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: most of 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.

(Review, Opinion, Dental, Not scientifically peer-reviewed)

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page 3- ADA submission

Urinary mercury levels before and after amalgam restoration.Chien YC, Feldman CA, Zohn HK, Weisel CP. (P-)(NGS)Sci Total Environ. 1996 Sep 20;188(1):39-47.

Department of Environmental Sciences, Rutgers University, Piscataway, NJ, USA.Urinary mercury levels and excretion rates were measured to determine the effect of dental amalgam restoration on the mercury body burden. No consistent increase in urinary mercury concentrations was found among subjects who had a single restoration, but a continuously increasing statistically significant (P < 0.05) trend, that was 33% above background levels, was detected between 9 and 12 days after restoration, in the subject with four restorations in a single day. The current findings suggested that even though amalgam restorations can cause an increase in mercury body burden, the elevation above background levels is small and thus the risks associated with the use of this material are considered minimal for the general population. ****************************************

[ There is a large amount of research that documents that those with amalgam have much higher levels of mercury in urine, feces, and saliva than those without amalgam; and that exposures are commonly above governement health guidelines for mercury.

The following is snipped from the following review that has the documentation referenced:

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

( A large NIDH study of the U.S. military population(49) with an average of 19.9 amalgam surfaces and range of 0 to 60 surfaces found the average urine level was 3.1 ug/L, with 93% being inorganic mercury. The average in those with amalgam was 4.5 times that of controls and more than the U.S. EPA maximum limit for mercury in drinking water(218). The average level of those with over 49 surfaces was over 8 times that of controls.From the study results it was found that each 10 amalgam surfaces increased urine mercury by approx. 1 ug/L. )

( In a population of women tested In the Middle East(254,223e), the number of fillings was highly correlated with the mercury level in urine, mean= 7 ug/L. )

(Amalgam has also been found to be the largest source of organic mercury in most people(506,79,386,220,etc.).

( After filling replacement levels of mercury in the blood, urine, and feces typically temporarily are increased for a few days, but levels usually decline in blood and urine within 6 months to from 60 to 85% of the original levels(57,79,82,89,196,303). Mercury levels in saliva and feces usually decline between 80 to 95% (79,196,335,386))

(The number of amalgam surfaces has a statistically significant correlation to urine mercury level (38,49,57,76,77,79,82,83,134,138,167,176,254,303,332,335))

(The blood and urine mercury load of a person with amalgam fillings is often 5 times that of a similar person without.(14,16,17,79,80,82,93,136,138, 303,315,317,318) ]

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Tissue response to potential root-end filling materials in infected root canals.Chong BS, Ford TR, Kariyawasam SP. (A)Int Endod J. 1997 Mar;30(2):102-14.

Department of Conservative Dentistry, United Medical and Dental Schools, Guy's Hospital, London, UK.The tissue responses to two potential root-end filling materials, a light-cured glass ionomer cement (Vitrebond) and a reinforced zinc oxide-eugenol cement (Kalzinol) were compared with that to amalgam. In 27 premolar teeth of beagle dogs (54 roots), a collection of endodontic pathogenic bacteria was first inoculated into the root canals to induce periapical lesions. On each root, an apicectomy was performed and root-end cavities prepared to receive fillings of each material. The teeth and surrounding jaw were removed after 8 weeks (24 roots) and 4 weeks (30 roots); and they were prepared for histological examination. The tissue response to amalgam fillings after 4 and 8 weeks was marked by moderate or severe inflammation on all roots, and extended > 0.5 mm in 10 out of 18 roots. In contrast, after 8 weeks, the majority of roots filled with Kalzinol showed little or moderate inflammation while the tissue response to Vitrebond was the best of the three materials, and was also less extensive. After 4 weeks, the overall best tissue response was with Kalzinol, followed closely by Vitrebond. The differences between materials for both time periods with either none or few inflammatory cells when compared with that with either moderate or severe inflammation were statistically significant (P < 0.01). Similarly, the differences between materials for both time periods with no inflammation or inflammation extending < 0.2 mm when compared with that with inflammation extending > 0.2 mm (< or = 0.5 mm or > 0.5 mm) were statistically significant (P < 0.01). Both Vitrebond and Kalzinol have potential as root-end filling materials as the tissue response was considerably more favourable than that to amalgam

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Other studies have similarly found retrograde use of amalgam causes significant harm and systemic mercury exposures(www.home.earthlink.net/~berniew1/periodon.html)

Other countries including Canada and Amalgam manufacturer MSDS warn against use of amalgam for such purposes. (Dentsply)

^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^Use of inductively coupled plasma-emission spectroscopy and mercury vapor analyses to evaluate elemental release from a high-copper dental amalgam: a pilot study.Cohen BI, Penugonda B. (A)J Prosthet Dent. 2001 Apr;85(4):409-12.

Essential Dental Laboratories, South Hackensack, NJ, USA. EDS@pipeline.comSTATEMENT OF PROBLEM: The use of dental amalgam as a direct restorative material has been a subject of controversy for many years. The potential safety of amalgam has been questioned because of leakage of elements such as mercury, copper, tin, and silver. PURPOSE: This study evaluated the elemental leaching from Tytin dental amalgam placed in deionized water for 2 months. Both mercury vapor and elemental (silver, copper, tin, and mercury) analyses were performed. MATERIAL AND METHODS: Two capsules of Tytin amalgam were triturated (one for the precipitate and liquid analysis, and the other for the mercury vapor analysis) and stored in a polypropylene tube with 10 mL deionized water for 60 days at room temperature. The amalgam pellet then was removed and rinsed with deionized water. The resulting liquid was separated from a precipitate, and 2 separate analyses were run: one on the liquid without any precipitate and another on the precipitate. Elemental analyses for copper (Cu), tin (Sn), mercury (Hg), and silver (Ag) were determined by inductively coupled plasma-emission spectroscopy with a Perkin-Elmer P2000 spectrometer. Mercury vapor analyses were performed daily for 60 days with a Jerome 431-X vapor analyzer. RESULTS: The maximum amount of copper (80 microg), silver (2.6 microg), mercury (15 microg), and tin (550 microg) was found in the precipitate. The maximum amount of mercury vapor released was 67 microg/m(3)/d. CONCLUSION: Under the conditions of this in vitro study, there was a significant amount of elemental leaching and mercury vapor release from the Tytin amalgam over a 60-day period.***********************************************

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 a high negative current and much greater release of mercury vapor than conventional silver amalgams and are more cytotoxic (35,258,298,299). Clinics have found the increased toxicity and higher exposures to be factors in increased incidence of chronic degenerative diseases(35,etc). 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: they form droplets of mercury on the surface of the amalgams(182,297). This has also 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 the high mercury release levels of modern amalgams, mercury poisoning from amalgam fillings is widespread throughout the population”(95,199,238,258). Numerous other studies also support this finding(Section IV).

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

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Stormy weather. (D)Conley JF. J Calif Dent Assoc. 2001 Sep;29(9):645-6.

********************************************************************Dental amalgam: update on safety concerns. ADA council on Scientific Affairs. (R, D)[No authors listed] J Am Dent Assoc. 1998 Apr;129(4):494-503.

This report of the Council on Scientific Affairs reviews and discusses recent studies concerning the safety of dental amalgam, with an emphasis on studies that have been published since the 1993 review of dental amalgam by the U.S. Public Health Service Committee to Coordinate Environmental Health and Related Programs. The Council concludes that, based on currently available scientific information, amalgam continues to be a safe and effective restorative material.**********************************************

The common adverse health effects caused by amalgam are well documented by thousands of peer-reviewed studies in the medical literature(www.home.earthlink.net/~berniew1/indexa.html)

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Issues in design and analysis of a randomized clinical trial to assess the safety of dental amalgam restorations in children. (R, NS)DeRouen TA, Leroux BG, Martin MD, Townes BD, Woods JS, Leitao J, Castro-Caldas A, Braveman N.

Control Clin Trials. 2002 Jun;23(3):301-20.

Department of Dental Public Health Sciences, University of Washington, Seattle, WA 98195-7475, USA. derouen@u.washington.eduThe Casa Pia Study of the Health Effects of Dental Amalgams in Children is a randomized clinical trial designed to assess the safety of low-level mercury exposure from dental amalgam restorations in children. It is being carried out in 507 students (8 to 12 years of age at enrollment) of the Casa Pia school system in Lisbon, Portugal, by an interdisciplinary collaborative research team from the University of Washington (Seattle) and the University of Lisbon, with funding from the National Institute of Dental and Craniofacial Research. Since the goal of the trial is to assess the safety of a treatment currently in use, rather than the efficacy of an experimental treatment, unique design issues come into play. The requirements to identify as participants children who have extensive unmet dental treatment needs and who can be followed for 7 years after initial treatment are somewhat in conflict, since those with the most treatment needs are usually in lower socioeconomic categories and more difficult to track. The identification of a primary study outcome measure around which to design the trial is problematic, since there is little evidence to indicate how health effects from such low-level exposure would be manifested. The solution involves the use of multiple outcomes. Since there are concerns about safety, multiple interim comparisons over time between treatment groups are called for which, in conjunction with the use of multiple outcomes, require an extension of statistical methodology to meet this requirement. Ethical questions that have to be addressed include whether assent of the children participating is required or appropriate, and whether the director of the school system, who is the legal guardian for approximately 20% of the students who are wards of the state and live in school residences, should provide consent for such a large number of children. Approaches taken to address these and other design issues are described.***************************************

In vitro corrosion behavior and microstructure examination of a gallium-based restorative.DeSchepper EJ, Oshida Y, Moore BK, Cook NB, Eggertson H.Oper Dent. 1997 Sep-Oct;22(5):209-16.

Indiana University School of Dentistry, Indianapolis 46202, USA.Concerns of mercury toxicity have led to the development of gallium-based restorative materials to replace dental amalgam. A new gallium-based dental restorative, Galloy, was compared with a high-copper amalgam, Permite, for anodic polarization behavior in deoxygenated Ringer's solution and by immersion testing in normal Ringer's solution at 37 degrees C. Corrosion products were analyzed using energy dispersive X-ray spectrometry and transmission electron diffraction. The data from both sources were consistent with the presence of alpha-Ga2O3 and SnO2 as the primary corrosion products of Galloy. Anodic polarization behavior of Galloy- and Permite-coupled specimens suggests that coupling Galloy with the more noble Permite amalgam may cause accelerated electrochemical corrosion and that Galloy is more corrosion prone than

Permite.******************************

Amalgams still viable, safe treatment, controversies notwithstanding.Dixon SE. J Indiana Dent Assoc. 1998 Spring;77(1):37-40. (P) (R,O,D)

Indiana University School of Dentistry, Restorative Dentistry Department, Indianapolis 46202, USA.This article addresses the dental amalgam debate from two aspects. The first is a review of the current status regarding the appropriate treatment planning of direct restorations. The second is a discussion of the safety of amalgam and the mercury toxicity concerns. Dental research continues to support the use of amalgam while the search continues for the "ideal" restorative material ******************************************************************

Common adverse health effects are well documented in the medical literature.

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

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The amalgam controversy. An evidence-based analysis. (P)(R,O,D)Dodes JE. J Am Dent Assoc. 2001 Mar;132(3):348-56.

johndodes@aol.comBACKGROUND: There are a number of patients and health care professionals who believe dental amalgam restorations are a factor in a host of diseases and conditions. They have been influenced by anecdotal case reports in the medical and dental literature, research published in the refereed literature and media stories concerning the alleged dangers of amalgam restorations. METHODS: The author uses an evidence-based approach in analyzing the data both supporting and condemning the continued use of amalgam restorations. He reviewed the articles from both peer-reviewed and non-peer-reviewed sources and evaluated their relevance, research design and statistical analysis, as well as whether the conclusions follow from the data. CONCLUSIONS: There are numerous logical and methodological errors in the anti-amalgam literature. The author concludes that the evidence supporting the safety of amalgam restorations is compelling. CLINICAL IMPLICATIONS: Amalgam restorations remain safe and effective. Dentists should educate patients and other health care professionals who may be mistakenly concerned about amalgam safety.*****************************************************

[Amalgam is the largest source of mercury in most people(www.home.earthlink.net/~berniew1/damspr1.html) and the mechanisms by which mercury from amalgam causes over 20 chronic health conditions is documented by thousands of medical studies(www.home.earthlink.net/~berniew1/amalg6.html]

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The mercury concentration in breast milk resulting from amalgam fillings and dietary habits.Drexler H, Schaller KH. (M)(Sc)Institute and Out-patient Clinic for Occupational, Social and Environmental Medicine of the University Erlangen-Nuremberg, Schillerstrasse 25/29, Erlangen, D-91054, Germany.Health risks from amalgam fillings are a subject of controversy. In Germany it is not advised to use amalgam fillings during breast feeding. Objectives of this study were to examine the concentration of mercury in human breast milk and the confounders which may modify the mercury levels. Women who gave birth between August 1995 and May 1996 in a district hospital were asked to participate in the study. The examination included a standardized anamnesis and an inspection of the teeth by an dentist. Blood and urine samples of 147 women and breast milk samples of 118 women were collected in the first week after birth. After 2 months of breast feeding a second breast milk sample was collected from 85 of women. Mercury was measured by cold-vapor atomic absorption spectrometry. The concentration of mercury in the breast milk collected immediately after birth showed a significant association with the number of amalgam fillings as well as with the frequency of meals. Urine mercury concentrations correlated with the number of amalgam fillings and amalgam surfaces. In the breast milk after 2 months of lactation, the concentrations were lower (mean: <0.25 microg/L; range <0.25-11.7 microg/L) compared with the first sample (mean: 0.90 microg/L; range <0.25-20. 3 microg/L) and were positively associated with the fish consumption but no longer with the number of the amalgam fillings. Accordingly, the additional exposure to mercury of breast-fed babies from maternal amalgam fillings is of minor importance compared to maternal fish consumption.

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Mercury vapor readily crosses the placenta. The largest source of mercury in the fetus of mother’s with amalgams is from the mother’s fillings and the fetus gets much higher levels of exposure than in the mother’s blood. Amalgam is also documented to be the largest source of mercury in the breast milk in many cases, with significant exposures and adverse health effects documented by studies in the literature. (www.home.earthlink.net/~berniew1/fetaln.html)

Dental amalgams are the main source of mercury in breast milk(112,186,304,339,20). Milk increases the bioavailability of mercury(112,304,391) and mercury is often stored in breast milk and the fetus at much higher levels than that in the mother's tissues (19,20,22,23,61,112,186,210, 287,304). Mercury is transferred mainly by binding to amino acids like albumin(339). The level of mercury in breast milk was found to be significantly correlated with the number of amalgam fillings(61,339), with milk from mothers with 7 or more fillings having levels in milk approx. 10 times that of amalgam-free mothers. The milk sampled ranged from 0.2 to 6.9 ug/L. Several authors suggest use of early mother’s milk as a screen for potential problems since it is correlated both to maternal and infant mercury levels. The highest level is in the pituitary gland of the fetus which affects development of the endocrine system. Levels for exposure to mercury vapor has been found to be approx 10 times that for maternal exposure to an equivalent dose of inorganic mercury(281,287), and developmental behavioral effects from vapor have been found at levels considerably below that required for similar effects by methyl mercury (20,49,119c,264,287,304,338). The level of total mercury in nursing infants was significantly correlated to total mercury level in maternal hair(22,541). References: www.home.earthlink.net/~berniew1/amalg6.html

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Page 4 ADA submissions

Current materials and techniques for direct restorations in posterior teeth. Part 1: Silver amalgam. (R, D) Dunne SM, Gainsford ID, Wilson NH.Int Dent J. 1997 Jun;47(3):123-36.

Conservation Department, King's Dental Institute, London, UK.This paper, the first of two reviewing materials and techniques for direct intracoronal restorations in posterior teeth, deals with the use of silver amalgam. Based on a consensus view on appropriate applications and contraindications for silver amalgam, the toxicity of amalgam and competing materials, financial implications and international legislation, consideration is given to the continued use of this material. It is concluded that silver amalgam still has a place in everyday practice, albeit restricted in comparison to its former use. Amalgam should only be used where it offers clear advantages over other materials. This requirement for use of silver amalgam will continue until true substitutes are developed and evaluated, alternative materials are optimised and dentists are fully trained in the use of adhesive techniques.************************************************

Doesn’t appear to evaluate health risk in the assessment.

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Neurobehavioral effects from exposure to dental amalgam Hg(o): new distinctions between recent exposure and Hg body burden. (A, Sc, HE)Echeverria D, Aposhian HV, Woods JS, Heyer NJ, Aposhian MM, Bittner AC Jr, Mahurin RK, Cianciola M.FASEB J. 1998 Aug;12(11):971-80.

Battelle Centers for Public Health Research and Evaluation, Seattle, Washington 98105, USA.Potential toxicity from exposure to mercury vapor (Hg(o)) from dental amalgam fillings is the subject of current public health debate in many countries. We evaluated potential central nervous system (CNS) toxicity associated with handling Hg-containing amalgam materials among dental personnel with very low levels of Hg(o) exposure (i.e., urinary Hg <4 microg/l), applying a neurobehavioral test battery to evaluate CNS functions in relation to both recent exposure and Hg body burden. New distinctions between subtle preclinical effects on symptoms, mood, motor function, and cognition were found associated with Hg body burden as compared with those associated with recent exposure. The pattern of results, comparable to findings previously reported among subjects with urinary Hg >50 microg/l, presents convincing new evidence of adverse behavioral effects associated with low Hg(o) exposures within the range of that received by the general population.*********************************************************

Toxicological aspects on the release and systemic uptake of mercury from dental amalgam.Ekstrand J, Bjorkman L, Edlund C, Sandborgh-Englund G. (A, Sc, E)Eur J Oral Sci. 1998 Apr;106(2 Pt 2):678-86.

Department of Basic Oral Sciences, Faculty of Dentistry, Karolinska Institutet, Huddinge, Sweden. Jan.A.Ekstrand@ofa.ki.seThis paper summarizes some recent reports on mercury release from amalgam fillings and resulting concentrations in biological fluids, development of antibiotic resistance, and kidney function. In a series of studies of subjects with amalgam fillings, mercury (Hg) levels were followed in saliva, feces, blood, plasma, and urine before and until 60 d after removal of all of the fillings. The Hg concentrations in saliva remained elevated for at least 1 wk, suggesting that dissolved Hg vapor is not the major source of mercury in mixed saliva. An absorption phase of Hg was seen in plasma during 24 h after amalgam removal. After 60 d the plasma Hg concentration was reduced to 40%, of the baseline level. The decrease per amalgam surface was 0.11 nmol/l (range 0.02 0.40). The Hg level in feces increased two orders of magnitude two days after amalgam removal. At day 60, the median Hg concentration was still slightly higher than the median value of the amalgam free control group. The resistance patterns of the oral and intestinal microflora in these subjects were also studied. In the intestinal microflora, the relative amount of intestinal microorganisms resistant to 50 microM HgCl2 peaked 7 d after removal of the amalgam fillings, with a median value per sample of 6.1%, compared to 1.3% in samples collected prior to the Hg exposure. However, no statistical differences in the resistance pattern of the oral microflora were detected between the control and the experimental groups. A number of sensitive kidney function parameters were measured 1 wk before and 1, 2, and 60 d after amalgam removal. No effects on the various kidney parameters studied were recorded. According to the conclusions of independent evaluations from different state health agencies, the release of mercury from dental amalgam does not present any non-acceptable risk to the general population.**************************************

The study confirmed that amalgam is the largest source of mercury exposure in most people, and that mercury exposure and body burden levels decline rapidly and significantly after amalgam replacement. The decline in daily exposure measured by saliva and feces level declined over 90%. The level in blood, which is also affected by accumulated body burden declined over 60%. This study did little to assess health effects before and after amalgam replacement.

The common adverse health effects of mercury from amalgam are well documented in the medical literature by hundreds of studies and thousands of clinical cases.

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

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The future of dental amalgam: a review of the literature. Part 7: Possible alternative materials to amalgam for the restoration of posterior teeth.Eley BM. (R, D)Br Dent J. 1997 Jul 12;183(1):11-4.

Periodontal Department, King's College School of Medicine & Dentistry, Denmark Hill, London.This is the last in a series of articles on the future of dental amalgam. It considers possible alternative materials to amalgam for the restoration of posterior teeth. The materials discussed are gold inlays, gold foil, gallium alloys, and tooth coloured non-metal alternatives including glass-ionomer cements, composite resins, glass-ionomer-resin hybrids, compomers and ceramics. The clinical indications for these restorations are first described along with their potential clinical problems and their mean survival rates in comparison with dental amalgam. Secondly, the safety of composite resins is considered and potential toxic and hypersensitive effects of these materials are discussed. Finally, it is concluded that the present evidence does not appear to demonstrate that dental amalgam is hazardous to the health of the general population. It does, however, recommend that in continuing to use amalgam dentists must use strict mercury hygiene procedures to avoid risk to their staff and contamination of the environment. It seems that mercury contamination of the environment is likely to be the main reason for any future government action against the continued clinical use of dental amalgam.****************************************************************

The study did not include a serious assessment of the thousands of peer-reviewed studies documenting high exposures and common adverse health effects from amalgam.

