[dentalcleanse] FAQ, Amalgam Related Ilness

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Some references are on the the bottom, more is available on the web site:

http://www.algonet.se/~leif/AmFAQk03.html

This site is " most scientific " of all web sites.=20

Excerpts from this page:

http://www.algonet.se/~leif/AmFAQk03.html

3. IS IT POSSIBLE THAT DENTAL AMALGAM CAN CAUSE THESE SYMPTOMS?

3.1 Are we exposed to toxic levels of mercury from our amalgam fillings?=20

Dental amalgam consists of approximately 50% (inorganic) mercury (by

weight) ( DHHS 1993 page I - 2). Besides mercury the amalgam usually

consists of silver, tin, copper and sometimes zinc, palladium, or indium (

DHHS 1993 page I - 2). Mercury is highly toxic. Whether or not mercury or

any other specific (toxic) metal will cause toxic and / or immunological

reactions depends upon a combination of at least:=20

1) the absorbed dose (NIH 1992)=20

2) the genetically determined individual sensitivity (NIH 1992 page 142)=20

3) other factors as:=20

a) age of the individual (NIH 1992)=20

body weight=20

c) nutritional status (NIH 1992)=20

d) additional / synergistic effects of exposure to other heavy metals=20

e) alcohol consumption (NIH 1992)=20

f) existence of pre-existing diseases (NIH 1992) for example acatalasia=20

g) duration of exposition (NIH 1992) including foetal exposure (NIH 1992)=20

h) exposure route (NIH 1992)=20

i) chemical state of the metal (vapour, metallic, salts, organic)=20

Allergic and / or autoimmune reactions to metals, however, do not need to

follow the same dose-dependency as that seen in toxic reactions, in fact we

know very little about the doses needed in order to give allergic or

autoimmune reactions in susceptible humans. Mercury is released from your

amalgam-fillings (Bjorkman 1992, Gay 1979, Langworth 1988, Skare 1994, WHO

1991...) and is taken up by your body (Molin 1990, Nylander 1987, Skare

1990, Skare 1994, Weiner 1993, WHO 1991...). However, it seems that

somewhere around 5-200 times (see section 7.2) higher levels of absorbed

Hg-dose, than those people absorb from amalgam-fillings on a group level,

are required to produce adverse health effects (on a group level) in

individuals occupationally exposed to inorganic mercury . This dose-gap

points strongly in the direction that the majority of the population would

not be affected by mercury from their amalgam-fillings. But if there is a

minority (for example 1-3%) of the population that is substantially more

(non-allergic-) sensitive to mercury / amalgam than the rest of the

population there could well be a relation between amalgam-fillings and a

multi-symptomatic illness in such a minority, the question is however

scientifically unclear. A small minority of the (non-occupationally mercury

exposed) amalgam-bearing population, has raised mercury levels from their

amalgam fillings (see section 7.3), could (some of) these individuals get

symptoms because of raised mercury levels rather than raised sensitivity to

mercury?

3.2 Studies in individuals with suspected (non-allergic-) amalgam-related

illness.=20

3.2.1 Do they have higher mercury levels?

A small fraction of the population with suspected (non-allergic-)

amalgam-related illness as well as apparently healthy people has been

reported to have rather high mercury levels in some body-fluids. However,

individuals with suspected (non-allergic-) amalgam-related illness have, on

a group level, not shown to have significantly higher mercury levels in

their blood-plasma (Berglund 1996, Molin 1987,) / whole blood /

erythrocytes (Berglund 1996, Molin 1995) / urine (Aronsson 1989, Berglund

1996, Molin 1995,) / intraoral air (Aronsson 1989 , Berglund 1996,Fredin

1988) than healthy people with the same amount of amalgam. So it seems that

if there is a (non-allergic-) amalgam-related illness in individuals

suspecting they have such an illness, it is, on a group level, based upon

increased (non-allergic-) sensitivity towards mercury / amalgam rather than

higher mercury levels in these body fluids compared with the general

population. This does not exclude that there could be a sub-minority among

people with suspected amalgam-related illness that has an illness more

because of raised mercury-levels than raised sensitivity to mercury. There

have been reports of cases where raised mercury levels from, as it seems,

amalgam fillings is highly suspected to be the cause of illness (Barregard

1995, Langworth 1996, Taskinen 1989).=20

3.2.2 Provocation with Hg / amalgam in these patients.

Marcusson (1996),(1. see references) in a double-blinded study,

patch-tested (with mercury or placebo) a selected group of patients who had

earlier reported symptom-increase in conjunction with drilling out of old

amalgam fillings. Marcusson reported that the symptoms increased after

patch testing with phenyl mercuric acetate (but not significantly with

metallic mercury) compared to placebo. As the calculated mercury uptake

from a patch-testing (4-10 ug, Marcusson1996) is about the same as one days

uptake of mercury from amalgam (3-17 ug, WHO 1991, a non-allergic systemic

reaction to such a patch-test can be seen upon as a sign of a extreme

individual non-allergic sensitivity to mercury.=20

3.2.3 Did these individuals get a symptom reduction after amalgam removal?=

=20

Reports stating that groups of people, suspecting that they have a

(non-allergic-) amalgam-related illness, have reduced their symptoms, by up

to 80%, after removing their amalgam-fillings have been presented

(Lichtenberg 1993, Lindqvist 1996, Siblerud 1990) (se references 2.,3.,4.).

Also presented are case-reports of people regaining their health after

amalgam-removal (Barregard 1995, Godfrey 1990, Langworth 1996, Redhe

1994)(se references 5.,6.,7.,8.). It is not possible to definitely

distinguish between a ceased poisoning, a placebo-effect, spontaneous

recovery or biases due to the subjects potential desire to have his own

view on the causation of his illness confirmed or due to his desire to

please the investigator. Berglund (1995) has reviewed the case-reports of

adverse effects to amalgam, available in the literature, and found that:

" Removal of amalgam was the common measure that led to improvement or cure "

In several countries there are patient organisations with members convinced

that they have achieved a symptom reduction after amalgam removal.=20

Twelve months after a complete amalgam-removal the mercury levels in plasma

and urine are reduced to about 50 % (Molin 1990) and 25 % (Begerow 1994,

Molin 1990, Molin 1995) respectively of the levels that were present before

the amalgam-removal.

