Don't blame God!

Jos yksi lääkäri on tuota mieltä ja sata lääkäriä 100.000 potilasta toista mieltä, niin mitä pitäisi uskoa?

hoidettu kirjoitti:

Jos yksi lääkäri on tuota mieltä ja sata lääkäriä 100.000 potilasta toista mieltä, niin mitä pitäisi uskoa?

"Jos yksi lääkäri on tuota mieltä"

Miten onnistut tästä luettelosta laskemalla saamaan yhden lääkärin?

"Kirjallisuutta

Ahlqwist M, Bengtsson C, Furunes B, ym.: Number of amalgam tooth fillings in relation to subjectively experienced symptoms in a study of Swedish women. Community Dent Oral Epidemiol 16: 227–231, 1988

Aho L, Rytömaa I: Amalgaamipaikkojen aiheeton saneeraus–tapausselostus. Suom Hammaslääkäril N.s.1: 797–798, 1994

Berglund A: Estimation by a 24 hour study of the daily dose of intra-oral mercury vapor inhaled after release from dental amalgam. J Dent Res 69: 1646–1651, 1990

Eley B M, Cox S W: The release, absorption and possible health effects of mercury from dental amalgam: a review of recent findings. Br Dent J 175: 161–168, 1993

Finne K, Göransson K, Winckler L: Oral lichen planus and contact allergy to mercury. Int J Oral Surg 11: 236–239, 1982

Grace M: The amalgam controversy. Br Dent J 175: 149, 1993

Hannuksela M: Amalgam fillings and contact allergy to mercury. First Congress of the European Society of Contact Dermatitis, Brussels, 8–10 October, 1992 (abstrakti)

Hietanen J, Pihlman K, Förström L, ym.: No evidence of hypersensitivity to dental restorative materials in oral lichen planus. Scand J Dent Res 95: 320–327, 1987

Hörstedt-Binslev P, Magos L: Mercury and the dental team. Kirjassa: Dental amalgam–a health hazard? s. 33–40. Toim. P Hörstedt-Binslev, P Holmstrup, D Arenholt-Binslev. Munksgaard, Copenhagen 1991

Ibbotson S H, Speight E L, Macleod R I, ym.: The prevalence and relevance of mercury allergy in subjects with oral lichenoid reactions. Br J Dermatol 131 (Suppl 44): 26–27, 1994

James J, Ferguson M M, Forsyth A, ym.: Oral lichenoid reaction related to mercury sensitivity. Br J Oral Maxillofac Surg 25: 474–480, 1987

Kanerva L, Komulainen M, Estlander T, Jolanki R: Occupational allergic contact dermatitis from mercury. Contact Dermatitis 28: 26–28, 1993

Kousa M, Fräki J: Metalliallergia hammashoidossa. Suom Hammaslääkäril 37: 758–764, 1990

Laine J, Kalimo K, Forssell H, Happonen R-P: Resolution of oral lichenoid lesions after replacement of amalgam restorations in patients allergic to mercury compounds. Br J Dermatol 126: 10–15, 1992

Lind P O, Hurlen B, Lyberg T, Aas E: Amalgam-related oral lichenoid reaction. Scand J Dent Res 94: 448–451, 1986

Mackert J R Jr: Factors affecting estimation of dental amalgam mercury exposure from measurements of mercury vapor levels in intra oral and expired air. J Dent Res 66: 1775–1780, 1987

Magos L: Mercury metabolism and toxicology. Kirjassa: Dental amalgam–a health hazard?, s. 11–32. Toim. P Hörsted-Binslev,P Holmstrup, D Arenholt-Binslev. Munksgaard, Copenhagen 1991

Malm J: Hammaspaikka-amalgaamin ympäristöhaitat ja niiden vähentäminen Suomessa. Vesi- ja ympäristöhallitus. Kemikaalivalvontayksikkö, 1993

Mjör I A: Long term cost of restorative therapy using different materials. Scand J Dent Res 100: 60–65, 1992

Molin C: Amalgam–fact and fiction. Scand J Dent Res 100: 66–73, 1992

Möller H: All these positive tests to thimerosal. Contact Dermatitis 31: 209–213, 1994

Nordling K, Lidén S: Patch test reactions to metal salts in patients with oral mucosal lesions associated with amalgam restorations. Contact Dermatitis 27: 157–160, 1992

Osborne J W: Dental amalgam and mercury vapour release. Adv Dent Res 6: 135–138, 1992

Skoglund A: Effekten av fyllingsbyte på patienter med lichenliknande munslimmeförändringar. SoS-rapport 34: 30–34, 1990

Skoglund A, Egelrud T: Hypersensitivity reactions to dental materials in patients with lichenoid oral mucosal lesions and in patients with burning mouth syndrome. Scand J Dent Res 99: 320–328, 1991

Socialstyrelsen: Rapport från Socialstyrelsens Expertgrupp: Blir man sjuk av amalgam? Socialstyrelsen, Stockholm 1994

WHO: Environmental Health Criteria 118. Inorganic Mercury. WHO, 1991

Vimy M J, Lorscheider F L: Serial measurements of intra-oral air mercury: estimation of daily dose from dental amalgam.J Dent Res 64: 1072–1075, 1985

