Abstracts of all articles submitted by American Dental Assoc

Abstracts of all articles submitted by American Dental Assoc.(ADA) to FDA amalgam review panel, along with review by B. Windham, Pres. DAMS, Inc.

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Note: the references referenced in my reviews were sent to the FDA Panel.

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Review of articles on 14 pages submitted by ADA to FDA amalgam panel:

(most science articles ADA submitted are strongly anti-amalgam use and support warnings or phasing out use of mercury)

Categorization based on my analysis of the studies:

very strongly anti-amalgam use(A+) 8

strongly anti-amalgam use(A) 29

anti-amalgam use, but poorly done(A-) 27

anti-amalgam use, environmental (AE) 2

Neutral (N) 8

Neutral, poorly done study (N-PDS) 12

Mechanical issues, not health related 10

Not related to amalgam use 7

pro-amalgam use, PDS (P-PDS) 4 (I documented what is poorly done in the studies)

Dental publications, Reviews

pro-amalgam use, opinion, review (P/R/O/D) 29 opinion or review article in dental journal

neutral, opinion, review 9

anti-amalgam use, review 2

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Toxicol In Vitro. 2001 Aug-Oct;15(4-5):463-7.

Genotoxicity of mercury used in chromosome aberration tests. (A-)Akiyama M, Oshima H, Nakamura M.Department of Biomaterials, Osaka Dental University, 8-1, Kuzuhahanazono-cho, Hirakata-shi, Osaka 573-1121, Japan. mari@cc.asaka-dent.ac.jpThe purpose of this study was to investigate the genotoxic effects of Hg released from dental amalgams. The chromosome aberration test was conducted using original extracts and their diluted solutions of conventional type amalgam and high copper amalgam. The concentrations of Hg, Cu and Ag in the original extract of high copper amalgam were 17.64, 7.97 and 43.90 microM, respectively. Those in the original extract of conventional type amalgam were 20.63, 7.87 and 14.79 microM, respectively. 10 and 30 microM Hg(2+) were also used for comparison. The frequency of chromosome aberrations was below 5% with 0 microM Hg(2+) and with a triple dilution of high copper amalgam extract, containing 5.88 microM Hg, 14.63 microM Cu and 2.65 microM Ag. However, 9.5% of the cells showed chromosome aberrations with a quadruple dilution of conventional type amalgam, containing 5.15 microM Hg, 3.69 microM Cu and 1.96 microM Ag. The amount of Hg in the quadruple dilution of conventional type amalgam was less than that in the triple dilution of high copper amalgam extract and 10 microM Hg(2+). A concentration of 30 microM Hg(2+) caused 34.5% of the cells to show chromosome aberrations while with a two-thirds dilution of high copper amalgam extract, containing 11.76 microM Hg, 29.26 microM Cu and 5.31 microM Ag, 58.5% of the cells showed chromosome aberrations. A two-thirds dilution of high copper amalgam extract induced more chromosome aberrations than 30 microM Hg(2+), although the amount of Hg was less than 30 microM Hg(2+). A triple dilution of conventional type amalgam extract, original extracts of conventional type amalgam and high copper amalgam and 100 microM Hg(2+) were induced few metaphases. It was revealed that the conventional type amalgam induced chromosome aberrations with quadruple dilution where cell viability was about 80% and that the high copper amalgam induced a high level of chromosome aberrations with the two-thirds dilution. The effects of low level Hg on humans are not clear.

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The study showed that amalgam is highly genotoxic at low levels of exposure, but was not comprehensive enough to fully assess the pattern of genotoxicity trends by level of exposure.^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^

Introduction: scope and purpose of the multicenter project " Assessment of effects due to low doses in inorganic mercury following environmental and occupational exposure: human and in vitro studies on specific toxicity mechanisms"][Article in Italian]Alessio L, Apostoli P, Cortesi I, Lucchini L.Med Lav. 2002 May-Jun;93(3):148-56.

