Mercury in Dentistry

All silver-colored fillings, also called “dental amalgams,” contain 45-55% metallic mercury.1  Dental amalgams are used for 45% of all direct dental restorations worldwide,2 and it has been estimated that these mercury-containing fillings are used on more than 50% of Americans.3 4  While hazards to the environment and human health from dental mercury have been established and some countries have banned or restricted its use, the U.S. Food and Drug Administration (FDA) “considers dental amalgam fillings safe for adults and children ages 6 and above.”5

Dental amalgam mercury pollutes the environment through wastewater from dental offices, human waste, cremation and burial, and emissions of mercury vapor.  Once in the environment, mercury pollution damages animals, plants, and the entire ecosystem, with dangers existing as a result for centuries.6  More information about dental mercury’s harm to the environment.

Human health risks have been clearly associated with the use of dental mercury.  Scientific research has related the mercury in dental amalgam to Alzheimer’s disease,  amyotrophic lateral sclerosis (Lou Gehrig’s disease), antibiotic resistance, autism spectrum disorders, autoimmune disorders/immunodeficiency, cardiovascular problems, chronic fatigue syndrome, hearing loss, kidney disease, multiple sclerosis, Parkinson’s disease, reproductive dysfunction, and other health problems.7  Additionally, authorities have issued distinct warnings about mercury’s use in children and pregnant women.  Furthermore, scientific studies have demonstrated potential hazards of mercury in the workplace to dental workers and dental students. 8  For more information about the health risks of dental mercury.

Potential responses to elemental mercury, the form used in dental amalgam fillings, include hundreds of specific symptoms, which can vary from person to person and change over time.  Mercury vapor is absorbed by the lungs and passed to the rest of the body, particularly the brain, kidney, liver, lung, and gastrointestinal tract. The half life of metallic mercury varies depending on the organ where the mercury was deposited and other factors. More information on the symptoms and effects of mercury exposures.

Some consumers have mercury-containing amalgam fillings removed due to device failure, personal preference, or other reasons.  However, it is important to note that removal of dental mercury requires a number of precautions because an unsafe amalgam removal process releases mercury vapor and particles that can be harmful to the patient, the dentist, the dental staff, and the environment.   The International Academy of Oral Medicine and Toxicology (IAOMT) has developed safety recommendations for the removal of existing dental mercury amalgam fillings known as the Safe Mercury Amalgam Removal Technique (SMART). More information about SMART.

Alternatives to amalgam fillings include composite resin, glass ionomer, porcelain, and gold, among other options.  Most consumers choose direct composite fillings because the white coloring matches the tooth better and the cost is considered moderate. More information on alternatives to mercury fillings.

More detailed information about dental amalgam mercury with references to scientific literature:

A Comprehensive Review of the Toxic Effects of Mercury in Dental Amalgam Fillings on the Environment And Human Health (pdf)

IAOMT Position Paper Against Dental Mercury Amalgam

1 World Health Organization. Mercury in Health Care [policy paper].  August 2005: 1.  Available from WHO Web site: http://www.who.int/water_sanitation_health/medicalwaste/mercurypolpaper.pdf.  Accessed December 15, 2015.

2 Heintze SD, Rousson V.  Clinical effectiveness of direct Class II restorations—a meta-analysis.  J Adhes Dent. 2012; 14(5):407-431.

3 Makhija SK, Gordan VV, Gilbert GH, Litaker MS, Rindal DB, Pihlstrom DJ, Gvist V.  Dental practice-based research network restorative material: Findings from the characteristics associated with type of practitioner, patient and carious lesion. J Am Dent Assoc. 2011; 142: 622-632.

4 Simececk JW, Diefenderfer KE, Cohen ME.  An evaluation of replacement rates for posterior resin-based composite and amalgam restorations in U.S. Navy and Marine recruits. J Am Dent Assoc. 2009; 140 (2): 207.

5 United States Food and Drug Administration. About dental fillings: potential risks.  Last updated 2 February 2015.  Available from FDA Web site:  fda.gov/MedicalDevices/ProductsandMedicalProcedures/DentalProducts/DentalAmalgam/ucm171094.htm.  Accessed December 15, 2015.

6 Pirrone N, Mason R.  Mercury Fate and Transport in the Global Atmosphere: Emissions, Measurements, and Models.  New York, New York: Springer. 2009: 166.

7 For a detailed list of health risks related to dental mercury, see Kall J, Just A, Aschner M.  What’s the risk? Dental amalgam, mercury exposure, and human health risks throughout the lifespan.  Epigenetics, the Environment, and Children’s Health across Lifespans. David J. Hollar, ed. Springer. 2016. pp. 159-206 (Chapter 7).