3.3 Epidemiological comparisons between individuals with different amounts

of amalgam.

There are epidemiological studies that found that groups of individuals

with few or no amalgam-fillings were healthier than groups of individuals

that had (more) amalgam-fillings (Kampe 1986, Siblerud 1990b , Siblerud

1994). Contrary to this there are studies that failed to show this (Saxe

1995, Ahlqwists 1988). Because of methodological problems they can not,

alone or together, conclusively answer the question if there is a minority

of the population that has or hasn't got a (non-allergic-) amalgam related

illness. Ahlqwists report (1988), however, seems to give additional support

to the conclusion (se section 3.1) that a majority or even a big minority

(for example over 10-30 %) of the general amalgam-bearing population is

probably not negatively health effected from their dental amalgam fillings.

Among the methodological problems, that these studies are afflicted with,

are:=20

all these reports had selected groups because belonging to a

non-(few)-amalgam-bearing or high number-amalgam group sub-populations has

reasons, for example:=20

depression -> antidepressants -> lower salivary flow -> more caries -> more

amalgam...

=20

asthma -> medicine -> changed oral microflora -> increased caries risk ->

individual knows this and overcompensates for this -> less caries -> fewer

amalgam fillings...

=20

loosing teeth -> fewer amalgam fillings

=20

So which came first? Socio-economic group belonging, illness/health, (dys-)

function, tooth loss... which gave rise to different amount of amalgam

fillings or the amalgam fillings which gave rise to changed socio-economic

group, illness/health, (dys-) function, tooth loss...? Correlation / lack

of correlation does not prove a true effect / no effect, it only proves a

correlation / no correlation. The mechanism can not easily be determined as

there are more than one variable (amalgam per se and all the variables that

makes individuals belong to a non (low)- or high number-amalgam group).=20

some reports had an extra much selected patient material (Siblerud 1990b ),

(Siblerud 1994- local newspaper advertisements for people with no amalgam

and for people with at least 10 amalgam-fillings), (Ahlqwist 1988; a major

(the main?) reason why the group with 0-4 amalgam-fillings had only a few

amalgam-fillings was that they had lost their teeth and there were no

information available about how long ago they lost their teeth or how many

amalgam-fillings they had before loosing their teeth. Also the age range

was limited to 38-72 years old, women only), (Ahlqwist 1988; Invited to the

study were 1827 individuals but only about 984 remains as the base for Fig

1-2 and table 2 and a maximum of 1158 for table 3-4 in this study =3D

participants, this participation rate (approximately. 54% and 63%

respectively - the higher participation rate for table 3-4 is achieved

because here individuals without any own teeth are included) is not high

enough to exclude effects in a minority of the population, there could have

been a selection, of eventual individuals having an adverse reaction to

amalgam, into the non-participants group). (Ahlqwist 1988,Saxe 1995; there

is a hypothetical possibility that (some) individuals who had suspected an

amalgam-related illness could have removed their amalgam-fillings, thereby

left the group of amalgam-bearers with many amalgam fillings. No

information if the study-objects had done so was presented.), (Saxe 1995;

Women only, age range 75-102 years).=20

insufficient sensitivity: the number of participants in the

non(low)-amalgam group were small (Ahlqwist 1988; 193 individuals, Saxe

1995; 22 individuals) -> hard / impossible to detect an effect that would

only affect a small minority (for example 1-3%) of the high number amalgam

group, especially since the symptoms of Hg-intoxication are unspecific and

very usual in the common population. Ahlqwist (1988) used the prevalence of

the symptoms rather than the severity of the symptoms, the question was

" Have you had any of the following symptoms during the last three months " .=

=20

-one of these reports had no unexposed control-group (Ahlqwist 1988)

compared a 0-4 with a >20 number of amalgam-fillings group)=20

______________________________________________________

REFERENCES with abstaract:

1.

http://www.algonet.se/~leif/yfmar96a.html

Marcusson JA.

Psychological and somatic subjective symptoms as a result of dermatological

patch testing with metallic mercury and phenyl mercuric acetate.

Toxicology Letters 84(2):113-122 (1996)

ABSTRACT: " Sixty patients with a history of malaise over the ensuing weeks

following the drilling out of old amalgam fillings were included in the

study. They were tested epicutaneously weekly (standard procedure) with

either 0.5% metallic mercury in petrolatum or 0.01% phenyl mercuric acetate

in water, and, on 2 separate occasions, with only saline or petrolatum as a

control according to a randomized double-blind protocol. The presence or

absence of an allergic patch test response was read on day 3. Two patients

showed allergic cutaneous responses towards metallic mercury and 1 to

phenyl mercuric acetate. There was a concurrent 7-day self-registration of

subjective psychological and somatic symptoms, using a validated visual

analogue scale (minor symptom evaluation profile; MSE). In the group

analysis it was clearly shown that the patients reacted with subjective

symptoms to phenyl mercuric acetate. A reaction to test doses of metallic

mercury seems to exist but could only be visualized when a scoring system

was elaborated to individually define those subjects with a psychological

and somatic response to test doses of mercury. This psychosomatic

reactivity, named intolerance, seems to be unrelated to the cutaneous

delayed allergic skin response. Thus, it might be possible to identify

patients intolerant to small test doses of percutaneously penetrating

mercury (previously considered innocuous). These findings may have a

bearing on the systemic side-effects attributed to mercury released from

amalgam tooth fillings. " =20

2.

http://www.algonet.se/~leif/yfLIC93a.html

Lichtenberg H J

Elimination of symptoms by removal of dental amalgam from mercury poisoned

patients, as compared with a control group of average patients.