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

The study did point out the serious environmental effects of amalgam that will have to be increasing dealt with, and which are having huge and expensive impacts on environment, commerce, and health. Amalgam is documented to be the largest source of mercury in most sewer systems, and the level of mercury has been found to be very high and causing huge harmful effects. Amalgam has been found to be the source of about 15% of mercury going into the nations waterways, fish, and wildlife. In the U.S., high levels of mercury are being found in fish and wildlife, with 33% of all lakes, 15% of all river miles, and 90% of coastal areas having warnings to limit fish consumption, which is an important major protein and essential fatty acid source. The ecomonic loss is very high, along with the impacts on fish, wildlife, and human health. All sewer sludge has been found to have dangerous levels of mercury by Government studies by Oak Ridge National Laboratory and municipal sewer agencies. Mercury from sludge has been found to enter crops when used by landspreading, and to be methylated by soil bacteria and outgased to the atmosphere and rain. High levels of mercury is being found in rain all over the U.S., and in the environment and food chain. www.home.earthlink.net/~berniew1/damspr2f.html

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Speciation of mercury excreted in feces from individuals with amalgam fillings.Engqvist A, Colmsjo A, Skare I. (A, Sc, E)Arch Environ Health. 1998 May-Jun;53(3):205-13.

Department of Toxicology and Chemistry, National Institute for Working Life, Solna, Sweden.Investigators established methods for the analysis of total mercury (Hg-total), oxidized mercury and mercury bound to sulfhydryl groups (Hg-S), mercury vapor (Hg0), and mercury from amalgam particles (APs) in fecal samples. Two individuals consumed mercury as a mercury-cysteine complex mercury vapor, and mercury from amalgam particles, and the cumulative excretion of mercury in feces was followed. Investigators found that 80% of the mercury from amalgam particles and mercury bound to sulfhydryl groups was excreted, but only 40% of the mercury vapor was excreted. Speciation of mercury excreted in feces from 6 individuals with a moderate loading of amalgam fillings showed that most of the mercury originating from the fillings consisted of oxidized mercury, which was probably bound to sulfhydryl-containing compounds. The proportion of amalgam particles in fecal samples from these individuals was low, and it did not exceed 26% of the total amount of mercury excreted.***********************************************

The study found that significant levels of mercury from mercury vapor or other mercury states are absorbed and accumulated, but did not assess the level of exposure of those with amalgam.

It has been documented that amalgam is the largest source of mercury exposure in most people,

with absorption of significant levels of mercury vapor through the lungs, as well as mercury from the gastrointestinal tract from saliva, and with high levels accumulating and being dispersed through the oral mucosa and oral cavity. www.home.earthlink.net/~berniew1/damspr1.html

Mercury from amalgam has been found to bioaccumulate in the major body organs including the brain, heart, liver, kidneys, hormone glands, etc. and to have common significant health effects. www.home.earthlink.net/~berniew1/amalg6.html

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Mercury derived from dental amalgams and neuropsychologic function.Factor-Litvak P, Hasselgren G, Jacobs D, Begg M, Kline J, Geier J, Mervish N, Schoenholtz S, Graziano J.Environ Health Perspect. 2003 May;111(5):719-23. (P, PDS)

Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York 10032, USA. prf1@columbia.eduThere is widespread concern regarding the safety of silver-mercury amalgam dental restorations, yet little evidence to support their harm or safety. We examined whether mercury dental amalgams are adversely associated with cognitive functioning in a cross-sectional sample of healthy working adults. We studied 550 adults, 30-49 years of age, who were not occupationally exposed to mercury. Participants were representative of employees at a major urban medical center. Each participant underwent a neuropsychologic test battery, a structured questionnaire, a modified dental examination, and collection of blood and urine samples. Mercury exposure was assessed using a) urinary mercury concentration (UHg); b) the total number of amalgam surfaces; and c) the number of occlusal amalgam surfaces. Linear regression analysis was used to estimate associations between each marker of mercury exposure and each neuropsychologic test, adjusting for potential confounding variables. Exposure levels were relatively low. The mean UHg was 1.7 micro g/g creatinine (range, 0.09-17.8); the mean total number of amalgam surfaces was 10.6 (range, 0-46) and the mean number of occlusal amalgam surfaces was 6.1 (range, 0-19). No measure of exposure was significantly associated with the scores on any neuropsychologic test in analyses that adjusted for the sampling design and other covariates. In a sample of healthy working adults, mercury exposure derived from dental amalgam restorations was not associated with any detectable deficits in cognitive or fine motor functioning.***********************************************

The study was not well designed to use current knowledge of mercury toxicity effects. The authors conclusions are incorrect due to poor study design and invalid assumptions. Susceptability factors such as immune reactivity, genetic and other factors affecting ability to excrete mercury, etc. are well documented in the medical literature to be major factors in determination of mercury toxicity effects. www.home.earthlink.net/~berniew1/suscept.html

It is well documented that effects are not directly dose response related, though exposure level is also important in effects. (www.home.earthlink.net/~berniew1/amalg6.html)

The amalgam connection to widespread and diverse forms of neurological effects including depression, anxiety, manic-depression, memory, ADHD, autism, learning disabilities, alzheimer’s, Parkison’s, etc. are well documented by hundreds of peer-reviewed studies in the medical literature, as well as by thousands of clinical cases.

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

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Fenrich J Toxicity of Amalgams Int J Pharm Compound

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Dental mercury amalgam: Part II. Safety of mercury amalgam.Fisher AA. Cutis. 1997 Nov;60(5):231.

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Materials for restoration of primary teeth: I. Conventional materials and early glass ionomers. (R, D, M) Fleming GJ, Burke FJ, Watson DJ, Owen FJ.Dent Update. 2001 Dec;28(10):486-91.

University of Birmingham School of Dentistry.This paper demonstrates how the treatment of primary dentition may present the clinician with increased difficulties compared with the preparation and placement of restorations in adult dentition. Established dental materials (dental amalgam and conventional glass ionomer cements) and less well established alternative materials (copper cements) are reviewed. The use of amalgam to restore primary dentition is the subject of concern amongst the dental profession in terms of lack of adhesion and potential toxicity concerns, while the low tensile strength of traditional glass ionomer cements make them less suitable for the restoration of primary dentition.*********************************************************

Composites in the mainstream.Freedman G. Dent

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Mercury determination in nursing home patients with Alzheimer's disease.Fung YK, Meade AG, Rack EP, Blotcky AJ, Claassen JP, Beatty MW, Durham T.Gen Dent. 1996 Jan-Feb;44(1):74-8. (P, PDS)

Department of Oral Biology, University of Nebraska Medical Center, College of Dentistry, Lincoln 68538-0740, USA.Trace-element neurotoxicity contributing to the development of Alzheimer's disease (AD) may be an important etiologic factor for this disorder. This clinical study was conducted to determine the urine concentrations of mercury (Hg) from patients with AD disorders. Within the confines of a nursing home, all subjects were exposed to the same environment and a diet that excluded seafood. The results of this study do not indicate that subjects with AD have a greater body burden of Hg, according to urinary excretion. This can be further evidence that Hg from amalgam restorations or diet is not related to etiology and pathogenesis of AD

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Determination of blood mercury concentrations in Alzheimer's patients.Fung YK, Meade AG, Rack EP, Blotcky AJ, Claassen JP, Beatty MW, Durham T.J Toxicol Clin Toxicol. 1995;33(3):243-7. (P, PDS)

Department of Oral Biology, University of Nebraska Medical Center, College of Dentistry, Lincoln 68583-0740, USA.Trace element neurotoxicity can be an etiologic factor for Alzheimer's disease. This cross sectional clinical study determined blood mercury in patients with diagnosed Alzheimer's disease as compared to control subjects without known central nervous system and renal disorders. Unique within the confines of a nursing home, all subjects were exposed to the same environment and consumed a diet without fish and seafood for a period of three months prior to the study. The results of this study show that blood mercury concentrations detected in subjects with Alzheimer's disease were not statistically different than that of control subjects. Ratios of blood mercury to blood selenium were also determined and no statistical difference was found between these two groups.

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The study was not well designed to assess the possible connection of mercury exposure to Alzheimer’s. The study did not assess the most relevant variables known from the medical literature to affect mercury neurotoxicity, body burden or susceptability. Susceptability factors are well documented in the literature to play a major role in mercury neurotoxicity effects, such as immune reactivity(www.melisa.org) and systemic detoxification ability

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

It is well documented in the medical literature that blood mercury levels represent mostly recent exposure and are not a reliable measure of body burden. www.home.earthlink.net/~berniew1/damspr17.html

The most reliable test for mercury body burden is the chelator challange test; with hair test more useful than blood test for assessing body burden- but understanding that for mercury toxic individuals, the extent of essential mineral imbalances are more reliable measures of mercury toxicity than hair level. ( 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; www.safeminds.org/ &

Andrew H. Cutler, PhD, PE; Amalgam Illness:Diagnosis and Treatment; 1996 )

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The use of amalgam in pediatric dentistry. (R, D, M)Fuks AB.Pediatr Dent. 2002 Sep-Oct;24(5):448-55.

Department of Pediatric Dentistry, Hebrew University, Hadassah School of Dental Medicine, Jerusalem, Israel. fuks@cc.huji.ac.ilAmalgam has been widely utilized to restore posterior teeth in pediatric dentistry, and is still taught as the material of choice for Class I and Class II restorations in many dental schools in the United States and Canada. Results of clinical trials are difficult to compare due to their heterogenicity, mainly due to differences in caries risk, operator skills, study duration, or patients' age. Thus, the different studies report failure rates of amalgams ranging from 12% to over 70%. Treatment of caries should meet the needs of each particular patient, based on his/her caries risk. In general, for small occlusal lesions, a conservative preventive resin restoration, using composite or compomer in conjunction with sealant, would be more appropriate than the classic Class I amalgam preparation. For proximal lesions, amalgam would be indicated for 2-surface Class II preparations that do not extend beyond the line angles of primary teeth. This recommendation might not be appropriate for high-risk patients or for restoring first primary molars in children 4 years of age and younger where stainless steel crowns have demonstrated better longevity. Currently, amalgam demonstrates the best clinical success for Class II restorations that extend beyond the proximal line angles of permanent molars.********************************************

Study deals with technical aspects of material use comparisons, rather than health effects.

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page 5

Elimination of mercury from amalgam in rats.Galic N, Prpic-Mehiic G, Prester LJ, Krnic Z, Blanusa M, Erceg D.J Trace Elem Med Biol. 2001;15(1):1-4.

Department of Dental Pathology, School of Dentistry, Zagreb, Croatia.The aim of this study was to measure the urinary mercury excretion in rats exposed to amalgam over a two months period. Animals were either exposed to mercury from 4 dental amalgams or fed the diet containing powdered amalgams. The results showed significantly higher mercury amount in urine of both exposed groups than in control. Even two months after the amalgam had been placed in rats teeth, the amount of mercury in the urine remained 4-5 times higher than in control, and 4 times higher than in rats exposed to diet containing powdered amalgam. The elevated urinary Hg amount was accompanied by an increased level of total protein in urine. In the same exposure period the excretion of total protein in urine of rats with amalgam fillings was 2 times higher than in control and 1.5 times higher than in rats exposed to amalgam through diet. Concentrations of mercury in the sera of all groups were below the detection limit of the method. The results show that amount of mercury and protein in the urine of rats were related to the mercury release from dental amalgam

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The study shows that amalgam causes significant exposure to mercury, with 4 to 5 times as much mercury exposure as controls; and adverse metabolic and kidney effects.

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[Influence of chewing gum consumption and dental contact of amalgam fillings to different metal restorations on urine mercury content][Article in German]Gebel T, Dunkelberg H.Abteilung fur Allgemeine Hygiene und Umweltmedizin, Zentrum Umwelt- und Arbeitsmedizin, Universitat Gottingen.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 microgram 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.****************************************************************

Chewing gum or drinking hot liquids or use of bleaching products to whiten teeth can result in 3 to 100 times normal levels of mercury exposure from amalgams during that period(15,35,136,199,258).

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

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Concentrations of blood and hair mercury and serum PCBs in an Ojibwa population that consumes Great Lakes region fish.Gerstenberger SL, Tavris DR, Hansen LK, Pratt-Shelley J, Dellinger JA.J Toxicol Clin Toxicol. 1997;35(4):377-86.

Department of Preventive Medicine, Medical College of Wisconsin, Milwaukee 53226, USA. gerst@post.its.mcw.eduOBJECTIVE: This paper describes an exposure assessment of an American Indian population using blood and hair samples as indicators of mercury and polychlorinated biphenyl exposure from the consumption of fish taken from the Great Lakes region. METHODS: Questionnaires regarding fish consumption were completed by 89 Ojibwa tribal members. Mercury concentrations were determined in human hair and blood samples, and polychlorinated biphenyl concentrations were determined in serum. RESULTS: Fish were consumed at the highest rates in April, May, June, and July. Lake trout, whitefish, and walleye were the preferred fish consumed by 91.4% of the respondents. Concentrations of blood mercury were all below 55 micrograms/L (ppb), while concentrations of mercury in hair were all less than 3 mg/L (ppm). Hair mercury concentrations were correlated with the previous year's fish consumption (p = .05). Dental amalgams and blood mercury concentrations were also significantly correlated (p < .002). Serum polychlorinated biphenyl concentrations, determined as the sum of 89 congeners, were all below 9.6 ppb total polychlorinated biphenyls. Subject age and total serum polychlorinated biphenyls were correlated (p < .001). CONCLUSIONS: The concentrations of mercury and polychlorinated biphenyls in this Ojibwa population were relatively low, but several individuals were identified as having elevated concentrations and additional testing may be warranted. Since the accumulation of contaminants was related to fish consumption and age, a long-term monitoring program that assesses chronic exposure to fish diets would be beneficial.**********************************

Amalgam fillings and fish consumption were both found to be directly correlated to mercury exposure. Hair mercury level was found to primarily measure methyl mercury. This has been documented in many other studies. While hair mercury level tends to be correlated with the number of amalgam fillings for those with normal detoxification systems, hair mercury levels have been found to be inversely correlated with exposure levels and mercury toxicity effects in those with chronic mercury related health conditions.

( 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; www.safeminds.org/ &

Andrew H. Cutler, PhD, PE; Amalgam Illness:Diagnosis and Treatment; 1996 ) The referenced books points out that for hair tests, the existence of multiple essential mineral imbalances and deficiences in someone with normal diet is a strong indication of mercury accumulation and mercury toxicity, due to mercury’s effect on cell membrane permeability and absorption.

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Pulp response in primary teeth with deep residual caries treated with silver fluoride and glass ionomer cement ('atraumatic' technique)Gotjamanos T.Aust Dent J. 1996 Oct;41(5):328-34.

School of Dentistry, University of Western Australia.Histological assessment of the dental pulps of 55 carious primary teeth was carried out 3 to 58 months after treatment by the 'atraumatic' technique involving application of 40 per cent silver fluoride to residual caries followed by restoration with glass ionomer cement. Fifty of the 55 teeth examined showed a favourable pulpal response, inducing presence of abundant reparative dentine and a wide odontoblast layer. Histological comparisons were made between these teeth and others not treated with silver fluoride but restored with glass ionomer cement, amalgam or zinc oxide and eugenol. Possible mechanisms of the action of silver fluoride in arresting residual caries are discussed. The question of whether or not treatment of carious dentine with silver fluoride represents a biologically acceptable clinical procedure cannot be answered on the basis of pulpal histology alone. The very high concentration of fluoride in commercial preparations of silver fluoride raises several questions concerning its clinical safety

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(not related to amalgam issues)

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Placebo response in environmental disease. Chelation therapy of patients with symptoms attributed to amalgam fillings.Grandjean P, Guldager B, Larsen IB, Jorgensen PJ, Holmstrup P.J Occup Environ Med. 1997 Aug;39(8):707-14.

Department of Environmental Medicine, Odense University, Denmark.Treatment of patients who attribute their environmental illness to mercury from amalgam fillings is largely experimental. On the Symptom Check List, overall distress, and somatization, obsessive-compulsive, depression, and anxiety symptom dimensions, were increased in 50 consecutive patients examined, and Eysenck Personality Questionnaire scores suggested less extroversion and increased degree of emotional liability. Succimer (meso-2, 3-dimercaptosuccinic acid) was given at a daily dose of 30 mg/kg for five days in a double-blind, randomized placebo-controlled trial. Urinary excretion of mercury and lead was considerably increased in the patients who received the chelator. Immediately after the treatment and 5 to 6 weeks later, most distress dimensions had improved considerably, but there was no difference between the succimer and placebo groups. These findings suggest that some patients with environmental illness may substantially benefit from placebo.********************************************

Mercury from amalgam has been documented by thousands of peer-reviewed studies to cause over 30 chronic health conditions(www.home.earthlink.net/~berniew1/amalg6.html)

and the majority treated by amalgam replacement(and chelation) recover or have significant improvement. Section VI. provides documentation on over 60,000 clinical cases of such recoveries. Not many have long term recoveries from degenerative chronic conditions due to placebo and often its likely that patients aren’t monitored for other factors they might change from normal patterns during a trial. . The placebo effect has been much exagerated by some.

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Hakimi R, Comment on W. Hausotter: modern illness from the critical viewpoint., Versicherungsmedizin

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Compartmental transfer of mercury released from amalgam. (A-)Halbach S, Kremers L, Willruth H, Mehl A, Welzl G, Wack FX, Hickel R, Greim H.Hum Exp Toxicol. 1997 Nov;16(11):667-72.

Institute of Toxicology, GSF-National Research Center for the Environment and Health, Neuherberg, Germany.The number of amalgam-covered surfaces and the occlusal area of the fillings, the concentrations of total mercury in plasma, erythrocytes and urine, the urinary excretion rate, and the absorbed daily doses estimated by two separate methods from intra-oral Hg emission were determined in 29 volunteers with a low amalgam load. The transfer of Hg from the fillings via the oral cavity and blood to urinary excretion was evaluated by multiple correlations between these variables. In addition, the combination of variables most representative of the entire compartmental transfer of amalgam Hg was determined. Urinary excretion (1), Hg concentration in plasma (2) and absorbed dose (3) were most closely correlated to each other, followed by correlations with the variables of the fillings (4). Correlation coefficients were 0.75 for variables 1 vs 2 and 2 vs 3, and 0.49 for variables 3 vs 4. It was concluded that variables 1-3 best reflected the transfer of mercury from amalgam fillings throughout the organism and that they were relatively insensitive to dietary mercury. The determination of total mercury in plasma and of its urinary excretion rate appears, under practical aspects, most suitable for the investigation of Hg uptake from amalgam.**********************************************************

(not a very useful study, documents that mercury from amalgam fillings is directly correlated with urine and blood mercury)

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Systemic transfer of mercury from amalgam fillings before and after cessation of emission. (A-)Halbach S, Kremers L, Willruth H, Mehl A, Welzl G, Wack FX, Hickel R, Greim H.Environ Res. 1998 May;77(2):115-23.

Institute of Toxicology, Institute of Biomathematics and Biometry, GSF-National Research Center for Environment and Health, Neuherberg, Oberschleissheim, D-85758, Germany.In 29 volunteers with a low amalgam load, the number of amalgam-covered tooth surfaces and the occlusal area of the fillings were determined. Concentrations of total mercury were measured in plasma and erythrocytes as well as in urine together with the excretion rate. Absorbed daily doses were estimated from intraoral Hg emission by two separate methods. The transfer of Hg from the fillings via the oral cavity and blood to urinary excretion was evaluated according to the most representative combination of parameters. This consisted of urinary excretion (1), Hg concentration in plasma (2), absorbed dose (3), and occlusal area (4). Pairwise correlation coefficients were 0.75 for parameters 1 vs 2 and 2 vs 3 and 0.49 for parameters 3 vs 4. Within 9 days after removal of the fillings, a transient increase was observed in plasma Hg levels only. This was reduced in those volunteers to whom a rubber dam had been applied during removal. Peak plasma Hg was 0.6 ng/ml on average and decreased with halftimes between 5 and 13 days. A significant decrease in Hg excretion was noted not before 100 days after removal. Being relatively insensitive to dietary mercury, the determination of total mercury in plasma and of its urinary excretion rate appears, under practical aspects, most suitable for the investigation of Hg uptake from amalgam.***********************************************************

(not a very useful study; but documents that amalgam is the largest source of mercury in this population and daily and body mercury burden decline significantly after amalgam replacement)

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Mercury in urine and ejaculate in husbands of barren couples. (P) (PDS)Hanf V, Forstmann A, Costea JE, Schieferstein G, Fischer I, Schweinsberg F.Toxicol Lett. 1996 Nov;88(1-3):227-31.

Universitats-Frauenklinik, Tubingen, Germany.Mercury concentrations in morning urine and ejaculate were detected in 80 husbands of women presenting for infertility treatment. Additionally, the number of their dental amalgam fillings was documented. A routine spermiogram was performed, from which a numerical "fertility index" was calculated. Urinary mercury concentrations were in the range of non-exposed populations, only minute Hg concentrations were determined in ejaculate, 75% of the semen sample concentrations were under the detection limit of 5 micrograms/l. In comparison, 7 proven fertile workers with occupational mercury exposure had elevated levels of mercury in their ejaculates (range 10-65 micrograms/l). No positive correlation could be established between subject mercury concentrations in urine or ejaculate and the quality of their semen, expressed as fertility index. Equally, no such correlation could be established between the fertility index and the number of their dental amalgam fillings. From these preliminary data no evidence can be derived for the alleged relation between the mercury burden from dental amalgam fillings and male fertility disorders.*********************************************

[the connection between mercury(from amalgam) and fertility disorders is well documented in the medical literature by dozens of peer reviewed studies; and large numbers of infertile couples have become fertile again after amalgam replacement and detoxification. Since it is easy to document that mercury damages sperm levels and semen quality, the results of this study seem unusual. The results of this study are contrary the majority of studies on this topic. That mercury damages semen quality is well documented in the literature; mercury has been used as a contraceptive because it effectively disables sperm at low levels.

www.home.earthlink.net/~berniew1/fetaln.html]

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U.S. EPA, NTIS Technical Report(EPA/452/R97/007), Mercury study report to Congress.

