Overview of the Occupational Health and Safety in the United States:
Why is considering occupational health and safety so imperative for dentists and dental workers who are exposed to dental mercury from amalgam fillings? National standards for occupational health and safety are founded upon the undeniable fact that industry can kill and seriously harm workers. This concept has been tragically evidenced by a list of veritable disasters, including the development of Caisson’s disease during the Brooklyn Bridge construction, the Triangle Shirtwaist Factory fire, and asbestos exposure from manufacturing.
As a result, the United States and most developed countries of the world have adopted standards for occupational health, safety, and worker protection. Such standards generally state that when it is reasonable to assume a risk is present, the employer is required to take appropriate measures to protect its workers. In the United States, this effort was first officially attempted with the Occupational Safety and Health Act (OSH Act), which was passed by Congress in 1970.
However, the Occupational Safety and Health Act is clearly a work in progress, which is made especially evident by the Workers’ Right to Know Act of 1987. This “addition” to the Occupational Safety and Health Act became necessary because in some cases, workers were endangered without their knowledge.
At any extent, when it comes to dental mercury, employee exposure is strictly regulated by the 1970 Occupational Health and Safety Act and the 1987 Right to Know Act. OSHA’s Hazard Communication Standard (HCS) states: “All employers with hazardous chemicals in their workplaces must have labels and safety data sheets [SDS] for their exposed workers, and train them to handle the chemicals appropriately. The training for employees must also include information on the hazards of the chemicals in their work area and the measures to be used to protect themselves.”
A major issue with these occupational health and safety standards for dental mercury is that while there might be safety data sheets and training requirements, dental mercury is still being used. Additionally, the few existing OSHA standards related to dental mercury are not being enforced, and many dental workers are not aware of the occupational risks. What this means is that dentists, their staff, and dental students are all still being exposed to mercury, and patients are as well.
Norway was the first country in the world to ban the use of dental amalgam mercury fillings in January 2008. Most people are not aware that part of the impetus for the Norwegian ban can be linked to the movement against on-the-job injury from dental mercury. In 1994 dental nurse Tordis Stigen Klausen contacted the Government and the Regional Development and Directorate of Norwegian Labour Inspection (similar to the USA’s Occupational Safety and Health Administration) to bring the issue of dental mercury exposure to their attention.
It took years, but in 2012, Tordis Stigen Klausen succeeded in having the Norwegian Labour and Welfare Service (NAV) officially acknowledge her mercury-related occupational illness. Norway’s Supreme Court upheld the decision to officially acknowledge mercury injury as an occupational disease.
Scientific studies have demonstrated hazards of mercury in the dental workplace by providing data about the following occupational health and safety issues related to dental mercury:
- Handling of dental mercury waste
- Occupational health risks for dental workers
- Occupational health risks for female dental workers
- Health risks for dental students
- Need for protective measures
Each year that passes brings more evidence and data showing that mercury fillings pose risks to dental workers, patients, and the environment. Meanwhile, there is clearly a global trend to phase-down the use of mercury, as aptly evidenced in the United Nations Environment Programme’s Minamata Convention on Mercury, which entered into force in 2017. Thus, it seems inevitable that protective measures for dental mercury will be called for more and more over the next decade.
It is also essential to note that if placing dental mercury fillings is ever completely banned, mercury fillings will still be in the mouths of millions of patients. The IAOMT encourages dental professionals to utilize measures that mitigate mercury exposures to dentists, their staff, and patients during amalgam removal. These recommendations are known as the Safe Mercury Amalgam Removal Technique (SMART) and are based on up-to-date science. In addition to protecting patients and the environment, SMART provides occupational health and safety measures for dentists and other staff who are exposed to dental mercury.