidzwa kuuropi. Iko kune data remhuka uye post-mortem data revanhu, asi hapana pane chaiko kufamba kwemekiyuri muhuropi hwevashandi vanobatanidzwa muzvidzidzo izvi.

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Tafura 3. mareferenzi:

• a- Mackert naBerglund (1997)
• b- Skare uye Engkvist (1994)
• c- yakaongororwa muRichardson (2011)
• d-Roels, nevamwe (1987)

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Pakati pegore ra1990 kwakaona kuburitswa kweakasiyana maitiro ekuyedzwa kwekubatana uye kuchengetedzeka. Uyo akave nesimba rakanyanya pakukurukurirana mukati memharaunda yemazino yakanyorwa naH. Rodway Mackert naAnders Berglund (1997)¹⁹, mapurofesa emazino paMedical College yeGeorgia, uye Umea University muSweden, zvichiteerana. Iyi ndiyo bepa mune izvo zvirevo zvinoitwa zvekuti zvinotora zvinosvika mazana mana nemakumi mana ezviremera zve amalgam kusvika kune chepfu dose. Vanyori ava vakadoma mapepa aifarira kudzikisira zvinoitwa neklorini pakubata kwemweya wemekiyuri, uye vakashandisa muganho wekuburitsa pabasa, (wakatorwa kuvarume vakuru vakaburitsa maawa masere pazuva, mazuva mashanu pasvondo), e450 µg-Hg / cubic mita yemhepo seyavo de-facto REL. Ivo havana kufunga kusava nechokwadi kwenhamba iyoyo sezvo zvaizoshanda kune vanhu vese, kusanganisira vana, vaizoburitswa maawa makumi maviri nemana, mazuva manomwe pavhiki.

Iko kuverenga kunoenda nenzira inotevera: iyo yakaderera yakacherechedzwa maitiro ezvekuda kudedera pakati pevakuru vashandi vechirume, kunyanya chloralkali vashandi, yaive 25 µg-Hg / cubic mita yemhepo yakaenzana neiyo weti chikamu cheinenge 30 µg-Hg / gr-creatinine. Kuzvidavirira padiki diki yeiyo yekutanga urine mercury inowanikwa muvanhu vasina kuzadza, uye nekuparadzanisa iyo 30 byg nemubhadharo wepasi pevhu kune weti mercury, 0.06 µg-Hg / gr-creatinine, mhedzisiro yacho inosvika mazana mana emakona anodiwa kusvika padanho iro. .

Zvichakadaro, G. Mark Richardson, nyanzvi yekuongorora njodzi akashandiswa neHealth Canada, naMargaret Allan, mainjiniya ekuongorora, vese vasina ruzivo rwemberi nezvemavezi, vakapiwa basa nesangano iri kuita ongororo yenjodzi yemalgam muna 1995. mhedzisiro yakasiyana kwazvo naMackert naBerglund. Vachishandisa kuburitswa-dhiraidhi dhata uye kusava nechokwadi zvinhu zvinoenderana neizvo zvataurwa pamusoro, ivo vakakurudzira kuCanada REL ye mercury vapor ye0.014 µg Hg / kg-zuva. Kufunga kuti 2.5 maspace ekuzadza, vakaverenga huwandu hwehuwandu hwekuzadza husingapfuure iwo mwero wekuratidzwa kwemazera mashanu akasiyana ezera, zvichibva pahuremu hwemuviri: vana vadiki, 0-1; vana, 0-1; vechidiki, 1-3; vakuru, 2-4; vakuru, 2-4. Kubva pane aya manhamba, Hutano Canada yakaburitsa akateedzana ekurudziro ekumisa mashandisirwo emalgam, ayo akave asina hanya zvakanyanya mukuita.^{20, 21}

Muna 2009, iyo US Chikafu neDrug Administration, pasi pekumanikidzwa kubva kumatare edzimhosva, yakapedzisa kuiswa kwayo kwema pre-capsulated dental amalgam, maitiro akambotemerwa neCongress muna 1976.²² Vakarongedza amalgam seClass II chishandiso chine mamwe mazita ekunyorera, zvichireva kuti vakaiwana yakachengeteka kushandiswa kusingavharirwe kune wese munhu. Iwo maratidziro ekunyora aive akafanirwa kuyeuchidza vanachiremba vemazino kuti ivo vaizenge vachibata chishandiso chine mercury, asi pakanga pasina mvumo yekuendesa iwo ruzivo kune varwere.