Zenarola P, Lomuto M, Bisceglia M: Hypertrophic amalgam dermatitis of the tongue simulating carcinoma. Contact Dermatitis 29: 157–158, 1993

Äärimaa M: Elohopean mobilisaatiotesti. Suom Lääkäril 49: 149, 1994

Kirjoittajat: INKERI RYTÖMAA, apulaisprofessori Helsingin yliopiston kariesopin laitos, Mannerheimintie 172, 00300 Helsinki MATTI HANNUKSELA, dosentti, johtajaylilääkäri Etelä-Karjalan sairaanhoitopiiri, Käkelänkatu 4 A, 53130 Lappeenranta"

"sata lääkäriä 100.000 potilasta toista mieltä, niin mitä pitäisi uskoa?"

Tekstistä löytyy tuohon vastaus:
"Epäasiallinen, tieteellisistä tosiasioista piittaamaton tiedottaminen on saanut yleisön hämmennyksiin ja monet potilaat etsimään tarpeettomasti helpotusta vaivoihinsa amalgaamipaikkojen vaihtamisesta muuhun materiaaliin."
"...amalgaamiperäisellä elohopeamyrkytyksellä pelottelu on aiheetonta ja elohopeamyrkytyksestä puhumiseen amalgaamipaikkojen yhteydessä liittyy merkittävä kaupallinen intressi: suuren väestönosan tutkiminen ja amalgaamipaikkojen vaihtaminen muihin materiaaleihin hyödyttäisi analyyttisiä laboratorioita, elohopeadiagnostiikkaa tekeviä lääkäreitä ja paikkoja vaihtavia hammaslääkäreitä mutta tulisi tavattoman kalliiksi."

tieteellinen totuus kirjoitti:

"Jos yksi lääkäri on tuota mieltä"

Miten onnistut tästä luettelosta laskemalla saamaan yhden lääkärin?

"Kirjallisuutta

Ahlqwist M, Bengtsson C, Furunes B, ym.: Number of amalgam tooth fillings in relation to subjectively experienced symptoms in a study of Swedish women. Community Dent Oral Epidemiol 16: 227–231, 1988

Aho L, Rytömaa I: Amalgaamipaikkojen aiheeton saneeraus–tapausselostus. Suom Hammaslääkäril N.s.1: 797–798, 1994

Berglund A: Estimation by a 24 hour study of the daily dose of intra-oral mercury vapor inhaled after release from dental amalgam. J Dent Res 69: 1646–1651, 1990

Eley B M, Cox S W: The release, absorption and possible health effects of mercury from dental amalgam: a review of recent findings. Br Dent J 175: 161–168, 1993

Finne K, Göransson K, Winckler L: Oral lichen planus and contact allergy to mercury. Int J Oral Surg 11: 236–239, 1982

Grace M: The amalgam controversy. Br Dent J 175: 149, 1993

Hannuksela M: Amalgam fillings and contact allergy to mercury. First Congress of the European Society of Contact Dermatitis, Brussels, 8–10 October, 1992 (abstrakti)

Hietanen J, Pihlman K, Förström L, ym.: No evidence of hypersensitivity to dental restorative materials in oral lichen planus. Scand J Dent Res 95: 320–327, 1987

Hörstedt-Binslev P, Magos L: Mercury and the dental team. Kirjassa: Dental amalgam–a health hazard? s. 33–40. Toim. P Hörstedt-Binslev, P Holmstrup, D Arenholt-Binslev. Munksgaard, Copenhagen 1991

Ibbotson S H, Speight E L, Macleod R I, ym.: The prevalence and relevance of mercury allergy in subjects with oral lichenoid reactions. Br J Dermatol 131 (Suppl 44): 26–27, 1994

James J, Ferguson M M, Forsyth A, ym.: Oral lichenoid reaction related to mercury sensitivity. Br J Oral Maxillofac Surg 25: 474–480, 1987

Kanerva L, Komulainen M, Estlander T, Jolanki R: Occupational allergic contact dermatitis from mercury. Contact Dermatitis 28: 26–28, 1993

Kousa M, Fräki J: Metalliallergia hammashoidossa. Suom Hammaslääkäril 37: 758–764, 1990

Laine J, Kalimo K, Forssell H, Happonen R-P: Resolution of oral lichenoid lesions after replacement of amalgam restorations in patients allergic to mercury compounds. Br J Dermatol 126: 10–15, 1992

Lind P O, Hurlen B, Lyberg T, Aas E: Amalgam-related oral lichenoid reaction. Scand J Dent Res 94: 448–451, 1986

Mackert J R Jr: Factors affecting estimation of dental amalgam mercury exposure from measurements of mercury vapor levels in intra oral and expired air. J Dent Res 66: 1775–1780, 1987

Magos L: Mercury metabolism and toxicology. Kirjassa: Dental amalgam–a health hazard?, s. 11–32. Toim. P Hörsted-Binslev,P Holmstrup, D Arenholt-Binslev. Munksgaard, Copenhagen 1991