J Orthomol Med 8:145-148 (1993)

ABSTRACT: " The findings presented here suggest a correlation between many

health complaints and mercury amalgam fillings. Removal of amalgam fillings

results in significant improvement of these symptoms. These same symptoms

which are improved or eliminated in amalgam-removal patients are present

but undiagnosed in the general population. " =20

3.

http://www.algonet.se/~leif/yflin96a.html

Lindqvist B & Mornstad H.

Effects of removing amalgam fillings from patients with diseases affecting

the immune system.

Med Sci Res 24:355-356 (1996)

ABSTRACT: " 53 patients with complaints which they attributed to their

amalgam fillings, and with pathological tests indicating abnormality of the

immune system, were followed for 1-3 years after the removal of all, part

of, or none of their amalgam fillings. Within the group of 34 individuals

who had all their amalgam fillings replaced, there was a significant number

of decreased antibody titres, but only two had normalised their laboratory

tests after 1-3 years. A significant improvement in subjective symptoms

occurred in 20 (59%) of cases. In the group of patients who still had

amalgam fillings, there were no statistically significant changes in the

antibody titres. It thus seems that mercury released from amalgam fillings

may initiate or support an ongoing immune disease. However. this study

group was rather heterogeneous, and had received various pharmacological

treatments. Further studies, are, therefore, needed to confirm, or refute,

the results. [References: 12] " =20

4.

Siblerud R L

Health Effects After Dental Amalgam Removal.

J Orthomolecular Med 5(2):95-106 (1990a)

NO ABSTRACT AVAILABLE=20

5.

Barregard L, Sallsten G & Jarvholm B

People with high mercury uptake from their own dental amalgam fillings.

Occup Environ Med 52:124-128 (1995)

ABSTRACT: " Objectives - To describe people with high mercury (Hg) uptake

from their amalgam fillings, and to estimate the possible fraction of the

occupationally unexposed Swedish population with high excretion of urinary

Hg. Methods - Three case reports are presented. The distribution of

excretion of urinary Hg in the general population was examined in pooled

data from several sources. Results - The three cases excreted 23-60 ug of

Hg/day (25-54 ug/g creatinine), indicating daily uptake of Hg as high as

100 ug. Blood Hg was 12-23 ug/l, which is five to 10 times the average in

the general population. No other sources of exposure were found, and

removal of the ammalgam fillings resulted in normal Hg concentrations.

Chewing gum and bruxism were the probable reasons for the increased Hg

uptake. Extrapolations from data on urinary Hg in the general population

indicate that the number of people with urinary excretion of more than or

equal to 50 ug/g creatinine could in fact be larger than the number of

workers with equivalent exposure from occupational sources. Conclusion -

Although the average daily Hg uptake from dental amalgam fillings is low,

there is a considerable variation between people; certain people have a

high mercury uptake from their amalgam fillings. " =20

6.

Godfrey ME.

Chronic illness in association with dental amalgam: Report of two cases.

J Adv Med 3:247-255 (1990)

ABSTRACT: " Two case studies, involving multiple symptomatology, are

presented. A casual relationship with dental amalgam is proposed, with

remission of symptoms and signs following removal of the source. " =20

7.

Langworth S & Stromberg R.

A case of high mercury exposure from dental amalgam.=20

Eur J Oral Sci 104:320-321 (1996)=20

ABSTRACT: " This report describes a patient who suffered from several

complaints, which by herself were attributed to her amalgam fillings.

Analysis of mercury in plasma and urine showed unexpectedly high

concentrations, 63 and 223 nmol/l, respectively. Following removal of the

amalgam fillings, the urinary excretion of mercury became gradually

normalized and her symptoms declined. " =20

8.

Redhe O & Pleva J

Recovery from amyotrophic lateral sclerosis and from allergy after removal

of dental amalgam fillings.=20

Int J Risk & Safety in Med 4:229-236 (1994)

NO ABSTRACT AVAILABLE. CITATION FROM THE TEXT FOLLOWS: " ...Five months

after the completion of DA removal (29 August 1984) the patient was called

for a week-long investigation at the same University clinic where the

diagnosis ALS had been made. She felt now extraordinarily healthy and her

health status was also confirmed by the words in her record: " The

neurologic status is completely without comment. Hence, the patient does

not show any motor neuron disease of type ALS. She has been informed that

she is in neurological respect fully healthy. " ...At the time of writing

(early 1993), 9 years have elapsed since removal of the DA fillings, and

the patient continues to enjoy good health... " =20

9.

Berglund F.

150 years of dental amalgam. Case reports spanning 150 years on the adverse

effects of dental amalgam. Relationship to poisoning by elemental mercury.

Book published by Bio-Probe, Inc. Orlando, Florida 1995. (ISBN=

0-9410011-14-3)

ABSTRACT: " Case reports over 150 years on adverse effects of dental

amalgam. Relationship to poisoning by elemental mercury. BACKGROUND. Dental

amalgam consists of a 1:1 mixture of metallic mercury and an alloy powder

consisting of silver, tin, copper and zinc. The amalgam continuosly

releases mercury. This is absorbed mainly through the oral mucosa. METHODS.

Case reports on 245 amalgam patients that were published in periodic

scientific journals over 150 years, from 1844 to 1993, were analyzed.

Exposure in terms of dental restorations with amalgam, various metal

alloys, and electro-galvanism, was documented. Symptoms, immunological

tests, dental treatment, and outcome were Analyzed. A summary table

compares symptoms with those in Kussmaul's case reports on mirror workers

in 1861. RESULTS. Almost all of the symptoms in amalgam patients were

reported already in the 19th century and mostly agree with those in chronic

poisoning by elemental mercury. Epicutaneous tests in patients with skin

symptoms were positive to mercury or, in a few cases, to silver or copper.

Removal of amalgam was the common measure that led to improvement or cure.

