Mercury From Amalgam Fillings:
A Major Factor in Periodontal
Disease and Oral Health Problems
I. Introduction & Mercury Exposure
Levels from Amalgam
Mercury is one of the most toxic
substances in existence and is known to bioaccumulate in the body of people and
animals that have chronic exposure.
Mercury exposure is cumulative and comes primarily from 3 main sources:
occupational exposure, food(mainly fish), and
silver/mercury dental fillings. Whereas mercury exposure from fish is primarily
methyl mercury, mercury from occupational exposure and dental fillings is
primarily from elemental mercury vapor. But bacteria in the mouth and
intestines methylate other forms of mercury to methyl, and some demethylation
also occurs.
The
most common type of occupational exposure comes from dental office exposure and
is documented to result in significant adverse health effects(602). Mercury in amalgam fillings, because of its high volatility and galvanic action due to presence of dissimilar metals in the
mouth, has been found to be continuously vaporized and released into the body (192,600,etc.), and
has been found to be the largest source
of mercury in the majority of people who have amalgam fillings (WHO:183,199,209,601,
18). The level of daily exposure
commonly exceeds the U.S. EPA health guideline for daily mercury exposure(2,217,601).
Concentrations
of mercury in oral mucosa for a population of patients with 6 or more amalgam
fillings taken during oral surgery were 20 times the level of controls(174).
Studies have shown mercury travels from amalgam into dentin, root tips,
and the gums, with levels in roots tips as high as 41 ppm(192).
Studies have shown that mercury in the gums such as from root caps for root
canaled teeth or amalgam tattoos result in chronic inflammation, including
proliferation of inflammatory cytokines in addition to migration to other parts of the
body(200,47,35, 86a,314a). Mercury and
silver from fillings can be seen in the tissues as amalgam “tattoos”, which
have been found to accumulate in the oral mucosa as granules along collagen
bundles, blood vessels, nerve sheaths, elastic fibers, membranes, striated
muscle fibers, and acini of minor salivary glands. Dark granules are also present
intracellularly within macrophages, multinucleated giant cells, endothelial
cells, and fibroblasts, and metals also accumulate in tooth roots and the jaw bone(47,35). There is
in most cases chronic inflammatory response or macrophagic reaction to the metals(47), usually in the form of a foreign body granuloma
with multinucleated giant cells of the foreign body and Langhans types(192). In
a group of patients with amalgam tattoos that were tested, 74% of the patients revealed high lymphocyte
reactivity (positive MELISA test) to one or more metal components of dental
restorations(47k). The majority of MELISA positive patients suffered from
serious health problems (various allergies, autoimmune diseases, Parkinson's
syndrome etc.). Nickel and inorganic mercury were the most common sensitizers
in vitro. The cytokine assay revealed that mercury chloride activated
predominantly TH2 lymphocytes, while nickel chloride activated mainly TH1
lymphocytes.
Most dentists are not aware of the main source of amalgam tattoos, oral galvanism where electric currents caused by mixed metals in the mouth take the metals into the gums and oral mucosa, accumulating at the base of teeth with large fillings or metal crowns over amalgam base(192). Such mercury including that in the commonly formed amalgam tattoos moves to other parts of the body over time in significant amounts and more rapidly than the other metals. Macrophages remove mercury by phagocytosis and the mercury moves to other parts of the body through the blood and along nerves(47). Another study (47l) demonstrated a dense mononuclear inflammatory infiltrate associated with large and powdered debris and positivity for HLA-DR and MT in inflammatory cells. While blood vessel walls and connective fibers impregnated with powdered particles were negative for HLA-DR, they were positive for MT. In addition, wherever epithelial basement membrane impregnation by powdered amalgam particles was observed, a strong positivity for MT was detected. These findings demonstrate that residual elements of AT still have noxious local effects over tissues. Such metals are documented to cause local and systemic lesions and health effects, which usually recover after removal of the amalgam tattoo by surgery (47fghim). The high levels of accumulated mercury also are dispersed to other parts of the body.
Mercury vapor given off by amalgam
fillings accumulates in the teeth, tooth roots, gums, jawbone, and oral
tissue. The number of amalgam surfaces
has a statistically significant correlation to the level of mercury in oral mucosa and
saliva (18,77,79,182,199,211,222,292).