Cattedra di Medicina del Lavoro, Universita degli Studi di Brescia, p.le Spedali Civili 1, 25123 Brescia.The principal aims of the project financed by the Italian Ministry of University and Scientific and Technological Research were: to verify if at the current limit values early biological effects can be demonstrated; to identify the levels of internal dose that can cause early effects; to evaluate the non-occupational factors that can contribute to the levels of internal dose. In particular, the mercury intake derived from dental amalgams and fish consumption was considered. The internal dose was measured with the traditional biological indicators (urinary and blood mercury) and with the speciation of a large percentage of biological samples by ICP-MS. The central nervous system, neuroendocrine function, kidney and the immune system were considered as target organs and were examined using previously standardized indicators of effects. Two groups of subjects were included in the study: workers with occupational exposure to inorganic mercury in different industrial settings and control subjects identified from the general population. The first group was characterized by an exposure level to inorganic mercury clearly below the current limit values; whereas the HgU levels of a relevant number of control subjects were similar to those measured in the exposed subjects. The in vitro studies covered several issues: the percutaneous absorption of mercury using skin derived from human post-mortem samples in a standardized model; the release of the metal from dental amalgams in different physiological conditions of the oral cavity; the effects of increasing doses of mercury chloride on tubular renal cells. The project was realized with the cooperation of seven Research Units from six Italian Universities. Researchers belonging to Departments of Occupational Medicine, Industrial Hygiene, General Pathology, Biochemistry, Odontology, and Biostatistics were involved to achieve a multidisciplinary approach. The results of this research project are described and discussed in the following papers.****************************************************************

Urinary mercury levels in females: influence of skin-lightening creams and dental amalgam fillings.al-Saleh I, Shinwari N.Biometals. 1997 Oct;10(4):315-23.

Biological & Medical Research Department, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia.The influence of application of skin-lightening creams and dental amalgam fillings on the urinary mercury (Hg) level was evaluated in 225 females (ages 17 to 58 years) living in Riyadh, capital of Saudi Arabia. The arithmetic mean of the urinary Hg level was 6.96 +/- 20.43 micrograms 1(-1), in the range 0 to 204.8 micrograms 1(-1). The mean urinary Hg level adjusted by creatinine (Cr) was 11.22 +/- 37.23 micrograms g-1 Cr, in the range 0 to 459.37 micrograms g-1. No significant difference in urinary Hg was noted between the females regarding the use of skin-lightening creams. On the other hand, results showed that urinary Hg concentration was influenced by the use and number of dental amalgam fillings. No women were identified with symptoms or signs that could be attributed to Hg intoxication. Urine analyses for creatinine, urea, uric acid, phosphorus, magnesium, glucose and calcium showed significant correlation with urinary Hg. This suggests that chronic exposure to Hg may be associated with a deterioration of renal function.********************************************************

study shows amalgam is significant source of mercury exposure and appears to cause renal effects.

^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^Metallothionein induction in fetal rat brain and neonatal primary astrocyte cultures by in utero exposure to elemental mercury vapor (Hg0).Aschner M, Lorscheider FL, Cowan KS, Conklin DR, Vimy MJ, Lash LH. (A-)Brain Res. 1997 Dec 5;778(1):222-32.