CONCLUSIONS. Three pathogenic mechanisms prevail: 1) dose-related toxicity

by elemental mercury; 2) immunological (immunosuppression, autoimmunity,

hypersensitivity types 1-4); 3) electrogalvanic, inter alia for leukoplakia

and oral lichen. Recovery after removal of amalgam is often incomplete.

This is also the case after occupational mercury poisoning. The use of

amalgam for dental restorations carries an unacceptable risk of chronic ill

health and suffering. " =20

10.

Molin M, Bergman B, Marklund S L, Sch=FCtz A & Skerfving S

Mercury, selenium, and glutathione peroxidase before and after amalgam

removal in man.=20

Acta Odontol Scand 48:189-202 (1990)

ABSTRACT: " In 10 healthy persons all amalgam were replaced with gold

inlays. Blood and urinary levels were measured on 10 occasions during a

4-month period before and a 12-month period after amalgam removal. These

variables were also measured three times in 10 healthy controls. A strong

statistically significant relation was found between plasma mercury values

and both the total number of amalgam surfaces (r=3D0.71, p=3D0.0006) and the

total surface area of the fillings (r=3D0.73, p=3D0.0004). In the immediate

postremoval phase plasma mercury rose three- to four-fold, whereas the

urinary and erythrocyte mercury rose about 50%. These peak values declined

to the preremoval level at about 1 month. Twelve months after the removal

the plasma and urinary mercury levels were significantly reduced to 50% and

25%, respectively, of the initial values for the experimental group. Apart

from the significantly lower plasma selenium values 5 and 10 days after

removal no significant differences were forund with regard to plasma

selenium or erythrocyte glutathione peroxidase either within or between the

experimental and the control groups. A large number of supplementary

biochemical analyses did not show any influence on organ functions or any

differences between the groups before or after the amalgam removal. Amalgam

fillings considerably contributed to the plasma and urinary mercury levels. " =

=20

11.

Begerow J, Zander D, Freier I & Dunemann L

Long-term mercury excretion in urine after removal of amalgam fillings.

Int Arch Occup Health 66:209-212 (1994)

ABSTRACT: " The long-term urinary mercury excretion was determined in 17 28-

to 55-year-old persons before and at varying times (up to 14 months) after

removal of all (4-24) dental amalgam fillings. Before removal the urinary

mercury excretion correlated with the number of amalgam fillings. In the

immediate post-removal phase (up to 6 days after removal) a mean increase

of 30% was observed. Within 12 months the geometric mean of the mercury

excretion was reduced by a factor of 5 from 1.44 ug/g (range: 0.57-4.38

ug/g) to 0.36 ug/g (range: 0.13-0.88 ug/g). After cessation of exposure to

dental amalgam the mean half-life was 95 days. These results show that the

release of mercury from dental amalgam contributes predominantly to the

mercury exposure of non-occupationally exposed persons. The exposure from

amalgam fillings thus exceeds the exposure from food, air and beverages.

Within 12 months after removal of all amalgam fillings the participants

showed substantially lower urinary mercury levels which were comparable to

those found in subjects who have never had dental amalgam fillings. A

relationship between the urinary mercury excretion and adverse effects was

not found. Differences in the frequency of effects between pre- and the

post-removal phase were not observed. " =20

12.

Molin M, Berglund JR & Mackert Jr

Kinetics of mercury in blood and urine after amalgam removal.

J Dent Res 74:420 IADR Abstract 159 (1995)

ABSTRACT: " Even though a number of studies have not been able to reveal any

correlation between subjective symptoms and amalgam load there still are

speculations wether patients with subjective symptoms related by the

patients themselves to their amalgam fillings could have a changed pattern

of elimination of mercury. The aim of the present investigation was to

study the elimination half-time of mercury in plasma. erythrocytes and

urine over an extended period of time after amalgam removal in a group of

10 patients with subjective symptoms by the patients themselves reffered to

their amalgam fillings and a group of 8 healthy subjects. The average

number of occlusal and total amalgam surfaces in the patient group were

13.0 (range 4 - 20) and 44.4 (range 24 - 68), respectively. Corresponding

figures in the control group were 12.9 (range 10 - 16) and 40.9 (range 24 -

63). The amalgam removal using rubberdam, water spray cutting and high

volume vacuum evacuator, was carried out at one and the same time. Blood

and urine samples were collected at two occasions before the amalgam

removal, then blood was collected at thirthytwo occasions and urine at

forthythree occasions during the following year.

The mercury content was analysed by CVAAS technique. The measured P-, Ery-

and U-Hg concentrations before amalgam removal were slightly higher in the

control group 6.4+/-3.3 nmol/L, 19.4+/-6.6 nmol/L, and 2.7+/-1.3 nmol/mmol

creatinine respectively than in the symptom group 5.6+/-1.8 nmol/L,

14.8+/-8.8 nmol/L, and 1.6+/-0.9 nmol/mmol creatinine respectively. The

Hg-concentrations did not significantly increase in the two groups after

amalgam removal.

Six days after the removal the plasma mean concentration was significantly

decreased at p<0.05 level and ten days after the decrease was at a

permanent p<0.005 level. The mean Ery-Hg level was significantly decreased

after eleven days (p<0.05) a level that remainedstabel for the rest of the

year. The mean U-Hg level was significantly decreased one month after the

removal and after six months the mean level was reduced with 80% compared

to the initial level in bothgroups. The conclusion to be drawn from the

present study is that the symptom group did not have a changed pattern of

elimination of mercury compared to the healthy group. " =20

13.

Bjorkman L & Lind B.

Factors influencing mercury evaporation rate from dental amalgam fillings.