Malm J: Hammaspaikka-amalgaamin ympäristöhaitat ja niiden vähentäminen Suomessa. Vesi- ja ympäristöhallitus. Kemikaalivalvontayksikkö, 1993

Mjör I A: Long term cost of restorative therapy using different materials. Scand J Dent Res 100: 60–65, 1992

Molin C: Amalgam–fact and fiction. Scand J Dent Res 100: 66–73, 1992

Möller H: All these positive tests to thimerosal. Contact Dermatitis 31: 209–213, 1994

Nordling K, Lidén S: Patch test reactions to metal salts in patients with oral mucosal lesions associated with amalgam restorations. Contact Dermatitis 27: 157–160, 1992

Osborne J W: Dental amalgam and mercury vapour release. Adv Dent Res 6: 135–138, 1992

Skoglund A: Effekten av fyllingsbyte på patienter med lichenliknande munslimmeförändringar. SoS-rapport 34: 30–34, 1990

Skoglund A, Egelrud T: Hypersensitivity reactions to dental materials in patients with lichenoid oral mucosal lesions and in patients with burning mouth syndrome. Scand J Dent Res 99: 320–328, 1991

Socialstyrelsen: Rapport från Socialstyrelsens Expertgrupp: Blir man sjuk av amalgam? Socialstyrelsen, Stockholm 1994

WHO: Environmental Health Criteria 118. Inorganic Mercury. WHO, 1991

Vimy M J, Lorscheider F L: Serial measurements of intra-oral air mercury: estimation of daily dose from dental amalgam.J Dent Res 64: 1072–1075, 1985

Zenarola P, Lomuto M, Bisceglia M: Hypertrophic amalgam dermatitis of the tongue simulating carcinoma. Contact Dermatitis 29: 157–158, 1993

Äärimaa M: Elohopean mobilisaatiotesti. Suom Lääkäril 49: 149, 1994

Kirjoittajat: INKERI RYTÖMAA, apulaisprofessori Helsingin yliopiston kariesopin laitos, Mannerheimintie 172, 00300 Helsinki MATTI HANNUKSELA, dosentti, johtajaylilääkäri Etelä-Karjalan sairaanhoitopiiri, Käkelänkatu 4 A, 53130 Lappeenranta"

"sata lääkäriä 100.000 potilasta toista mieltä, niin mitä pitäisi uskoa?"

Tekstistä löytyy tuohon vastaus:
"Epäasiallinen, tieteellisistä tosiasioista piittaamaton tiedottaminen on saanut yleisön hämmennyksiin ja monet potilaat etsimään tarpeettomasti helpotusta vaivoihinsa amalgaamipaikkojen vaihtamisesta muuhun materiaaliin."
"...amalgaamiperäisellä elohopeamyrkytyksellä pelottelu on aiheetonta ja elohopeamyrkytyksestä puhumiseen amalgaamipaikkojen yhteydessä liittyy merkittävä kaupallinen intressi: suuren väestönosan tutkiminen ja amalgaamipaikkojen vaihtaminen muihin materiaaleihin hyödyttäisi analyyttisiä laboratorioita, elohopeadiagnostiikkaa tekeviä lääkäreitä ja paikkoja vaihtavia hammaslääkäreitä mutta tulisi tavattoman kalliiksi."

1. The tolerable daily exposure level for mercury developed in a report for Health Canada is .014 micrograms/kilogram body weight(ug/kg) or approximately 1 ug/day for average adult(217). The U.S. EPA Health Standard for elemental mercury exposure(vapor) is 0.3 micrograms per cubic meter of air(2). The U.S. ATSDR health standard(MRL) for mercury vapor is 0.2 ug/ M3 of air, and the MRL for methyl mercury is 0.3 ug/kg body weight/day(217). For the average adult breathing 20 M3 of air per day, this amounts to an exposure of 4 or 6 ug/day for the 2 elemental mercury standards. The EPA health guideline for methyl mercury is 0.1 ug/kg body weight per day or 7 ug for the average adult(2), or approx. 14 ug for the ATSDR acute oral toxicicity standard. Since mercury is methylized in the body, some of both types are present in the body. The older World Health Organization(183) mercury health guideline(PTWI) is 300 ug per week total exposure or approx. 42 ug/day.

2. Mercury in the presence of other metals in the oral environment undergoes galvanic action, causing movement out of amalgam and into the oral mucosa and saliva(192). Mercury in solid form is not stable due to low vapor pressure and evaporates continuously from amalgam fillings in the mouth, being transferred over a period of time to the host(15-19,26,31,36,79,83,211,182,183,199,298,299,303,332,335,371). The daily total exposure of mercury from fillings is from 3 to 1000 micrograms per day, with the average exposure being above 10 micrograms per day and the average uptake over 5 ug/day (183,199,209,18,19,77,83, 85,100,335,352,371,etc.). (see further details continued)

A large study was carried out at the Univ. Of Tubingen Health Clinic in which the level of mercury in saliva of 20,000 persons with amalgam fillings was measured(199). The level of mercury in unstimulated saliva was found to average 11.6 ug Hg/L, with the average after chewing being 3 times this level. Several were found to have mercury levels over 1100 ug/L, 1 % had unstimulated levels over 200 ug/L, and 10 % had unstimulated mercury saliva levels of over 100 ug/L.. The level of mercury in saliva has been found to be proportional to the number of amalgam fillings, and generally was higher for those with more fillings. The following table gives the average daily mercury exposure from saliva alone for those tested, based on the average levels found per number of fillings and using daily saliva volumes of 890 ml for unstimulated saliva flow and 80 ml for stimulated flow (estimated from measurements made in the study and comparisons to other studies). It also gives the 84th percentile mercury exposure from saliva for the 20,000 tested by number of fillings. Note that 16% of all of those tested with 4 amalgam fillings had daily exposure from their amalgam fillings of over 17 ug per day, and even more so for those with more than 4 fillings.