The amount
of mercury in saliva averaged between 1.5 to 1.9 micrograms per Liter for each
amalgam filling(199ab).
The
amount of mercury released by a gold alloy bridge over amalgam over a 10 year
period was measured to be approx. 101 milligrams(mg)(60%
of total) or 30 micrograms(ug) per day(18), and other studies have found
similar results(182). The average mercury levels in gum tissue near
amalgam fillings are often over 100 ppm(192), and levels in oral mucosa removed
during oral surgery averaged over 2 ppm(over 20 times controls ) and levels in
root tips of 41 ppm(174,192,47).
Having dissimilar metals in the teeth(e.g.‑gold and mercury) causes galvanic action,
electrical currents, and much higher mercury vapor levels and mercury levels in
tissues. (182,191,192,18,19,27, 30,47,48,8,174). The level of mercury in the gums or jaw bone
is often 1000 ppm near a gold cap on an amalgam filling (30,25,35,48,58), and
similar levels as high as 5600 ppm have been found in the jaw bone under large
amalgam fillings or gold crowns over amalgam by German oral surgeons(436). These levels are among the highest levels
ever measured in tissues of living organisms, exceeding the highest levels
found in chronically exposed chloralkali workers, those who died from mercury in Minamata,
or animals that died from mercury poisoning.
The FDA action level for warnings of dangerous levels in fish or food is 1 ppm and the
EPA health criterion level is 0.3 ppm. In patients with galvanic cell
in their oral cavity we found decreased levels of antiinflamatory markers, such
as secretory IgA, IgA 1, IgA 2, and lysozyme, and increased levels of the
proinflammatory marker albumin (192i).
Amalgam
also releases significant amounts of silver, tin, and copper which also have
toxic effects, with organic tin compounds formed in the body being even more
neurotoxic than inorganic mercury.
German
studies of mercury loss from vapor in unstimulated saliva found the saliva of
those with amalgams had at least 5 times as much mercury as for controls(179,199].
Much mercury in saliva and the brain is also organic, since mouth
bacteria convert inorganic mercury to methyl mercury(81,88,600).
Oral bacteria streptococommus mitior,S.mutans, and
S.sanguis were all found to methylate mercury(81,600),as well as Candida
albicans. Methyl mercury, like mercury
vapor, crosses the blood-brain barrier, and both forms are converted to very
neurotoxic inorganic compounds which have a long half-life in the brain. The
process also results
in formation of hydrogen sulfide and metal protein compounds that
are involved in mouth odor(334).
A large U.S. Centers for Disease
Control epidemiological study, NHANES III, found that those with more amalgam
fillings(more mercury exposure) have significantly higher levels of chronic
health conditions(543a). A
2009 study found that inorganic mercury levels in people have been increasing
rapidly in recent years(543b). It used data from the
U.S. Centers for Disease Control and Prevention’s National Health Nutrition
Examination Survey (NHANES) finding that while inorganic mercury was detected
in the blood of 2 percent of women aged 18 to 49 in the 1999-2000 NHANES survey, that level rose to 30 percent of women by 2005-2006.
Surveys in all states using hair tests have found dangerous levels of mercury
in an average of 22 % of the population, with over 30% in some states like
Florida and New York(543c).
II. Oral Health Effects of Mercury from
Amalgam
A large study of 20,000 subjects at a
German university found a significant relation between the number of amalgam
fillings with periodontal problems(199). Some of the oral effects documented in
the literature to be caused by amalgam
include gingivitis, oral gum tissue inflammation, bleeding gums, bone
loss, mouth sores, oral lesions, pain and discomfort, burning mouth(89),
metallic taste, chronic sore throat, chronic inflammatory response, lichen
planus autoimmune response, oral keratosis, oral cancer(251,252), bad breath, mouth dryness,
tender teeth, trigeminal neuralgia, sinusitis, TMJ, orafacial
granulomatosis, oral lichen planus(86-90,95), leukoplakia, amalgam
tattoos, etc. (27,29,48a,86-90,95,192a,
303,341,525a,582,5). Amalgams are also a factor in periodontal disease(303,etc.).