And Kall J, Robertson K, Sukel P, Just A. International Academy of Oral Medicine and Toxicology (IAOMT) Position Statement against Dental Mercury Amalgam Fillings for Medical and Dental Practitioners, Dental Students, and Patients. ChampionsGate, FL: IAOMT. 2016.  Available from the IAOMT Web site: iaomt.org/iaomt-position-paper-dental-mercury-amalgam/.  Accessed December 18, 2015.

8 For a detailed list of health risks to dental workers and students related to dental mercury, see Kall J, Just A, Aschner M.  What’s the risk? Dental amalgam, mercury exposure, and human health risks throughout the lifespan.  Epigenetics, the Environment, and Children’s Health across Lifespans. David J. Hollar, ed. Springer. 2016. pp. 159-206 (Chapter 7).

And Kall J, Robertson K, Sukel P, Just A. International Academy of Oral Medicine and Toxicology (IAOMT) Position Statement against Dental Mercury Amalgam Fillings for Medical and Dental Practitioners, Dental Students, and Patients. ChampionsGate, FL: IAOMT. 2016.  Available from the IAOMT Web site: iaomt.org/iaomt-position-paper-dental-mercury-amalgam/.  Accessed December 18, 2015.

The Real Cost of Dental Mercury

While its use has essentially been eliminated in many countries, dental amalgam is now being considered for a global phase-out in the ongoing mercury treaty negotiations1 and in the European Union (BIO 2012) because of significant environmental concerns. The negative effects of mercury releases related to amalgam use are widely recognized in countries where its use has been prevalent: it is often the largest source of mercury in municipal wastewater as well as an increasing source of mercury air pollution from crematoria. On the other hand, high-quality mercury-free alternatives have long been available. While most dental professionals charge lower prices for amalgam fillings than for mercury-free alternatives, this paper shows that when factoring in “external” environmental and societal costs,2 amalgam is a higher-priced dental material by far (Hylander and Goodsite 2006). Ultimately, society pays for mercury releases related to amalgam use through additional pollution control costs, the loss of common (public-owned) resources, and the health effects associated with mercury releases and contamination (MPP 2008).

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Autoimmunity and Metal Implants, Devices, and Vaccine Adjuvants

By Amanda Just, MS, and Jack Kall, DMD, MIAOMT, World Mercury Project Partner

 

Autoimmune diseases are on the rise, with more and more people being stricken with these illnesses each year. The fact that the average person’s overall exposure to chemicals, including metals, has drastically increased over the past century cannot be overlooked when discussing the synonymous rise of autoimmune illnesses.

It is generally agreed that autoimmune conditions are related to a combination of genetic traits and environmental factors.  “Environmental factors” is a phrase that encompasses all aspects of the environment with which humans interact, including bacteria, viruses, chemicals, etc.

Even trace amounts of metals can potentially cause a reaction.

Metals have been recognized as one of the environmental factors capable of contributing to autoimmune disease, and metals have also been recognized as one of the triggers capable of producing inflammation.  Reactions are more likely to occur for individuals who are genetically predisposed to having lower excretion rates of metals, as well as other individualized factors.  Even trace amounts of metals can potentially cause a reaction.

Autoimmune Conditions Associated with Metals

While numerous health conditions have been related to the presence of metals in the body, scientific research has clearly shown that autoimmune diseases can be associated with metals used in dentistry and medicine, including metals in implants, devices, and vaccine adjuvants/preservatives (such as aluminum and mercury).  Several of the autoimmune conditions studied scientifically for their relation to metal exposure in this regard include the following:

  • Amyotrophic Lateral Sclerosis (Lou Gehrig’s Disease)
  • Autoimmune Thyroiditis
  • Chronic Fatigue Syndrome
  • Crohn’s Disease
  • Diabetes (Type 1 Mellitis)
  • Fibromyalgia
  • Gulf War Syndrome
  • Lupus (Systemic Lupus Erythematosus)
  • Macrophagic Myofasciitis
  • Multiple Sclerosis
  • Oral Lichen Planus
  • Rheumatoid Arthritis

Some metals are recognized as essential to human life and serve important roles within the human body. However, the beneficial effects of trace elements are based on safe and adequate intake levels, with too little resulting in deficiencies and too much resulting in toxicities. Many of the metals used in dentistry and medicine have no established function in the human body, such as aluminum, which is both a neurotoxin and an immune stimulator, and mercury, which is recognized as being toxic even in low doses.