Department of Physiology and Pharmacology, Bowman Gray School of Medicine of Wake Forest University, Winston-Salem, NC 27157-1083, USA. maschner@bgsm.eduBrain metallothionein (MT) protein and mRNA levels were determined in the fetal rat following in utero (gestational days 7-21) exposure to elemental mercury vapor (Hg0; 300 microg Hg/m3; 4 h/day). Total RNA was probed on Northern blots with [alpha-32P]dCTP-labeled synthetic cDNA probes specific for rat MT isoform mRNAs. The probes for MT-I and MT-II mRNA hybridized to a single band of approximately 550 and 450 nucleotides, respectively. Expression of whole brain MT-I mRNA in full-term fetal rats (day 21) was significantly increased (P < 0.03) by in utero exposure to Hg0 compared to nonexposed controls. This corresponded to a 14-fold increase (P < 0.001) in fetal brain Hg concentration after in utero Hg0 exposure. In addition, astrocytes from both control and in utero Hg0-exposed fetuses were isolated, and neonatal primary astrocyte cultures were established and maintained in vitro for up to 3 weeks without additional experimental intervention. Astrocyte monolayers derived from in utero Hg0-exposed fetuses consistently expressed increased abundance of MT-I mRNA transcripts after 1, 2, and 3 weeks in culture (P < 0.03, P < 0.01, and P < 0.03, respectively) compared with controls. The abundance of astrocyte MT-II mRNA was unchanged at 1 and 2 weeks in culture, but was significantly increased at 3 weeks in cultures derived from brains of Hg0-exposed fetuses (P < 0.04). Consistent with the increase in MT mRNA, an increase in astrocytic levels of MT proteins was noted by Western blot analysis and MT-immunoreactivity. These studies suggest that in utero exposure to Hg0 induces brain MT gene expression, and that MT mRNAs and their respective proteins are useful quantitative biochemical markers of intrauterine exposure to Hg0, a potentially cytotoxic challenge to astrocytes in the developing brain. It is concluded that induction of MT by fetal/neonatal astrocytes represents an attempt by these glial cells to protect against Hg cytotoxicity in maintaining cerebral homeostasis.

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Adverse health effects related to mercury exposure from dental amalgam fillings: toxicological or psychological causes? (P) (PDS)Bailer J, Rist F, Rudolf A, Staehle HJ, Eickholz P, Triebig G, Bader M, Pfeifer U.Psychol Med. 2001 Feb;31(2):255-63.

Department of Clinical Psychology, Central Institute of Mental Health, Mannheim, Germany.BACKGROUND: Possible adverse health effects due to mercury released by amalgam fillings have been discussed in several studies of patients who attribute various symptoms to the effects of amalgam fillings. No systematic relation of specific symptoms to increased mercury levels could be established in any of these studies. Thus, a psychosomatic aetiology of the complaints should be considered and psychological factors contributing to their aetiology should be identified. METHODS: A screening questionnaire was used to identify subjects who were convinced that their health had already been affected seriously by their amalgam fillings (N = 40). These amalgam sensitive subjects were compared to amalgam non-sensitive subjects (N = 43). All participants were subjected to dental, general health, toxicological and psychological examinations. RESULTS: The two groups did not differ with respect to the number of amalgam fillings, amalgam surfaces or mercury levels assessed in blood, urine or saliva. However, amalgam sensitive subjects had significantly higher symptom scores both in a screening instrument for medically unexplained somatic symptoms (SOMS) and in the SCL-90-R Somatization scale. Additionally, more subjects from this group (50% versus 4.7%) had severe somatization syndromes. With respect to psychological risk factors, amalgam sensitive subjects had a self-concept of being weak and unable to tolerate stress, more cognitions of environmental threat, and increased habitual anxiety. These psychological factors were significantly correlated with the number and intensity of the reported somatic symptoms. CONCLUSIONS: While our results do not support an organic explanation of the reported symptoms, they are well in accord with the notion of a psychological aetiology of the reported symptoms and complaints. The findings suggest that self-diagnosed 'amalgam illness' is a label for a general tendency toward somatization.

*****************************[It does not appear that the authors were aware of or that any consideration was taken in the study to assess well documented susceptability measures that are known to be major factors in mercury toxicity effects for the 2 populations or to diagnose or assess the cause of the conditions of the patients. Based on other such populations with such conditions it is likely that if tests had been carried out, confirmation of mercury toxicity induced effects would have been obtained in a significant portion of the patients. The study does not appear very useful, since it does not appear that a serious effort was made to assess whether the patients suffered from mercury toxicity effects.] www.home.earthlink.net/~berniew1/suscept.html

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Barregard L, Ellingsen D, Alexander J, Thomassen Y, Aaseth J. (Review, N)Tidsskr Nor Laegeforen. 1998 Jan 10;118(1):58-62.