Removal of amalgam fillings led to cure or significant improvement
for most of such oral health problems
(8,27,56,57,75,82,86,87,90,94,95,101,115,133,145, 167,168, 192abcf,212,222,233,303,313,317,320,321,
341,525a,582,etc.) and oral keratosis(pre cancer) (87,251,252). For example, in
one clinic(95) that replaced amalgams for a large
number of such patients, there was cure or significant improvement in over 90%
of cases for metallic taste, tender teeth, mouth sores, and bad breath and in over 80% of cases for bleeding gums and
throat irritation. A Jerome meter was
used to measure mercury vapor level in the mouth, and many had over 50
micrograms mercury per cubic meter of air, far above the Government health
guideline for mercury(217).
Mercury accumulates in the
trigeminal ganglia(325,329ab,303) and can cause trigeminal neuralgia from which most
recover after amalgam replacement(525a,192a,35d,222,437b,303). Temporomandibular
joint disorder(TMJ) is a common type of joint pain which can be caused by
accumulation of mercury in the joint due to the high amount of mercury in the
mouth area of those with amalgam fillings and due to inflammation, similar to
arthritic effects on other joints caused by mercury(303). Accumulation of mercury in the cranial nerves
is a common cause of tinnitus, TMJ, cataracts, loss of smell, etc. (303).
Cavitations from improperly healed
tooth extractions also commonly cause trigeminal neuralgia and most such
recover after cavitation surgery(437b,35a). The periodontal ligament of extracted teeth
is often not fully removed and results in incomplete jawbone regrowth resulting
in a pocket (cavitation) where mouth bacteria in anaerobic conditions along with
similar conditions in the dead tooth produce extreme toxins similar to botulism
which like mercury are extremely toxic and disruptive to necessary body
enzymatic processes at the cellular level, comparable to the similar enzymatic
disruptions caused by mercury and previously discussed(35,437ab).
Extremely toxic anaerobic bacteria
from root canals or cavitations formed at incompletely healed tooth extraction
sites have also been found to be common
factors in Fibromyalgia and other chronic neurological conditions such as
Parkinson’s and ALS, with condensing osteitis which must be removed with a
surgical burr along with 1 mm of bone around it(35,200,437ab). Cavitations have been found in 80% of sites
from wisdom tooth extractions tested and 50% of molar extraction sites
tested(35,200,437ab). The incidence is
likely somewhat less in the general population.
. The interruption of the ATP energy
chemistry results in high levels of porphyrins in the urine(260). Mercury, lead, and other toxics have
different patterns of high levels for the 5 types of porphyrins, with pattern
indicating likely source and the level extent of damage. The average for those with amalgams is over
3 time that of those without, and is over 20 times normal for some severely
poisoned people(232,260). The FDA has approved a test
measuring porphyrins as a test for mercury poisoning. However some other dental problems such as
nickel crowns, cavitations, and root canals also can cause high porphyrins. Cavitations are diseased areas in bone under
teeth or extracted teeth usually caused by lack of adequate blood supply to the
area. Tests by special equipment(Cavitat) found
cavitations in over 80% of areas under root canals or extracted wisdom teeth
that have been tested, and toxins such as anaerobic bacteria and other toxics
which significantly inhibit body enzymatic processes in virtually all
cavitations(200,437ab). These toxins
have been found to have serious systemic health effects in many cases, and
significant health problems to be related such as arthritis, MCS, and CFS. These have been found to be factors along
with amalgam in serious chronic conditions such as MS, ALS, Alzheimer’s, MCS,
CFS, etc.(35,200,204,222,292,437). The problem occurs in extractions that are not cleaned out
properly after extraction. Supplements
such as glucosamine sulfate and avoidance of orange juice and caffeine have
been found to be beneficial in treating arthritic conditions as well(35).
Nickel and beryllium are 2 other metals
commonly used in dentistry that are very carcinogenic, toxic, and cause DNA malformations(35,456).