Table: Average daily mercury exposure in saliva by number of amalgam fillings(199)

Number of fillings: 4 5 6 7 8 9 10 11 12 13 14 15 16

Av. Daily Hg(ug) 6.5 8 9.5 11 12.4 14 15.4 16.9 18.3 19.8 21.3 22.8 24.3

84th percentile(ug) 17 23.5 26 30.5 35 41.5 43.8 48.6 50.3 46.7 56.6 61.4 64.5



Saliva tests for mercury are commonly performed in Europe, and many other studies have been carried out with generally comparable results(292,315,79,9b,335,179,317,352). Another large German study(352) found significantly higher levels than the study summarized here, with some with exposure levels over 1000 ug/day.

Three studies that looked at a population with more than 12 fillings found generally higher levels than this study, with average mercury level in unstimulated saliva of 29 ug/L(18), 32.7 ug/L (292c), and 175 ug/day(352). The average for those with 4 or less fillings was 8 ug/L(18). While it will be seen that there is a significant correlation between exposure levels and number of amalgam surfaces and exposure generally increases as number of fillings increases, there is considerable variability for a given number of fillings. Some of the factors that will be seen to influence this variability include composition of the amalgam, whether person chews gum or drinks hot liquids, bruxism, oral environmental factors, type of tooth patse used, etc.

The Tubingen study did not assess the significant exposure route of intraoral air and lungs. One study that looked at this estimated a daily average burden of 20 ug from ionized mercury from amalgam fillings absorbed through the lungs(191), while a Norwegian study found the average level in oral air to be 0.8 ug/M3(176). Another study at a Swedish University(335) measured intraoral air mercury levels from fillings of from 20 to 125 ug per day, for persons with from 18 to 82 filling surfaces. Another study found similar results(83), and some individuals have been found to have intraoral air mercury levels above 400 ug/ M3 (319). Most of those whose intraoral air mercury levels were measured exceeded Gov’t health guidelines for workplace exposure(2).

The studies also determined that the number of fillings is the most important factor related to mercury level, with age of filling being much less significant(319b). Different filling composition/manufacturer can also make a difference in exposure levels( as will be further discussed). The authors of the Tubingen study calculated that based on the test results with estimates of mercury from food and oral air included, over 40 % of those tested in the study received daily mercury exposure higher than the WHO standard(PTWI). As can be seen most people with several fillings have daily exposure exceeding the Health Canada TDE and the U.S. EPA and ATSDR health guideline for mercury(2,209,199,etc.), and many tested in past studies have exceeded the older and higher WHO guideline for mercury(183), without consideration of exposure from food, etc..

3. The main exposure paths for mercury from amalgam fillings are absorption by the lungs from intraoral air; vapor absorbed by saliva or swallowed; amalgam particles swallowed; and membrane, olfactory, venous, and neural path transfer of mercury absorbed by oral mucosa, gums, etc. (6,17,18,31,34,77,79,83,94,133,182,209,211, 216,222,319, 335,348,364) A study at Stockholm Univ.(335) made an effort to determine the respective parts in exposure made by these paths. It found that the majority of excretion is through feces, and that the majority of mercury exposure was from elemental vapor. Daily exposure from intraoral air ranged from 20 to 125 ug of mercury vapor, for subjects with number of filling surfaces ranging from 18 to 82. Daily excretion through feces amounted to from 30 to 190 ug of mercury, being more variable than other paths. Other studies had similar findings(6,15,16,18,19,25,31,36,79,80,83,115,196,386.)