Dec 1997. (A)

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Product analysis of acrylic resins compared to information given in material safety data sheets.Henriks-Eckerman ML, Kanerva L.Contact Dermatitis. 1997 Mar;36(3):164-5.

Turku Regional Institute of Occupational Health, Finland.***********************************************

Acute glomerulonephritis, Henoch-Schonlein purpura and dental amalgam in Swedish children: a case-control study.Herrstrom P, Hogstedt B, Aronson S, Holmen A, Rastam L. (N)Sci Total Environ. 1996 Nov 22;191(3):277-82.

Primary Care Center Hertig Knut, Halmstad, Sweden.The issue of adverse health effects from dental amalgam and the concurrent low-dose exposure to inorganic mercury have been scrutinized by several Swedish expert groups during the past years. Only rarely have amalgam fillings in children been related to health effects. Experimental studies in genetically disposed animals have shown that low doses of inorganic mercury can induce autoimmune glomerulonephritis. The present case-control study included 31 children with acute glomerulonephritis and 33 with Henoch-Schonlein purpura retrieved from an in-patient register for the period 1973-1992 at the county hospital in Halmstad, Sweden. The median age was 10 and 9 years, respectively, for the two diagnostic groups. Dental clinics reported amalgam burden of the patients during the year before the date of diagnosis. Corresponding data were obtained for three randomly selected controls for each case, drawn from the case records of the same dental clinics, with matching for age and sex. Odds ratios (95% confidence interval) were 1.42 (0.49, 4.11) for Henoch-Schonlein purpura, 0.59 (0.25, 1.38) for acute glomerulonephritis and 0.84 (0.40, 1.75) for both diseases combined. The results of this study did not indicate increased disease risk in relation to amalgam burden.*********************************************

It appears that the study neither measured mercury body burden, nor assessed mercury toxicity susceptability factos such as immune reactivity, which have been documented in the medical literature to be factors in such conditions. While the number of fillings is important and positively correlated to chronic health conditions; it is documented in the medical literature that susceptability is a bigger factor for those with amalgam fillings.

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

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Allergic disease, immunoglobulins, exposure to mercury and dental amalgam in Swedish adolescents.Herrstrom P, Hogstedt B, Holthuis N, Schutz A, Rastam L. (A-)Int Arch Occup Environ Health. 1997;69(5):339-42.

Primary Care Center Hertig Knut, Halmstad, Sweden.High-dose exposure to inorganic mercury in man can influence the immune system and in rare cases cause immune-related disease. Some experimental animals also react with autoimmunity after low doses of inorganic mercury. Glomerulonephritis and an increased formation of immunoglobulin type E (IgE) are characteristic of these reactions. A recent study of 15-year-old adolescents demonstrated an association between immunoglobulin type A (IgA) and mercury concentration in plasma (P-Hg). There was also an association between allergic disease and IgA levels. The present study included 54 male and 23 female 19-year-old students who were recruited from a cohort that had been previously defined in a survey of allergic disease. Of the students, 39 (51%) had asthma, allergic rhinoconjunctivitis or eczema. Similar amalgam burden and P-Hg levels were observed in students with (n = 39) and without (n = 38) allergic disease (P = 0.48 and P = 0.98, respectively). As expected, IgE levels were significantly higher in the group with allergic disease (P = 0.006), but there was no association between P-Hg and IgE. The P-Hg levels were very low (median 1.50 nmol/l) and correlated significantly (r = 0.31) with the small number of amalgam surfaces (P = 0.007). Thirty-seven students had no amalgam fillings. P-Hg levels did not associate significantly with IgA, but did so with IgG2 (r = 0.33; P = 0.003). No conclusive correlation was observed between IgG2 and amalgam fillings. The findings of this study in 19-year-old subjects differ from earlier data obtained in a sample 4 years younger. The possibility of chance in the association between P-Hg levels and IgG2 must, however, be considered.***************************************************

Study documented link between mercury levels and number of amalgam fillings; also found that plasma mercury level was directly correlated to autoimmune antibodies(IgG2). Study noted that statistical significance level was not reached between number of amalgams and IgG2, but this could have been because of the small sample size.

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Dental amalgam affects urinary selenium excretion. (N+)Hol PJ, Vamnes JS, Gjerdet NR, Eide R, Isrenn R.Biol Trace Elem Res. 2002 Feb;85(2):137-47.

Department of Odontology--Dental Biomaterials, University of Bergen, Norway.Selenium may have a protective effect against mercury toxicity. The aim of the present study was to investigate if selenium excretion in urine was affected in persons with dental amalgam fillings. The reason for this study is that dental amalgam is the most important source of inorganic mercury exposure in the general population, although the potential toxic effects of this exposure remain a subject for debate. The chelating agent 2,3 dimercaptopropane-1-sulfonate (DMPS) was injected intravenously (2 mg/kg) to provoke metal excretion. Urine samples were subsequently collected at intervals over a 24-h period. Selenium concentration was determined by hydride-generation atomic absorption spectrometry. The study was comprised of 20 persons who claimed symptoms from dental amalgam and 21 healthy persons with amalgam fillings. There were two control groups without amalgam. One control group had amalgam replaced because of concern about illness resulting from mercury release (n = 20), whereas the other control group never had amalgam (n = 19). Individuals with amalgam excreted less selenium (36.4 microg, median value) over 24 hours than those without amalgam

(47.5 microg) (p = 0.016). There was no difference in selenium excretion between groups with (42.4 microg) and without (39.4 microg) amalgam-related symptoms (p = 0.15). The findings indicate that individuals exposed to low levels of elemental mercury from dental amalgam excrete less selenium to urine than unexposed individuals.

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study simply showed that those with amalgam excrete less selenium than those without amalgam. Apparently did not try to assess toxicity effects or degree of heath protection of selenium.

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Dental amalgam and selenium in blood. (N+)Hol PJ, Vamnes JS, Gjerdet NR, Eide R, Isrenn R. Environ Res. 2001 Dec;87(3):141-6.

Department of Odontology-Dental Biomaterials, University of Bergen, Aarstadveien 17, Bergen, N-5009, Norway.It has been suggested that selenium (Se) exhibits protective effects against mercury (Hg) toxicity in humans due to formation of a Hg-Se complex bound to selenoprotein P in blood. The aim of the present study was to investigate Se concentrations in persons who had been examined with respect to general health problems associated with dental amalgam fillings. The Se concentrations were determined in whole-blood samples of 80 individuals by hydride generation atomic absorption spectrometry. The subjects comprised two main groups: 21 healthy controls with amalgam fillings and 20 patients who claimed symptoms from existing amalgam fillings. The median concentration of Se in blood (119.2 microg/L) was statistically significantly lower in subjects who claimed symptoms of mercury amalgam illness than in healthy subjects with amalgam (130.3 microg/L). The difference was more evident in individuals with more than 35 amalgam surfaces (P=0.003). Additional control groups without amalgam fillings comprised 19 healthy controls without amalgam experience and 20 subjects who have had amalgam fillings removed due to suspected symptoms associated with amalgam. The Se concentrations in these groups were not different from those with amalgam. It is indicated that persons with ill health self-related to dental amalgam might have a Se metabolism different from that of healthy people.********************************************

people suffering from mercury toxicity appear to have a Se metabolism different from healthy people

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Activation of the immune system and systemic immune-complex deposits in Brown Norway rats with dental amalgam restorations.Hultman P, Lindh U, Horsted-Bindslev P. (A, Sc)J Dent Res. 1998 Jun;77(6):1415-25.

Department of Health and Environment, Linkoping University, Sweden.Dental amalgam restorations are a significant source of mercury exposure in the human population, but their potential to cause systemic health effects is highly disputed. We examined effects on the immune system by giving genetically mercury-susceptible Brown Norway (BN) rats and mercury-resistant Lewis (LE) rats silver amalgam restorations in 4 molars of the upper jaw, causing a body burden similar to that described in human amalgam-bearers (from 250 to 375 mg amalgam/kg body weight). BN rats with amalgam restorations, compared with control rats given composite resinous restorations, developed a rapid activation of the immune system, with a maximum 12-fold increase of the plasma IgE concentration after 3 wks (p < 0.001; Mann-Whitney's test). LE rats receiving amalgam restorations showed no significant increase of plasma IgE (p > 0.05). After 12 wks, BN rats with amalgam restorations showed significantly increased (p < 0.05) titers of immune-complex (IC) deposits in the renal glomeruli and in the vessel walls of internal organs. These rats also showed a significant (p < 0.05), from six- to 130-fold, increase in tissue mercury concentration in the concentration order kidney > spleen > cerebrum occipital lobe > cerebellum > liver > thymus, and the tissue silver concentration was significantly (p < 0.05) increased from three- to 11-fold. Amalgam-implanted BN rats showed a significant (p < 0.05) increase in copper concentration in the kidney and spleen, and in kidney selenium concentration. We conclude that dental amalgam restorations release substantial amounts of their elements, which accumulate in the organs and which, in genetically susceptible rats, give rise to activation of the immune system and systemic IC deposits.***************************************************************

study shows that amalgam is unstable, losing substantial mercury into organs of body, and causing autoimmune conditions in susceptible rats.

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Shedding light on amalgam. (D, O)Horseman RE. J Calif Dent Assoc. 2001 Sep;29(9):710, 709.

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The use of gallium-based metal-containing filling materials as a replacement for mercury] [Article in Russian] (Gallium)Iankelich OV. Stomatologiia (Mosk). 1999;78(4):54-5.

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Impact of nocturnal bruxism on mercury uptake from dental amalgams.Isacsson G, Barregard L, Selden A, Bodin L. (A-, Sc, NVU)Eur J Oral Sci. 1997 Jun;105(3):251-7.

Orofacial Pain Clinic, Postgraduate Dental Education Centre, Orebro County Council, Sweden. goran.isacsson@pain.se.astra.comThe mercury (Hg) release from dental amalgam fillings increases by mechanical stimulation. The aim of this study was to investigate the possible impact of nocturnal bruxism on Hg exposure from dental amalgams and to evaluate the effect of an occlusal appliance. 88 female patients from an orofacial pain clinic with a complete maxillary and mandibular dentition, a normal frontal vertical overbite with cuspid guidance, and at least 4 occlusal amalgam fillings in contact with antagonists in intercuspidal position, were examined with the Bruxcore bruxism monitoring device to measure the level of on-going nocturnal bruxism. Based on the degree of abrasion recorded, the subjects were divided into a group defined as bruxists, (n = 29), another group defined as non-bruxists, (n = 32), serving as controls, the intermediate group being discarded. The Hg exposure was assessed from the Hg concentration in plasma and urine, corrected for the creatinine content. In a regression model with bruxism as the only explanatory variable, no significant effect of bruxism was found, but when the number of amalgam fillings, chewing gum use, and other background variables were taken into account, there was a limited impact of bruxism on Hg in plasma. The nocturnal use of an occlusal appliance did not, however, significantly change the Hg levels. This study indicates that mechanical wear on amalgams from nocturnal bruxism may increase the Hg uptake, but the magnitude of this effect seems to be less than from the use of chewing gum.***********************study shows gum chewing has more effect on amalgam release than bruxism

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Dentistry, amalgam, and pollution prevention. (A, Env,D)Johnson WJ, Pichay TJ. J Calif Dent Assoc. 2001 Jul;29(7):509-17.

California Dental Association, 1201 K St., 14th Floor, Sacramento, CA 95814, USA.California has issued fish consumption advisories because of mercury in lakes, reservoirs, creeks, rivers, and bays. Mercury in these waterways leads to the formation of methylmercury, which is toxic and bioaccumulative. Dental practices and other health care settings contribute a portion of this mercury. Government agencies are implementing programs to reduce mercury pollution. Dentists can reduce their contributions by implementing best management practices. They may also consider using pretreatment technologies as more information becomes available about their use and effectiveness.*****************************************************************

Exposure or absorption and the crucial question of limits for mercury.Jones DW. J Can Dent Assoc. 1999 Jan;65(1):42-6. (P, O, D, Ext.Poor Study)

Dalhousie University, Halifax.Health Canada recently lowered the recommended maximum daily exposure of mercury from all sources for women of child-bearing age and for children less than 10 years. This new exposure guideline does not seem to be based on any new scientific finding of human toxicity. The average daily intake of methylmercury (mainly from fish) that may cause demonstrable health effects in the most sensitive individual is 300 micrograms/day, or 4.3 micrograms Hg/day/kg body weight. The new, lower Health Canada limit is 95% below the level that may cause health effects. A number of studies have looked at methylmercury in human breast milk (where maternal consumption of fish is high), but no strong evidence of toxicity has been reported. The amount of mercury released from dental amalgam is minimal; a person would have to have 490 amalgam surfaces for there to be enough mercury vapour and ionic mercury given off from amalgam fillings to meet the maximum exposure guidelines. The uptake of food-related organic mercury is six times higher than the uptake of mercury from amalgam; moreover, food-related mercury is significantly more toxic. Many studies of amalgam-related mercury are flawed by confusion between exposure and absorption for the various forms of mercury, a limited selection of data, the ignoring of confounding variables or the misclassification of data.

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The study discusses obsolete standards, and apparently did not bother to review the extensive new studies that contradict the opinions expressed.and resulted in the newer lower standards due to studies showing mercury toxicity effects at much lower levels than those discussed in this paper. All of extreme opinions expressed in the abstract are clearly contradicted by medical studies readily available in the National Library of Medicine Medline. It is surprising that the ADA would submit such a clearly biased and unscientific paper.

************************************************Mercury exposure and early effects: an overview.Kazantzis G.Med Lav. 2002 May-Jun;93(3):139-47.

Environmental Geochemistry Research Group, Department of Environmental Science and Technology, Imperial College of Science, Technology & Medicine, Prince Consort Road, London SW7 2BP, UK.OBJECTIVES: This paper was given as a keynote address at the conference on The Assessment of the Effects Due to Low Doses of Inorganic Mercury following Environmental and Occupational Exposures: Human and in vitro Studies on the Specific Mechanisms of Toxicity in Gargnano, Italy, in September 2001. METHODS: The most relevant literature over the past 40 years has been reviewed, and in particular, the proceedings of the World Health Organisation conferences on the health effects of inorganic and organic mercury exposure have been considered. RESULTS: In an uncontaminated environment the general population is exposed to mercury vapour from the atmosphere and from dental amalgam, while the diet, mainly from fish, is the principal source for methyl mercury absorption. Mercury vapour release from amalgam fillings increases with chewing, with absorption and uptake by the brain and kidneys. Infants exposed to phenyl mercury from treated diapers and young children ingesting mercurous chloride in teething powders have developed acrodynia (pink disease), and Kawasaki disease and the use of mercurial skin lightening creams has been followed by the development of the nephrotic syndrome. Both mercury compounds and mercury vapour have given rise to contact dermatitis in the general population. Epidemics of mercury poisoning have followed release of mercury into the environment from industrial activity, with uptake of methyl mercury from fish eating in Minamata Bay and uptake of both inorganic and methyl mercury following release of mercury vapour and deposition into waterways from gold recovery procedures in the Amazon basin. The ingestion of wheat and barley seed treated with an alkyl mercury fungicide for sowing, by a largely illiterate population in Iraq, led to a major outbreak of poisoning with a high fatality rate. Following exposure to mercury vapour, the earliest clinically observed adverse effects at urine mercury levels of the order of 30-100 mg/g creatinine, are objectively detectable tremor, psychological disorder and impaired nerve conduction velocity in sensitive subjects, with subjective symptoms of irritability, fatigue and anorexia. At these and at lower levels, proteinuria has also been observed. Both glomerular and tubular damage may occur at exposure levels lower than those giving rise to central nervous system effects. An immunological effect has also been observed in studies on clinically asymptomatic workers with low level exposure. CONCLUSIONS: As mercury can give rise to allergic and immunotoxic reactions which may be genetically regulated, in the absence of adequate dose-response studies for immunologically sensitive individuals, it has not been possible to set a level for mercury in blood or urine below which mercury related symptoms will not occur.**********************************************************

Like other studies, the study notes that mercury effects can occur in susceptable populations at very low levels of exposure; A significant portion of the population has been found to be susceptable by medical tests and studies, amounting to many millions of people.

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

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Cytotoxicity of mineral trioxide aggregate using human periodontal ligament fibroblasts. (A, Sc) Keiser K, Johnson CC, Tipton DA.J Endod. 2000 May;26(5):288-91.

Department of Biologic and Diagnostic Sciences, Division of Endodontics, University of Tennessee College of Dentistry, 875 Union Avenue, Memphis, TN 38163, USA.The purpose of the present study was to compare the cytotoxicity of mineral trioxide aggregate (MTA) to other commonly used retrofilling materials, Super-EBA and amalgam. This was accomplished using a cell viability assay for mitochondrial dehydrogenase activity in human periodontal ligament fibroblasts after 24-hr exposure to extracts of varying concentrations of the test materials, in both freshly mixed and 24-hr set states. Methyl methacrylate 2% (vol/vol) served as the positive control, and complete culture medium served as the negative control. Differences in mean cell viability values were assessed by ANOVA (p < 0.05). In the freshly mixed state, the sequence of toxicity was amalgam > Super-EBA > MTA. In the 24-hr set state the sequence of toxicity at a low extract concentration was Super-EBA > MTA, amalgam, and Super-EBA > amalgam > MTA at a higher extract concentration. This study supports the use of MTA in the root-end environment.**********************************************************Urinary mercury excretion following amalgam filling in children.Khordi-Mood M, Sarraf-Shirazi AR, Balali-Mood M.J Toxicol Clin Toxicol. 2001;39(7):701-5.

Department of Pedodontics, Imam Reza Hospital, Mashhad University of Medical Sciences, Iran. mkhordimood@yahoo.comOBJECTIVES: Dental amalgam is the major source of inorganic mercury exposure in the general population. Dental amalgam contains approximately 50% mercury, which is a toxic element. Since children are more at risk for mercury toxicity, we aimed to study prospectively the effects of amalgam filling on urinary mercury excretion in 5- to 7-year-old children. METHODS: Children admitted to the Pedodontics Department with no previous amalgam filling, and in a good state of health with one or more carious posterior teeth, were selected. All fillings were placed in one session for each child using Sina (Iran) amalgam powder and Degussa (Germany) mercury, which were mixed by an automated electric amalgamator (Dentomate 3, Germany). Urinary mercury concentrations were estimated before and 9-12 days after amalgam filling by atomic absorption using the mercuric hydride system. RESULTS: Forty-three children (20 male, 23 female) aged 5.95+/-0.92 years and weighing 19.09+/-3.10 kg were studied. Urinary mercury concentrations before and after amalgam filling were 3.83+/-2.45 and 5.14+/-3.14 microg/L, respectively (p = 0.001). There were no statistically significant correlations between the urinary mercury concentrations and any other variables, including the number and surfaces of filled teeth, weight, age, and sex. CONCLUSION: Although there were highly significant increases in urinary mercury concentrations after amalgam filling, no significant correlation was found between the urinary mercury concentration and the amounts of filled amalgam. Additional investigation is required concerning the effects of mercury release from amalgam.*****************************************************

Although the study was too small to assess levels statistically, there was a considerable and significant increase in urinary mercury exposure levels after amalgam work.

Other studies have documented that amalgam is the largest source of mercury in most people, and that mercury levels are often 5 times that of those without amalgam.

(Snipped) The saliva and feces of children with amalgams have approximately 10 times the level of mercury as children without(25,315,386,528), and much higher levels in saliva after chewing. A group of German children with amalgam fillings had urine mercury level 4 times that of a control group without amalgams(76), and in a Norwegian group with average age 12 there was a significant correlation between urine mercury level and number of amalgam fillings(167). The level of mercury in maternal hair was significantly correlated to level of mercury in nursing infants(541).

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

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Mercury concentrations in urine and whole blood associated with amalgam exposure in a US military population. (A+, Sc)Kingman A, Albertini T, Brown LJ.J Dent Res. 1998 Mar;77(3):461-71.

Oral Health Promotion, Risk Factors and Molecular Epidemiology Branch, National Institute of Dental Research, Bethesda, Maryland 20892, USA.Minute amounts of mercury vapor are released from dental amalgams. Since mercury vapor is known to be associated with adverse health effects from occupationally exposed persons, questions regarding the margin of safety for exposure to mercury vapor in the general population continue to be raised. To address this issue, one needs information regarding exposure to mercury vapor from dental amalgam fillings and its possible consequences for health in the general population. The NIDR Amalgam Study is designed to obtain precise information on amalgam exposure and health outcomes for a non-occupationally-exposed population of US adults. One hypothesis was that in a generally healthy population a significant association between amalgam exposure and Hg levels in urine and/or whole blood could be detected. The cohort investigated was an adult military population of 1127 healthy males. Their average age was 52.8 years, and their ages varied from 40 to 78 years. Ninety-five percent of the study participants were white males, and slightly over 50% had some college education. Five percent were edentulous. The dentate participants, on average, had 25 natural teeth, 36.9 decayed or filled surfaces (DFS), and 19.9 surfaces exposed to amalgam, with amalgam exposure varying from 0 to 66 surfaces. Their average total and inorganic urinary mercury concentrations were 3.09 microg/L and 2.88 microg/L. The average whole-blood total and inorganic mercury concentrations were 2.55 microg/L and 0.54 microg/L. Significant correlations were detected between amalgam exposure and the total (r = 0.34, p < 0.001) and inorganic 0.34 (r = 0.34, p < 0.001) urinary mercury concentrations on the original scale. Stronger correlations were found for total (r = 0.44, p < 0.001) and inorganic (r = 0.41, p < 0.001) urinary Hg on the log scale, as well as for creatinine-corrected total (r = 0.43, p < 0.001) and inorganic (r = 0.43, p < 0.001) urine concentrations. In whole blood, statistically significant, but biologically weak, correlations were detected for total (r = 0.09, p = 0.005) and inorganic (r = 0.15, p < 0.001) Hg concentrations, respectively. Based on these cross-sectional data, it is estimated that, on average, each ten-surface increase in amalgam exposure is associated with an increase of 1 microg/L mercury in urine concentration.*******************************************************

Large NIDH study of military population documents that amalgam is the largest source of mercury in most people, that those with amalgam get significant exposures above Federal health guideline levels.

