REPOSITORY > RESULTS

Abstract

The present dissertation evaluates the effectiveness of the Minamata Convention implementation in Slovenia with a specific focus on regulatory measures related to dental amalgam phase-out, by drawing on administrative and environmental metrics. It first examines policy implementation in the dental sector, particularly the phase-out of dental amalgam, and then evaluates actual mercury exposure patterns through human biomonitoring in children. Consistent with Article 22 of the Minamata Convention, these two components were used to determine how regulatory measures translate into measurable outcomes.
The administrative component of the dissertation investigates the responses of 171 dentists to a comprehensive questionnaire to understand current practice regarding the use and phase-out of dental amalgam. It assesses compliance with EU Regulation 2017/852, its 2024 amendment (Regulation (EU) 2024/1849), and the Minamata Convention. Conducted as a cross-sectional study, the research collected information on amalgam use, alternative restorative materials, legislation, and separator practices, while also identifying challenges and support needs for transitioning to mercury-free dentistry. The results revealed regional and sector specific variations in amalgam use, emphasizing the role of education, financial incentives, and safety standards on professional practices and the environmental impact. Amalgam use varied the most in adult clinics, influenced by clinical needs, patient preferences, and systemic barriers related to the reimbursement of costs for alternative materials that were not covered by health insurance until recently. Paediatric clinics demonstrated higher compliance with phase-out guidelines, highlighting the effectiveness of targeted training and policy interventions. These findings provide valuable insights for policymakers and other stakeholders to enhance and improve the planning and implementation of measures (primarily regulative) and support mechanisms to mitigate health risks associated with the use of mercury, and encourage transition to safer dental practices. Since the level of compliance with regulatory requirements varies across regions, targeted measures, particularly in adult clinics, were suggested to improve the transition process. Targeted educational programs and financial incentives are crucial for successful gradual phase-out of dental amalgam.
The environmental component of the dissertation analysed urinary mercury (U-Hg) concentrations in 1.412 Slovenian children across four human biomonitoring campaigns conducted between 2007 and 2024. Median U-Hg levels declined from 0.76 ng mL⁻¹ in the 2007 PHIME cohort to 0.22 ng mL⁻¹ in the 2018–2024 SLO-HBM-II cohort, paralleling reductions in the prevalence of amalgam fillings (from 65% to 3%) and the average number of fillings per child. Multilevel mixed-effects models showed a consistent temporal decline in U-Hg after controlling for demographic and environmental covariates, whereas including amalgam number substantially attenuated the time trend, suggesting that reduced amalgam use contributed to the overall decrease. As amalgam prevalence declined, other sources of exposure, such as fish consumption, became relatively more influential predictors of U-Hg, while children living in historically Hg-contaminated areas exhibited persistently higher levels. Although Slovenia phased down dental amalgam use in children befor ratifying the Minamata Convention, these long-term biomonitoring data illustrate how shifts in exposure sources are reflected in internal mercury levels and demonstrate the value of repeated national HBM programmes for tracing exposure pathways, monitoring their evolution, and providing evidence relevant to effectiveness-evaluation frameworks under Article 22 of the Minamata Convention.