The feces mercury was essentially all inorganic with particles making up at most 25%, and the majority being mercury sulfuhydryl compounds- likely originating as vapor. Their study and others reviewed found that at least 80% of mercury vapor reaching the lungs is absorbed and enters the blood from which it is taken to all other parts of the body(335,348,349,363). Elemental mercury swallowed in saliva can be absorbed in the digestive tract by the blood or bound in sulfhydryl compounds and excreted through the feces. A review determined that approx.20 % of swallowed mercury sulfhydryl compounds are absorbed in the digestive tract, but approx 60% of swallowed mercury vapor is absorbed(292,335,348). At least 80% of particle mercury is excreted. Approx. 80% of swallowed methyl mercury is absorbed(335,199,etc.)e, with most of the rest being converted to inorganic forms apparently. The primary detoxification/excretion pathway for mercury absorbed by the body is as mercury-glutathione compounds through the liver/bile loop to feces(111,252), but some mercury is also excreted though the kidneys in urine and in sweat. The range of mercury excreted in urine per day by those with amalgams is usually less than 15 ug(6,49,83,138,174,335,etc.), but some patients are much higher(93). 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 avergage level of those with over 49 surfaces was over 8 times that of controls. The same study found that the average blood level was 2.55 ug/L, with 79 % being organic mercuy. The total mercury level had a significant correlation to the number of amalgam fillings, with fillings appearing to be reponsible for over 75% of total mercury. From the study results it was found that each 10 amalgam surfaces increased urine mercury by approx. 1 ug/L. A study of mercury species found blood mercury was 89% organic and urine mercury was 87% inorganic(349b), whicle another study(363) found on average 77% of the mercury in the occipital cortex was inorganic. In a population of women tested In the Middle East(254), the number of fillings was highly correlated with the mercury level in urine, mean= 7 ug/L. Nutrient transport and renal function were also found to be adversely affected by higher levels of mercury in the urine.

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(301,274,327,329,348,18,19,85),liver, kidneys, (14,85)heart(59,205,348)), and oral mucosa(174,192) with the half life in the brain being over 20 years. Elemental mercury vapor is transmitted throughout the body via the blood and readily enters cells and crosses the blood-brain barrier, and the placenta of pregnant women(38,61,287,311,361), at much higher levels than inorganic mercury and also higher levels than organic mercury. Significant levels are able to cross the blood brain barrier, placenta, and also cellular membranes into major organs such as the heart since the oxidation rate of Hg0 though relatively fast is slower than the time required by pumped blood to reach these organs(290,370). Thus the level in the brain and heart is higher after exposure to Hg vapor than for other forms(360,370). While mercury vapor and methyl Hg readily cross cell membranes and the blood-brain barrier, once in cells they form inorganic mercury that does not readily cross cell membranes or the blood brain barrier readily and is responsible for the majority of toxicity effects. Thus inorganic mercury in the brain has a very long half life(274,etc.).

4. The average amalgam filling has approximately 0.5 grams(500,000 ug) of mercury. As much as 50% of mercury in fillings has been found to have vaporized after 5 years and 80% by 20 years(182,204). Mercury vapor from amalgam is the single largest source of systemic mercury intake for persons with amalgam fillings, ranging from 50 to 90 % of total exposure. (14,16,17,19,36,57,61,78-83,94,129,130,138,161,167,183, 191,

196,211,216,273,292,303,332,), averaging about 80% of total systemic intake. 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)

5. Having dissimilar metals in the teeth(e.g.-gold and mercury) causes galvanic action, electrical currents, and much higher mercury vapor levels and levels in tissues. (182,192,292,348,349,390,19,25,27,29,30,47,48,100) Average mercury levels in gum tissue near amalgam fillings are about 200 ppm, and are the result of flow of mercury into the mucous membrane because of galvanic currents with the mucous membrane serving as cathode and amalgam as cathode(192). Average mercury levels are often 1000 ppm near a gold cap on an amalgam filling due to higher currents when gold is in contact with amalgam (30,25,35,48,58). These levels are among the highest levels ever measured in tissues of living organisms, exceeding the highest levels found in chronically exposed chloralkali workers, those who died in Minamata, or animals that died from mercury poisoning. Concentrations of mercury in oral mucosa for a population of patients with 6 or more amalgam fillings taken during oral surgery were 20 times the level of controls(174). These levels are much higher than the FDA/EPA action level for prohibiting use of food with over 1 ppm mercury. Likewise the level is tremendously over the U.S. Dept. Of Health/EPA drinking water limit for mercury which is 2 parts per billion(218). Studies have shown that mercury in the gums such as from root caps for root canaled teeth result in chronic inflammation, in addtion to migration to other parts of the body(200,47). Mercury and silver from fillings can be seen in the tissues as amalgam "tatoos", which have been found to accumulate in the oral mucosa as granules along collagen bundles, blood vessels, nerve sheaths, elastic fibers, membranes, striated muscle fibers, and acini of minor salivary glands. Dark granules are also present intracellularly within macrophasges, multinucleated giant cells, endothelial cells, and fibroblasts. There is in most cases chronic inflammatory response or macrophagic reaction the the metals(47), usually in the form of a foreingn body granuloma with multinucleated giant cells of the foreign body and Langhans types.

The component mix in amalgams has also been found to be an important factor in mercury vapor emissions. The level of mercury and copper released from high copper amalgam is as much as 50 times that of low copper amalgams(191). Studies have consistently found modern high copper non gamma-two amalgams have greater release of mercury vapor than conventional silver amalgams (298,299). 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 instable 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 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). Numerous other studies also support this finding(Section IV).

Amalgam also releases significant amounts of silver, tin, and copper which also have toxic effects, with organic tin compounds formed in the body being even more neurotoxic than mercury(51,222,262)

7. Feces is the major path of excretion of mercury from the body, having a higher correlation to systemic body burden than urine or blood, which tend to correlate with recent exposure level (35,36,79,80,183, 278). For this reason many researchers consider feces to be the most reliable indicator of daily exposure level to mercury or other toxics. The average level of mercury in feces of those with fillings is over 1 ppm and approx. 10 times that of a similar group without fillings (79,80,83,335,386,25,), with significant numbers of those with several filings having over 10 ppm and 170 times those without fillings(80). The saliva test is another good test for daily mercury exposure, done commonly in Europe and representing one of the largest sources of mercury exposure.