Nickel ceramic crowns, root canals and cavitations have also been found
to be a factor in some breast cancer and other cancers and some have recovered
after TDR, which includes amalgam replacement, replacement of metal crowns over
amalgam, nickel crowns, extraction of root canaled teeth, and treatment of
cavitations where necessary(35,200,228a,486,530). Similarly nickel crowns and gold crowns over
amalgam have been found to be a factor in lupus(456,35,229)
and Belle’s Palsy from which some have recovered after TDR and Felderkrais
exercises(35). An analysis of the large
U.S. NHANESIII population found that the age-adjusted geometric mean urine Cadmium
concentration was significantly higher among participants with periodontal disease(240.) Smoking
is known to be a common source of elevated cadmium level.
Toxic/allergic reactions to toxic metals
such as mercury/amalgam often result in autoimmune conditions such as lichen
planus lesions in oral mucosa or gums, eczema, pustulosis, dermatitis and play
a roll in pathogenesis of periodontal disease(85-88,90,313,314,303,etc.). A
high percentage of patients with oral mucosal problems along with other
autoimmune problems such as chronic fatigue(CFS) have
significant immune reactions to mercury, palladium, gold, and nickel(313,118,369). 94% of such patients had significant immune
reactions to inorganic mercury(MELISA test) and 72% had immune reactions to low
concentrations of HgCl2(<0.5 ug/ml). 61% also had immune reaction to
phenylHg, which has been commonly used in root canals and cosmetics(313)
. Removal of amalgam fillings usually
results in cure of such lesions. [75,82,86,87,90,94,101,118,133,
145,167,168,313]. Patients with other
systemic neurological or immune symptoms such as arthritis, myalgia, eczema,
CFS, MS, diabetes, etc. also often recover after amalgam replacement(313,118,369,86,600,etc.) 10% of controls had significant immune
reactions to HgCl and 8.3% to palladium.
In a recent study of patients with OLP, 60
% showed
sensitization to 1 or more allergens using a patch test(85). The greatest
frequency of positive reactions was to dental metals. The order of tested metals according to
frequency of positive reactions was mercury, amalgam nickel , palladium , cobalt, gold , chrome ,
and indium. However, patch tests have been found to not be a reliable indicator
of mercury immune reactivity or allergy(303,etc). In large number of clinical trials by doctors
treating OLP, between 39 and 53% of patients tested by patch tests were
indicated to be reactive to mercury . However when patients had amalgams replaced,
the majority recovered or significantly improved in a relatively short time
period irregardless of patch test results . Thus the
authors recommend replacement of amalgam in all cases of OLP and similar
conditions. The MELISA blood lymphocyte
immune reactivity test appears to be a more accurate indicator of immune
reactivity than the patch test. When
patch tests are to be used it should be noted that the clinical trials found
that mercury immune reactivity is often a delayed reaction, with positive patch
test observed only later on the 10th or 17th day of the test. Patients with OLP also commonly have been
found to be immune reactive to gold or nickel so that replacement of gold or
nickel crowns may be beneficial in such patients when amalgam replacement is
not sufficient to resolve the
problem(85).
Oral
lichen planus and oral lesions, caused most commonly by reactivity to mercury,
are inflammatory pre-cancerous conditions that have been well documented in the
literature to often develop into oral squamous cell carcinoma(OSCC)(85). Infection and
chronic inflammation have
been found to contribute to carcinogenesis through inflammation-related
mechanisms(85). Inflammatory bowel
diseases are associated with colon carcinogenesis and inflammatory oral conditions such
as oral lichen planus (OLP) and leukoplakia are
associated with OSCC.
Mercury(as well as toxins from root canals and
cavitations) interact with brain tubulin and disassembles microtubules that
maintain neurite structure(207b,258,35,200,303,437). Thus chronic exposure to low level mercury vapor can inhibit polymerization
of brain tubulin and creatinine kinase which are essential to formation of
microtubules. Studies of mercury studies
on animals give results similar to that found the Alzheimer brain. The effects of mercury with other toxic
metals have also been found to be synergistic,
having much more effect than with individual exposure(35).
Teeth are living tissue and have
massive communication with the rest of the body via blood, lymph, and nerves.