Yrkesmedisinska Kliniken, Sahlgrenska Universitetssjukhuset, Goteborg.Inorganic mercury is absorbed in small amounts from dental amalgam fillings. Exposure can be calculated by measuring the level of mercury in the blood or urine (u-Hg). The average u-Hg in Norwegians is approximately 2-3 micrograms/g creatinine (approximately 1-2 nmol/mmol creatinine). Classic signs of mercury poisoning occur in a fraction of long-term exposed subjects with u-Hg > 100 micrograms/g creatinine (56 nmol/mmol creatinine). Subtle effects (e.g. enzymuria, altered selenium metabolism, and changes in tremor spectra) have been reported in humans at average levels of 20-35 micrograms/g creatinine (approximately 11-20 nmol/mmol creatinine). There is widespread concern about possible adverse effects of mercury from amalgam fillings. Data on exposure-response relationships make it less likely that low-level mercury exposure from amalgam fillings should cause symptoms or physical signs. Studies of the association between symptoms and amalgam fillings have been negative. Patients with symptoms allegedly caused by mercury from amalgam should undergo thorough medical examination. Based on the patient's symptoms and physical signs adequate time should be allowed for careful recording of medical history, physical examination and relevant laboratory tests.******************************

[This review appears to have been conducted by authors with no experience at testing for and treating mercury toxicity; and who do not appear to be aware of susceptability factors important in assessing effects of mercury toxicity that are well known and documented in the literature. It appears well intentioned but doesn’t appear to have significant relevant information]

www.home.earthlink.net/~berniew1/suscept.html

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[Dimensional changes of silver and gallium-based alloy] ( NHE, M)[Article in Portuguese]Ballester RY, Markarian RA, Loguercio AD.Departamento de Materiais Dentarios, Faculdade de Odontologia, USP.Gallium-based dental alloys were created with the aim of solving the problem of toxicity of mercury. The material shows mechanical properties similar to those of dental amalgam, but researches point out two unfavorable characteristics: great corrosion and excessive post-setting expansion, and the latter is capable of cracking dental structures. The aim of this study was to evaluate, during 7 days, the in vitro dimensional alteration of a gallium dental alloy (Galloy, SDI, Australia), in comparison with a dental amalgam containing zinc (F400, SDI, Australia), as a function of the contact with saline solution (0.9% NaCl) during the setting period. The storage experimental conditions were: storage in dry environment, immersion in saline solution and contamination during condensation. Additionally, the effects of contamination during the trituration of dental amalgam and the effects of protecting the surface of the gallium alloy with a fluid resin were studied. Specimens were stored at 37 degrees C +/- 1 degree C, and measuring was carried out, sequentially, every 24 h during 7 days. When the gallium alloy was either contaminated or immersed, an expansion significantly greater than that observed in the other experimental conditions was noticed after 7 days. The application of a fluid resin to protect the surface of the cylinders was able to avoid the increase in expansion caused by superficial moisture. The amalgam alloy did not show significant dimensional alterations, except when it was contaminated during trituration.************************************************

Not relevant to amalgam toxicity issues

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Dental amalgam and multiple sclerosis: a case-control study in Montreal, Canada. (A, Sc)Bangsi D, Ghadirian P, Ducic S, Morisset R, Ciccocioppo S, McMullen E, Krewski D.Int J Epidemiol. 1998 Aug;27(4):667-71.

Epidemiology Research Unit, Research Center, Hotel-Dieu Pavilion, CHUM, Montreal, Quebec, Canada.BACKGROUND: The aetiology of multiple sclerosis (MS) remains poorly understood. Dental amalgams containing mercury have recently been suggested as a possible risk factor for MS. METHODS: In a case-control study conducted between 1991 and 1994, we interviewed a total of 143 MS patients and 128 controls, to obtain information on socio-demographic characteristics and the number of dental amalgams and the time since installation based on dentists' records. RESULTS: Neither the number nor the duration of exposure to amalgams supported an increased risk of MS. After adjustment for age, sex, smoking, and education those who had more than 15 fillings had an odds ratio (OR) of 2.57 (95% CI: 0.78-8.54) compared to those who had none; for individuals whose first amalgam was inserted more than 15 years prior to the study, we found an OR of 1.34 (95% CI: 0.38-4.72). CONCLUSIONS: Although a suggestive elevated risk was found for those individuals with a large number of dental amalgams, and for a long period of time, the difference between cases and controls was not statistically significant.**********************************************************