There is only a weak correlation between blood or urine mercury levels and body burden or level in a target organ(36,157,183,278,11,etc.). Mercury vapor passes through the blood rapidly(half-life in blood is 3 seconds,370) and accumulates in other parts of the body such as the brain, kidneys, liver, thyroid gland, pituitary gland, etc. Thus blood test measures mostly recent exposure. As damage occurs to kidneys over time, mercury is less efficiently eliminated (11,36,57,183, 216,260), so urine tests are not reliable for body burden after long term exposure. Some researchers suggest hair offers a better indicator of mercury body burden than blood or urine(279), though still not totally reliable and may be a better indicator for organic mercury than inorganic. Mercury hair level in a population sampled in Madrid Spain ranged from 1.3 to 92.5 ppm. This study found a significant positive correlation between maternal hair mercury and mercury level in nursing infants. Hair mercury levels did not have a significant correlation with urine mercury in one study(340) and did not have a significant correlation to number of fillings(350). One researcher suggests that mercury levels in hair of greater than 5 ppm are indicative of mercury intoxication.

A new test approved by the FDA for diagnosing damage that has been caused by toxic metals like mercury is the fractionated porphyrin test(260), that measures amount of damage as well as likely source. Provocation challenge tests after use of chemical chelators such as DMPS or DMSA also are effective at measuring body burden(57), but can be dangerous to some people- especially those still having amalgam fillings or those allergic to sulfur drugs or sulfites. Many studies using chemical chelators such as DMPS or DMSA have found post chelation levels to be poorly correlated with prechelation blood or urine levels(57,115,303), but one study (340) found a significant correlation between pre and post chelation values when using DMPS. Challange tests using DMPS or DMSA appear to have a better correlation with body burden and toxicity symptoms such as concentration , memory, and motor deficits(290)- with many studies finding a significant correration between post chelation mercury level and the number of amalgam surfaces(57,172,173,222,290,292,273,303). Several doctors use 16 ug/L as the upper bound for mercury after DMPS challange, and consider anyone with higher levels to have excess body burdern(222,352). However one study(290) found significant effects at lower levels. Some researchers believe DMSA has less adverse side effects than DMPS and prefer to use DMSA for chelation for this reason. Some studies have also found DMSA as more effective at removing mercury from the brain. Another chelator used for clogged arteries, EDTA, forms toxic compounds with mercury and can damage brain function(307). Use of EDTA may need to be restricted in those with high Hg levels. N-acetylcystein(NAC) has been found to be effective at increasing cellular glutathione levels and chelating mercury(54). Experienced doctors have also found additional zinc to be useful when chelating mercury(222). Also lipoic acid has been found to dramatically increase excretion of inorganic mercury(over 12 fold), but to cause decreased excretion of organic mercury(54).

8. The number of amalgam surfaces has a statistically significant correlation to :

(a) blood plasma mercury level (17,49,79,89,133,211)(usually not as strong as other measures)

(b) urine mercury level (38,49,57,76,77,79,82,83,134,138,167,176,254,303,332,335)

© oral air(16,18,100,176,335)

(d) saliva and oral mucosa(18,58,77,79,117,179,174,199,211,222,292,315,317)

(e) feces mercury (25,79,80,83,115,117,182,335,386)

(f) pituitary gland (19,20,25,85,99,273/274)

(g) brain occipital cortex (14,16,19,25,34,85,211,273,348,366/274)

(h) renal(kidney) cortex(14,16,19,20,85,273,348,366)

(I) liver(14,19,85,366)

(j) motor function areas of the brain & CNS: brain stem, cerebellum, rhombencephalon, dorsal root ganglia, and anterior horn motor neurons (48,291,327,329,etc.)

(k) fetal and infant liver/brain levels(61,112,186,231) related to maternal fillings.



9. A person with amalgam fillings has daily systemic intake from mercury vapor of between 3 and 70 micrograms of mercury, with the average being at least 7 micrograms(ug) per day (18,77,83,85,93,138,183,199,211,292,315,335). In a large German study, the median daily exposure for those with fillings through saliva was approx. 10 ug/day, 4% of those with fillings had daily exposure through saliva of over 80 ug/day, and 1% had over 160 ug/day(199). The methods and results of the Tubingen study(199) were similar to those of other German studies(292,315,9, 138, 317,335). Total intake is proportional to the number and extent of amalgam surfaces, but other factors such as chewing gum, drinking hot liquids, brushing or polishing, and using fluoride toothpaste significantly increase the intake(15,18,28,31,100,134-137,182, 183,199,209,211,292,317,319,348,349,350). Vapor emissions range up to 200 ug/M3 (35) and are much higher after chewing(137,319). After chewing, those with amalgams had levels over 50 times higher than those without, and the average level of exposure was 29 ug/day for those with at least 12 occlusal surfaces(18). At least 30% of those having amalgam fillings tested in a large German study had ingested mercury levels exceeding the WHO PTWI mercury standard of 43 ug/day (199,183), and over 50% of those with 6 or more fillings had daily exposures more than the U.S. EPA health guideline level(199) of 0.1 ug/kg body weight/day(199). The median daily exposure through saliva for those with 10 or more fillings was over 10 times that of those with no fillings(199,292,315,318). Mercury level in saliva has been found to give much better indication of body levels than blood or urine levels(36). Most people with fillings have daily exposure levels exceeding the U.S. ATSDR and EPA health guideline levels (2,36,83,89,183,199,209,217,261,292,335,93)

