Conrad Naleway

Behavioral Effects of Low-Level Exposure to Hg" Among Dentists

Abstract Exposure thresholds for health effects associated with elemental mercury (Hg∘) exposure were examined by comparing behavioral test scores of 19 exposed (mean urinary Hg = 36 μg/l) with those of 20 unexposed dentists. Thirty-six μg Hg/l is 7 times greater than the 5 μg Hg/l mean level measured in a national sample of dentists. To improve the distinction between recent and cumulative effects, the study also evaluated porphyrin concentrations in urine, which are correlated with renal Hg content (a measure of cumulative body burden). Subjects provided an on-site spot urine sample, were administered a 1-h assessment consisting of a consent form, the Profile of Mood Scales, a symptom and medical questionnaire, and 6 behavioral tests: digit-span, symbol-digit substitution, simple reaction time, the ability to switch between tasks, vocabulary, and the One Hole Test. Multivariate regression techniques were used to evaluate dose-effects controlling for the effects of age, race, gender and alcohol consumption. A dose-effect was considered statistically significant below a p value of 0.05. Significant urinary Hg dose-effects were found for poor mental concentration, emotional lability, somatosensory irritation, and mood scores. Individual tests evaluating cognitive and motor function changed in the expected directions but were not significantly associated with urinary Hg. However, the pooled sum of rank scores for combinations of tests within domains were significantly associated with urinary Hg, providing evidence of subtle preclinical changes in behavior associated with Hg exposure. Coproporphyrin, one of three urinary porphyrins altered by mercury exposure, was significantly associated with deficits in digit span and simple reaction time. The prophyrin pooled sums of rank scores were as sensitive as the urinary Hg analyses within the cognitive and motor domains but were less sensitive for the overall battery of tests. The reported effects were detected among dentists with a mean urinary Hg level of 36 μg/l, which lies between the proposed biologic thresholds of 25 and 50 μg Hg/creatinine, suggesting the need for a more comprehensive study to determine the threshold of adverse biologic effects.

Behavioral Effects of Low-Level Exposure to Hg0 Among Dental Professionals: A Cross-Study Evaluation of Psychomotor Effects

A Across-study design was used to evaluate the sensitivities of five psychomotor tasks previously used to assess preclinical effects of low-level Hg0 (urinary < or =55 microg/l). Pooling dental professional subject populations from six studies conducted over the last 6 years, a larger study population was obtained with a high degree of uniformity (N = 230). The five psychomotor tests were: Intentional Hand Steadiness Test (IHST); Finger Tapping: The One-Hole Test: NES Simple Reaction Time (SRT); and Hand Tremor. Multivariate analyses were conducted following the hierarchical analysis of multiple responses (HAMR) approach. First, multiple scores of each test were combined into a single-factor (or related summary) variable and its reliability was estimated. Second. multiple regression analyses were conducted including log-transformed [Hg0]U levels, age, gender, and alcohol consumption in each model. Computed were both B and bu, the magnitudes of the log-Hg0 standardized coefficient. respectively uncorrected and corrected for dependent variable attenuation due to unreliability. Results indicated remarkable differences in the effects of relative level of Hg0 on psychomotor performance. Significant associations were found for the IHST factor (B = 0.415, p < 10(-6)), followed by finger tapping, which was relatively meager and insignificant (B 0.141, p = 0.17). The IHST results hold the greatest occupational relevance for dental professionals who rely on manual dexterity in restorative dentistry. Further, this statistical approach is recommended in future studies for condensation of multiple scores into summary scores with enhanced reliabilities useful in correcting for attenuation relationships (B(u)s) with exposure levels.

Fractional mercury levels in Brazilian gold refiners and miners

A field study survey of individuals residing in the region of Para, Brazil, was conducted to determine fractional mercury levels in individuals at risk for exposure in the Brazilian Amazon region. Subjects with a history of exposure to mercury either in the gold mining or refining industry, or exposure to these processes through proximity were included. Three groups were identified as either having recent (less than 2 d since last exposure), intermediate (less than 60 d), or remote (greater than 60 d) exposure to mercury vapors. Fractional blood and urinary mercury levels were assessed for these groups. Group I (recent) had the highest geometric mean blood 24.8 (SD 44.1, range 7.6-158.8) micrograms/L and urine 75.6 (SD 213.4, range 6.5-735.9) micrograms/g-cr (microgram mercury per gram of creatinine) mercury; intermediate (group II) geometric mean blood 7.6 (SD 5.5, range 2.2-19.4) micrograms/L and urine levels 23.8 (SD 84.0, range 7.8-297.0) micrograms/g-cr; the lowest levels in remote exposure (group III): geometric mean blood 5.6 (SD 3.3, range 3.1-14.3) micrograms/L and urine 7.0 (SD 9.8, range 3.1 to 32.9) micrograms/g-cr. The fraction of organic was lowest in group I (32.4%), higher in group II (65.7%), and highest in group III (72.2%). While the frequency of symptoms was comparable in the recent and intermediate groups (2.6 mean, SD 2.3, range 0-8, and 3.1 mean, SD 1.9, range 0-7, symptoms per patient), those with remote exposure demonstrated the highest rate of reporting (6.4 mean, SD 4.1, range 0-11, symptoms per patient). There is significant exposure to mercury for those working in or living near the mining and refining industry. Blood and urine levels are a better marker of recent than remote exposure. The fraction of organic mercury increases with time since exposure. Symptoms may be persistent and low levels of blood and urine mercury do not exclude remote or cumulative toxicity.

Assessment of the effectiveness of glove use as a barrier technique in the dental operatory

To assess the effectiveness of routine glove use as a barrier technique in the dental operatory, the relationship between frequency of glove use and hepatitis B infection was examined. Hepatitis B screening results and information on infection control practices of 1,109 dentists who attended the 1985 annual session were compiled and statistically analyzed. The results showed that 18% of the dentists wore gloves routinely, 65% wore gloves intermittently, and 17% never wore gloves. Frequency of glove use was related to hepatitis B infection (P less than .01), with dentists who never wore gloves being infected more than twice as often as dentists who wore gloves routinely. Dentists with less frequent glove use and more years in practice had a higher incidence of hepatitis B infection (P less than .0001).

Use of an in vitro model to assess the effects of APF gel treatment on the staining potential of dental porcelain

Porcelains and resin composites exposed to acidulated phosphate fluorides (APF) have been reported to result in increased roughness, loss of weight, and loss of specular reflectance (gloss). Six samples of five commercial porcelains were subjected to five four-minute treatments with APF gels. Samples were then subjected to a nine-day cyclic staining procedure that utilized a tea, coffee, and mucin mixture. Changes in reflectance were then measured by means of a Minolta Chromameter (CR121) and converted to CIE L* a* b* values at illuminant D65 against a white background. delta L*, delta a*, delta b*, and delta E values were calculated. There was a substantial decrease in the L* value (lightness) for all porcelains. The average L* value for APF-treated and then stained porcelains was 43.6, for the stained-untreated samples, 48.2, and for untreated-unstained porcelain, 53.5. For three of the five porcelains, the differences in L* between treated and untreated stained porcelains were statistically significant. Changes in a* and b* values were also found to be consistent with but not as large as the changes in L*.