Although the subpopulations for which the high odds ratios were found were not large enough for statistical significance computations, the study found 2.6 times more MS in patients with 15 or more fillings than in those with none, and 1.3 times more MS in patients with amalgams for over 15 years. This is suggestive of a connection between MS and amalgam. Other studies have confirmed this connection and thousands diagnosed with MS have recovered significantly after amalgam replacement and proper detoxification. www.home.earthlink.net/~berniew1/ms.html

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Mercury in hair for a child population from Tarragona Province, Spain.Batista J, Schuhmacher M, Domingo JL, Corbella J. (NRAmal)Sci Total Environ. 1996 Dec 20;193(2):143-8.

Laboratory of Toxicology and Environmental Health, School of Medicine, Rovira i Virgili University, Reus, Spain.Mercury concentrations were determined in scalp hair of 233 school children aged 6-16 years. The study was carried out in three communities (Flix, Tarragona and Tortosa) from Tarragona Province (Southern Catalonia, Spain). The influence of the variables place of residence, age, sex, fish and seafood consumption, number of dental amalgam fillings, hair color, parents' occupation, and smoking habits of the household members was also examined. The geometric mean mercury concentration in hair was 0.77 microgram/g. The place of residence, sex, and the frequency in consuming fish and seafood were the variables that significantly affected hair mercury concentrations. Girls had more mercury in their hair than boys, whereas hair mercury levels were significantly correlated with the frequency in the fish and seafood consumption, with the levels being more elevated when the fish and seafood consumption was also higher. Hair mercury concentrations were also affected by the place of residence, with school children of Flix showing lower mercury concentrations than those found in children from Tarragona and Tortosa. The remaining variables had no influence on hair mercury levels.***************************************

It is well documented in the literature that hair mercury level mostly measures methyl mercury and is not a reliable measure of mercury vapor exposure. Also hair mercury level is inversely correlated with mercury body burden and toxicity effects in most who are mercury toxic

( A.S. Holmes, M.F. Blaxill and B.E. Haley, Reduced Levels of Mercury in First Baby Haircuts of Autistic Children; International Journal of Toxicology, 2003) While it is well documented that amalgam is the largest source of mercury exposure for most general populations( www.home.earthlink.net/~berniew1/damspr1.html) , it is also documented that the half life of mercury vapor in the blood is less than 10 seconds, with most transferred to cells in organs rather rapidly, with most not making it into major organs that receive the largest amount of blood. (Magos, 1989). The authors do not appear to be aware of the properties of the different forms of mercury or of the method used by those treating mercury toxicity to assess mercury toxicity using hair tests. Since mercury is documented to cause cell membrane permeability changes and poor absorption of minerals, the best indication of mercury toxicity using hair analysis looks at the essential mineral levels. If a person with normal diet has a high degree of essential mineral imbalances and deficiencies, this is a strong indication of mercury toxicity (Andrew Hall Cutler, PhD, PE; Amalgam Illness:Diagnosis and Treatment; 1996 ).

While this study is useful in pointing out the direct correlation in the general population between hair mercury level and fish consumption, it is not adequate to assess body mercury burdens or mercury toxicity effects. Other tests are necessary for these.)

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Methylmercury and inorganic mercury in serum--correlation to fish consumption and dental amalgam in a cohort of women born in 1922.Bergdahl IA, Schutz A, Ahlqwist M, Bengtsson C, Lapidus L, Lissner L, Hulten B.Environ Res. 1998 Apr;77(1):20-4.