Scand J Dent Res 100(6):354-360 (1992)

ABSTRACT: " Factors influencing mercury evaporation from dental amalgam

fillings were studied in 11 volunteers. Air was drawn from the oral cavity

for 1 min and continuously analyzed with a mercury detector. In six

volunteers the median unstimulated evaporation rate was 0.1 ng Hg/s, range

0.09-1.3 ng Hg/s. After chewing gum for 5 min the highest evaporation rate

was 2.7 ng Hg/s. Chewing paraffin wax gave only a small increase in

evaporation rate. Changes in airflow rates between 1.5 and 2.5 1/min during

the 1 min sampling did not change the amount of mercury drawn from the oral

cavity. Sampling with different mouthpieces and closed mouth was compared

to open mouth sampling with a thin plastic tube. It was found that the

latter method could result in lower values for some volunteers due to

simultaneous mouth breathing. After placing individual plastic teeth covers

in the mouth, the intraoral evaporation of mercury decreased immediately by

89-100% of previous levels. This technique could be used to detect mercury

evaporation from separate amalgam fillings or to reduce the intraoral

mercury vapor concentration. Rinsing the mouth with heated water for 1 min

increased the mean evaporation rate by a factor of 1.7 when the water

temperature increased from 35 degrees C to 45 degrees C. " =20

14.

Gay Don D, D, Reinhardt W.

Chewing releases mercury from fillings.

Lancet 8123: 985-986 (1979)

NO ABSTRACT AVAILABLE. QUOTATION FROM THE TEXT FOLLOWS: " ...We found that

the level of elemental mercury in expired breath of patients with silver

amalgams up to 2 years old increased almost four times after a 15 min

period of chewing (see table). The patients with no silver-mercury fillings

had lower levels of mercury than did patients with fillings, and their

mercury levels were not affected by chewing. One patient with no fillings

was also a heavy smoker yet no increase in mercury was observed... " =20

15.

Langworth S, Kolbeck K-G & Akesson A

Mercury exposure from dental fillings II. Release and absorption.

Swed Dent J 12:71-72 (1988)

NO ENGLISH ABSTRACT AVAILABLE. CITATIONS FROM THE TEXT FOLLOWS: " ...To get

an appropriate estimation of the absorbed amount of mercury released from

dental amalgam, we made parallel measurements of oral and tracheal

air-concentrations of mercury in ten individuals with 8-54 amalgam

surfaces, (mean =3D 25) with an abrasive tooth-paste... As demonstrated in

the table, the tracheal mercury concentrations were considerably lower than

the intra-oral levels. During inhalation through the nose, there was no

measurable mercury concentration in the trachea, i.e. mercury

concentrations below 1ug/m3 which is the sensitivity limit of the detector.

The low mercury concentrations in tracheal air are probably due to a

dilution of the small volume if intra-oral air (40-50 ml) containing

mercury vapor with more than ten times greater volume of inhaled air with a

very low content of mercury. There may also exist some degree of mercury

binding and inactivation in the mucous membranes of the airways. We have

estimated the average daily mercury absorption from amalgam fillings based

on mercury concentration in tracheal air of about 2 ug/m3 during four hours

of " stimulated " conditions and a five fold lower concentration during 20

hours of " unstimulated " conditions. With a ventialtion of 10 m3/24 h, nose

breathing about 50% (without mercury content) and a alveolar mercury

absorption of 80%, the daily mercury uptake from amalgam fillings is

estimated to be about 3 ug. As a comparison the mercury uptake during a

work-day at the TLV exposure level (50 ug/m3), is calculated to the about

200 ug... " =20

16.

Skare I & Engqvist A

Human Exposure to Mercury and Silver Released from Dental Amalgam

Restorations.=20

Archives of Environmental Health 49:384-394 (1994)

ABSTRACT: " In 35 healthy individuals, the number of amalgam surfaces was

related to the emission rate of mercury into the oral cavity and to the

excretion rate of mercury by urine. Oral emissions ranged up to 125 microg

Hg/24 h, and urinary excretions ranged from 0.4 to 19 ug Hg/24 h. In 10

cases, urinary and fecal excretions of mercury and silver were also

measured. Fecal excretions ranged from 1 to 190 microg Hg/24 h and from 4

to 97 microg Ag/24h. Except for urinary silver excretion, a high interplay

between the variables was exhibited. The worst case individual showed a

fecal mercury excretion amounting to 100 times the mean intake of total Hg

from a normal Swedish diet. With regard to a Swedish middle-age individual,

the systemic uptake of mercury from amalgam was, on average, predicted to

be 12 microg Hg/24 h. " =20

=20

17.

WHO

WHO Environmental Health Criteria 118. Inorganic Mercury.

WHO Geneva 1991 ISBN 92 4 157118 7

NO ABSTRACT AVAILABLE.INSTEAD CITATIONS FROM THE TEXT FOLLOWS: " In the

1940s, " pink disease " (acrodynia) was reported in children below 5 years of

age as a result of the use of mercurous chloride in teething powder and

oinments. Affected children became irritable and generally miserable and

had difficulty in sleeping. Profuse sweating, photophobia, and generalized

rash followed. The extremities became cold, painful, red, and swollen, and

the skin desquamated. NEITHER the occurrence of this disease nor its

severity was DOSE RELATED... After the withdrawal of teething powder

preparations by the main United Kingdom manufacturers in 1953, there was a

dramatic decline in the occurence of pink disease... " =20

18.

Nylander M, Friberg L & Lind B

Mercury concentrations in the human brain and kidneys in relation to

exposure from dental amalgam fillings.=20

Swed Dent J 11:179-187 (1987)

ABSTRACT: " Samples from the central nervous system (occipital lobe cortex,

cerebellar cortex and ganglia semilunare) and kidney cortex were collected

from autopsies and analysed for total mercury content using neutron

activation analyses. Results from 34 individuals showed a statistically

significant regression between the number of tooth surfaces containing

amalgam and concentration of mercury in the occipital lobe cortex (mean

10.9, range 2.4-28.7 ng Hg/g wet weight). The regression equation y=3D7.2 +

0.24x has a 95% confidence interval for the regression coefficient of

0.11-0.37. In 9 cases with suspected alcohol abuse mercury levels in the

occipital lobe were, in most cases, somewhat lower than expected based on

the regression line. The observations may be explained by an inhibition of

oxidation of mercury vapour. The regression between amalgams and mercury

levels remained after exclusion of these cases. The kidney cortex from 7

amalgam carriers (mean 433, range 48-810 ng Hg/g wet weight) showed on

average a significantly higher mercury level than those of 5 amalgam-free

individuals (mean 49, range 21-105 ng Hg/g wet weight). In 6 cases analysis

of both inorganic and total mercury was carried out. A high proportion

(mean 77% SD 17%) of inorganic mercury was found. It is concluded that the

cause of the association between amalgam load and accumulation of mercury

in tissues is the release of mercury vapour from amalgam fillings. " =20

19.