Mercury vapor (and bacteria in teeth ) have paths to
the rest of the body. (34,325,etc.) Mercury has direct routes from the teeth and
gums to the brain and CNS, where it accumulates to high levels in those with a
large number of amalgam fillings(34,327,329).
Due to galvanism of mixed metals,
amalgam fillings produce electrical currents which increase mercury vapor
release and may have other harmful effects(14,19,27-30,35,47, 100,192, 600). These currents are measured in micro amps,
with some measured at over 4 micro amps. The central nervous system operates on
signals in the range of nana-amps, which is 1000 times less than a micro amp(28). The metals
also have electrical potentials which can be measured in millivolts(mV). One clinical study determined that electrical
potential differences of over 50 mV were pathological(48b), causing galvanism,
leukoplakia, oral lichen planus, or toxic or allergic reactions to restorations(48a,etc.). In most
subjects with amalgam fillings, potential differences of more than 50
mV are present between restorations(48a), with potentials ranging from -417 mV
to +150 mV. Negative potentials may be more pathological than positive
ones. The average potential for metal crowns and bridges was
154 mV and for brace brackets was 74 mV(48a).
Negatively charged fillings or crowns
push electrons into the oral cavity since saliva is a good electrolyte and
cause higher mercury vapor losses(35,192). Patients with autoimmune conditions like
MS, or epilepsy, depression, etc. are often found to have a lot of high
negative current fillings(35). The Huggins total dental revision(TDR)
protocol calls for teeth with the highest negative charge to be replaced
first(35). Other protocols for amalgam
removal are available from international dental associations like IAOMT(153) and mercury poisoned patients organizations like
DAMS(447). For these reasons it is
important that no new gold dental work be placed in the mouth until at least 6
months after replacement. Some studies
have also found persons with chronic exposure to electromagnetic fields(EMF) to have higher levels of mercury exposure and
excretion(28). The post MRI saliva mercury levels for a sample of
patients was on average 31% higher after MRI than before(28e).
In a large German study of MS patients
after amalgam revision, extraction resulted in 80% recovery rate versus only
16% for filling replacement alone (302,308). Other cases have found that
recovery from serious autoimmune diseases, dementia, or cancer may require more
aggressive mercury removal techniques than simple filling replacement due to
body burden. This appears to be due to migration of mercury into roots and
gums that is not eliminated by simple amalgam replacement., providing
a lasting residue for chronic mercury exposure.
. That such mercury(and
similarly bacteria) in the teeth and gums have direct routes to the brain and
CNS has been documented by several medical studies(34,325,etc.).
Periodontal offices also often are a
source of exposure to mercury for staff and patients. Both dental hygienists and patients get
high doses of mercury vapor when dental hygienists polish or use ultrasonic
scalars on amalgam surfaces(240). Pregnant women or pregnant hygienist
especially should avoid these practices during pregnancy or while nursing since
maternal mercury exposure has been shown to affect the fetus and to be related
to birth defects, SIDS, etc.(38, 61,272), and breast milk contains up to 6
times higher mercury than in the mother's blood(20,186). There is considerable
exposure as well when polishing amalgam fillings and hygienists are generally
advised not to polish amalgam fillings.
The component mix in amalgams has also been
found to be an important factor in mercury vapor emissions. The level of mercury and copper released from
high copper amalgam is as much as 50 times that of low copper
amalgams(191). Studies have
consistently found modern high copper non gamma-two amalgams have greater
release of mercury vapor than conventional silver amalgams (298). While the non gamma-two amalgams were
developed to be less corrosive and less prone to marginal fractures than
conventional silver amalgams, they have been found to be unstable in a
different mechanism when subjected to wear/polishing/ chewing/ brushing/bleaching,
etc. they form droplets of mercury on the surface of the amalgams
(297,136,182,192). This has been found
to be a factor in the much higher release of mercury vapor by the modern non
gamma-two amalgams. Recent studies have
concluded that because of the high mercury release levels of modern amalgams,
mercury levels higher than Government health guidelines are being transferred
to the lungs, blood, brain, CNS, kidneys, liver, etc. of large numbers of
people with amalgam fillings and widespread neurological, immune system, and
endocrine system effects are occurring(34,35,199,212,222,313,118,600).
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