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Mercury as a potential hazard for the dental practitioner.Kostyniak PJ. N Y State Dent J. 1998 Apr;64(4):40-3. (N, O, D)

Department of Pharmacology, School of Medicine and Biomedical Sciences, University at Buffalo, USA.Mercury has been used for centuries for medical, chemical, metallurgical and electrical applications. It is an element of mystery, which in its metallic form is an enticing silvery liquid that can be as fascinating as it is dangerous. Its use in dental amalgam has a potential for continuous occupational exposure of dental practitioners to mercury vapor. It is imperative that the dental practitioner understands the hazards associated with the use of mercury, and controls exposures to prevent the development of any untoward effects. This article provides an overview of the toxicology of the different forms of mercury to which human exposure occurs and addresses safety issues associated with mercury vapor, the primary form of mercury encountered in the practice of dentistry.*************************************************************

That dental staff get significant occupational exposures that commonly cause adverse health effects is well documented in the medical literature.

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

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Experiences from the amalgam unit at Huddinge hospital--somatic and psychosomatic aspects.Langworth S.Scand J Work Environ Health. 1997;23 Suppl 3:65-7.

Institute of Occupational Medicine, Karolinska Institute, Huddinge University Hospital, Sweden.The "amalgam unit" at the Huddinge University Hospital in Sweden examined 379 of 1300 patients referred for health problems which the patients related to amalgam tooth fillings. Toxicologic, clinical, odontological, and psychiatric examinations were performed. More than 30% had medical causes for their complaints; 7% had severe diseases which had been unrecognized. The most common symptoms were diffuse pain, general weakness, fatigue, headache, and difficulties in concentrating. Anxiety and depression were the most prevalent psychiatric complaints. The psychological examination revealed a high prevalence of somatization. The treatment was information about mercury and amalgam, appropriate odontological routines without removal of intact amalgam fillings, medical therapy when necessary, and strengthening of the patients' social networks. Ninety percent were satisfied with the treatment. The results indicate that there are various explanations for the complaints of patients fearing "amalgam disease". No cases of mercury intoxication were found.***************************************************************

The study did not appear to assess the cause of the conditions dealt with in the patients or to review the many studies of similar patients in the medical literature.

The study is contrary to other studies of the patients at Huddinge

( Lindh U, Hudecek R, Danersund A, Eriksson S, Lindvall A., Removal of dental amalgam and other metal alloys supported by antioxidant therapy alleviates symptoms and improves quality of life in patients with amalgam-associated ill health. Neuroendocrinol Lett 2002 Oct-Dec;23(5-6):459-82. (750 cases) )

and of hundreds of other studies for other similar clinics.

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

That mercury commonly causes depression and other mood and neurological conditions is well documented in the medical literature.

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

www.home.earthlink.net/~berniew1/damspr16.html

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Exposure to mercury vapor and impact on health in the dental profession in Sweden.Langworth S, Sallsten G, Barregard L, Cynkier I, Lind ML, Soderman E.J Dent Res. 1997 Jul;76(7):1397-404.

Department of Occupational Medicine, Huddinge University Hospital, Sweden.Possible adverse effects of mercury exposure in dentistry have been discussed in several studies. The objective of the present study was to carry out detailed measurements of mercury exposure in the dental profession in Sweden, and to search for adverse health effects from such exposure. We examined 22 dentists and 22 dental nurses, working in teams, at six Swedish dental clinics. Measurements of air mercury, performed with personal, active air samplers, showed a median air Hg of 1.8 micrograms/m3 for the dentists, and 2.1 micrograms/m3 for the dental nurses. Spot measurements with a direct reading instrument displayed temporarily elevated air Hg, especially during the preparation and application of amalgam. The average concentration of mercury in whole blood (B-Hg) was 18 nmol/L, in plasma (P-Hg) 5.1 nmol/L, and in urine (U-Hg) 3.0 nmol/mmol creatinine. Possible effects on the central nervous system (CNS) were registered with three questionnaires: Q16, Eysenck Personality Inventory (EPI), and the Profile of Mood Scales (POMS).In the Q16, the number of symptoms was statistically significantly higher in the dentistry group compared with an age- and gender-matched control group (n = 44). The urinary excretion of albumin and urinary activity of the tubular enzyme N-acetyl-beta-glucose-aminidase (NAG) did not differ between the two groups. The results confirm that exposure to mercury in the dental profession in Sweden is low. The air Hg levels were mainly influenced by the method of amalgam preparation and inserting, and by the method of air evacuation during drilling and polishing.******************************************************************

The study found evidence of significant effects of mercury exposure in dental staff, like the many other studies in the medical literature with similar findings.

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

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A case of high mercury exposure from dental amalgam. (A+)Langworth S, Stromberg R. Eur J Oral Sci. 1996 Jun;104(3):320-1.

Dept. Occupational Medicine, Huddinge University Hospital, Sweden.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

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The study shows that mercury can cause very high exposures to mercury and adverse health effects from which the patients mercury level declines and the patient recovers after amalgam replacement. There are many other such studies in the literature.

L.Barregard et al, "People with high mercury uptake from their own dental amalgam fillings", Occup Envir Med 52: 124-128, 1995; & R. Stromberg et al, "A case of unusually high mercury exposure from amalgam fillings", Tandlakartidningen 88(10): 570-572, 1996; & Kraub P, Deyhle M, Maier KH, Roller HD, "Field Study on the mercury content of saliva", Heavy Metal Bull, vol.3, issue 1, April '96; & Dr. P.Kraub & M.Deyhle, Universitat Tubingen- Institut fur Organische Chemie, “Field Study on the Mercury Content of Saliva”, 1997 (20,000 people tested for mercury level in saliva and health status/symptoms compiled);

www.amalgam.ukgo.com/tu.htm

& www.home.earthlink.net/~berniew1/hgremove.html

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page 8

Larose P, Dental amalgam: tradition or evidence-based care? (A, R, D)J Can Dent Assoc. 2001 Apr;67(4):190-1.

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Larose P, Amalgam safety. (A, R, D) J Can Dent Assoc. 2000 Oct;66(9):476-7

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Retrograde degeneration of neurite membrane structural integrity of nerve growth cones following in vitro exposure to mercury. (A+, Sc)Leong CC, Syed NI, Lorscheider FL.Neuroreport. 2001 Mar 26;12(4):733-7.

Faculty of Medicine, Department of Physiology and Biophysics, University of Calgary, Alberta, Canada.Inhalation of mercury vapor (Hg0) inhibits binding of GTP to rat brain tubulin, thereby inhibiting tubulin polymerization into microtubules. A similar molecular lesion has also been observed in 80% of brains from patients with Alzheimer disease (AD) compared to age-matched controls. However the precise site and mode of action of Hg ions remain illusive. Therefore, the present study examined whether Hg ions could affect membrane dynamics of neurite growth cone morphology and behavior. Since tubulin is a highly conserved cytoskeletal protein in both vertebrates and invertebrates, we hypothesized that growth cones from animal species could be highly susceptible to Hg ions. To test this possibility, the identified, large Pedal A (PeA) neurons from the central ring ganglia of the snail Lymnoea stagnalis were cultured for 48 h in 2 ml brain conditioned medium (CM). Following neurite outgrowth, metal chloride solution (2 microl) of Hg, Al, Pb, Cd, or Mn (10(-7) M) was pressure applied directly onto individual growth cones. Time-lapse images with inverted microscopy were acquired prior to, during, and after the metal ion exposure. We demonstrate that Hg ions markedly disrupted membrane structure and linear growth rates of imaged neurites in 77% of all nerve growth cones. When growth cones were stained with antibodies specific for both tubulin and actin, it was the tubulin/microtubule structure that disintegrated following Hg exposure. Moreover, some denuded neurites were also observed to form neurofibrillary aggregates. In contrast, growth cone exposure to other metal ions did not effect growth cone morphology, nor was their motility rate compromised. To determine the growth suppressive effects of Hg ions on neuronal sprouting, cells were cultured either in the presence or absence of Hg ions. We found that in the presence of Hg ions, neuronal somata failed to sprout, whereas other metalic ions did not effect growth patterns of cultured PeA cells. We conclude that this visual evidence and previous biochemical data strongly implicate Hg as a potential etiological factor in neurodegeneration

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[The "dental amalgam syndrome" - an environmental somatization Syndrome? A comparison between chronic carbon monoxide intoxication and illness related to dental amalgam] [Article in Danish] (R, O, NS)Leonhardt T. Dan Medicinhist Arbog. 2001;:177-86.

In 1940, during World War II, restrictions in import of petroleum products to Sweden necessitated the use of producer gas in motor traffic. In the following years, the incidence of acute carbon monoxide intoxications raised steeply. However, many patients with minor but longstanding exposition to producer gas exhibited a neurastenic syndrome (fatigue, headaches and vertigo) thought to be specific. In Stockholm, an epidemic of this syndrome can afterwards be traced to the personal conviction of an internist who also had an important influence on various authorities, leading to a forceful campaign to the public about the dangers of using producer gas. After some years, the frequency and even the existence of a chronic carbon monoxide intoxication was called in question and at the end of the war that diagnosis lost its actuality. In Sweden, oral galvanism attributed to dental amalgam was discussed in mass media in the 1970s, not least by evidence given by some well-known personalities. In the 1980s, the frequency of illness attributed to dental amalgam increased to an important epidemic. The question of the dangers of mercury released from amalgam fillings is still an important issue of debate among dentists and physicians, although the majority remains sceptical. Also medical authorities have found little evidence of the importance of dental amalgam toxicity. A patients organisation, Tandvardsskadeforbundet, seems to have played a significant part in the acceptance of the syndrome among laymen. Thus, various psychosocial factors seem to have played a role in both syndromes which could thus be conceived as environmental somatization syndromes.****************************************************

Study does not review the science of mercury toxicity; nor the other topic discussed

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Lindqvist B & Mornstad H. (A+, Sc)

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.

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The majority of patients with indications of immune problems experienced lessened immune problems per tests and subjective symptoms. Supported the conclusion that amalgam causes immune problems and replacing amalgam alleviates such problems.

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Neurotoxicity of dental amalgam is mediated by zinc. (A, PDA)Lobner D, Asrari M. J Dent Res. 2003 Mar;82(3):243-6.

Department of Biomedical Sciences, Marquette University, 561 N. 15th Street, Rm. 426, Milwaukee, WI 53201, USA. Doug.Lobner@marquette.eduThe use of dental amalgam is controversial largely because it contains mercury. We tested whether amalgam caused toxicity in neuronal cultures and whether that toxicity was caused by mercury. In this study, we used cortical cell cultures to show for the first time that amalgam causes nerve cell toxicity in culture. However, the toxicity was not blocked by the mercury chelator, 2,3-dimercaptopropane-1-sulphonate (DMPS), but was blocked by the metal chelator, calcium disodium ethylenediaminetetraacetate (CaEDTA). DMPS was an effective mercury chelator in this system, since it blocked mercury toxicity. Of the components that comprise amalgam (mercury, zinc, tin, copper, and silver), only zinc neurotoxicity was blocked by CaEDTA. These results indicate that amalgam is toxic to nerve cells in culture by releasing zinc. While zinc is known to be neurotoxic, ingestion of zinc is not a major concern because zinc levels in the body are tightly regulated.***************************************************

In spite of the clear miswording of the abstract with incompatible statements, the study seems to have demonstrated along with many similar such studies that amalgam causes nerve cell toxicity

and zinc has a relationship to this toxicity. Also that some chelators can block such amalgam related toxicity.

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In vitro effects of mercuric chloride (HgCl2) on human mononuclear cells.Loftenius A, Ekstrand J, Moller E. Clin Exp Immunol. 1997 Dec;110(3):418-22.

Department of Basic Oral Sciences, Karolinska Institute, Huddinge, Sweden.Due to the release of the toxic compounds of mercury from amalgam fillings, dental amalgam has been questioned as an adequate restoration material for tooth fillings. HgCl2 has been found to be mitogenic for human blood lymphocytes in vitro. However, activation required much higher concentrations than are ever found in vivo. This study has been initiated to evaluate further the influence of HgCl2 on human immunocompetent cells in vitro. It is found that HgCl2 in a narrow concentration range has the ability to preferentially stimulate the CD4+ T cell subset to blast transformation and DNA synthesis. The reaction, when monitored during days 2-6, is maximal at day 6, and most blasts express the IL-2 receptor (IL-2R), indicating in vitro activation. The CD8+ T cell subset is not affected to the same extent. In addition, HgCl2-induced lymphocyte reactivity is dependent on accessory cells, i.e. CD14+ cells.******************************************************************

Study shows HgCl2 affects immune cell blast transformation and DNA synthesis.

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Acute exposure to mercury from amalgam: no short-time effect on the peripheral blood lymphocytes in healthy individuals. (A-, Sc)Loftenius A, Sandborgh-Englund G, Ekstrand J.J Toxicol Environ Health A. 1998 Aug 7;54(7):547-60.

Dept. of Basic Oral Sciences, Karolinska Institute, Huddinge, Sweden. Annika.Loftenius@ofa.ki.seMercury, released from dental amalgam, has been considered to adversely affect the human immune system. This study has been performed in order to evaluate if an acute low-dose mercury exposure, achieved by total amalgam removal in 10 healthy individuals, would affect the immunocompetent cells in human blood when the mercury level in blood and plasma was increasing. Induction of lymphocyte proliferation, measured as spontaneous de novo DNA synthesis, and total T cells, CD4+ T cells, CD8+ T cells, and B cells, was studied prior to and 7, 31, and 48 h after amalgam removal. In addition, the levels of interleukin-6 (IL-6) and C-reactive protein (CRP) in serum/plasma were measured. Despite a significant increase of the plasma mercury levels within 24 h after intervention, no significant influence on the peripheral blood lymphocytes could be detected during the first 48 h. The serum IL-6 levels increased significantly within 48 h after intervention, but were still low and within normal range. No influence on the CRP levels up to 7 d after amalgam removal was detected.***************************************************

Amalgam replacement caused some short term increases in blood lymphocyte proliferation but the increase was not considered significant by the authors. Longer term studies have found decreases in immune effects after amalgam replacement.

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Lorscheider F, Vimy M.

Mercury and idiopathic dilated cardiomyopathy. J Am Coll Cardiol. 2000 Mar 1;35(3):819-20.

Mercury linked to heart disease ROME, ITALY. Medical researchers at the Catholic University in Rome report that patients with congestive heart failure (idiopathic dilated cardiomyopathy or IDCM) have vastly elevated concentrations of mercury and antimony in their heart tissue. They compared trace element concentrations in biopsy samples from the left ventricle among patients with IDCM and patients with valvular disorders or no heart disease at all. The IDCM patients had mercury concentrations 22,000 times higher than in the controls. Antimony concentrations were 12,000 times higher and silver, gold, chromium and arsenic levels were also highly elevated. Holter monitoring revealed frequent ectopic (premature) beats in all the IDCM patients and ventricular tachycardias in six of the 13 patients. None of the patients had had occupational exposure to the trace elements. Researchers at the University of Calgary point out that dental amalgams would be the most likely source of the mercury.

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The original study being discussed by this study was: Frustaci, Andrea, et al. Marked elevation of myocardial trace elements in idiopathic dilated cardiomyopathy compared with secondary cardiac dysfunction. Journal of the American College of Cardiology, Vol. 33, May 1999, pp. 1578-83 [32 references]

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The study showed that mercury appeared to be a significant problem related to congestive heart disease

and idiopathic dilated cardiomyopathy in some individuals. This has also been demonstrated in heart attacks of atheletes who have mercury exposure.

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Amalgam allergy and amalgam controversy] (P, VPDS)[Article in German]Lubbe J, Wuthrich B.Schweiz Med Wochenschr. 1996 Apr 20;126(16):661-5.

Dermatologische Klinik und Poliklinik, Universitatsspital Zurich.Safety concerns regarding dental amalgam have been voiced ever since its introduction 150 years ago. As most people have amalgam fillings, the issue has received extensive coverage in the lay as well as the medical medical media. This has led to confusion about the terms amalgam allergy, mercury burden and intoxication, and amalgam disease, an understanding of which is crucial in consideration of this controversy. Allergy to amalgam is rare and should be investigated by a specialist, as diagnosis may result in a decision to remove dental amalgam. Dental amalgam is the most important source of mercury burden in the general population. Occupational exposure to mercury within established exposure limits reaches levels much higher without evidence of intoxication. However, mercury released from dental amalgam induces measurable organ effects. Amalgam disease has been introduced as a term to identify patients who typically ascribe a variety of symptoms to their amalgam fillings. Current literature lacks sound evidence of a role for amalgam in human disease other than allergy.************************************************

The author states conclusions clearly not supported by science and contradicted by a large number of peer-reviewed studies and vast clinical test data- such as that “Allergy to amalgam is rare”. Actually medical labs such as Clifford Lab that does dental material biocompatibility testing finds that over 90% show significant immune reactivity to mercury.

[the following is snipped from another review of the mercury allergy reactions:

Although patch tests for mercury allergy are often given for unresolved oral allergic symptoms, this is not generally recommended as a high percentage of such problems are resolved irrespective of the outcome of a patch test(87,86,90,101,168,etc.) Also using mercury in a patch test has resulted in some adverse health effects.

Of the over 3,000 patients with chronic conditions tested for lymphocyte reactivity to metals(342), the following were the percentages testing positive: nickel- 34%, inorganic mercury- 20%, phenol mercury- 13%, gold- 14%, cadmium- 16%, palladium- 13%, lead-11%. For people with autoimmune conditions such as CFS, Fibromyalgia, or Multiple Chemical Sensitivity, the percentage testing immune reactive to mercury was much higher- 28% percent were immune reactive to palladium, 26% to gold, 23% to inorganic mercury, 23% to phenyl mercury, and 12% to methyl mercury, as compared to less than 5% for controls. Of 98 patients who had amalgam fillings replaced, 76% had long term health improvement and significant improvement in MELISA scores.

Other studies have also found relatively high rates of allergic reactions to inorganic mercury and nickel(81,35,445,456). For groups with suspected autoimmune diseases such as neurological problems, CFS, and oral lichen planus(313); most of the patients tested positive to inorganic mercury and most of such patients health improved significantly and immune reactivity declined after amalgam removal. In a group of patients tested by MELISA before and after amalgam removal at a clinic in Uppsala Sweden, the patients reactivity to inorganic mercury, palladium, gold and phenyl mercury all had highly significant differences from the control group, with over 20 % being highly reactive to each of these metals(375).

A patch test was given to a large group of medical students to assess factors that lead to sensitization to mercury(132). 13% tested positive for allergy to mercury. In a population of dental students tested, 44% were positive for allergy to mercury(156).

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

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[Mercury and dental amalgam fillings] [Article in Norwegian]Lygre GB, Gronningsaeter AG, Gjerdet NR. (A-, PDS)Tidsskr Nor Laegeforen. 1998 Apr 30;118(11):1698-701.

Det odontologiske fakultet Universitetet i Bergen.During 1993-95 a total of 169 patients (112 women, 57 men) with a wide range of complaints associated with earlier or present amalgam fillings were seen by the "Dental Biomaterials Adverse Reaction Unit" in Norway. Most patients had amalgam fillings; 19 had removed all amalgam, and 14 were in the process of replacing the amalgam fillings with other materials. Predominant symptoms were of a subjective and general nature (96% of the patients). Muscle and joint pain, headache, dizziness and feeling exhausted comprised the most common symptoms. Intra-oral pathology was observed in 48%. There was a correlation between the amount of amalgam ("amalgam score") and urinary mercury. Those without amalgam fillings had significantly lower values (median = 1.6 micrograms mercury/g creatinine) than those with amalgam fillings (medians: with amalgam = 3.5 micrograms/g; with partial removal of amalgam = 2.7 micrograms/g). Overall, in the present group of patients, no statistically significant correlation seemed to exist between the type and number of subjective symptoms or objective findings and the urinary mercury. This would indicate therefore that there is no straightforward association between urinary mercury and symptoms in the present group of patients.**************************************************

The authors showed that the level of mercury in urine is directly related to the number of amalgam fillings and those without fillings have significantly lower mercury levels than those with fillings. The authors analysis of health effects relation to mercury level was comprimised by the fact that they assumed that mercury toxicity effects are only related to dose, even though there is documentation in the literature that susceptability factors such as immune reactivity and ability to detoxify metals are at least as important factor as dose.

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

The Government in Norway after a long review of the science of amalgam including that of these authors has advised that amalgam should not be used in dental work.