Dhairekitori reDAA raive rakatsanangurwa 120 peji bepa iyo nharo dzaitsamira zvakanyanya pakuongororwa kwenjodzi, tichienzanisa amalgam mercury kuratidzwa kune iyo EPA's 0.3 µg-Hg / cubic mita yemhepo standard. Nekudaro, iyo FDA ongororo yakashanda chete zvinorehwa nehuwandu hwevanhu vemuUS kuoneswa kune amalgam, kwete iyo yakazara renji, uye, zvinoshamisa, haina kugadzirisa dhizaini pahuremu hwemuviri. Yaibata vana sekunge vanhu vakuru. Aya mapoinzi akakwikwidzwa zvine simba mu "zvikumbiro zvakawanda zvekufunga" zvakatumirwa nemapoka maviri evagari uye ehunyanzvi kuDAA mushure mekuburitswa kwechirongwa. Zvikumbiro zvakanzi zvakaringana zvakakwana nevakuru veDFA kuti iyo agency yakatora nhanho isingawanzo kuunganidzwa nyanzvi yemapurisa kuti itarisezve chokwadi chekuongorora kwengozi.

Richardson, parizvino chipangamazano akazvimiririra, akabvunzwa nevakawanda vevanokumbira kuti vavandudze ongororo yake yekutanga. Ongororo nyowani, ichishandisa ruzivo rwakadzama pamusoro pehuwandu hwemazino akazadzwa muhuwandu hweUS, yaive nzvimbo yekukurukurirana kuDFA yaDecember, 2010 nyanzvi yemusangano wepaneru. (Ona Richardson et al 2011⁵).

Dhata pane huwandu hwemazino akazadzwa muvanhu veAmerica yakabva kuNational Health and Nutrition Examination Survey, ongororo yenyika yose yevanhu vangangoita zviuru gumi nezviviri vane makore makumi maviri nemana zvichikwira, yakapedziswa kupera muna 12,000-24 neNational Center for Health Statistics, chikamu yeCentre for Disease Control uye Kudzivirira. Icho chiitiko chakakosha kuongororwa kunomiririra huwandu hwese hweUS.

Ongororo iyi yakaunganidza data pamusoro pehuwandu hwenzvimbo dzemazino dzakazadzwa, asi kwete pane zvekuzadza zvinhu. Kugadzirisa kushomeka kweboka raRichardson rakapa zviitiko zvitatu, zvese zvakataurwa nemabhuku asipo: 1) nzvimbo dzese dzakazadzwa dzaive amalgam; 2) 50% yenzvimbo dzakazara dzaive amalgam; 3) 30% yezvidzidzo yanga isina amalgam, uye 50% yevamwe yaive amalgam. Pasi pechiitiko chechitatu, icho chinotora iwo mashoma mashoma amalgam kuzadza, nzira dzakaverengerwa dzeicho chaicho zuva nezuva mercury dosage yaive:

Vana vadiki 0.06 µg-Hg / kg-zuva
Vana 0.04
Vechidiki 0.04
Vakuru 0.06
Vakuru 0.07

Zvese izvi zvezuva nezuva zvakayerwa madhivhosi anosangana kana kupfuudza ezuva nezuva dhizaini yeHg0 inosanganisirwa neRELs dzakaburitswa, sezvinoonekwa muTafura 2.

Huwandu hwenzvimbo dzemalgam dzaisapfuudza iyo US EPA's REL ye0.048 µg-Hg / kg-zuva yakaverengerwa, kune vana vadiki, vana uye vechidiki vechidiki kuve matanhatu nzvimbo. Kune vechidiki vechidiki, vakuru nevakuru, ndiwo masere masere. Kuti usapfuure iyo California EPA's REL, iwo manhamba angave 6 uye 8 nzvimbo.

Zvisinei, izvi zviyero zvepakati hazvitaure nyaya yese, uye hazviratidze kuti vanhu vangani vanopfuura muyero "wakachengeteka". Kuongorora huwandu hwese hwenhamba yemazino akazara muhuwandu hwevanhu, Richardson akaverenga kuti pari zvino pachave nemamiriyoni makumi matanhatu nematanhatu emaAmerican ane amalgam mercury exposure inodarika REL inosungirirwa neUS EPA. Kana iyo yakaoma California REL yakashandiswa, iyo nhamba yaizove mamirioni gumi nemaviri. Izvi zvinopesana neiyo FDA's 67 ongororo, iyo inongotarisa chete inoreva huwandu hwemazino akazadzwa, nokudaro ichibvumira huwandu hwevanhu kuti vangokodzera pasi peiyo yazvino EPA REL.