Onset of Symptoms Can Be Delayed

An issue with calculating the number of patients who have adverse reactions to metals is that the onset of symptoms can be delayed and therefore might not be associated with the implant, device, or vaccine adjuvant.  Another issue is that there may not be any local reaction on the skin or in the mouth to help the patient and doctor identify the metal as the culprit in ill health. Even if hypersensitivity reactions are noticed, they can be misdiagnosed as infection.

In some genetically susceptible individuals, metals can trigger allergies, and recent studies and reports tend to agree that metal allergies are on the rise.  Clinical screening for metal allergy has been recommended, but the importance of patients reporting reactions to metals to their doctors has also been emphasized.

…sensitization to metal can develop years after an implant or device has been placed…

In addition to reporting any rashes from jewelry, watches, or other metal exposures, it is essential for each patient to recognize the gamut of symptoms that can be related to the presence of a metal implant, device, or adjuvant in their body, such as the development of an autoimmune disease.  It is also vital for patients to remember that sensitization to metal can develop years after an implant or device has been placed and that adverse effects can occur with or without the sign of a rash or eruption on the skin or in the mouth.

Improving or Recovering After Removal of Metals

Removal of metal implants and devices is an obvious course of action when adverse effects occur.  Indeed, the scientific literature is abundant with cases of individuals improving or recovering from autoimmune diseases usually within a year or two after removal of the offending metal.  Examples of health conditions related to metal implants, devices, and vaccine adjuvants that improved (or from which patients even recovered) upon removal of metals in the body include autoimmune thyroiditis, chronic fatigue syndrome, Crohn’s disease, fibromyalgia, multiple sclerosis, oral lichen planus, Sjögren’s syndrome, and systemic lupus erythematosus.

Source: https://thesmartchoice.com/wp-content/uploads/Table-Autoimmunity-Metal-Removal.pdf

It is important to note that many factors can influence whether or not a patient improves after the removal of a metal implant or device.  While many patients improve or even recover, there are some who do not.  One obvious reason for this is if the patient is still being exposed to the metal or a different sensitizer through another implant, device, vaccine adjuvant, or other source.  Additional impediments in achieving improved health can include the presence of another illness and/or allergy, exposure to certain pesticides, solvents, molds, and foods, hormonal imbalances, stress, a sedentary lifestyle, and countless other circumstances.

Meanwhile, even though alternatives are available, millions of people are being exposed to metals used in dentistry and medicine.  Simultaneously, millions of people are suffering from autoimmune diseases, with substantial numbers of new patients being diagnosed each year. For all these reasons and more, it is imperative to recognize that metal implants, devices, and vaccine adjuvants can be a contributing factor to ill health.

 

A more detailed version of this article (Autoimmune Diseases and Metal Implants and Devices) can be found on the International Academy of Oral Medicine and Toxicology’s SMART website.

Author Bios:
These writers co-authored a chapter about the health risks of dental mercury that was published in a textbook about epigenetics from Springer in 2016.

Amanda Just, MS:  Ms. Just is the Program Director of the International Academy of Oral Medicine and Toxicology.  She is also a freelance writer and dental consumer who has shared her writings about the impact of dental mercury amalgam fillings with the United Nations Environment Programme, the U.S. Department of State, the U.S. Food and Drug Administration (FDA), and various NGOs.

John Kall, DMD:  Dr. Kall serves as the Chairman of the International Academy of Oral Medicine and Toxicology’s Board of Directors.  He is a member of the American Dental Association, a fellow of the Academy of General Dentistry (AGD), Past President of the KY Chapter of the AGD, a member of the Louisville Dental Society, and a member of the Kentucky Dental Association

 

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Protecting the Innocent: Dental Amalgam Mercury and Risks to Fetuses, Infants and Children

By Amanda Just, David Kennedy, DDS, and Jack Kall, DMD from WMP’s Partner: International Academy of Oral Medicine and Toxicology (IAOMT)

 

Dorice Madronero offered a grave warning to a 2010 Dental Products Panel of United States Food and Drug Administration (FDA): “As a young expectant mother I know that twice following dental work I miscarried.  I know that at the time the dentist gave no warning about a mercury exposure.  I know that at no point in my visits to the obstetrician was I warned about a mercury exposure, in the dental fillings or asked about my medical and dental history.”

At the same meeting Madronero presented her experiences with dental mercury, one of the Dental Products Panel members supported her concerns about children. Dr. Suresh Kotagal a pediatric neurologist at the Mayo Clinic, concluded: “…I think that there is really no place for mercury in children.”