10. 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) The average blood level for one large population was 5 ug/l(176). Normal blood levels are less than 20 ppb, but health effects have been observed in patients in the upper part of this range. A Swedish study estimated the total amount mercury swallowed per day from intra-oral vapor was 10 micrograms per day(177),and a large German study(199) found median exposure through saliva alone for those with fillings to be about 10 ug/day, with many having several fillings with over 10 times that level. Other studies have found similar amounts(18,83,211,183,209).

11. Teeth are living tissue and have massive communication with the rest of the body via blood, lymph, and nerves. Mercury vapor (and bacteria in teeth ) have paths to the rest of the body. (34,etc.) German studies of mercury loss from vapor in unstimulated saliva found the saliva of those with amalgams had at least 5 times as much mercury as for controls(138,199,292,315).

12. Mercury (especially mercury vapor) rapidly crosses the blood brain barrier and is stored preferentially in the pituitary gland, hypothalamus, and occipital cortex in direct proportion to the number and extent of amalgam surfaces.(14,19,20,25,34,38,85,99,273,274,287,348,366) Thus mercury has a greater effect on the functions of these areas. The range in one study was 2.4 to 28.7 ppb(85), and one study found on average that 77% of the mercury in the occipital cortex was inorganic(363).

13. 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 fibres (5,25,34,35,327,329).

14. Mercury has a long half life in the body and over 20 years in the brain, and chronic low level intake results in a slow accumulation in body tissues. (20,34,35,38,85,etc.)

15. Methyl mercury is more toxic to some body processes than inorganic mercury. Mercury from amalgam is methylated by bacteria and candida albicans in the mouth and intestines(51,81,98,182,225). Oral bacteria streptococommus mitior,S.mutans, and S.sanguis were all found to methylate mercury(81). High levels of Vit B12 in the system also have been found to result in increased methyl mercury concentrations in the liver and brain(51). Methyl mercury is 10 times more potent in causing genetic damage than any other known chemical (Ramel, in(35)), and also crosses the blood-brain barrier readily. Once mercury vapor or methyl mercury are converted to inorganic mercury in cells or the brain, the mercury does not readily cross cell membranes or the blood-brain barrier. Thus mercury has a very long half life in the brain. N-acetylcysteine(NAC) has been found to be effective at increasing glutathione levels and chelating methyl mercury(54,126).

16. The level of mercury in the tissue of the fetus, new born, and young children is directly proportional to the number of amalgam surfaces in the mother’s mouth. (20,23,61,112,210,361) The level of mercury in umbilical cord blood and placenta was higher than that in mother’s blood(22,186). The saliva and feces of children with amalgams have approximately 10 times the level of mercury as children without(25,315,386), 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(279). One study found a 60% increase in average cord blood mercury level between 1980 and 1990 in Japan(186).



17. Mercury from amalgam in the blood of pregnant women crosses the placenta and appears in amniotic fluid and fetal blood, liver, and pituitary gland soon after placement (20,22,23,31,36,61,162,186,281,348,366). 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). The level of mercury in breast milk was found to be significantly correlated with the number of amalgam fillings(61), 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 potenital 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, immune, and reproductive systems. The fetal mercury content after maternal inhalation of mercury vapor was found to be approx. 40 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(22,279).

18. There is a significant correlation between number of amalgam fillings of the mother and the level of the fetus and older infants(20,23,61,304), and also with the level in mother’s milk (19,20,38,112, 304). Fertile women should not be exposed to vapor levels above government health guidelines(38,61,182,282) ;the U.S. ATSDR mercury health MRL of 0.2 mcg/M3 (2,217); or have amalgams placed or removed during pregnancy(20,182,231,304,etc.).

IV. Immune System Effects and Autoimmune Disease

1. Many thousands of people with symptoms of mercury toxicity have been found in tests to have high levels of mercury, and many thousands who have had amalgam fillings removed(most) have had health problems and symptoms alleviated or greatly improved(see Section VI). From clinical experience some of the symptoms of mercury sensitivity/mercury poisoning include chronic fatigue, dizziness, frequent urination, insomnia, headaches, chronic skin problems, metallic taste, gastrointestinal problems, asthma(8,97), stuffy nose, drycrusts in nose, rhinitis, plugged ears, ringing ears, chest pain, hyperventilation, diabetes, spacy feeling, chilly, chronic skin problems, immune and autoimmune diseases, cardiovascular problems and many types of neurological problems (26,34,35,36,38,45,59,60,69,70,71,75,91,109,148,165,204,212,199,246,255,268-270,290,291,294, 313,343). Amalgam results is chronic exposure rather than acute exposure and accumulation in body organs over time, so most health effects are of the chronic rather than acute in nature, but serious health problems have been documented to be related to amalgam and researchers have attributed some deaths as due to amalgam (356,32,245).