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[Study on the significance of mercury accumulation in the brain from dental amalgam fillings through direct mouth-nose-brain transport] [Article in German]Maas C, Bruck W, Haffner HT, Schweinsberg F. (N, PDS)

Zentralbl Hyg Umweltmed. 1996 Feb;198(3):275-91. Abteilung Allgemeine Hygiene und Umwelthygiene, Hygiene-Institut der Universitat Tubingen.The transport of mercury (Hg) from the oro-nasal to the cranial cavity via a direct route was investigated. In 55 deceased persons, Hg concentrations were measured in the olfactory bulb and the trigeminal ganglion, and the number of dental amalgam fillings was assessed. For the purpose of comparison, Hg concentrations were also determined in the occipital lobe cortex, the pituitary gland and the kidney cortex. Quantitative Hg analysis was performed by cold vapor atomic absorption spectroscopy after acid digestion using high pressure microwave treatment. In the olfactory bulb (geom. mean 17.4 micrograms/kg w. w.), the Hg concentration was significantly higher than in the occipital lobe cortex (geom. mean 9.2 micrograms/kg w. w.) (p < 0.0001). No significant difference was found between the Hg concentration in the trigeminal ganglion (geom. mean 12 micrograms/kg w. w.) and the occipital lobe cortex (alpha = 0.005; p = 0.0342). Regression analysis did not reveal a statistically significant correlation between the number of dental amalgam fillings and the Hg content in the olfactory bulb and the trigeminal ganglion, respectively (alpha = 0.01). Therefore, these results do not support the hypothesis of a significant flow o Hg from dental amalgam fillings to the cranial cavity by a direct oro-nasal route. In contrast, a statistically significant correlation exists between the number of dental amalgam fillings and the Hg concentration in the kidney cortex (r2 = 0.317; p < 0.0001), and, to a lesser extent, the Hg concentration in the occipital lobe cortex (r2 = 0.17; p = 0.0016). The highest Hg concentrations (geom. mean 93.1 micrograms/kg w. w.) were detected in the kidney cortex, followed by the pituitary gland (geom. mean 30.0 micrograms/kg w. w.). In this study, Hg concentration in the pituitary gland did not correlate with the number of dental amalgam fillings.**************************

The study found that the number of amalgam fillings is significantly correlated with the concentration of mercury in the kidney cortex and brain occipital lobe cortex. This and many other studies have found much higher levels of mercury in areas of the brain and the pituitary gland than for those without amalgam. The following is snipped from another review:

[Some mercury entering nasal passages is absorbed directly into the olfactory lobe and brain without coming from blood(34,35,182,222,348,364). Mercury also is transported along the axons of nerve fibers (5,25,34,35,327,329). Mercury (especially mercury vapor) rapidly crosses the blood brain barrier and is stored preferentially in the pituitary gland, thyroid gland, hypothalamus, and occipital cortex in direct proportion to the number and extent of dental amalgam surfaces (1,14,16,19,20,25,34,38,50,61,85,99,162,211,273,274,287, 327,348,360,366, 369) Thus mercury has a greater effect on the functions of these areas. Studies have documented that mercury causes hypothyroidism(50,390,35), damage of thyroid RNA(458), autoimmune thyroiditis (369,382,91) and impairment of conversion of thyroid T4 hormone to the active T3 form(369,382,459,35,50d,91).

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

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Mercury exposure from dental amalgam fillings: absorbed dose and the potential for adverse health effects.Mackert JR Jr, Berglund A. (R, O, PDS)Crit Rev Oral Biol Med. 1997;8(4):410-36.

Medical College of Georgia, Augusta 30912-1260, USA.This review examines the question of whether adverse health effects are attributable to amalgam-derived mercury. The issue of absorbed dose of mercury from amalgam is addressed first. The use of intra-oral Hg vapor measurements to estimate daily uptake must take into account the differences between the collection volume and flow rate of the measuring instrument and the inspiratory volume and flow rate of air through the mouth during inhalation of a single breath. Failure to account for these differences will result in substantial overestimation of the absorbed dose. Other factors that must be considered when making estimates of Hg uptake from amalgam include the accurate measurement of baseline (unstimulated) mercury release rates and the greater stimulation of Hg release afforded by chewing gum relative to ordinary food. The measured levels of amalgam-derived mercury in brain, blood, and urine are shown to be consistent with low absorbed doses (1-3 micrograms/day). Published relationships between the number of amalgam surfaces and urine levels are used to estimate the number of amalgam surfaces that would be required to produce the 30 micrograms/g creatinine urine mercury level stated by WHO to be associated with the most subtle, pre-clinical effects in the most sensitive individuals. From 450 to 530 amalgam surfaces would be required to produce the 30 micrograms/g creatinine urine mercury level for people without any excessive gum-chewing habits. The potential for adverse health effects and for improvement in health following amalgam removal is also addressed. Finally, the issue of whether any material can ever be completely exonerated of claims of producing adverse health effects is considered.**********************************

One author appears to be a paid lobbyist on the amalgam issue. The authors make extreme statements clearly not supported by science. They quote very obsolete standards and don’t appear to have reviewed recent studies related to mercury exposure levels from amalgam or of levels documented to cause adverse health effects.

It is well documented in the medical literature that amalgam is the largest source of mercury in most people, and exposures commonly exceed U.S. government health guidelines for mercury exposure, and levels known to cause adverse effects.

www.home.earthlink.net/~berniew1/damspr1.html

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Histological study of periapical tissue healing in the rat molar after retrofilling with various materials. (A-)(Sc)Maeda H, Hashiguchi I, Nakamuta H, Toriya Y, Wada N, Akamine A.Department of Operative Dentistry and Endodontology, Faculty of Dentistry, Kyushu University, Fukuoka, Japan.We histologically examined the effects on the periapical tissue of various dental filling materials applied as retrofillings in rats and compared them with those of amalgam. The 4-META-TBB resin Superbond and the light-cured composite resin produced the least severe inflammatory reaction, with the greatest amount of new bone. In these specimens, regeneration of a part of the periodontal ligament was also observed. These results indicate that these materials might be very biocompatible and thus foster the natural regeneration of the periapical tissue.**********************************************************

The study tests alternative retrograde filling materials for biocompatiblity since amalgam has been found to cause significant adverse health effects and government health agencies in Canada and Europe advise against its use, as do some amalgam manufacturer safety data sheets. Composite filling materials were found to be much more biocompatible than amalgam.

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Cytotoxicity of root perforation repair materials.Makkawy HA, Koka S, Lavin MT, Ewoldsen NO. (A-, RG, Sc)J Endod. 1998 Jul;24(7):477-9.

Department of Surgical Specialties, University of Nebraska Medical Center College of Dentistry, Lincoln 68583-0750, USA.The cytotoxicity of restorative dental materials must be investigated to ensure a safe biological response. The MTS assay, a valid and reliable measure of cell viability based on the mitochondrial activity of cultured cells, was used to evaluate the affects on human periodontal ligament (PDL) cells of two resin-modified glass ionomer cements (R-M GICs) (Fuji Duet and Fuji II LC, GC America, Chicago, IL) and one dental amalgam (Contour, Caulk, York, PA)-all suggested materials for root perforation repair. Twelve 4 x 6 mm cylinders of each material were fabricated and placed in 5 ml of alpha-minimum essential medium supplemented with 100 micrograms/ml of penicillin, 50 micrograms/ml of gentamicin, and 5% fetal bovine serum for 24, 48, and 72 h (n = 3). One hundred microliters of eluate was transferred to triplicate wells containing PDL cells previously plated at a density of 10,000 cells/well in a 96-well plate, and incubated for 24 h at 37 degrees C with 5% carbon dioxide. alpha-Minimum essential medium with supplements provided baseline data. Optical density at 490 nm, directly proportional to the number of viable cells, was determined according to manufacturer instructions. Analysis of variance was used to detect differences between treatments and Tukey's HSD (p < 0.05) to detect for differences between group means. Results demonstrated that both material and time affected cell viability (p < 0.0001), with amalgam eluate significantly inhibitory on cell viability at 24 h, compared with control and the two other tested materials. At 48 and 72 h, all three materials exhibited a similar slightly inhibitory effect on the cell viability. Use of resin-modified glass ionomer cement as a root perforation repair material initially (< 24 h) may result in a more favorable response by PDL cells than the tested dental amalgam.*************************************************************

Physical and mental problems attributed to dental amalgam fillings: a descriptive study of 99 self-referred patients compared with 272 controls.Malt UF, Nerdrum P, Oppedal B, Gundersen R, Holte M, Lone J.Psychosom Med. 1997 Jan-Feb;59(1):32-41.

Department of Psychosomatic and Behavioural Medicine, National Hospital, Oslo, Norway.OBJECTIVE: The physical and mental symptomatology of 99 self-referred patients complaining of multiple somatic and mental symptoms attributed to dental amalgam fillings were compared with patients with known chronic medical disorders seen in alternative (N = 93) and ordinary (N = 99) medical family practices and patients with dental amalgam fillings (N = 80) seen in an ordinary dental practice. METHOD: The assessments included written self-reports, a 131-item somatic symptom checklist; Eysenck Personality Questionnaire, the General Health Questionnaire, and Toronto Alexithymia Scale. RESULTS: The dental amalgam sample reported significantly more physical symptoms from all body regions. Self-reports suggested that 62% suffered from a chronic anxiety disorder (generalized anxiety disorder or panic). Forty-seven percent suffered from a major depression compared with 14% in the two clinical-comparison samples and none in the dental control sample. Symptoms suggesting somatization disorder were found in 29% of the dental amalgam sample compared with only one subject in the 272 comparison subjects. One third of the dental amalgam patients reported symptoms of chronic fatigue syndrome compared with none in the dental control sample and only 2 and 6%, respectively, in the two clinical comparison samples. The dental amalgam group reported higher mean neuroticism and lower lie scores than the comparison groups. CONCLUSION: Self-referred patients with health complaints attributed to dental amalgam are a heterogeneous group of patients who suffer multiple symptoms and frequently have mental disorders. There is a striking similarity with the multiple chemical sensitivity syndrome.***************************************

The sample reporting problems related to amalgam had numerous physical and psychological conditions that are well documented in the medical literature to be caused by mercury, such as

chronic fatique and fibromyalgia(www.home.earthlink.net/~berniew1/cfsfm.html)

depression and anxiety(www.home.earthlink.net/~berniew1/depress.html)

This study documented the symptoms of the groups, but apparently made no attempt to assess the extent of mercury immune reactivity or other measures of mercury toxicity used to assess the cause of such conditions. Most of the symptoms listed are consistent with immune reactivity to mercury(www.melisa.org).

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Serotonin production in lymphocytes and mercury intolerance.Marcusson JA, Cederbrant K, Gunnarsson LG. (A-, PDS)Toxicol In Vitro. 2000 Apr;14(2):133-7.

Department of Dermatology, Haukelands Sykehus, Postboks 1, 5021, Bergen, Norway. jan@mbox302.swipnet.sePatients with suspected illness due to mercury in dental amalgam were classified as tolerant or intolerant depending on their psychosomatic responses following in vivo epicutaneous provocation with low doses (patch test doses) of metallic mercury and phenylmercuric acetate. Ten intolerant patients and nine tolerant patients plus seven healthy amalgam-free and metal non-allergic controls were recruited to the study. Peripheral blood lymphocytes were exposed in vitro to three concentration of mercuric chloride (0.92, 1.83 and 3.68 microM) with and without 10 microg phytohaemagglutinine (PHA)/ml and the release of serotonin into the supernatant was measured. Lymphocytes exposed only to HgCl(2) showed no significant dose-dependent increase of serotonin, but the response of the tolerant patients was significantly higher compared with the controls. No other differences were found. Co-culture with mercuric chloride and PHA showed a statistically significant dose-dependant release of serotonin, but no differences between the three clinical groups could be detected. Thus, our results could not validate the concept of mercury tolerance and intolerance.******************************************************************

The sample sizes were much to small to assess statistical significance, but differences were found based on mercury dose and between tolerant and intolerant groups.

^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^Psychological and somatic subjective symptoms as a result of dermatological patch testing with metallic mercury and phenyl mercuric acetate.Marcusson JA. Toxicol Lett. 1996 Feb;84(2):113-22. (A-) (Sc)

Department of Dermatology, Huddinge University Hospital, Sweden.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.****************************************

It is well documented in the medical literature that susceptability is a major factor in mercury toxicity effects, with immune reactivity being a major susceptability factor. It would appear this likely explains some of the results seen in this paper.

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

(A later study by these authors also had relevant results. “ The results indicate that the oxidative metabolism and, in particular, superoxide dismutase may be perturbed in mercury-intolerant patients. “ Marcusson JA, Carlmark B, Jarstrand C. Mercury intolerance in relation to superoxide dismutase, glutathione peroxidase, catalase, and the nitroblue tetrazolium responses. Environ Res. 2000 Jun;83(2):123-8. )

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Indium and iridium allergy in patients exposed to dental alloys.Marcusson JA, Cederbrant K, Heilborn J.Contact Dermatitis. 1998 May;38(5):297-8.

Department of Dermatology, Huddinge University Hospital, Sweden.****************************************************************

J A Marcusson & C Jarstrand: Oxidative metabolism of neutrophils in vitro and human mercury intolerance (1998).

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Dissolution of mercury from dental amalgam at different pH values.Marek M. J Dent Res. 1997 Jun;76(6):1308-15. School of Materials Science and Engineering, Georgia Institute of Technology, Atlanta 30332-0245, USA.Dissolution of mercury from dental amalgam has been shown to be diminished by the formation of a tin oxide film on the surface of the mercury-rich gamma 1 phase (Marek, 1990b). Since tin oxides dissolve at low pH values (Deltombe et al., 1974), acidic conditions in the oral cavity may cause an increase in the mercury release. The purpose of this study was to determine the effect of acidity in the range of pH 1 to pH 8 on the rate of mercury dissolution in synthetic saliva from tin-free and tin-containing gamma 1 phase and two commercial dental amalgams. The tested hypothesis was that pH affects mercury dissolution only when a protective oxide film dissolves in an acidic environment. After exposures of the specimens for 2 hr or 24 hr in sealed glass bottles, the solutions were analyzed by flameless atomic absorption spectrophotometry for mercury and silver. The results have shown pH-independent mercury dissolution in the range of pH 3 to 8, and a much faster dissolution at pH 1. At all pH values, more mercury dissolved from the tin-free phase than from the tin-containing phase, and the rate of dissolution was lowest for the dental amalgams. The results were affected by the length of the test exposure. The pH independence in a wide range of pH values has been attributed to the atomic mechanism of mercury dissolution. The low rate of mercury dissolution from specimens containing tin has been explained by the formation of a barrier tin oxide film, which dissolved only at the lowest pH. Dissolution of silver at low pH values is believed to have accelerated dissolution of mercury from the tin-free gamma 1 phase. Variation of the dissolution rate with concentration of the dissolved species and kinetics of oxide film dissolution caused the effect of the exposure period.********************************

Biological monitoring and exposure to mercury.Mason HJ, Hindell P, Williams NR. (A-)Occup Med (Lond). 2001 Feb;51(1):2-11.

Health & Safety Laboratory, Sheffield, UK.Occupational health professionals' interest in controlling mercury (Hg) exposure, and the use of biological monitoring in this context, has been ongoing for a number of years. Evidence from urinary Hg results in a number of UK firms who have undertaken some form of biological monitoring or occupational health surveillance suggest that exposure has decreased over the last 10-15 years. This decrease precedes the establishment in the UK of an advisory biological monitoring guidance value (HGV) for urinary Hg and the production of updated medical guidance from the Health & Safety Executive on Hg exposure (MS12 1996). This latter document recommends a urinary sampling interval for urinary Hg of between 1 and 3 months, which is consistent with the reported toxicokinetics of Hg excretion, but we highlight that urinary Hg represents integrated exposure over many previous months. Mercury is a recognized nephrotoxin and MS12 1996 mentions the use of regular dipstick protein estimations. We review our experience of investigating proteinuria and enzymuria in a large-scale cross-sectional occupational study. The incidence of Hg-induced renal disease is probably very rare at current exposure levels. Therefore acceptance of a high false-positive rate of proteinuria not related to Hg exposure needs to be considered in any urinary protein testing regime of Hg workers. The establishment of an HGV for urinary Hg has raised questions about the uncertainty associated with a urinary Hg result, including factors such as diurnal variation, whether urine correction by creatinine or specific gravity is preferable and the possibility of non-occupational sources of Hg contributing significantly towards breaching the HGV. Correction of urinary Hg results by creatinine or specific gravity and the use of a fixed sampling time, such as the beginning or end of the day, substantially reduce the uncertainty in a urinary Hg measurement. But even with good laboratory precision, an individual with a true urinary Hg excretion of 20 nmol/mmol creatinine could supply urine samples of between 14 and 26 nmol/mmol creatinine. The influence of dietary sources in the UK contributing to urinary Hg values approaching or exceeding the HGV is unlikely. The use of tribal or ethnic cosmetics and remedies needs to be considered if a urinary Hg result looks inappropriately high, as some such preparations have been found to contain Hg and can be absorbed through the skin. The ability of excessive chewers or teeth grinders who have a large number of dental amalgam fillings to breach the urinary HGV in the absence of substantial occupational Hg exposure has been reported in a few Scandanavian studies. We report here a likely case of this phenomenon. Since the establishment of the HGV, our biological monitoring Hg data from a number of industry sectors using inorganic or metallic Hg have suggested that a minority of samples (13%) are still greater than the HGV.*************************************

Occupational exposure to mercury in dentistry and dentist mortality.McComb D. J Can Dent Assoc. 1997 May;63(5):372-6. (N, R, O)

Department of Restorative Dentistry, Faculty of Dentistry, University of Toronto, ON.In response to public concern, Health Canada recently conducted a review of amalgam safety and released a position statement entitled The Safety of Dental Amalgam. Essentially, the department has concluded that the levels of mercury absorbed by the body due to the release of mercury vapor from amalgam restorations, while detectable, do not approach those recognized to cause illness. It has therefore confirmed that amalgam restorations can be used safely in most patients, with some notable caveats. Despite Health Canada's position statement in support of amalgam, patient doubts about amalgam safety remain, including the tenuous hypothesized link between amalgam restorations and specific diseases. This article reviews the available studies of dentist mortality to identify possible links between mercury exposure and negative health effects. A lack of evidence to suggest a detrimental health outcome in dentists who are occupationally exposed to higher levels of mercury than their patients, and are known to have higher levels of mercury in their blood, provides an important reassurance concerning the safety of amalgam. The reviewed data indicates that the 10 leading causes of death in the United States and Canada are the same for both dentist and non dentist population groups, and that the percentage of deaths by the same cause are remarkably similar. By 1975, the year of the most recent U.S. study, the average age at death for white male dentists was about three years higher than for all adult white males. Although suicide standard mortality rates are known to be higher for dentists, suicide deaths have also been shown to be a factor in many other occupations, particularly those where there is easy access to drugs. Although updated actuarial data for dentist mortality are needed, the available data indicate no reduction in the life expectancy of practising dentists, nor any specific or disproportionate rates of disease associated with high mercury exposure. In fact, the available mortality studies are generally optimistic about the health of dentists, which should reassure patients about the safety of dental amalgam.*************************************

While this study is called a review of health of dentists, it does not appear that much of the medical literature was reviewed. Hardly any of the many studies finding adverse health effects are reviewed. The authors make broad statements, apparently without having reviewed the literature. That adverse health effects are common among dentists and dental staff over time is well documented in the medical literature:

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

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Alloy electrodes with high hydrogen overvoltage for analytical use in voltammetry. Some preliminary results.Mikkelsen O, Schroder KH.Analyst. 2000 Dec;125(12):2163-5.

Norwegian University of Science and Technology, Department of Chemistry, N-7491 Trondheim, Norway.Liquid mercury and liquid diluted mercury amalgams have been the major electrode systems employed in voltammetry and related methods. This is mainly due to their high overvoltage to hydrogen, which enables the determination of heavy metals (zinc, nickel, cobalt, etc.) and other species with high negative half-wave potentials; the toxicity of mercury and liquid diluted mercury leads to ever increasing restrictions in their use. The use of such systems may even be forbidden in the future, at least in online systems for work in the field. Recent work, carried out in our laboratory, has demonstrated that a non-toxic solid dental amalgam may be used as the electrode material, conveniently replacing mercury. An extension of this work has shown that electrode materials comprising a metal or a compound with low hydrogen overvoltage change their hydrogen overvoltage properties substantially when contaminated with even small amounts of metals or compounds which show high hydrogen overvoltage. This extends greatly the range of potentially available electrode systems and thereby analytical possibilities of voltammetry. This new discovery also makes it possible to produce solid electrodes that have high overvoltage to hydrogen without any use of mercury.*********************************************

doesn’t seem relevant to the mercury amalgam dental issue

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[Dental amalgam and multiple sclerosis: what is the connection?][Article in French] Moreau T, Loudenot V. Presse Med. 1999 Sep 4;28(25):1378-80. (P, R, PDS)

Service de Neurologie, Hopital de la Croix-Rousse, Lyon.BACKGROUND: There is some debate concerning a possible relationship between dental fillings and multiple sclerosis. Many patients ask their dentist to remove fillings. TOXICITY: Dental fillings contain mercury (more than 50%) which can cross the blood-brain barrier. Massive mercurial intoxication is neurotoxic both for the central and peripheral nervous system. Dental fillings release as much mercury in 24 hours as is ingested in a normal meal, i.e. a level well under the neurotoxicity level. RELATIONSHIP: Mercurial poisoning is histologically, clinically, immunologically, and toxicollogically different from multiple sclerosis. Based on data available today, it is not warranted to propose removing dental fillings.************************************

It does not appear that the authors attempted a serious review of the literature, but mainly expressed opinions. For example, they state “Dental fillings release as much mercury in 24 hours as is ingested in a normal meal” without any documentation. But it is clear that the statement is false, as World Health Organization Environmental Criteria 118 and hundreds of peer-reviewed articles have documented that amalgam is by far a larger source of mercury exposure than food: www.home.earthlink.net/~berniew1/damspr1.html

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Mercury in dental restoration: is there a risk of nephrotoxicity?Mortada WL, Sobh MA, El-Defrawy MM, Farahat SE.J Nephrol. 2002 Mar-Apr;15(2):171-6.