While health agencies inform the public about the possible presence of mercury in certain types of fish and shellfish and recommend that pregnant women and children restrict these food products in their diet, the use of mercury in dentistry continues in the United States without any warnings.

Dental mercury: Dangerous to children in Europe but safe in the US?

Meanwhile, other parts of the world are taking action.  In 2013, the United Nations Environment Programme (UNEP) formalized a global convention to end mercury usage, which includes initiatives to phase down the use of dental mercury. As part of this effort, a new EU mercury regulation plans to prohibit the use of amalgam for vulnerable populations (pregnant or breastfeeding women, children under 15 years old) and provide for discussion about the feasibility of ending dental amalgam use in the European Union by 2030.

Prior to this recent development, some countries had already banned or drastically reduced the use of dental amalgam. Also, France had previously recommended that alternative mercury-free dental materials be used for pregnant women, and Austria, Canada, Finland, and Germany had been working to reduce the use of dental amalgam fillings for pregnant women and children.

Importantly, there are no enforced FDA dental mercury regulations for women of child-bearing age, children, or any other population.

In spite of these international actions, the U.S. Food and Drug Administration (FDA) currently “considers dental amalgam fillings safe for adults and children ages 6 and above.” However, details in the FDA’s public statements about dental mercury amalgam on its website have changed over the years, including information about its potentially harmful impact on pregnant women, fetuses, and children under the age of six. Importantly, there are no enforced FDA dental mercury regulations for women of child-bearing age, children, or any other population.

Due in part to concerns about this lack of protection, the International Academy of Oral Medicine and Toxicology (IAOMT) filed a lawsuit in 2014 against the FDA over its classification of dental mercury amalgam. As part of the case, the IAOMT secured an internal document from the FDA that had proposed restricting dental mercury amalgam use in pregnant and nursing women and children under the age of six, as well as individuals with mercury allergies and pre-existing kidney or neurological disease. Yet, allegedly for administrative reasons, the FDA communication (dated January 2012) was never released to the public.

Other American authorities have addressed the FDA about dangers of dental mercury for women and children. In 2009, 19 members of the U.S. Congress wrote a letter to the FDA with a focus on dental mercury’s potential dangers to pregnant women and children, and when Representative Diane Watson of California proposed a Mercury Filling Disclosure and Prohibition Act (H.R. 2101{not enacted}), she explained: “It is, in fact, children who are at greatest risk from these fillings.”

Research on fetal and infant risks from dental amalgam has provided significant data associating the number of maternal amalgam fillings with mercury levels in cord blood;

Scientific proof of dental mercury’s hazards to children

Research on fetal and infant risks from dental amalgam has provided significant data associating the number of maternal amalgam fillings with mercury levels in cord blood; in the placenta; in the kidneys and liver of fetuses; in fetal hair; and in the brain and kidneys of infants. Another trend in research about maternal amalgam fillings are studies that have found the mercury concentration in breast milk increases as the number of amalgam fillings in the mother increases.

Although two studies (commonly referred to as the “New England Children’s Amalgam Trial” and the “Casa Pia Children’s Amalgam Trial”) have repeatedly been used to defend the use of amalgam in children, other researchers have since demonstrated that factors such as long term effects, genetic predisposition, and measurement errors must be taken into account. Furthermore, researchers studying the same cohort of children have since identified potential risks to these subjects from mercury exposure based on gender, genetic predisposition, and even gum-chewing.

While other countries around the world are enacting measures to protect children and women of child-bearing age from the hazards of dental mercury, the US is still allowing this dangerous scenario to continue. Millions of Americans, including children and fetuses, are needlessly exposed to the neurotoxin mercury because of dental amalgam fillings.

For more about this subject, including citations and scientific sources, read the IAOMT’s Comprehensive Review on Mercury in Dental Amalgam. Also, WMP’s Mercury in Dentistry which includes material provided by IAOMT.

 

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How Mercury Causes Brain Neuron Damage

Medical laboratories have established that dental amalgam tooth fillings are a major contributor to mercury body burden. This short presentation on University of Calgary’s Faculty of Medicine’s website reveals how mercury ions actually alter cell membrane structure and how mercury in fillings can destroy brain neurons as seen with people who have Alzheimer’s Disease.