Nekusimudzira kweiyi poindi, Richardson (2003) akacherekedza mapepa gumi nemanomwe mumabhuku aiburitsa fungidziro yemutero wehuwandu hwemekiyuri kuburitswa kubva kune amalgam mafillings. ²³ Mufananidzo 3 unovaratidza, pamwe nedhata kubva pabepa rake ra2011, rinomiririra mune yakajeka fomu huremu hweuchapupu. Mitsara yakatsvuka yakatwasuka inoisa muyero wakaenzana weREL California EPA, Rakamomoka pane zvakaburitswa zvemitemo ye mercury vapor exposure, neUS EPA's REL, inonyanya kurerekera. Zviripachena kuti vazhinji vaongorori vane mapepa anomiririrwa muMufananidzo 3 vaizogumisa kuti kushandiswa kusingabvumirwe kwemalgam kwaizoguma nekuburitsa pachena kune mercury.

Ramangwana reDental Amalgam

Sekunyora uku, Chikumi, 2012, iyo FDA haisati yazivisa mhedzisiro yezvavanofunga pamusoro pehunhu hwekutonga hwemazino amalgam. Zvakaoma kuona kuti iyo agency ichakwanisa sei kupa amalgam mwenje mutema wekushandisa zvisina kudzivirirwa. Zviripachena kuti kushandiswa kusingabvumirwe kunogona kuendesa vanhu kumekyuri mukuwedzera kweiyo EPA's REL, iwo iwo muganho uyo marasha akadzinga indasitiri yemagetsi iri kumanikidzwa kutevedzera, uye kushandisa mabhiriyoni emadhora kuzviita. EPA inofungidzira kuti sagore ra2016, kudzikisira kuburitswa kwemekiyuri, pamwe chete nesipo uye magasi eacid, kuchachengetedza $ 59 bhiriyoni kusvika kumadhora zana nemakumi mana emamiriyoni emadhora mumari yehutano pagore, ichidzivirira kufa kwevanhu zviuru zvisere zvisati zvaitika pagore, pamwe nezvirwere uye nemazuva ekushanda akarasika.

Zvakare, musiyano uripo pakati penzira yeMackert neBerglund yekuchengetedza amalgam uye nzira yeRichardson inosimbisa iyo polarization iyo yakaratidza nhoroondo ye "amalgam war." Chero isu toti "hazvigone kukuvadza chero munhu," kana "zvinofanirwa kukuvadza mumwe munhu." Muzera rino reresin-based restorative dentistry, kana huwandu hwevanachiremba vemazino huri kuwedzera zvachose pasina kubatana, isu tine mukana uri nyore wekurarama nechengetedzo. Iyo nguva yakwana kuendesa mazino amalgam kunzvimbo yayo inokudzwa munhoroondo yemazino, uye rega iende. Tinofanira kuenda kumberi nekushongedzwa kwayo - kugadzira nzira dzekuchengetedza varwere uye vashandi vezvemazino kubva pakuratidzika kwakanyanya kana zadziso dzabviswa; chengetedza vashandi kubva pakufumurwa kwenguva pfupi, senge kunoitika kana uchidurura zviteyeso.

Meno mercury inogona kungori chikamu chidiki chechinetso chepasirese che kusvibiswa kwemekiyuri, asi ndicho chikamu icho isu vanachiremba vemazino takanangana navo zvakananga. Tinofanira kuenderera mberi nekuedza kwedu kwekuchengetedza zvakatipoteredza, kupatsanura mercury yakaremerwa mvura yakasviba kubva murukova rwetsvina, kunyangwe isu tichimira kushandisa kwayo kunetseka kwehutano hwevanhu.

Stephen M. Koral, DMD, CHIKAMU

_________

Kuti uwane rumwe ruzivo rwakakwana pane iyi nyaya, ona "Amalgam Njodzi Yekuongorora 2010" uye "Amalgam Njodzi Yekuongorora 2005. "

Chairi chekupedzisira, chinyorwa ichi chakaburitswa muna Kukadzi, 2013 chinyorwa che "Kuunganidzwa Kwekuenderera Dzidzo muDentistry." 

Yekuwedzera hurukuro pamusoro pekuongororwa kwenjodzi ine chekuita neyemazino amalgam inogona kuverengwa mu "IAOMT Position Pepa rinopesana neDental Amalgam. "

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