Department of Occupational and Environmental Medicine, Lund University, Sweden.Methylmercury in serum (S-MeHg) was assessed from serum concentrations of total (S-TotHg) and inorganic mercury (S-InoHg), determined by cold vapor-atomic absorption spectrometry. The samples were collected from 135 women on two occasions, in 1968-1969 and 1980-1981. In a subgroup of 29 women, an association was found between S-MeHg and the amount of fish consumed in 1968-1969 (r = 0.38, P = 0.04). The association was stronger (r = 0.50; P = 0.006) when the individuals' mean S-MeHg from 1968-1969 and 1980-1981 were plotted vs fish consumption 1968-1969. In the group, as a whole, there was an association between S-InoHg and number of dental amalgam surfaces, in both 1968-1969 (r = 0.48, P = 0.0001) and 1980-1981 (r = 0.57, P < 0.0001). The S-InoHg increased by approximately 0.1 nmol/L per amalgam tooth surface, corresponding to an uptake of approximately 0.2 microgram/day per amalgam surface, but with considerable interindividual differences. The levels were lower in 1980-1981 than in 1968-1969 for both MeHg and InoHg. The medians and ranges (nmol/L) were for MeHg 1968-1969: 3.6 (0.3-11.9); MeHg 1980-1981, 2.0 (-0.4-8.7); InoHg 1968-1969, 3.3 (0.7-11.8); InoHg 1980-1981, 1.7 (0.1-11.8); TotHg 1968-1969, 7.2 (1.9-18.8); and TotHg 1980-1981, 3.9 (1.0-14.2). The decrease in S-MeHg is probably due to a decreased consumption of MeHg via contaminated fish. The decrease in S-InoHg may reflect a decrease in environmental exposure, but the possibility of contamination of the 1968-1969 samples at sampling and/or storage cannot be excluded.**************************************Influence of low frequency magnetic fields on the intra-oral release of mercury vapor from amalgam restorations.Berglund A, Bergdahl J, Hansson Mild K.Eur J Oral Sci. 1998 Apr;106(2 Pt 1):671-4.

Department of Dental Materials Science, Faculty of Odontology, Umea University, Sweden. Anders.Berglund@denmatsc.umu.seSince the results of a preliminary study have shown that the magnetic fields of some visual display units (VDUs) increased the release of mercury from amalgam specimens, the aim of the present study was to examine whether exposure to magnetic fields might affect the mercury vapor release from amalgam restorations in humans. The test group consisted of five subjects with an average of 31.4 amalgam surfaces (range 13-48). In each of the subjects tested, the intra-oral release of mercury vapor was measured during three 9-h periods at intervals of 30 to 90 min, using a standardized schedule and standardized food. During the first 9-h period which served as control, no intentional magnetic fields were applied. During the second and the third 9-h period, magnetic fields with flux densities of 20 microT at 30 kHz or 500 microT at 50 Hz, respectively, were applied. Although these flux densities were one thousand times higher than those caused by VDUs, no effects could be found on the release of mercury vapor from the amalgam restorations. The results of the present study do not support the assumption that exposure to magnetic fields increases the mercury vapor release from amalgam restorations in humans.*************************

I’m not sure that anyone had hypothesized that magnetic fields would cause increased mercury release. There is no obvious mechanism I could think of. But its known(and already demonstrated by these authors and others) that electromagnetic fields cause release of additional mercury; and the mechanism is well known and understood. See also:

F.Schmidt et al, “Mercury in urine of employees exposed to magnetic fields”, Tidsskr Nor Laegeforen, 1997, 117(2): 199-202; & Granlund-Lind R, Lans M, Rennerfelt J, "Computers and amalgam are the mostcommon causes of hypersensitivity to electricity according to sufferers' reports", Läkartidningen 2002; 99: 682-683 (Swedish); & Sheppard AR and EisenbudM., Biological Effects of electric and magnetic fields of extremely low frequency. New York university press. 1977; & Ortendahl T W, Hogstedt P, Holland RP, "Mercury vapor release from dental amalgam in vitro caused by magnetic fields generated by CRT's", Swed Dent J 1991 p 31 Abstract 22; & Bergdahl J, Anneroth G, Stenman E. Description of persons with symptoms presumed to be caused by electricity or visual display units--oral aspects. Scand J Dent Res. 1994, 102(1):41-5

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Mercury vapor release from dental amalgam in patients with symptoms allegedly caused by amalgam fillings.Berglund A, Molin M.Eur J Oral Sci. 1996 Feb;104(1):56-63.