Skare I, Bergstrom T, Engquist A & Weiner JA

Mercury exposure of different origins among dentists and dental nurses.=20

Scand J Work Environ Health 16:340-347 (1990)

ABSTRACT: " Mercury exposure was studied among dental personnel with the use

of urinary mercury excretion rates and questionaries. The study covered 314

dentists and dental nurses employed in public clinics and private practices

in Stockholm. The obtained urinary mercury excretion rates were analyzed by

stepwise regression for assigning them to different origins, such as

environmental factors, number of amalgam surfaces, chewing of gum, kind of

employment and profession, age, sex, amalgam handling time, and use of

amalgam capsules. One the average the occupational contribution to the

total urinary excretion rate was small and of the same order as the

contribution from their own amalgam fillings (approximately 2 ug of

mercury/24 h). There were, however, individuals showing excretion rates

close to the levels at which effects on the central nervous system and the

kidneys have been reported. " =20

=20

----------------------------------------------------------------------------

----

20.

Weiner JA & Nylander M

The relationship between mercury concentration in human organs and

different predictor variables.=20

Sci Total Environ 138(1-3):101-115 (1993)

ABSTRACT: " Samples from different tissues were collected from autopsies of

individuals of the general population of the Stockholm area, Sweden. The

samples were analysed for total mercury content using radiochemical neutron

activation analysis. Average concentrations of mercury in occipital cortex,

abdominal muscle, pituitary gland and kidney cortex were, 10.6 (2.4-28.7),

3.3 (0.9-5.4), 25.0 (6.3-77) and 229 (21.1-810) micrograms/kg wet weight,

respectively. Possible predictor variables for mercury concentrations were

tested in multiple linear regression models. An effect of a number of tooth

surfaces with amalgam was seen in occipital lobe cortex, abdominal muscle

and pituitary gland, but not in kidney cortex. In occipital lobe cortex and

abdominal muscle, concentrations of mercury increased with age.

Explanations discussed include: that a significant fraction of the mercury

retained from amalgam fillings has a very long biological half-life; a

decreasing capacity of mercury excretion with age; or higher fish

consumption in the older individuals. In kidney cortex mercury

concentrations decreased with age. The reason for this remains unclear, but

it might indicate a decreasing capacity of mercury excretion with age.

Chronic alcohol abuse was associated with decreased concentrations of

mercury in occipital cortex. " =20

=20

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----

21.

Sallsten G, Thoren J, Barregaard L Schutz A & Skarping G.=20

Long-term Use of Nicotine Chewing Gum and Mercury Exposure from Dental

Amalgam Fillings.

J Dent Res 75(1):594-598 (1996)

ABSTRACT: " In experimental studies, chewing gum has been shown to increase

the release rate of mercury vapor from dental amalgam fillings. The aim of

the present study was to investigate the influence of long-term frequent

chewing on mercury levels in plasma and urine. Mercury levels in plasma

(P-Hg) and urine (U-Hg), and urinary cotinine were examined in 18 subjects

who regularly used nicotine chewing gum, and in 19 referents. Age and

number of amalgam surfaces were similar in the two groups. Total mercury

concentrations in plasma and urine were determined by means of cold vapor

atomic absorption spectrometry. Urinary cotinine was determined by gas

chromatography-mass spectrometry. The chewers had been using 10 (median)

pieces of gum per day for the past 27 (median) months. P-Hg and U-Hg levels

were significantly higher in the chewers (27 nmol/L and 6.5 nmol/mmol

creatinine) than in the referents (4.9 nmol/L and 1.2 nmol/mmol

creatinine). In both groups, significant correlations were found between

P-Hg or U-Hg on the one hand and the number of amalgam surfaces on the

other. in the chewers, no correlations were found between P-Hg or U-Hg and

chewing time per day or cotinine in urine. Cotinine in urine increased with

the number of pieces of chewing gum used. The impact of excessive chewing

on mercury levels was considerable. "

22.

Bjorkman L, Sandborgh-Englund G, Ekstrand J.

Mercury in saliva and feces after removal of amalgam fillings.=20

Toxicol Appl Pharmacol 144(1):156-162 (1997)

ABSTRACT: " The toxicological consequences of exposure to mercury (Hg) from

dental amalgam fillings is a matter of debate in several countries. The

purpose of this study was to obtain data on Hg concentrations in saliva and

feces before and after removal of dental amalgam fillings. In addition Hg

concentrations in urine, blood, and plasma were determined. Ten subjects

had all amalgam fillings removed at one dental session. Before removal, the

median Hg concentration in feces was more than 10 times higher than in

samples from an amalgam free reference group consisting of 10 individuals

(2.7 vs 0.23 mumol Hg/kg dry weight, p < 0.001). A considerable increase of

the Hg concentration in feces 2 days after amalgam removal (median 280

mumol Hg/kg dry weight) was followed by a significant decrease. Sixty days

after removal the median Hg concentration was still slightly higher than in

samples from the reference group. In plasma, the median Hg concentration

was 4 nmol/liter at baseline. Two days after removal the median Hg

concentration in plasma was increased to 5 nmol/liter and declined

subsequently to 1.3 nmol/liter by Day 60. In saliva, there was an

exponential decline in the Hg concentration during the first 2 weeks after

amalgam removal (t 1/2 =3D 1.8 days). It was concluded that amalgam fillings

are a significant source of Hg in saliva and feces. Hg levels in all media

decrease considerably after amalgam removal. The uptake of amalgam mercury

in the GI tract in conjunction with removal of amalgam fillings seems to be

low. " =20

23.

