en Water quality and wastewater treatment and reuse Systematic Review <div style="text-align: justify;"><span style="font-size:12pt"><span style="line-height:115%"><span style="font-family:&quot;Calibri&quot;,sans-serif"><b><i><span style="font-size:10.0pt"><span style="line-height:115%"><span style="font-family:&quot;Times New Roman&quot;,serif">Introduction</span></span></span></i></b><b><i><span style="font-size:10.0pt"><span style="line-height:115%"><span style="font-family:&quot;Times New Roman&quot;,serif">:</span></span></span></i></b><span style="font-size:10.0pt"><span style="line-height:115%"><span style="font-family:&quot;Times New Roman&quot;,serif"> Dental amalgam, a mercury-based restorative material, is a significant point source of environmental mercury contamination in clinical wastewater. Mercury and other heavy metals from dental clinics enter wastewater systems untreated, posing risks to ecosystems and human health. This review </span></span></span><span style="font-size:10.0pt"><span style="line-height:115%"><span style="font-family:&quot;Times New Roman&quot;,serif">uniquely bridges the critical gap between dental practice effluent pathways, quantitative environmental risk assessment, and practical evaluation of mitigation technologies.</span></span></span><b><span style="font-size:10.0pt"><span style="line-height:115%"><span style="font-family:&quot;Times New Roman&quot;,serif"></span></span></span></b></span></span></span><br> <span style="font-size:12pt"><span style="line-height:115%"><span style="font-family:&quot;Calibri&quot;,sans-serif"><b><i><span style="font-size:10.0pt"><span style="line-height:115%"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="letter-spacing:-.1pt">Methods and Methods:</span></span></span></span></i></b><span style="font-size:10.0pt"><span style="line-height:115%"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="letter-spacing:-.1pt"> A comprehensive literature search was conducted using Scopus, Web of Science, PubMed/MEDLINE, and Embase for publications from 2000 to 2024. This review focused on studies quantifying mercury in dental wastewater and evaluated the effectiveness of containment, treatment, and policy measures.</span></span></span></span></span></span></span><br> <span style="font-size:12pt"><span style="line-height:115%"><span style="font-family:&quot;Calibri&quot;,sans-serif"><b><i><span style="font-size:10.0pt"><span style="line-height:115%"><span style="font-family:&quot;Times New Roman&quot;,serif">Results:</span></span></span></i></b><span style="font-size:10.0pt"><span style="line-height:115%"><span style="font-family:&quot;Times New Roman&quot;,serif"> The findings confirmed that dental clinics contribute substantially to mercury loads in wastewater, with a single chair releasing as much as 4.5 g/day. Reported mercury concentrations in dental effluent vary widely, ranging from 0.90 &micro;g/L to 39 mg/L, reflecting differences in clinical practices and control measures. The primary mitigation technology is amalgam separators, which can remove more than 90% of amalgam particles and are increasingly required by regulations, such as the U.S. Environmental Protection Agency 2017. A multi-faceted approach combining separators, optimized chairside practices, waste segregation, and staff education is essential for effective management.</span></span></span></span></span></span><br> <b><i><span style="font-size:10.0pt"><span style="line-height:115%"><span style="font-family:&quot;Times New Roman&quot;,serif">Conclusion:</span></span></span></i></b><span style="font-size:10.0pt"><span style="line-height:115%"><span style="font-family:&quot;Times New Roman&quot;,serif"> Despite the declining use of dental amalgam, it remains an important environmental concern. Effective mitigation requires a combination of stringent policies, proven technologies, and professional stewardship. Future efforts should prioritize standardized monitoring, long-term performance data on control measures, and robust cost-benefit analyses to guide sustainable dental practices.</span></span></span></div> Dental Amalgam, Mercury, Dental Unit Wastewater, Amalgam Separator, Environmental Pollution, Wastewater Management. 2804 2814 http://jehsd.ssu.ac.ir/browse.php?a_code=A-10-81-4&slc_lang=en&sid=1 Mahla Mazloomian behdasht1998@gmail.com 0000-0003-2049-1153 No Environmental Sciences and Technology Research Center, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran Mohammad Taghi Ghaneian mtghaneian@gmail.com 0000-0002-6665-2226 No Environmental Sciences and Technology Research Center, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran Niloufar Borhani Yazdi سلام خانم دکتر behdasht1998@gmail.com nborhani795@gmail.com 0000-0001-9024-8779 No Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran Mohammad Hassan Ehrampoush ehram2000@yahoo.com 0000-0002-0388-3211 No Environmental Sciences and Technology Research Center, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran Farzan Madadizadeh statlearningeasy@gmail.com 0000-0002-5757-182X No Medical Informatics Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran Maryam Gholami gholami313114@gmail.com 0000-0001-7310-8600 Yes Genetics and Environmental Hazards Research Center, Abarkouh School of Medical Sciences, Shahid Sadoughi University of Medical Sciences, Yazd, Iran