Department of Dental Materials Science, Faculty of Odontology, Umea University, Sweden. Anders.Berglund@denmatsc.umu.seThe aim of this study was to determine whether a group of patients with symptoms, self-related to their amalgam restorations, experienced an exposure to mercury vapor from their amalgam restorations that reached the range at which subtle symptoms have been reported in the literature. Furthermore, the aim was to determine whether the mercury exposure for these patients was significantly higher than for controls with no reported health complaints. The symptom group consisted of 10 consecutively selected patients from a larger group, referred by their physicians for investigation into any correlation between subjective symptoms and amalgam restorations. The control group consisted of 8 persons with no reported health complaints. The intra-oral release of mercury vapor was measured between 7:45 a.m. and 9:00 p.m. at intervals of 30-45 min, following a standardized schedule. The mercury levels in plasma, erythrocytes, and urine were also determined. The calculated daily uptake of inhaled mercury vapor, released from the amalgam restorations, was less than 5% of the daily uptake calculated at the lower concentration range given by the WHO (1991), at which subtle symptoms have been found in particularly sensitive individuals. The symptom group had neither a higher estimated daily uptake of inhaled mercury vapor, nor a higher mercury concentration in blood and urine than in the control group. The study provides no scientific support for the belief that the symptoms of the patients examined originated from an enhanced mercury release from their amalgam restorations.********************************************

The authors apparently aren’t familiar with mercury toxicity effects or the literature on mercury toxicity effects. Thus the study was poorly designed. It is well documented in the medical literature that susceptability issues such as immune reactivity, liver function, metallothionein status, detoxification/excretion ability are what determines who is affected by mercury toxicity.

While level of exposure plays a role as well, it is well documented in the literature and clinical experience that susceptability is the biggest issue. These susceptability factors are measureable and it is known how to test and determine mercury toxicity. This study did not do so, so was not useful. www.home.earthlink.net/~berniew1/suscept.html

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Mercury in saliva and feces after removal of amalgam fillings.Bjorkman L, Sandborgh-Englund G, Ekstrand J.Toxicol Appl Pharmacol. 1997 May;144(1):156-62.

Department of Basic Oral Sciences, Karolinska Institutet, Stockholm, Sweden.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 = 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.*************************************************

Very good study; strongly supports banning amalgam; Shows 10 times more mercury exposure in those with amalgams; 90% decline in mercury level in feces and saliva after amalgam replacement; ie. (90% decline in daily exposure); Plus rapid and significant decline in blood mercury and body burden. Strong case for amalgam replacement.

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Acute contact allergy to dental amalgam.Bleiker TO, English JS.Contact Dermatitis. 1998 Feb;38(2):112.

Department of Dermatology, Queen's Medical Centre, Nottingham, UK

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Though I don’t have a copy, I assume it supports the common chronic and acute oral effects of amalgam, which are well documented in the literature. It is known that amalgam commonly causes numerous types of oral health effects including oral lichen planus and that replacing amalgam usually cures the conditions. www.home.earthlink.net/~berniew1/periodon.html

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Potential side effects of dental amalgam restorations. (II). No relation between mercury levels in the body and mental disorders.Bratel J, Haraldson T, Ottosson JO.Eur J Oral Sci. 1997 Jun;105(3):244-50.

Department of Endodontology/Oral Diagnosis, Faculty of Odontology, Goteborg University, Sweden. John.Bratel@odontologi.gu.seA group of 50 consecutive patients, referred for self-reported complaints which they related to dental amalgam restorations, was compared with control patients matched by age, sex and postal zip code. All patients were subjected to a psychiatric examination and a set of rating scales and questionnaires, and the symptoms were related to the mercury levels in blood, urine and hair. A psychiatric diagnosis was established in 70% of the patients in the index group versus 14% in the control group. The prevailing symptoms were anxiety, asthenia and depression. Mercury levels in blood, urine and hair were similar among index cases and controls, and were far below critical levels of mercury intoxication. There was no correlation between mercury levels and the severity of the reported symptoms. Therefore, mercury was not a likely cause of the complaints. Instead, the reported symptoms were part of a broad spectrum of mental disorders.******************************************