Edlund C, Bjorkman L, Ekstrand J, Sandborgh-Englund G & Nord CE.

Resistance of the Normal Human Microflora to mercury and Antimicrobials

After Exposure to Mercury from Dental Amalgam Fillings.=20

Clin Infect Dis 22(6):944-950 (1996)

ABSTRACT: " The concentrations of mercury in saliva and feces and the

resistance pattern of the gastrointestinal microflora were investigated for

20 subjects. Ten patients, with a mean number of 19 amalgam surfaces, had

all amalgam fillings removed during one dental session. Ten subjects

without amalgam fillings served as a control group, Saliva and fecal

samples were collected before amalgam removal and 2, 7, 14, and 60 days

afterward. Mercury levels in saliva and feces correlated significantly with

the number of amalgam surfaces. No differences in the resistance pattern of

the oral microflora were detected between the two groups. In the amalgam

group there was an increase in the relative number of intestinal

microorganisms resistant to mercury, ampicillin, cefoxitin, erythromycin,

and clindamycin on days 7-14. This was not statistically significant in

light of the normal variations of the control group. A significant

correlation between the prevalence of mercury resistance and multiple

antimicrobial resistance in intestinal bacterial strains was observed. "

24.

Berglund A

Estimation by a 24-hour Study of the Daily Dose of Intra-oral Mercury Vapor

Inhale after Release from Dental Amalgam.

J Dent Res 69(10):1646-1651 (1990)

ABSTRACT: " The difficulties associated with estimations of daily doses of

inhaled mercury vapor released from dental amalgam are considerable.

Existing data are often unreliable, especially if they are based on a

single or a small series of samples of intra-oral concentrations of mercury

vapor before, during, and after chewing stimulation. In the present paper,

the aim was to obtain a more representative estimation of the daily dose of

mercury vapor inhaled from amalgam fillings by measurements of amounts of

mercury vapor released in the oral cavity during 24 h, under conditions

that were as normal as possible. A series of measurements was carried out

on each of 15 subjects, with at least nine occlusal surfaces restored with

dental amalgam, and on five subjects without any amalgam restorations. The

subjects had to follow a standarized schedule for 24 h, whereby they ate,

drank, and brushed their teeth at pre-determined time periods. The amount

of mercury vapor released per time unit was measured at intervals of 30-45

min by means of a measuring system based on atomic absorption

spectrophotometry. None of the subjects was professionally exposed to

mercury, and all their amalgam fillings were more than one year old. Study

casts were made for each subject, and the area of the amalgam surfaces was

mesured. Samples of urine and saliva were analyzed so that values for the

mercury concentrations and the rate of release of mercury into saliva could

be obtained. The average frequency of fish meals per month was noted. The

daily release of elemental mercury from dental amalgam was corrected for

retention of inspired mercury vapor and for oral-to-nasal breathing ration.

The estimated average daily dose of mercury vapor inhaled from the amalgam

restorations was 1.7 ug, i.e., about 1 % of the dose obtained from a TLV

exposure of 50 ug Hg/m3 air. The treshold limit value (TLV) of a substance

is the airborne concentration to which nearly all workers can be exposed

eight hours a day, five days a week for a prolonged periods without

suffering adverse health effects (American Conference of Goverment

Industrial Hygienists: Threshold Limit Values and Biological Exposure

Indices for 1985-1986, Cincinnati, 1985) " =20

25.

Schulte A, Stoll R, Wittich M, Pieper K & Stachniss V

Urinary Mercury Concentrations in Children with and without Amalgam

Restorations.=20

J Dent Res 73(4):980 A-334 (1994)

ABSTRACT: " Studies on adults have documented that the content of mercury in

urine is determined by the number and extent of amalgam restorations. The

present assay was conducted to examine if this correlation can also be

shown in children. In addition, the mercury excretion in the urine of

children without amalgam fillings was to be assessed. Therefore the content

of mercury was determined in 24-h urine samples of 3-15 year old children

by means of atomic absorption-spectrometry. The concentration of creatine

was determined as well. The mean urinary mercury concentration for the 81

subjects with amalgam restorations was 0.66 mcg/l (range 0-4 mcg/l) and for

the 86 children without amalgam restorations it was 0.16 mcg/l (0-1.8

mcg/l). This difference proved to be very significant (p<0.001). Also a

distinct correlation between the number of amalgam points (each amalgam

surface was given 1 to 3 points depending on its extent) and the mercury

concentration in urine was found. There was no correlation with other

factors; i.e. consumption of fish or accidents with mercury thermometers.

These examinations show that amalgam restorations contribute in children,

too, mainly to the origins of mercury in the organism. However, this does

not permit any conclusions concerning the toxicity, especially as no

clinical symptoms for mercury intoxication were found in children

participateing in this study. " =20

26.

Zander D, Ewers U, Freier I, Westerweller S Jermann E & Brockhaus A

Untersuchungen zur Quecksilberbelastung der Bevolkerung II.

Quecksilberfreisetzung aus Amalgamf=FCllungen.=20

(Studies on Human Exposure to Mercury II. Mercury Concentrations in Urine

in Relation to the Number of Amalgam Fillings.)=20

Zbl Hyg 190:325-334 (1990)

ABSTRACT: " Urinary levels of mercury (HgU) were measured in 93 males and

females aged 18-63 years. Subjects with amalgam fillings (n=3D72) had, on

average, significantly higher levels of mercury in urine (x =3D 0.57 ug Hg/l

and 0.79 ug Hg/g creatinine, respectively) than subjects without amalgam

fillings (n =3D 0.21; x =3D 0.18 ug Hg/l and 0.24 ug Hg/g creatinine,

respectively). Urinary mercury excretion was significantly correlated with

the number of amalgam surfaces (log HgU (ug/l) vs. number of

amalgamfillings: r =3D 0.435, P < 0.001; log HgU (ug/ g creatinine) vs.

number of amalgam fillings; r =3D 0.575, p < 0.001). These results indicate

that internal mercury exposure from amalgam fillings is, on average, higher

than internal exposure to mercury from food and other sources. " =20

=20

27.