Urology and Nephrology Center, Mansoura University, Faculty of Science, Egypt.BACKGROUND: Concern has been voiced about exposure to mercury (Hg) from dental amalgam fillings, and there is a need to assess whether this leads to signs of nephrotoxicity. METHODS: A total of 101 healthy adults (80 males and 21 females) were included in this study. The population as grouped into those having amalgam fillings (39 males and 10 females) and those without (41 males and 11 females). Hg was determined in blood, urine, hair and nails to assess exposure. Urinary excretion of beta2-microglobulin (beta2M), N-acetyl-beta-D-glucosaminidase (NAG), gamma-glutamyltransferase (gammaGT) and alkaline phosphatase (ALP) were determined as markers of tubular damage. Albuminuria was assayed as an early indicator of glomerular dysfunction. Serum creatinine, beta2M and blood urea nitrogen (BUN) were determined to assess glomerular filtration. RESULTS: Hg levels in blood and urine were significantly higher in persons with dental amalgam than those without; in the dental amalgam group, blood and urine levels of Hg significantly correlated with the number of amalgams. Urinary excretion of NAG, gammaGT and albumin was significantly higher in persons with dental amalgam than those without. In the amalgam group, urinary excretion of NAG and albumin significantly correlated with the number of fillings. Albuminuria significantly correlated with blood and urine Hg. CONCLUSION: From the nephrotoxicity point of view, dental amalgam is an unsuitable filling material, as it may give rise to Hg toxicity. Hg levels in blood and urine are good markers of such toxicity. In these exposure conditions, renal damage is possible and may be assessed by urinary excretions of albumin, NAG, and gamma-GT.

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The study further demonstrates, like many other studies, that amalgam is the largest source of mercury in most people and also causes adverse effects on the kidneys. A study with similar findings was: (al-Saleh I, Shinwari N. Urinary mercury levels in females: influence of dental amalgam fillings. Biometals 1997; 10(4): 315-23);

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Moss ME, Myers GJ, Davidson PW, Pothin H, Cox C, Clarkson TW, Prenatal mercury vapor exposure from dental restorations in a cohort with high methylmercury exposure- design issues.

Am J Epidemiol , June 2001

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Localized cellular inflammatory responses to subcutaneously implanted dental mercury.Nadarajah V, Neiders ME, Aguirre A, Cohen RE. (A, Sc)J Toxicol Environ Health. 1996 Oct 11;49(2):113-25.

Department of Oral Diagnostic Sciences, School of Dental Medicine, State University of New York at Buffalo 14214, USA.Previous reports have demonstrated mercury accumulation and toxicity in oral tissues following exposure to mercury vapor from dental amalgam restorations. In the present study, inflammatory responses to subcutaneously administered mercury were assessed histopathologically and immunocytochemically in a rat model system. A panel of six well-characterized monoclonal antibodies specific for monocytes, macrophage subsets, T and B lymphocytes, and major histocompatibility complex (MHC) class II (la) determinants was used to quantitate alterations in mononuclear cell subsets in situ at time intervals from 2 d to 8 wk. The results revealed acute inflammatory cell infiltration at 2 and 3 d, followed by chronic inflammation that persisted after 8 wk. The numbers of monocytes, resident macrophage subsets, and mononuclear cells expressing la antigen were significantly different from control tissues at 1-2 wk. The numbers of resident macrophages remained significantly higher even after 8 wk. These data showed that in situ mercury accumulation can lead to altered expression of MHC class II determinants with persistent chronic inflammation and shifts in mononuclear cell subpopulations.

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The study shows that amagam commonly causes persistent chronic inflamation and allergic reactions in oral tissues.

^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^In vitro cytotoxicity of amalgams made with binary Hg-In liquid alloys.Nakajima H, Wataha JC, Rockwell LC, Okabe T.Dent Mater. 1997 May;13(3):168-73.

Department of Biomaterials Science, Baylor College of Dentistry-Texas A&M University System, Dallas, USA. hnakajima@tambcd.eduOBJECTIVE: Mercury vapor release from amalgams during setting significantly decreases when the amalgams are prepared with binary Hg-In liquid alloys. The objective of this study was to compare the cytotoxicity of amalgams made with experimental Hg-In alloys with that of amalgam without In and a commercial In-containing amalgam. METHODS: Amalgam specimens were prepared by triturating a high-Cu alloy powder (Tytin, Kerr) with pure Hg or Hg-In liquid alloy containing 5, 20 or 50% In and also by triturating an In-containing high-copper alloy powder (Indiloy, Shofu) with pure Hg. After the specimens were aged for 2 wk, a cylindrical specimen of each amalgam was immersed consecutively in cell culture medium for 0-8, 8-48 and 48-72 h. The cytotoxicity of the extracts was determined by placing them in contact with Balb/c 3T3 mouse fibroblasts for 24 h, after which the succinic dehydrogenase (SDH) activity was measured and expressed as a percentage of the Teflon negative controls. The results were statistically compared using ANOVA and Tukey's test (alpha = 0.05). The concentration of elements released into the extracts was determined by atomic absorption spectrophotometry and evaluated by Kruskal-Wallis and nonparametric multiple comparisons. RESULTS: For the 0-8 h and 8-48 h intervals, the 20% In amalgam was significantly (p < 0.05) less toxic than the other amalgams, and not different from the Teflon control. Results for the other amalgams were only slightly depressed compared to the Teflon control. For the 48-72 h interval, all amalgams were essentially no different from the control. Copper was the element dominantly released into the medium from all the amalgams tested. SIGNIFICANCE: For amalgam tested after aging, alloying indium to mercury did not deleteriously affect the cytotoxicity of the resultant amalgam compared to the amalgam without indium.*************************************FDI World Dental Federation WHO Consensus statement on amalgam. Nov/Dec 1997. (R,O,D)

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The statement is the work of a federation of dental organizations and did not represent

scientific consensus of any independent group of scientists or WHO scientific consensus.

The scientific consensus of the WHO scientific panel is represented by WHO Environmental Criteria 118, which states among other things that amalgam is the largest source of mercury exposure in most people. www.home.earthlink.net/~berniew1/damspr1.html

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Reports from the Conseil d'Evaluation des Technologies de la Sante du Quebec (CETS). The safety of dental amalgam: a state-of-the-art review.Int J Technol Assess Health Care. 1997 Fall;13(4):639-42. (R, O, D)

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Do we need more research on the safety of amalgam and other materials, JADA, July 1996.

(R,O,D)

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Resistance of the normal human microflora to mercury and antimicrobials after exposure to mercury from dental amalgam fillings. (A-, Sc)Edlund C, Bjorkman L, Ekstrand J, Sandborgh-Englund G, Nord CE.Clin Infect Dis. 1996 Jun;22(6):944-50.

Department of Microbiology, Karolinska Institute, Huddinge University Hospital, Stockholm, Sweden.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.******************************************************

Although the sample sizes were very small and too small for most statistical significance calculations, the study found that mercury exposure was directly related to the number of amalgam fillings and antimicrobial resistance was increased for amalgam population compared to non amalgam population.

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Significant mercury deposits in internal organs following the removal of dental amalgam, & development of pre-cancer on the gingiva and the sides of the tongue and their represented organs as a result of inadvertent exposure to strong curing light (used to solidify synthetic dental filling material) & effective treatment: a clinical case report, along with organ representation areas for each tooth.Omura Y, Shimotsuura Y, Fukuoka A, Fukuoka H, Nomoto T. (A-, Sc)Acupunct Electrother Res. 1996 Apr-Jun;21(2):133-60.

Heart Disease Research Foundation, New York, USA.Because of the reduced effectiveness of antibiotics against bacteria (e.g. Chlamydia trachomatis, alpha-Streptococcus, Borrelia burgdorferi, etc.) and viruses (e.g. Herpes Family Viruses) in the presence of mercury, as well as the fact that the 1st author has found that mercury exists in cancer and pre-cancer cell nuclei, the presence of dental amalgam (which contains about 50% mercury) in the human mouth is considered to be a potential hazard for the individual's health. In order to solve this problem, 3 amalgam fillings were removed from the teeth of the subject of this case study. In order to fill the newly created empty spaces in the teeth where the amalgams had formerly existed, a synthetic dental-filling substance was introduced and to solidify the synthetic substance, curing light (wavelength range reportedly between 400-520 nm) was radiated onto the substance in order to accelerate the solidifying process by photo-polymerization. In spite of considerable care not to inhale mercury vapor or swallow minute particles of dental amalgam during the process of removing it by drilling, mercury entered the body of the subject. Precautions such as the use of a rubber dam and strong air suction, as well as frequent water suctioning and washing of the mouth were insufficient. Significant deposits of mercury, previously non-existent, were found in the lungs, kidneys, endocrine organs, liver, and heart with abnormal low-voltage ECGs (similar to those recorded 1-3 weeks after i.v. injection of radioisotope Thallium-201 for Cardiac SPECT) in all the limb leads and V1 (but almost normal ECGs in the precordial leads V2-V6) the day after the procedures were performed. Enhanced mercury evaporation by increased temperature and microscopic amalgam particles created by drilling may have contributed to mercury entering the lungs and G.I. system and then the blood circulation, creating abnormal deposits of mercury in the organs named above. Such mercury contamination may then contribute to intractable infections or pre-cancer. However, these mercury deposits, which commonly occur in such cases, were successfully eliminated by the oral intake of 100 mg tablet of Chinese parsley (Cilantro) 4 times a day (for average weight adults) with a number of drug-uptake enhancement methods developed by the 1st author, including different stimulation methods on the accurate organ representation areas of the hands (which have been mapped using the Bi-Digital O-Ring Test), without injections of chelating agents. Ingestion of Chinese parsley, accompanied by drug-uptake enhancement methods, was initiated before the amalgam removal procedure and continued for about 2 to 3 weeks afterwards, and ECGs became almost normal. During the use of strong bluish curing light to create a photo-polymerization reaction to solidify the synthetic filling material, the adjacent gingiva and the side of the tongue were inadvertently exposed. This exposure to the strong bluish light was found to produce pre-cancerous conditions in the gingiva, the exposed areas of the tongue, as well as in the corresponding organs represented on those areas of the tongue, and abnormally increased enzyme levels in the liver. These abnormalities were also successfully reversed by the oral intake of a mixture of EPA with DHA and Chinese parsley, augmented by one of the non-invasive drug-uptake enhancement methods previously described by the 1st author, repeated 4 times each day for 2 weeks.***********************************************************MB Chenoweth was right!! (R, O, D, PDS)Osborne JW, Summitt J. Oper Dent. 2002 Nov-Dec;27(6):541-2.

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Psychological and medical effects of mercury intake from dental amalgam. A status report for the American Journal of Dentistry.Osborne JW, Albino JE. Am J Dent. 1999 Jun;12(3):151-6. (P, R, O, D)

School of Dentistry, University of Colorado, Denver 80262, USA. john.osborne@uchsc.eduStudies examining health consequences of the release of mercury from dental amalgams have concluded that there is insufficient mercury released from these restorations to cause a medical problem. Although the mercury vapor generated during removal of amalgams will cause a transient increase in the patient's mercury level in tissue fluids, biochemical assays have demonstrated that the increase is too small to have a negative influence on organ systems. This is true even when patients have all their amalgams removed in a single session. Nevertheless, over the past decade, the release of mercury from dental amalgam has been frequently blamed for a variety of health complaints. A number of sensationalized media reports regarding the mercury issue have no doubt contributed to the public concern that has been aroused. Consequently, patients may present at the dentist's office, either self-diagnosed or looking for a cause implicating mercury. In actuality, these patients may have symptoms of either medical problems or psychological disorders such as depression or anxiety. Unfortunately, the incorrect diagnosis may not only mislead, but actually place the patient in a dangerous situation. Two well-controlled studies have indicated that (1) 89% of the patients with self-reported "amalgam illness" had psychogenic disorders, whereas only 6% of the matched-pair manifested symptoms of these psychological disorders; and (2) these alleged "amalgam illness" patients had preneurotic reactive/defensive mechanisms that did not allow them to recognize aggressive and threatening situations which the control group would quickly and readily regard as potentially difficult to manage. Other studies involving psychological assessment seem to confirm that dental therapy (removal of amalgams) for people with alleged "amalgam illness" may, at best, provide a "placebo effect".

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The authors make extreme statements in the article not supported by science and without review of the relevant medical literature on the topic, of which there is a lot. It is not a serious scientific review. See www.home.earthlink.net/~berniew1/amalg6.html

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Page 11

The use of dental amalgam in pediatric dentistry: review of the literature.Osborne JW, Summitt JB, Roberts HW. Pediatr Dent. 2002 Sep-Oct;24(5):439-47. (R,O,D)

University of Colorado Health Science Center, Denver, USA. john.osborne@uchsc.eduDental amalgam is widely used as a restorative material even though it is not esthetic and there has been extensive anti-amalgam rhetoric. Although other materials have improved greatly, amalgam has the proven safety record and best cost-to-benefit ratio. Clinical evidence indicates that, in the posterior permanent dentition--where esthetics is not a primary concern--the small, minimally prepared, amalgam restoration, with its margins and any caries-susceptible fissures sealed with resin fissure sealant, is the restoration with the best survival. Amalgam also remains the best direct restorative option when larger restorations are required. In the primary dentition, the data indicates that resin-based composite and resin-modified glass-ionomer serve very well.**************************************************************

No review of health issues regarding mercury exposure from amalgam.

[The saliva and feces of children with amalgams have approximately 10 times the level of mercury as children without(25,315,386,528), and much higher levels in saliva after chewing. A group of German children with amalgam fillings had urine mercury level 4 times that of a control group without amalgams(76), and in a Norwegian group with average age 12 there was a significant correlation between urine mercury level and number of amalgam fillings(167). The level of mercury in maternal hair was significantly correlated to level of mercury in nursing infants(541).

References: www.home.earthlink.net/~berniew1/amalg6.html]

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Mercury release during autoclave sterilization of amalgam.Parsell DE, Karns L, Buchanan WT, Johnson RB. (A, Sc)J Dent Educ. 1996 May;60(5):453-8.

Department of Restorative Dentistry, University of Mississippi Medical Center, Jackson 39216-4505, USA.Natural teeth are an invaluable teaching tool for preclinical instruction in operative dentistry and endodontic techniques. Cavity preparation in teeth containing amalgam restorations is a realistic simulation of an often experienced clinical situation. As various pathogens are contained in saliva, teeth must be disinfected before use by students. The purpose of this study is to indirectly evaluate whether mercury vapor is released from amalgam restorations in such teeth during steam autoclave sterilization. Mercury vapor detection, sample mass changes and x-ray fluorescence data were collected from experimental steam autoclave sterilization of amalgam samples sealed in autoclave bags. All of the data showed evidence of mercury vapor generation coincident to steam autoclave sterilization. Mercury vapor levels within the room where amalgam was exposed to steam autoclave sterilization reached levels that constitute an unnecessary health risk to dental personnel. The volume of amalgam tested simulated that contained in 175 amalgam restored teeth. Initial venting of the autoclave chamber produced mercury vapor concentrations significantly in excess of OSHA vapor concentration ceiling levels. Thus, the use of a steam autoclave for sterilization of amalgam containing teeth for use in preclinical laboratory exercises may be harmful to personnel involved.**************************************************************Because of amalgam fillings, crematorias are a major source of mercury emissions and source of mercury in rain, waterbodies, the food chain.

[Rivola J, Krejci I, Imfeld T, Lutz F. Cremation and the environmental mercury burden.

Schweiz Monatsschr Zahnmed 1990;100(11):1299‑303; & Matter‑Grutter C, Baillod R, Imfeld T, Lutz F. Mercury emission measurements in a crematorium. The dentistry aspects. Schweiz Monatsschr Zahnmed 1995;105(8):1023‑8 ; & Yoshida M; Kishimoto T; Yamamura Y; Tabuse M; Akama Y; Satoh H. Amount of mercury from dental amalgam filling released into the atmosphere by cremation. Nippon Koshu Eisei Zasshi 1994 Jul;41(7):618‑24; & Reese Km. Mercury emissions from crematoria. Chem & Engin News, 12-7-98, p80-81; & Lancet 1998; 352, 1602.]

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Oral lichen planus versus oral lichenoid eruption as a manifestation of contact allergy. (A-)Pecegueiro M, Sachse MF, Amaro J, Farinha P, Fonseca I.Contact Dermatitis. 1999 Jun;40(6):333-4.

Dermatology Department, Instituto Portugues de Oncologia, Lisboa, Portugal.***************************************************************

Amalgam is documented in the medical and dental literature to be the main cause of oral lichen planus and it is also documented that most with oral lichen planus recover after amalgam replacement, irregardless of whether a patch test for mercury is positive or negative.

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

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Mercury vapor inhalation inhibits binding of GTP to tubulin in rat brain: similarity to a molecular lesion in Alzheimer diseased brain.Pendergrass JC, Haley BE, Vimy MJ, Winfield SA, Lorscheider FL. (A,Sc)Neurotoxicology. 1997;18(2):315-24.

College of Pharmacy, University of Kentucky, Lexington 40536, USA.Hg2+ interacts with brain tubulin and disassembles microtubules that maintain neurite structure. Since it is well known that Hg vapor (Hg0) is continuously released from "silver" amalgam tooth fillings and is absorbed into brain, rats were exposed to Hg0 4h/day for 0, 2, 7, 14 and 28 d at 250 or 300 micrograms Hg/m3 air, concentrations present in mouth air of some humans with many amalgam fillings. Average rat brain Hg concentrations increased significantly (11-47 fold) with duration of Hg0 exposure. By 14 d Hg0 exposure, photoaffinity labelling on the beta-subunit of the tubulin dimer with [alpha 32P] 8N3 GTP in brain homogenates was decreased 41-74%, upon analysis of SDS-PAGE autoradiograms. The identical neurochemical lesion of similar or greater magnitude is evident in Alzheimer brain homogenates from approximately 80% of patients, when compared to human age-matched neurological controls. Total tubulin protein levels remained relatively unchanged between Hg0 exposed rat brains and controls, and between Alzheimer brains and controls. Since the rate of tubulin polymerization is dependent upon binding of GTP to tubulin dimers, we conclude that chronic inhalation of low-level Hg0 can inhibit polymerization of brain tubulin essential for formation of microtubules.********************************************

Inhibition of brain tubulin-guanosine 5'-triphosphate interactions by mercury: similarity to observations in Alzheimer's diseased brain.Pendergrass JC, Haley BE. Met Ions Biol Syst. 1997;34:461-78. (A, Sc)

College of Pharmacy, Division of Medicinal Chemistry and Pharmaceutics, University of Kentucky Medical Center, Lexington 40536-0082, USA.^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^

Direct and indirect restorative materials.ADA Council on Scientific Affairs. (P, O, D)

BACKGROUND: In recent years, dentistry has benefited from a marked increase in the development of esthetic materials, including ceramic and plastic compounds. But the advent of these new materials has not eliminated the usefulness of more traditional restorative materials such as gold, base metal alloys and dental amalgam. OVERVIEW: This report outlines important features of direct and indirect restoratives, with an emphasis on the safety and efficacy of each material. CONCLUSIONS AND PRACTICE IMPLICATIONS: This article was developed to help dentists explain to their patients the relative pros and cons of various materials used in dental restorations, which include fillings, crowns, bridges and inlays. The weight of the scientific evidence indicates that all of these materials are safe and effective for their intended use. Patients, in consultation with their dentists, are free to choose the most appropriate among them for their particular needs.*********************************************************************

There was no review of biocompatability, exposures and adverse health effects as part of the review. The review is not very useful in this regard.

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Summary report for the expert panel review of the toxicological profile for mercury. (A-, PDS)Risher JF, De Rosa CT, Jones DE, Murray HE.Toxicol Ind Health. 1999 Aug;15(5):483-516.

Agency for Toxic Substances and Disease Registry, Division of Toxicology (E-29), Atlanta, Georgia 30333, USA.*************************************************************

Health and neuropsychological functioning of dentists exposed to mercury.Ritchie KA, Gilmour WH, Macdonald EB, Burke FJ, McGowan DA, Dale IM, Hammersley R, Hamilton RM, Binnie V, Collington D. (A, Sc)Occup Environ Med. 2002 May;59(5):287-93.

Institute of Hearing Research (Scottish Section), Glasgow Royal Infirmary, Glasgow, Scotland, UK. karen@ihr.gla.ac.ukOBJECTIVES: A cross sectional survey of dentists in the west of Scotland and unmatched controls was conducted to find the effect of chronic exposure to mercury on health and cognitive functioning. METHODS: 180 dentists were asked to complete a questionnaire that included items on handling of amalgam, symptoms experienced, possible influences on psychomotor function, and the 12 item general health questionnaire. Dentists were asked to complete a dental chart of their own mouths and to give samples of urine, hair, and nails for mercury analysis. Environmental measurements of mercury in dentists' surgeries were made and participants undertook a package of computerised psychomotor tests. 180 control subjects underwent a similar procedure, completing a questionnaire, having their amalgam surfaces counted, giving urine, hair, and nail samples and undergoing the psychomotor test package. RESULTS: Dentists had, on average, urinary mercury concentrations over four times that of control subjects, but all but one dentist had urinary mercury below the Health and Safety Executive health guidance value. Dentists were significantly more likely than control subjects to have had disorders of the kidney and memory disturbance. These symptoms were not significantly associated with urinary mercury concentration. Differences were found between the psychomotor performance of dentists and controls after adjusting for age and sex, but there was no significant association between changes in psychomotor response and mercury concentrations in urine, hair, or nails. CONCLUSIONS: Several differences in health and cognitive functioning between dentists and controls were found. These differences could not be directly attributed to their exposure to mercury. However, as similar health effects are known to be associated with mercury exposure, it would be appropriate to consider a system of health surveillance of dental staff with particular emphasis on symptoms associated with mercury toxicity where there is evidence of high levels of exposure to environmental mercury.**************************************

The dentists were shown to have significantly higher levels of mercury exposure than controls, however the standard compared to is an obsolete standard that does not represent a safe level of exposure, based on recent medical studies and ATSDR MRLs, etc. The authors were apparently not aware that the primary factor in who is most affected by mercury exposure among those with significant exposures is susceptability factors such as immune reactivity, ability to systemically detoxify mercury, etc. www.home.earthlink.net/~berniew1/suscept.html

There was no effort to assess the cause of the symptoms by tests commonly used in assessment of toxicity effects such as MELISA immune reactivity test(www.melisa.org) or the fractionated porphyrin urine test or blood allele typing or blood oxyhemoglobin test. Such tests would have

added to the studies completeness. The study found that the dentists not only higher mercury levels but had more neurological and kidney disorders than controls, conditions well documented in the literature to be caused by mercury.