Why We All Don’t Get Sick in the Same Way

The Science Behind Dental Mercury and Other Environmental Toxicants

By Amanda Just and John Kall, DMD of the International Academy of Oral Medicine and Toxicology (IAOMT)

If everyone had the same reaction to environmental toxicants, these hazardous substances would probably be banned immediately. It would be obvious to everyone, as well as their doctors, that exposure to a specific toxic material results in a definitive outcome– the exact same illness shared by all of those who come into contact with the dangerous substance. However, research has demonstrated that individuals respond to environmental toxicants in a way that is unique to their own bodies.

This “personalized response” has been studied in depth in the case of dental mercury. In fact, examining the science behind dental mercury sheds light on the complex variability of environmental illnesses. It also offers hope that this newfound understanding can help heal the ailing state of 21st century public health.

What is dental mercury?

Often referred to as “silver fillings,” all dental amalgams consist of 45-55% metallic mercury. Mercury is a known neurotoxin.  Amalgams are still used for about 45% of all direct dental restorations worldwide, including in the US.

What are some of the health risks that have been linked to dental mercury?

Properly diagnosing “adverse health effects” related to dental mercury amalgam fillings is impeded by the list of potential responses to the elemental form of the substance, which include over 250 symptoms. Not all individuals will experience the same symptom or combination of symptoms. Moreover, scientists have associated the mercury in amalgam fillings with Alzheimer’s disease, amyotrophic lateral sclerosis (Lou Gehrig’s disease), antibiotic resistance, anxiety, autism spectrum disorders, chronic fatigue syndrome, depression, infertility, kidney disease, multiple sclerosis, Parkinson’s disease, and other health problems. 

Response factor #1: The form of the substance

Mercury exists in different forms and compounds, and these different forms and compounds can produce different results in humans that are exposed to them. The type of mercury used in amalgam fillings is elemental (metallic) mercury. In contrast, the mercury in fish is methylmercury, and the mercury in the vaccine preservative thimerosal is ethylmercury.

Response factor #2: Different organs within the body

Another reason for the wide-range of symptoms is that mercury can accumulate in virtually any organ. In the case of dental mercury fillings, an estimated 80% of this mercury vapor is absorbed by the lungs and passed to the rest of the body, particularly the brain, kidney, liver, lung, and gastrointestinal tract. The half life of metallic mercury varies depending on the organ where the mercury was deposited.

Response factor #3: Delayed effects 

Symptoms of toxic exposures can take many years to manifest themselves. For example, the Occupational Safety and Health Administration (OSHA) recognizes that chronic diseases related to toxic exposures can have latency periods of 20-30 years or longer.

Response factor #4: Allergies 

Allergies and hypersensitivities are yet another essential aspect of reactions to toxic substances. Since most patients are not tested for mercury allergies prior to dental amalgam exposure, as many as 21 million people could be unknowingly allergic to the mercury in their mouths.  However, this figure could be higher since metal allergies are reportedly on the rise. 

Response factor #5: Genetic predisposition 

A growing volume of recently published scientific research is examining how mercury exposure can pose highly significant risks to individuals with specific genetic traits including CPOX4, APOE, BDNF, MT polymorphisms, COMT variants, MTHFR mutations, and PON1 variants. A 2016 news story featuring several prevalent dental mercury researchers established that 25-50% of people have these genetic variants and endure “a lifetime risk” of neurological damage.

Response factor #6: Other considerations

In addition to the weight and age of the individual, as well as other existing health conditions, the number of amalgam fillings, gender, dental plaque, diet, consumption of milk or alcohol, and other circumstances can play a role in each person’s unique response to mercury. Another important consideration is the synergy between different toxic exposures experienced by the same individual.

Conclusion

Clearly, the precise way that a person’s body responds to an environmental toxicant is based on a spectrum of circumstances and conditions. The factors described in this article are only a fraction of numerous pieces in the puzzle of adverse health effects related to toxic exposures. The science behind dental mercury demonstrates that in order to fully understand environmental illness, we need to recognize that just as each toxic exposure is unique, so is each person impacted by such a toxic exposure. As we accept this reality, we also offer ourselves the opportunity to create a future where dentistry and medicine acknowledge that each patient responds to materials and treatments differently. We also offer ourselves the opportunity to use safer products that reduce the overall toxic burden in our bodies and forge the path to renewed health.

To read a more detailed version of this article, including citations and scientific sources of information, click here to visit the webpage from the IAOMT.

To mitigate mercury exposure during amalgam filling removal, SMART-certified dentists use protective gear for themselves and their patients. For more “SMART” removal recommendations, go to https://iaomt.org/safe-removal-amalgam-fillings/ and to www.theSMARTchoice.com

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