This was a very poorly done study. The authors apparently aren’t familiar with testing or treating mercury toxicity or with the literature on such or on the connection of mercury to a broad spectrum of mental disorders. The literature has well documented that the major factors in mercury toxicity effects are susceptability factors like immune reactivity(www.melisa.org), systemic detoxification ability( American College of Medical Genetics Working Group findings on ApoE4 strong connection to Alzheimer’s, JAMA, 1995,274:1627-29. ; & Duke Univ. Medical Center, www.genomics.duke.edu/pdf/Alzheimer.pdf & Godfrey ME, Wojcik DP, Krone CA. Apolipoprotein E genotyping as a potential biomarker for mercury neurotoxicity. J Alzheimers Dis. 2003 Jun;5(3):189-95. )

, other exposures,etc. The mechanisms by which low level chronic mercury exposure causes mental conditions such as those looked at in this study are well documented in the literature; and the fact that those treated for mercury toxicity usually recover after treatment is also well documented in the literature.

Depression and anxiety: www.home.earthlink.net/~berniew1/depress.html

Alzheimer’s : www.home.earthlink.net/~berniew1/alzhg.html

Autism : www.home.earthlink.net/~berniew1/kidshg.html

ADHD and learning disabilities: www.home.earthlink.net/~berniew1/tmlbn.html

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Potential side effects of dental amalgam restorations. (I). An oral and medical investigation.Bratel J, Haraldson T, Meding B, Yontchev E, Ohman SC, Ottosson JO. Eur J Oral Sci. 1997 Jun;105(3):234-43.

Department of Endodontology/Oral Diagnosis, Faculty of Odontology, Goteborg University, Sweden. John.Bratel@odontologi.gu.seThe aim of this study was to explore a possible association between health status and self-reported adverse effects related to dental amalgam restorations. A group of 50 consecutive patients (index group), referred for complaints self-related to dental amalgam restorations, was compared with a control group of individuals matched by age, sex and postal zip code. The patients underwent an oral, stomatognathic, medical and clinical chemistry examination. Mercury levels were examined in blood, urine and hair. The results revealed that somatic diseases were more common in the index group (38% versus 6%). Symptoms related to cranio-mandibular dysfunction were reported by 74% of the patients in the index group versus 24% in the control group, and were diagnosed in 62% and 36%, respectively. The oral health status and the number of amalgam surfaces were similar in the 2 groups. No positive skin patch test to mercury was found in any of the groups. The estimated mercury intake from fish consumption, occupational exposure, and mercury levels in blood and urine were also similar and far below levels, where negative health effects would be expected. The correlation between the number of amalgam surfaces and mercury levels in plasma and urine (r=0.43) indicated a release of mercury from dental amalgam restorations in both groups. Since the mercury levels were similar among index patients and controls, mercury was not a likely cause of the impaired health reported by the patients.

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This was poorly done study due to lack of understanding of mercury toxicity by authors.

The authors apparently aren’t familiar with testing or treating mercury toxicity or with the literature on such or on the connection of mercury to a broad spectrum of conditions such as those described. The literature has well documented that the major factors in mercury toxicity effects are susceptability factors like immune reactivity(www.melisa.org), systemic detoxification ability( www.home.earthlink.net/~berniew1/suscept.html) , other exposures,etc. The mechanisms by which low level chronic mercury exposure causes conditions such as those looked at in this study are well documented in the literature; and the fact that those treated for mercury toxicity usually recover after treatment is also well documented in the literature.

The study found higher levels of conditions that mercury is well documented to cause such as

cranio-mandibular dysfunction but apparently didn’t attempt to assess the cause of the conditions or to test for mercury toxicity.

www.home.earthlink.net/~berniew1/periodon.html

www.home.earthlink.net/~berniew1/amalg6.html

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Reconsidering dental amalgam.Brookfield JR. J Can Dent Assoc. 1996 Jul;62(7):547.