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

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Potential health and environmental issues of mercury-contaminated amalgamators. (A-, PDS)Roberts HW, Leonard D, Osborne J.USAF Dental Investigation Service, Detachment 1, USAFSAM, 310C B St., Building 1H, Great Lakes, Ill. 60088, USA. howard.roberts@ndri.med.navy.milBACKGROUND: Dental amalgamators may become contaminated internally with metallic mercury. This contamination may result from mercury leakage from capsules during trituration or from the long-term accrual from microscopic exterior contaminants that result from the industrial assembly process. The potential health risk to dental personnel from this contamination is unknown. METHODS: The authors assessed used amalgamators from the federal service inventory for the amounts of mercury vapor levels, as well as the visual presence of mercury contamination. They evaluated these amalgamators for potential mercury vapor health risk, using established National Institute for Occupational Safety and Health methods and American Conference of Governmental Industrial Hygienists standards. RESULTS: Ten of the 11 amalgamators assessed had measurable mercury vapor levels. Four amalgamators were found to have internal static mercury vapor levels above Occupational Safety and Health Administration ceiling limit thresholds. During a simulated worst-case clinical use protocol, the authors found that no amalgamators produced mercury vapor in the breathing space of dental personnel that exceeded established time-weighted federal mercury vapor limits. CONCLUSIONS: Amalgamators may be contaminated internally with metallic mercury. Although the authors detected mercury vapor from these units during aggressive, simulated clinical use, dilution factors combined with room air exchange were found to keep health risks below established federal safety thresholds. CLINICAL IMPLICATIONS: Dental personnel should be aware that amalgamators may be contaminated with mercury and produce minute amounts of mercury vapor. These contaminated amalgamators may require disposal as environmentally hazardous waste.**************************************************************************

Since we are dealing with chronic exposures, the proper standard to use is the ATSDR MRL

of 0.2 micrograms per cubic meter of air. The levels of exposure found were far above this standard, meaning there is a significant health risk being involved with such operations.

Adverse health effects have been found to be common below exposure levels of the obsolete OSHA standard.

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Lichenoid tissue reactions of the oral mucosa. (N, PDS)Robinson NA. Singapore Dent J. 2000 Dec;23(1 Suppl):56-63.

NTUC Denticare, 3 Shenton Way, #03-06, Shenton House, Singapore 068805.The lichenoid tissue reaction (LTR) is characterised by epidermal basal cell damage and a variable subepithelial inflammatory infiltrate. There is a range of mucosal lesions exhibiting the LTR, chief of which is Oral Lichen Planus (OLP). The other oral lichenoid lesions resemble OLP clinically and histologically and at times it can be difficult to differentiate between the lesions. The important oral lichenoid lesions are reviewed in this paper.****************************************************************

The authors apparently were not very familiar with medical literature on this subject and didn’t do much literature review, as it is well documented in the medical literature that amalgam is the primary cause of oral lichenoid reactions and that such reactions disapate when the amalgam is replaced. www.home.earthlink.net/~berniew1/periodon.html

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Occupational exposure and health effects of metallic mercury among dentists and dental assistants: a preliminary study. Valencia, Venezuela; 1998][Article in Spanish] Acta Cient Venez. 2000;51(1):32-8. (A-, PDS)

Rojas M, Guevara H, Rincon R, Rodriguez M, Olivet C.Centro de Investigaciones Toxicologicas, Universidad de Carabobo (CITUC), Valencia, Venezuela.The aim of this investigation was to establish mercury (Hg) health effects on dentists and dental assistants, its relationship with exposure conditions and the potential renal damage Hg-related. The total population was 66 people, with a sample of 37 (56%), 22 dentists (59.5%, 19 male, 3 female) and 15 dental assistants (40.5%, all female). This was accomplished by an interview, Hg in urine (Hg-U) and N-acetyl-B-D-glucosaminidase activity in urine (NAG-U). Average values of Hg-U for dentists were 22.4 +/- 6.4 micrograms/g creatinine and 22.2 +/- 6.1 micrograms/g creatinine for dental assistants NAG-U average values were 2.9 +/- 3 U/L and 5.2 +/- 8.1 U/L respectively. There were no statistically significant differences between these averages (p > 0.05). There was no correlation between the quantity of amalgam prepared and working hours with Hg-U and NAG-U. Most frequent symptoms referred by dentists were: irritability (54.5%), cephalalgia (45.4%), arthralgias (40.9%), and the ones more referred by assistants were arthralgias (53.3%), irritability (46.7%) and cephalalgia (46.7%). It was not found a significative risk of having them among these groups. There is a need for further investigations including environmental monitoring of Hg, clinical evaluation and neurobehavioural tests to detect early effects. It is important to enforce personal safety measures to control the exposure.****************************************************

The study found high levels of health problems among the dentists and dental assistants, but apparently had no control group to compare exposures or health symptoms to; thus it does not seem to be very useful, other than noting the high level of adverse health symptoms and higher exposure of the dental staff than controls from other studies.

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page 12Long-term use of nicotine chewing gum and mercury exposure from dental amalgam fillings.Sallsten G, Thoren J, Barregard L, Schutz A, Skarping G. (A, Sc)Department of Occupational Medicine, Sahlgrenska University Hospital, Goteborg, Sweden.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.*************************************************************************This study like others found amalgam is a significant source of mercury exposure and chewing gum greatly increases exposure levels.

[Chewing gum or drinking hot liquids or use of bleaching products to whiten teeth can result in 10 to 100 times normal levels of mercury exposure from amalgams during that period(15,35,136,258).

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

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The absorption, blood levels, and excretion of mercury after a single dose of mercury vapor in humans. Sandborgh-Englund G, Elinder CG, Johanson G, Lind B, Skare I, Ekstrand J. (A-, Sc)Department of Basic Oral Sciences, Karolinska Institutet, Huddinge, Sweden. Nine healthy volunteers without amalgam fillings were exposed to 400 micrograms/m3 mercury vapor (Hg0) for 15 min, corresponding to 5.5 nmol Hg0/kg body wt (median range: 4.4-7.2). Frequent sampling of blood, urine, and exhaled air was performed for 30 days after exposure. The median retention of Hg0 was 69% of the inhaled dose. During the first 3 days after exposure 7.5-12% of the absorbed dose was lost by exhalation, with the median half time of Hg0 in expired breath being 2.0 days. In blood and plasma, a rapid absorption phase of Hg was seen, followed by a biexponential decline of the curves in both media. A substantial interindividual variation was observed in the area under the concentration-time curves of Hg in blood and plasma. In plasma the median half time of the second phase was 10 days. About 1.0% of the absorbed Hg was excreted via urine during the first 3 days after exposure, whereas the estimated amount excreted during 30 days ranged from 8 to 40%. In order to evaluate the chronic exposure to mercury from dental amalgam in the general population, the daily Hg dose from the fillings were estimated based on the plasma Hg levels found in subjects with amalgam fillings and on the plasma Hg clearance obtained in the present study. The daily Hg dose was estimated to 5-9 micrograms/day in subjects with an ordinary number of amalgam fillings.

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The level of mercury vapor found in the oral air of those with amalgams has been found to

commonly exceed the Government health standard for mercury in the workplace, and the level of daily exposure found in this study exceeds the U.S. ATSDR MRL level of mercury converted to a daily amount. www.home.earthlink.net/~berniew1/damspr1.html

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Mercury in biological fluids after amalgam removal.Sandborgh-Englund G, Elinder CG, Langworth S, Schutz A, Ekstrand J.J Dent Res. 1998 Apr;77(4):615-24.

Department of Basic Oral Sciences, Karolinska Institutet, Huddinge, Sweden.Dental amalgam is the major source of inorganic mercury (Hg) exposure in the general population. The objective of the present study was to obtain data on changes in Hg levels in blood, plasma, and urine following removal of all amalgam fillings during one dental session in 12 healthy subjects. The mean number of amalgam surfaces was 18 (range, 13 to 34). Frequent blood sampling and 24-hour urine collections were performed up to 115 days after amalgam removal, and in eight subjects additional samples of plasma and urine were collected up to three years after amalgam removal. A transient increase of Hg concentrations in blood and plasma was observed within 48 hours after amalgam removal. In plasma, the peak concentrations significantly exceeded the pre-removal plasma Hg levels by, on average, 32% (1.3 nmol/L; range, 0.1 to 4.2). No increase in the urinary Hg excretion rate was apparent after amalgam removal. An exponential decline of Hg was seen in all media. Sixty days after the amalgam removal, the Hg levels in blood, plasma, and urine had declined to approximately 60% of the pre-removal levels. In seven subjects, who were followed for up to three years, the half-lives of Hg in plasma and urine were calculated. In plasma, a bi-exponential model was applied, and the half-life was estimated at median 88 days (range, 21 to 121). The kinetics of Hg in urine (nmol/24 hrs) fit a mono-exponential model with a median half-life of 46 days (range, 35 to 67). It is concluded that the process of removing amalgam fillings can have a considerable impact on Hg levels in biological fluids. After removal, there was a considerable decline in the Hg levels of blood, plasma, and urine, which slowly approached those of subjects without any history of amalgam fillings.************************************************************

This study like many others confirmed that amalgam is the largest source of mercury in most people with amalgam, and mercury exposure declines signifantly after amalgam replacement.

www.home.earthlink.net/~berniew1/damspr1.html

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No evidence of renal toxicity from amalgam fillings.Sandborgh-Englund G, Nygren AT, Ekstrand J, Elinder CG.Am J Physiol. 1996 Oct;271(4 Pt 2):R941-5.

Department of Dental Toxicology, Karolinska Institute, Huddinge, Sweden.Dental amalgam continuously releases mercury. Studies of sheep [Boyd et al., Am. J. Physiol. 261 (Regulatory Integrative Comp. Physiol. 30): R1010-R1014, 1991] showed decreased renal function after placement of amalgam fillings. In this study, renal function was investigated in 10 healthy volunteers before and after amalgam removal. The subjects had an average of 18 tooth surfaces filled with amalgam, which was removed during one dental session. One week before and sixty days after removal, the glomerular filtration rate (GFR) was determined by 51Cr-EDTA clearance technique. Blood and urine samples were collected for analysis of mercury, creatinine, beta 2-microglobulin, N-acetyl-beta-glucosaminidase (NAG), and albumin 1 wk before and 1, 2, and 60 days after amalgam removal. The plasma mercury concentration increased significantly 1 day after removal. Sixty days later, significantly lower mercury levels were found in blood, plasma, and urine. The GFR values were similar before and after mercury exposure (mean 94 and 94 ml/min per 1.73 m2, respectively). No detectable effects occurred on excretion of NAG, beta 2-microglobulin, or albumin. It is concluded that no signs of renal toxicity could be found in conjunction with mercury released from amalgam fillings.********************************************************************

The conclusion stated in the abstract doesn’t follow from the study as there was no relevant hypothesis. The study showed that mercury levels decline significantly after amalgam is replaced, but there was no effort in the study to assess the adverse renal effects of amalgam placement. Stating that no significant improvement in renal test levels occured within 60 days of amalgam replacement is not the same as saying that there had been no previous kidney damage due to amalgam. That exposure from amalgam causes kidney damage is well documented in the medical literature(and by other studies included in this submission).

[mercury is nepthrotoxic(toxic to kidneys) (14,20,203,209c,223,254,260,268,334,438);

The number of amalgam surfaces is directly correlated with renal(kidney) cortex (14,16,19,20,85,254,273,348,366)

Mercury exposure has been shown to cause kidney effects in those with more than average number of amalgam fillings(254,223). Richardson(Health Canada) has estimated that about 20% of the population suffers a subclinical impairment of kidney or CNS function related to amalgam mercury(209c).]

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Alzheimer's disease, dental amalgam and mercury.Saxe SR, Wekstein MW, Kryscio RJ, Henry RG, Cornett CR, Snowdon DA, Grant FT, Schmitt FA, Donegan SJ, Wekstein DR, Ehmann WD, Markesbery WR.J Am Dent Assoc. 1999 Feb;130(2):191-9.

Geriatric Oral Health Program, College of Dentistry, University of Kentucky, Lexington, USA.BACKGROUND: Mercury, or Hg, is a neurotoxin that has been speculated to play a role in the pathogenesis of Alzheimer's disease, or AD. Dental amalgam releases low levels of Hg vapor and is a potential source of Hg for a large segment of the adult population. METHODS: The authors studied 68 subjects with AD and 33 control subjects without AD to determine Hg levels in multiple brain regions at autopsy and to ascertain the subjects' dental amalgam status and history. The subjects were from central Kentucky and Elm Grove, Wis. The authors conducted dental amalgam assessments during the lives of the majority of subjects and in some subjects at the time of autopsy only. The authors also determined three dental amalgam index scores--Event (placement, repair or removal of amalgam), Location and Time In Mouth--in addition to the numbers of and surface area of occlusal amalgam restorations. The authors determined Hg levels in multiple brain regions and performed full neuropathologic evaluations to confirm the normal status of the brain or the presence of AD. RESULTS: The authors found no significant association of AD with the number, surface area or history of having dental amalgam restorations. They also found no statistically significant differences in brain Hg level between subjects with AD and control subjects. CONCLUSIONS: Hg in dental amalgam restorations does not appear to be a neurotoxic factor in the pathogenesis of AD. The authors found that brain Hg levels are not associated with dental amalgam, either from existing amalgam restorations or according to subjects' dental amalgam restoration history. CLINICAL IMPLICATIONS: Dental amalgam restorations, regardless of number, occlusal surface area or time, do not relate to brain Hg levels.

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The study was poorly done and was not subject to scientific peer-review. The main conclusion stated in the study and under clinical implications - that “dental amalgam restorations, regardless of number, occlusal surface area or time, do not relate to brain Hg levels” has been well documented in the scientific literature to not be true. It is well documented that the level of mercury in the brain is directly related to the number of amalgam fillings or surfaces and there is scientific consensus on this point.

[The number of amalgam surfaces is directly correlated with the level of mercury in the brain occipital cortex (14,16,19,25,34,85,211,273,348,366/274).

Mercury penetrates and damages the blood brain barrier(311), resulting in accumulation of mercury and other toxic substances in the brain(14,20,21b,25,85,99,175,273,301,305,/149,262,274); also accumulates in the motor function areas of the brain and CNS(48,175,291,327,329).

Mercury is neurotoxic(kills brain and nerve cells): damages brain cells and nerve cells (19,27,34,36, 43, 69,70, 147,148,175,207,211,258,273,291,295,327,329,301,303,305,395/39,262,274,303); generates high levels of reactive oxygen species(ROS) and oxidative stress, depletes glutathione and thiols causing increased neurotoxicity from interactions of ROS, glutamate, and dopamine (13,56,98,102, 145,169,170, 184,213,219,250,257,259,286,288,290,291,302,324,326,329,416,424, 442, 496,564,565); kills or inhibits production of brain tubulin cells (66,67,161,166, 207,258,300); inhibits production of neurotransmitters by inhibiting: calcium-dependent neurotransmitter release(372,432), dihydroteridine reductase (27,122,257,333), nitric oxide synthase(259), blocking neurotransmitter amino acids (412), and effecting phenylalanine, serotonin, tyrosine and tryptophan transport to neurons (34,122,126,257,285,288,333,372,374,412/333).

As is known from autopsy studies for those with chronic exposure such as amalgam fillings (1,14,17,20,31,34,85,94), mercury also bioaccumulates in the brain/CNS (301,273,274,327,329,348,18,19,85

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

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Effects of dental amalgam and its components of histamine release from human basophils and tissue mast cells.Schedle A, Samorapoompichit P, Ghannadan M, Franz A, Sperr WR, Sperr W, Valent P.Wien Klin Wochenschr. 1998 Jul 31;110(13-14):467-72.

School of Dentistry, Department of Internal Medicine I, University of Vienna, Austria.Recent studies have shown that metal ions can be released from dental amalgam or other dental materials, and can cause toxic effects on various cells. In this study, the effects of amalgam-conditioned culture medium (ACCM), components of amalgam (Ag+, Cu2+, Sn2+, Hg2+) and dental composite-conditioned culture medium (CCCM) on histamine release from human blood basophils (healthy subjects, n = 3) and tissue mast cells (n = 3) were analyzed. ACCM and CCCM were prepared using either fresh or 6-weeks-aged specimens. Of the metal ions tested, Ag+, and Hg2+ were found to induce histamine release from basophils (Ag+, 0.33 mM: 83 +/- 11% vs Hg2+, 0.33 mM: 100% vs control medium: 5 +/- 5%) and mast cells (Ag+, 0.33 mM: 91 +/- 16% vs Hg2+, 0.33 mM: 99 +/- 1% vs control: 2 +/- 1%), whereas no effects were seen with Cu2+ and Sn2+. Neither ACCM from freshly prepared amalgam nor ACCM from 6-weeks aged amalgam, produced histamine release in basophils or mast cells. Inductively coupled plasma atomic emission spectrometry (ICP) revealed that the Ag(+)- and Hg(2+)-concentrations in ACCM were below the range in which histamine release occurred. Similar to ACCM, no effects on basophils or mast cells were observed with CCCM. In summary, our data show that distinct metal ions present in dental amalgam, can induce (toxic) histamine liberation from basophils and mast cells. However, the amounts of metal ions released from amalgam apparently were too low, to cause histamine release.*******************************************************

Amalgam has been well documented in the medical literature to cause adverse effects on the blood and immune system. www.home.earthlink.net/~berniew1/immunere.html

Adolph Coors Foundation, “Coors Amalgam Study: Effects of placement and removal of amalgam fillings”, 1995. (www) & International DAMS Newsletter, p17, Vol VII, Issue 2, Spring 1997. (31 cases);

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The biocompatibility of non-amalgam dental filling materials. (N, PDS)Schmalz G. Department of Operative Dentistry and Periodontology, University of Regensburg, Germany. gottfried.schmalz@klinik.uni-regensburg.deNon-amalgam filling materials may release substances which have been shown to be toxic in cytotoxicity tests and implantation studies. However, results from systemic toxicity tests do not indicate any unacceptable risk to the patient's general health, but data for non-amalgam dental filling materials are scarce in comparison to amalgam. Although estrogen-like effects of one fissure sealant have been claimed, no conclusions can be drawn at present for the patient from these in vitro data because of the limitation of the test methods and materials used. Some components of composite resins/dentin adhesives and a resin-modified glass ionomer cement were mutagenic mainly in in vitro tests. Due to the limitations of the test systems and the comparatively high concentrations needed to elicit the reactions, no unacceptable risk can yet be derived from those data for the patient. However, a no-touch technique is recommended for the dental personnel. As with amalgam, local reactions of the pulp are not expected with alternative filling materials, if the pulp tissue is not exposed and if bacterial penetration is avoided. The latter requirement is still difficult to fulfill, especially for composite resin systems and related materials in posterior teeth situations. Slight gingival reactions to alternative filling materials and to amalgams are mainly attributed to plaque accumulation. From all these data it can be concluded that, for the time being, it is not possible to rank dental filling materials in respect to their biocompatibility, and it is evident that biocompatibility must be considered to the same extent for both amalgams and commonly used or recommended alternative filling materials.****************************************************************

Poorly done study. Authors did not review the vast amount of medical literature and findings available on the biocompatiblity of amalgam and alternative materials.

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[Supplementary selenium , an antidote against mercury?][Article in Dutch]Schuurs AH, Groten J, van Dokkum W, van den Heuvel J. (N, PDS)Ned Tijdschr Tandheelkd. 1996 Apr;103(4):132-4.

Vakgroep Cariologie en Endodontologie, Academisch Centrum Tandheelkunde Amsterdam (ACTA).The consequences of both a high and a low intake of selenium are described in this article. Mercury released by dental silver amalgam might affect the protective functions of selenium. However, the literature does not sustain the existence of such an effect. In view of the small margin between safe and toxic doses of selenium and the absence of a scientific consensus as to the possible toxic effects of mercury from amalgam (additional to dietary mercury), it does not seem to be warranted to advise suppletion of selenium.****************************************************

There are good studies in the medical literature on this subject. This is not one of them.

[M.Molin et al, “Mercury, selenium, And GPX before & after amalgam removal”, Acta Odontol Scand, 1990,48:189-202.

M. Nylander et al,Mercury and selenium concentrations and their interrelations in organs from dental staff and the general population. Br J Ind Med 1991, 48(11):729-34;

I.Akesson et al, Dept. of Occupational Medicine, "Status of mercury and selenium in dental personnel", Arch Environ Health, 46(2): 102-109, 1991

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Lessons learnt from the amalgam controversy. (R, O, D)Skrabanek P. J Ir Dent Assoc. 1996;42(3):42-5.

