Mercury
From Amalgam Fillings:
A Major Factor in Periodontal
Disease and Oral Health Problems
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,
in addition to migration to other parts of the body(200,47,35). 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. 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 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, metallic taste, chronic sore throat, chronic
inflammatory response, lichen planus, autoimmune response, oral keratosis, oral
cancer, bad breath, mouth dryness, burning mouth tender teeth, trigeminal neuralgia, sinusitis, orafacial
granulomatosis, oral lichen planus, leukoplakia, amalgam tattoos, etc. (27,29,48a,86,87,90,95,192a,341,525a,582,5). 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, 313,317, 320,321,341,525a, 582,etc.)
and oral keratosis(pre cancer) (87,251). 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) and can cause
trigeminal neuralgia from which most recover after amalgam
replacement(525a,192a,35d,222,437b).
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).
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(313,314,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(313,118,369,600,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.
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,258,35,200,437). 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).
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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