Gebel T, Dunkelberg H.=20

(Influence of gum chewing and of amalgam fillings with dental contacts to

metal fillings of different type on the urinary mercury content.) Einfluss

des Kaugumikonsums sowie metallischen Restaurationen anderer Art auf den

Quecksilberuringehalt.=20

Zbl Hyg 199:69-75 (1996) (In German with abstract in English )

ABSTRACT: " It had been shown previously by various authors that contact of

amalgam fillings to metal fillings of different type can increase the

electrochemically caused amalgam corrosion in vitro thus leading to an

elevated release of mercury. So it was recommended to renounce of a dental

contact of amalgam to metal fillings of other type. One aim of the present

study was to evaluate possible influences of this contact in vivo on the

urinary mercury contents in human volunteers. Neither approximal nor

occlusal contacts had any influence on the urinary mercury excretion in

comparison to a reference group with similar amalgam status. Furthermore,

the influence of gum chewing on urinary mercury levels was taken into

account. It could be shown that the consumption of chewing gum resulted in

a significantly higher mean urinary mercury content in probands with

amalgam fillings in comparison to people with similar amalgam status (gum

chewers: 1.36 Hg/24 h vs. non-chewers 0.70 ug Hg/24 h). Thus, gum chewing

has to be considered as important parameter of influence on the urinary

mercury levels of people with amalgam fillings. " =20

28.

Nylander M & Weiner J

Mercury and selenium concentrations and their interrelations in organs from

dental staff and the general=20

population.=20

Br J Ind Med 48:729-734 (1991)

ABSTRACT: " Mercury (Hg) and selenium (Se) concentrations were determined by

radiochemical neutron activation analysis in samples from the pituitary

glands, occipital cortices, renal cortices, abdominal muscles, and thyroid

glands of cadavers. Samples were retrieved from dental staff occupationally

exposed to Hg and from the general population. Increased concentrations of

both Hg and Se in samples from dental staff showed that Se accumulated

together with Hg. Regression analysis of data from the pituitary glands and

occupational cortices of dental staff indicated the accumulation of Se at a

rough stoichiometric ratio of 1:1 with Hg. The same stoichiometric ratio

between the elements was seen in the renal cortices from the general

population. The regression analysis showed that a substantial fraction of

Se was not associated with Hg; it is assumed that this corresponds to

biologically available Se. Concentrations of biologically available Se

decreased with advancing age in the pituitary gland, but not in other

organs, and varied appreciably between organs. " =20

29.

Vimy M J, Takahashi Y & Lorscheider F L

Maternal-fetal distribution of mercury (203Hg) released from dental amalgam

fillings.=20

Am J Physiol 258:R939-R945 (1990)

ABSTRACT: " In humans, the contiuous release of Hg vapor from dental amalgam

tooth restorations is markedly increased for prolonged periods after

chewing. The present study establishes a time-course distribution for

amalgam Hg in body tissues of adult and fetal sheep. Under general

anesthesia, five pregnant ewes had twelwe occlusal amalgam fillings

containing radioactive 203 Hg placed in teeth at 112 days gestation. Blood,

amniotic fluid, feces, and urine specimens were collected at 1- to 3-days

intervals for 16 days. From days 16-140 after amalgam placement (16-41 days

for fetal lambs), tissue specimens were analyzed for radioactivity, and

total Hg concentrations were calculated. Results demonstrate that Hg from

dental amalgam will appear in maternal and fetal blood and amniotic fluid

within 2 days after placement of amalgam tooth restorations. Excretion of

some of this Hg will also commence within 2 days. All tissues examined

displayed Hg accumulation. Highest concentrations of Hg from amalgam in the

adult occurred in kidney and liver, whereas in the fetus the highest

amalgam Hg concentrations appeared in liver and pituitary gland. The

placenta progressively concentrated Hg as gestation advanced to term, and

milk concentration of amalgam Hg postpartum provides a potential source of

Hg exposure to the newborn. It is concluded that accunulation of amalgam Hg

progresses in maternal and fetal tissues to a steady state with advancing

gestation and is maintained. Dental amalgam usage as a tooth restorative

material in pregnant women and children should be reconsidered. " =20

30.

Drasch G, Schupp I, Hofl H, Reinke R & Roider G.

Mercury burden of human fetal and infant tissues.

Eur J Pediatr 153:607-610 (1994)

ABSTRACT: " The total mercury concentrations in the liver (Hg-L), the kidney

cortex (Hg-K) and the cerebral cortex (Hg-C) of 108 children aged 1 day - 5

years, and the Hg-K and Hg-L of 46 fetuses were determined. As far as

possible, the mothers were interviewed and their dental status was

recorded. The results were compared to mercury concentrations in the

tissues of adults from the same geographical area. The Hg-K (n=3D38) and=

Hg-L

(n=3D40) of fetuses and Hg-K (n =3D 35) and Hg-C (n =3D 35) of older infants

(11-50 weeks of life) correlated significantly with the number of

amalgamfillings of the mother. The toxicological relevance of the

unexpected high Hg-K of older infants from mothers with higher numbers of

dental amalgam fillings is discussed. " =20

(P.S. Ad to this list of references 30 people I personaly met (including my

wife :-) who have significantly improved their health after removal of

amalgam, and about 300 people who have reported health improvement after

amalgam replacement, patiaents of (Robin. S) Norwegian dentist who is

pecialized in Amalgam removal, and who have stopped using amalgam 20 years

ago, after he himself realized that he have been poisoned by working with

amalgam.) ---Dusan Stojkovic, Norway

" There are no scientific evidence that links amalgam to diseases. "

" Who don't want to see, will not see.=20

Who don't want to hear, will not hear.

Who don't want to agree, will not agree. "

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