Department of Community Health, Trinity College, University of Dublin, Irel

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Page 13

A history of dental amalgam. (R,O,D)Soler JI, Ellacuria J, Triana R, Guinea E, Osborne JW.J Hist Dent. 2002 Nov;50(3):109-16.

University of the Basque Country, Faculty of Dentistry, Spain.OBJECTIVES: Silver amalgam alloy has been used as a dental restorative material since the beginnings of restorative dentistry. It rose as an easily manipulated and low cost material in comparison to other restorative techniques of the time, but it had poor dimensional stability and clinical behavior. Successive research led to the standardization of both its composition and some aspects of its mechanical properties, which have contributed to its widespread acceptance. Nevertheless, the risk of environmental toxicity generated by mercury and its poor esthetics have given rise to the search for alternative and more promising materials. This article endeavors to give a brief historical description of the main events which have led to development of modern silver amalgam alloys. SIGNIFICANCE: It is concluded that extensive knowledge of the use of silver amalgam alloy has made it the most widely used restorative material for the posterior oral cavity. However, in recent years its preponderance has been brought into question even though some innovative ideas have been suggested which could help improve this material in the future.**********************************************************************

Symptoms and differential diagnosis of patients fearing mercury toxicity from amalgam fillings.Stenman S, Grans L.Scand J Work Environ Health. 1997;23 Suppl 3:59-63

University of Helsinki, Department of Medicine, Finland.Clinical signs, somatic symptoms reported by patients, and mercury excretion in urine were studied for 348 patients selected by odontologists or internists as amalgam-free referents, or as subjects with unexplained clinical findings or who were self-selected due to their fear of mercury intoxication from their amalgam fillings. Sixty patients were excluded because other explanations could be given for their complaints. The age distribution was bimodal, with peaks between 30 and 35 years and between 45 and 50 years. Mercury was determined in a morning urine sample and 30 minutes after the injection of 300 mg of 2,3 dimercapto-1-propane sulfonic acid (DMPS), a mercury-chelating agent. The patients were followed for 1-3 years. Among the patients there were 26 who had had their amalgam fillings removed and who, at the time of the follow-up, were subjectively cured. When the patients were classified according to the excretion of mercury after the DMPS challenge, those who belonged to the upper quartile had an odds ratio of 7.2 (95% confidence interval 3.1-15.2) for becoming cured after amalgam removal. The symptoms of the cured patients had been predominantly mental. No consistent clinical picture could, however, be found among the other patients, as various types of mental and physical distress were reported.************************************************

Mercury is well documented in the medical literature and from clinical experience to cause neurological and psychological conditions, that improve significantly after amalgam replacement. www.home.earthlink.net/~berniew1/depress.html

This study has results consistent with that experience. It does not appear that the authors were aware that susceptability factors such as immune reactivity and systemic detoxification ability are major factors in mercury toxicity effects, or that they were aware of how to test or treat such affected patients. www.home.earthlink.net/~berniew1/suscept.html

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Residual mercury content and leaching of mercury and silver from used amalgam capsules.Stone ME, Pederson ED, Cohen ME, Ragain JC, Karaway RS, Auxer RA, Saluta AR.Dent Mater. 2002 Jun;18(4):289-94.

The Naval Dental Research Institute, Building 1H, 310A B Street, 60088-5259, Great Lakes, IL 60088-5259, USA. mark.stone@ndri.med.navy.milOBJECTIVE: The objective of this investigation was to carry out residual mercury (Hg) determinations and toxicity characteristic leaching procedure (TCLP) analysis of used amalgam capsules. METHODS: For residual Hg analysis, 25 capsules (20 capsules for one brand) from each of 10 different brands of amalgam were analyzed. Total residual Hg levels per capsule were determined using United States Environmental Protection Agency (USEPA) Method 7471. For TCLP analysis, 25 amalgam capsules for each of 10 brands were extracted using a modification of USEPA Method 1311. Hg analysis of the TCLP extracts was done with USEPA Method 7470A. Analysis of silver (Ag) concentrations in the TCLP extract was done with USEPA Method 6010B. RESULTS: Analysis of the residual Hg data resulted in the segregation of brands into three groups: Dispersalloy capsules, Group A, retained the most Hg (1.225 mg/capsule). These capsules were the only ones to include a pestle. Group B capsules, Valliant PhD, Optaloy II, Megalloy and Valliant Snap Set, retained the next highest amount of Hg (0.534-0.770 mg/capsule), and were characterized by a groove in the inside of the capsule. Group C, Tytin regular set double-spill, Tytin FC, Contour, Sybraloy regular set, and Tytin regular set single-spill retained the least amount of Hg (0.125-0.266 mg/capsule). TCLP analysis of the triturated capsules showed Sybraloy and Contour leached Hg at greater than the 0.2 mg/l Resource Conservation and Recovery Act (RCRA) limit. SIGNIFICANCE: This study demonstrated that residual mercury may be related to capsule design features and that TCLP extracts from these capsules could, in some brands, exceed RCRA Hg limits, making their disposal problematic. At current RCRA limits, the leaching of Ag is not a problem

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The authors are apparently not aware of recent mercury research by Oak Ridge National Lab on

mercury in soil. It was found that soil bacteria convert mercury in soil to methyl mercury which is commonly outgased at high levels from landfills or areas where sewer sludge was landspread.

Amalgam was found by Government agencies to be the largest source of mercury in sewers, with dangerous levels in all sewers and sewer sludge, resulting in mercury in water bodies, fish, wildlife, crops, and high levels in rain all over the U.S. www.home.earthlink.net/~berniew1/damspr2f.html

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Dental amalgam and mercury. (R,O,D)Stringer G. Aust Dent J. 2001 Mar;46(1):60-1.

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The release of mercury from dental amalgam and potential neurotoxicological effects.Sweeney M, Creanor SL, Smith RA, Foye RH.J Dent. 2002 Jul-Aug;30(5-6):243-50.

Hard Tissue Research Group, Glasgow Dental Hospital and School, University of Glasgow, 378 Sauchiehall Street, Scotland Glasgow G2 3JZ, UK.OBJECTIVES: The aim of this study was to estimate the amount of mercury released into both air and saliva from fresh and aged, abraded amalgam discs and then investigate neurotoxic effects of inorganic mercury upon sensory neuronal cultures. METHODS: An air-tight chamber was constructed to allow the combined estimation of mercury species released from amalgam pellets. The level released into air and saliva from both freshly packed and aged-abraded amalgam pellets was assessed. Dorsal root ganglia cultures from male CBA mice were exposed to 1 and 10 microM mercuric chloride concentrations. The effects of this were assessed by means of morphology, adhesion, size and immunocytochemistry. RESULTS: The mercury released into air from dry fresh amalgam was low and less than the recommended industrial exposure limit for mercury. However, covering the discs with saliva reduced air-mercury levels by 46-56% and there was a statistically significant difference in the air-mercury levels recorded (p=0.013-0.048). The mercury released into air from dry abraded amalgam was shown to be above the recommended industrial limit. Coating the abraded amalgam discs with saliva reduced the mercury by 66-72% with the levels recorded being significantly lower (p<0.001). The level of total mercury within the saliva was found to be highly variable. Little change was noted in the neuronal cultures treated with 1 microM mercuric chloride. However, the cultures exposed to high level (10 microM) mercuric chloride showed cells that became rounded and clumped together indicating pathological change.CONCLUSIONS: Amalgam placement appears to present minimal mercury exposure risk. To reduce the amount of mercury released into air, however, amalgam should be polished in a moist atmosphere with high volume aspiration. The neurotoxic effect of mercury appears to be related to concentration, as only in the cultures treated with 10 microM mercuric chloride showed striking qualitative and quantitative cellular changes.********************************************************************

The study was not very useful since it only looked at acute effects and direct neurological effects; exposure from amalgam is documented to be the largest source of mercury in most people and exposures commonly exceed the federal health guideline levels for mercury; as well as commonly causing adverse health effects: www.home.earthlink.net/~berniew1/damspr1.html

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Cytotoxicity evaluation of perforation repair materials on human periodontal ligament cells in vitro. (N, Sc)Tai KW, Chang YC.Department of Oral Surgery, Chung Shan Medical and Dental College Hospital, Taichung, Taiwan, Republic of China.Perforation of a tooth structure resulting in communication of the pulp space with periodontium occasionally occurs during endodontic therapy. For the best prognosis, the perforation area must be sealed as soon as possible. Because these materials will be in direct contact with periodontal tissues, their cytotoxic potential must be evaluated before clinical use. The purpose of this study was to determine the cytocompatibility of three perforation repair materials (amalgam, resin, and glass ionomer). Cultured human periodontal ligament (PDL) cells were used to evaluate the cellular response resulting from these materials by cell viability and proliferation assays. Twenty-seven 5 x 4 mm cylinders of each material were fabricated for this study. All tested materials were cytotoxic to human PDL cells. Both types of material and time affected cell viability and proliferation. Resin exhibited the most cytotoxic effects followed by glass ionomer and amalgam during a 14-day incubation period. Amalgam and glass ionomer slightly inhibited cell viability and growth in the first 24 hr, compared with the control. Amalgam or glass ionomer may initially react more favorably to PDL cells than resin. The present model of cultured human PDL cells is simple, relatively cheap, and easily established and propagated under standardized conditions in any laboratory. Furthermore, this method allows long-term observation of human cellular reactions and thus might be a preliminary screening test for initial biocompatibility of dental materials.***************************************************************

Solving problems. (R,O, D)Toal KW. Dent Today. 2000 Nov;19(11):6.

^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^Urinary excretion of trace elements in humans after sodium 2,3-dimercaptopropane-1-sulfonate challenge test. (A-,Sc)Torres-Alanis O, Garza-Ocanas L, Bernal MA, Pineyro-Lopez A.J Toxicol Clin Toxicol. 2000;38(7):697-700.

Centro Antivenenos, Departamento de Farmacologia y Toxicologia, Facultad de Medicina, Universidad Autonoma de Nuevo Leon, Monterrey Nuevo Leon, Mexico. otorres@ccr.dsi.uanl.mxOBJECTIVE: To evaluate the effects of intravenous sodium 2,3-dimercaptopropane-1-sulfonate (DMPS, Dimaval) on urinary excretion of essential trace elements in subjects who received this chelating agent as a mercury challenge test. SUBJECTS: Eleven subjects sought medical attention due to concern with the toxicity of mercury released from dental amalgam fillings. DESIGN: The subjects were given DMPS 3 mg/kg intravenously. Spot urine samples were collected 1 hour before and 1 hour after the DMPS dose for laboratory analysis. In addition to mercury, the urinary excretion of copper, zinc, selenium, magnesium, manganese, molybdenum, chromium, cobalt, and aluminum were measured. RESULTS: A significant increase in urinary excretion of mercury (3- to 107-fold) was observed after the DMPS dose. The DMPS treatment led to a 2- to 119-fold increase in copper excretion; 3- to 43.8-fold in selenium excretion; 1.6- to 44-fold in zinc excretion; and 1.75- to 42.7-fold in magnesium excretion. The excretion of manganese, chromium, cobalt, aluminium, and molybdenum remained unchanged. CONCLUSIONS: In this study, an intravenous DMPS challenge test produced a significant increase in mercury excretion and also led to an increased excretion of copper, selenium, zinc, and magnesium.***************************************************

Those with amalgams usually have high excretion of mercury after challenge tests due to bioaccumulation in cells of the body. The study showed that in addition to causing excretion of the toxic metals mercury and coppper, some essential minerals are also excreted. This is well known and patients are cautioned to take multiminerals with chelating with chemical chelators.

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Complex single-tooth restorations. (R,O,D, N)Trushkowsky RD, Burgess JO.Dent Clin North Am. 2002 Apr;46(2):341-65.

Staten Island University Hospital, Staten Island, NY, USA. ComposiDoc@aol.comThere are many options for restoring the decimated dentition. [43] Excellent results can be obtained with many of the materials currently available. The restorative option will depend on the size and location of the lesion, adequate isolation for adhesive restorations, caries rate, the patient's age, the aesthetic needs of the patient, occlusal habits, maintenance of maximum tooth structure, the skill of the dentist, and the longevity desired for the restoration. Amalgam is a cost-effective material, and when used properly, it can provide many years of service. Aesthetic demands, the desire to strengthen teeth, [44] and concern about the safety of mercury in amalgam have increased the use of direct composites, ceramic material, and indirect composites. The main drawback with these materials, however, is their increased technique sensitivity and concerns about their longevity. Gold continues to be a cost-effective and predictable material if placed properly. Full-coverage gold or porcelain fused to metal provides long-term predictability but is more destructive and not as aesthetically appealing. The wide varieties of materials available provide both a challenge and an opportunity to place the most effective material for a particular patient. A thorough understanding of the available materials and their appropriate use is needed to achieve a long-lasting restoration that serves the patient's needs.**************************************************

Mercury amalgam safety: a review.van Zyl I. J Mich Dent Assoc. 1999 Jan;81(1):40-8, 50, 52. (R,O,D)

Department of Fixed Prosthodontics, University of the Pacific School of Dentistry, San Francisco, California, USA

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[Dental care using silver amalgam][Article in Dutch]Vanherle G. Verh K Acad Geneeskd Belg. 1996;58(5):587-634. (R,O,D,PDS)

School voor Tandheelkunde, Mondziekten en Kaakchirurgie, Faculteit Geneeskunde-Katholieke Universiteit Leuven.Dental amalgam is the most widely used filling material in dentistry. In our country there are an estimated 40 million amalgam fillings in place. The mercury present in these fillings has caused health concerns over the last 160 years that amalgam has been used in decayed teeth. The fears have always proven to be unjustified and no harmful effects have ever been demonstrated in dental patients. Mercury can be found in several forms. In dentistry, only the metallic form is used, while inorganic and organic compounds are also present in the environment. The metallic form is absorbed in the human body mostly through the lungs. Once mercury reaches toxic levels inside the body, it will interfere with cell metabolism. Most important among the target organs are the brain, the liver and the kidneys. Elimination occur through urine and feces. Mercury is universally found in blood and urine. The concentration depends on absorption by air, water, nutrition, medication (including dental fillings) and occupational hazards. There are four kinds of objectives to dental amalgam: oral galvanism, toxicity, allergenicity and ecological grievances. Disorders from oral galvanism are difficult and delicate to evaluate as the actual currents are very small. Furthermore, no significant difference can be found in current intensity between patients with and without complaints. Finally patients with complaints often present other oral disorders, the treatment of which most often eliminates all complaints that could be attributed to oral galvanism. Toxicity is dose dependent. Industrial safety rules indicate that the amount of mercury absorbed from dental amalgam fillings is far below the safety level. HgB and HgU levels in patients with amalgam fillings are situated well below the acceptable levels. Allergic disorders are observed in patients with amalgam fillings but far less than expected in view of the wide spread use of dental amalgam. The problem of mercury spilling from dental amalgam fillings into the environment will be resolved by strict legislation in the near future. In this context, it can be stated that the use of dental amalgam is safe and justified. Furthermore, it is also advisable as no other material can meet the actual dental needs as efficiently as can dental amalgam.*********************************************************

The review makes extreme claims throughout without apparently doing a review of the relevant medical literature. There are incorrect statements not supported by the literature throughout.

Dental amalgam is the largest source of mercury exposure for most

(www.home.earthlink.net/~berniew1/damspr1.html) and causes widespread adverse health effects, contrary to what the author claims(www.home.earthlink.net/~berniew1/damspr3.html)

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Mercury from maternal "silver" tooth fillings in sheep and human breast milk. A source of neonatal exposure.Vimy MJ, Hooper DE, King WW, Lorscheider FL. (A+, Sc)Biol Trace Elem Res. 1997 Feb;56(2):143-52.

Department of Medicine, Faculty of Medicine, University of Calgary, Alberta, Canada.Neonatal uptake of mercury (Hg) from milk was examined in a pregnant sheep model, where radioactive mercury (Hg203)/silver tooth fillings (amalgam) were newly placed. A crossover experimental design was used in which lactating ewes nursed foster lambs. In a parallel study, the relationship between dental history and breast milk concentration of Hg was also examined in 33 lactating women. Results from the animal studies showed that, during pregnancy, a primary fetal site of amalgam Hg concentration is the liver, and, after delivery, the neonatal lamb kidney receives additional amalgam Hg from mother's milk. In lactating women with aged amalgam fillings, increased Hg excretion in breast milk and urine correlated with the number of fillings or Hg vapor concentration levels in mouth air. It was concluded that Hg originating from maternal amalgam tooth fillings transfers across the placenta to the fetus, across the mammary gland into milk ingested by the newborn, and ultimately into neonatal body tissues. Comparisons are made to the U. S. minimal risk level recently established for adult Hg exposure. These findings suggest that placement and removal of "silver" tooth fillings in pregnant and lactating humans will subject the fetus and neonate to unnecessary risk of Hg exposure.***************************************************************************

Renal function and amalgam mercury. (A, Sc)Vimy MJ, Lorscheider FL. Am J Physiol. 1997 Sep;273(3 Pt 2):R1199-200.

*********************************************************************A biocompatible material for the new millennium: dental amalgam.Wahl MJ. Dent Today. 2001 Nov;20(11):16. (R,O,D)

**********************************************************************Amalgam--resurrection and redemption. Part 2: The medical mythology of anti-amalgam.Wahl MJ. Quintessence Int. 2001 Oct;32(9):696-710. (R,O,D,PDS)

WahlMichaelJ@aol.comMercury-containing amalgam restorative material has come under attack for its alleged harmful effects on systemic health. A literature search revealed that amalgam restorations release small quantities of mercury but apparently not enough to cause systemic health problems. Mercury from dental amalgam restorations cannot be linked to kidney damage, Alzheimer's disease, multiple sclerosis, other central nervous system diseases, "amalgam disease," mental disorders, damage to the immune system, increases in antibiotic resistance, or harmful reproductive effects. Dentists occupationally exposed to mercury have not been shown to suffer harmful reproductive or other systemic health effects, provided proper mercury hygiene is used. There are legitimate health concerns about alternative restorative materials, including resin composite. According to the latest scientific information available, dental amalgam remains a safe and effective restorative material.********************************************************

The author makes extreme claims without reviewing the vast medical literature on the subject.

Statements throughout the review are contrary to the published science.

Dental amalgam is the largest source of mercury exposure for most

(www.home.earthlink.net/~berniew1/damspr1.html) and causes widespread adverse health effects, contrary to what the author claims(www.home.earthlink.net/~berniew1/damspr3.html)^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^

page 14

Chemical hazards in health care workers.Weaver VM. Occup Med. 1997 Oct-Dec;12(4):655-67. (R, O, N)

Division of Occupational and Environmental Health, Johns Hopkins University School of Hygiene and Public Health Baltimore, MD 21205, USA.A comprehensive occupational health program is essential in health care settings to minimize the risk of occupational injury and illness in chemically exposed workers. Careful exposure assessment is the framework on which such a program is built. Medical surveillance provides an additional check by allowing earlier identification of at-risk workers. Regular analyses of these data are needed to increase knowledge regarding occupational hazards for health care workers. Correlation of adverse health effects detected in medical surveillance with exposure level is a powerful, although underutilized, tool for advancing occupational health. Worker training is the other critical element in an effective occupational health program. Employees are better able to comply with workplace rules designed to protect health and safety if they understand their rationale.**************************************************************************

Wuthrich B, Remission f a sensitization to amalgam and gold salts, Allergologie, 1998,

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[A study on the cytotoxicity of six filling materials in vitro][Article in Chinese]Yu W, Shen J, Sun W.Zhonghua Kou Qiang Yi Xue Za Zhi. 1997 Jul;32(4):246-8 (A, Sc)

Department of Stomatology, Nanjing Medical University.This paper deals with the cytotoxicologic analyses on 6 filling materials with morphology of cells, ultraviolet light spectrophotometry and incorporation test using mouse L-929 fibroblasts labelled 3H-TdR. The results showed that the cytotoxicity of Silver amalgam and the Gallium-Silver alloys, which were produced by mixing the conventional dental alloys powder or high copper alloys powder with Gallium, was significantly stronger than that of light curing composites and the Gallium-Silver alloys that were produced by the spherical amalgam alloys powder and Gallium. It suggested that the level of mercury and copper in the alloys can influence their cytotoxic properties.************************************************************************Cytotoxic evaluation of root-end filling materials in cultures of human osteoblast-like cells and periodontal ligament cells.Zhu Q, Safavi KE, Spangberg LS. (A, Sc)Department of Restorative Dentistry and Endodontology, School of Dental Medicine, University of Connecticut Health Center, Farmington 06030-1715, USA.The cytotoxicity of three root-end filling materials (amalgam, IRM, and Super-EBA) was evaluated in cultures of human periodontal ligament cells and human osteoblast-like cells. Ten-millimeter-long plastic test tubes were filled with 3 mm of freshly mixed root-end filling materials at one end (1.5 mm diameter). The opposite end was sealed and attached by heat to a 35-mm cell culture dish. Human periodontal ligament cells and human osteoblast-like cells were seeded in the dishes. The size of cell-free zones around the root-end filling materials and the total cell number per dish were calculated after 3 and 7 days. Empty test tubes used as controls did not influence the growth and distribution of the cultured cells. Cell density increased in all groups in the test period. Amalgam had a larger cell-free zone, compared with IRM and Super-EBA and showed a reduction in total cell number per dish for both tested cell types. IRM and Super-EBA also had a cell-free inhibition zone for both cell types, but no significant reduction in total cell number per dish. This study showed that amalgam had a higher cell toxicity to human periodontal ligament cells and human osteoblast-like cells than IRM and Super-EBA.*****************************************************************study shows that amalgam should not be used for root-end fillings, like many other studies and

health warnings of other countries and amalgam manufacturers.

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