• Kefi I Kefi
  • Maria A Maria
  • Majid Z Majid
  • Sana J Sana
  • Afreen M Afreen
  • Fareed M Fareed
  • Feroze A Feroze
  • Sajid H Sajid
  • Adel S Adel
  • Iftikhar A Iftikhar
  • Yawer A Yawer
  • Kaleem M Kaleem


Background: Silver dental amalgam is one of the oldest filling materials used in dentistry. TheAmerican Dental Association (ADA) has estimated that billions of amalgam restorations have beenplaced in patients in the last 150 years. Due to the presence of mercury and mishandling during thefilling make it more controversial. The objective of this study was to conduct a survey of the use ofdifferent brands and to assess any deviations in practice from the hand mixing manual method ofelemental mercury and alloy in a pestle/mortar and encapsulated form. Methods: A questionnaire wassent to 250 of randomly selected dental practitioner in various localities of Karachi. Data was analysed torecord the specified brands used along with their powder/liquid (P/L) ratio and the different methods fordisposing off mercury in this study. Results: The most commonly used form of dispensing method washand mixing (57%) and only 30% of the dentists followed the manufacturer instruction for hand mixingratio. Eighty-seven percent of dental amalgam restoration was performed and 13% removed by thedentist per month and the method of disposing the amalgam wastage that 55%, 25%, and 20% dentistswere used the sink, bin and other methods respectively in their dental clinics. Conclusion: Amalgamrestoration is still popular filling material in the posterior region of the mouth but we need to createawareness among the dentists who do not follow the ADA specifications.Keywords: Dental amalgam, alloy mercury ratio, amalgam wastage, amalgam dispensing


Xibio Y, Haojun Q, Peicheng X, Lin Z, Matthew PL, Hua F.

Nephrotoxicity, neurotoxicity, and mercury exposure among

children with and without dental amalgam filling. Int J Hyg

Environ Health 2009;212:378–6.

Lorscheider FL, Vimy MJ, Summer AO. Mercury exposure from

silver tooth fillings: emerging evidence questions a tradional

dental paradigm. FASEB J 1995;9:504–8.

Riethe P. The historical development of amalgams. Dtsch

Zahnarztl Z 1980;35:443–9.

Hyson JM, Jr. Amalgam: Its history and Perils. J Calif Dent Assoc


Sortur SH (Editor). Essential of dental material 1st ed. New Delhi:

Jaypee Brother Medical Publisher Pt (Ltd); 2002.p. 202.

Richard AD, Shaghayegh A, Wei-Hua M, Kun T, Fariborz F,

Brian WD, Gregory AC. Geometric, electronic and elastic

properties of dental silver amalgam g-(Ag3Sn),g1-(Ag2Hg3), g2-

(Sn8Hg) phases, comparison of experiment and theory.

Intermetallics 2010;18:756–60.

Sonja MM. The children’s amalgam trial study group. The Children’s

amalgam trial: design and methods. The children’s amalgam trial

study group. Controlled Clinical Trial 2003;24:795–814.

Mc Cabe JF, Walls AWG. Applied Dental Materials 9th ed. U.K:

Blackwell; 2008.p. 181–3, 192.

Powers JM, Sakaguchi RL Craig’s Restorative Dental Materials.

th ed., 11830, St Louis, Missouri: Mosby; 2006. p. 248.

Swedish Council for Planning and Coordinating Research (FRN)

Stockholm. Report No. 2652, 19 February 1998. Helsetilsynet

[Norwegian Board of Health Supervision] Available at: (accessed 26 August 2009).

Lundberg S. Swedish views on questions put at the stakeholder

meeting concerning the mercury export ban and storage

obligations of mercury 8th September 2005. Brussels, European

Commission, Ministry of Sustainable Development, Division for

Eco-management and Chemicals, 2005.

Anderson BA. Dental amalgam: a report with reference to the

medical devices directive 93/42/EEC from an Ad Hoc Working

Group mandated by DGIII of the European Commission.

Angelholm, Sweden: Nordiska Dental AB; 1998.

Dental mercury use banned in Norway, Sweden and Denmark.

Reuters, January 3, 2008. Available at:


Best management practices for amalgam waste. American Dental

Association [online article]. Available at:

prof/resources/topics/amalgam_bmp.asp. (accessed 26 Aug 2009).

Hörsted-Bindslev P. Amalgam toxicity-environmental and

occupational hazards. J Dent 2004;32:359–65.

Best Management Practices for Amalgam Waste. 211East

Chicago Avenue, Chicago, Illinois 60611-2678 American Dental

Association. October 2007. Available at:


Dowling AH, Fleming GJ. Is encapsulation of posterior glassionomer restoratives the solution to clinically induced variability

introduced on mixing? Dent Mater 2008;24:957–66.

Mumtaz R, Ali Khan, Noor N, Humayan S. Amalgam use and

waste management by Pakistani dentists: an environmental

perspective. East Mediterr Health J 2010;16:334–9.

American Dental Association. When your patients ask about

mercury in amalgam. J Am Dent Assoc 1990;120:395–8.