2. Mercury vapor exposure at very low levels adversely affects the immune system(17,27,31,38,45,60,84,118,129, 131,165,226,270,285,296,313,355368,369). From animal studies it has been determined that mercury damages T-cells by generating reactive oxygen species(ROS), depleting the thiol reserves of cells, damaging and decreasing the dimension of mitochondria, causing destruction of cytoplasmic organelles with loss of cell membrane integrity, inhibiting ability to secrete interleukin IL-1 and IL-2R, and inactivating or inhibiting enzyme systems involving the sulphydrol protein groups(226). Mercury caused adverse effects on both neutrophil and macrophage function and after depletion of thiol reserves, T-cells were susceptible to Hg induced cellular death (apoptosis).(226,272,355) Interferon syntheses was reduced in a concentration dependent manner with either mercury or methyl mercury as well as other immune functions(131), and low doses also induce aggregation of cell surface proteins and dramatic tyrosine phosporlation of cellular proteins related to asthma, allergic diseases such as eczema and lupus, and autoimmunity(181). One study found that insertion of amalgam fillings or nickel dental materials causes a supression of the number of T-lympocytes(270), and impairs the T-4/T-8 ratio. Low T4/T8 ratio has been found to be a factor in lupus, anemia, MS, eczema, inflamatory bowel disease, and glomerulonephritis.

Mercury induced autoimmunity in animals and humans has been found to be associated with mercury’s expression of major histocompatibility complex(MHC) class II genes(226). Both mercuric and methyl mercury chlorides caused dose dependent reduction in immune B-cell production. (316) B-cell expression of IgE receptors were significantly reduced(316,165), with a rapid and sustained elevation in intracellular levels of calcium induced(316,333). Both forms are immontoxic and cytotoxic ant very low levels seen in individuals. Mercury also inhibited B-cell and T-cell RNA and DNA synthesis. The inhibition of these functins by 50 % occurred rapidly at very low levels, in the range of 10 to 25 ug/L. All types of cells exhibited a dose dependent reduct in cellular glutathione when exposed to mercury, inhibiting generation of GSH by lumpocutes and moncytes(252). Workers occupationally exposed to mercury at levels within guidelines have been found to have impairment of lytic activity of neutrophils and reduced abiltiy of neutraphils to kill invaders such as candida(285). Low doses also induced autoimmuntiy in some species(181,226,314,404,131,129,43). Another effect found is increase in the average blood white cell count significantly (35). The increased white count usually normalizes after amalgam removal. Mercury also blocks the immune function of magnesium and zinc (198,38). Several studies found adverse health effects at mercury vapor levels of 1 to 5 mcg/M3 (35). Large numbers of people undergoing amalgam removal have clinically demonstrated significant improvements in the immune system parameters discussed here and recovery and significant improvement in immune system problems in most cases surveryed(Section VI).

3. Mercury from amalgam interferes with production of cytokines, disabling early control of viruses and leading to enhanced infection(131,251). Both mercuric and methyl mercury were equally highly toxic at the cellular level and in causing cell volume redcutions(131). However methyl mercury inhibits macrophage functions such as migration and phagocytosis at lower levels.

4. Body mercury burden was found to play a role in resistant infections such as Chlamydia trachomatis and herpes family viral infections; it was found many cases can only be effectively treated by antibiotics after removal of body mercury burden(cilantro tablets were used with followup antibiotics)(251,131). Similar results have been found for treatment of cancer.



5. Mercury by its effect of weakening the immune system contributes to increased chronic diseases and cancer(91,180,237,239,222,234,355,38,40,etc,). Exposure to mercury vapor causes decreased zinc and methionine availability, depresses rates of methylation, and increased free radicals-all factors in increased suscepability to cancer(14,34,38,143,144,180,237,239,251,256,283). Amalgam fillings have also been found to be positively associated with mouth cancer(206,251,403).

6. Among a group of patients testing positive as allergic to mercury, low level mercury exposure was found to cause adverse immune system response, including reduction of in vitro production of tumor necrosis factor TNF alfa and interleukin-1. (152) Mercury also interrupts the cytochrome oxidase system, blocking the ATP energy function(35,232) and impairing astrocyte function(119).. These effects often result in fatigue and reduced energy levels (35,60,119,140,141,182,202,212,232,235,313).



7. Toxic/allergic reactions to metals such as mercury often result in lichen planus lesions in oral mucosa or gums and play a roll in pathogenesis of periodontal disease. A high percentage of patients with oral mucosal problems along with other autoimmune problems such as CFS have significant immune reactions to mercury, palladium, gold, and nickel(60,118,313,81,90,212,313,342,368,369,374,375), including to mercury preservatives such as thimersol. 94% of such patients had significant immune reactions to inorganic mercury(MELISA test) and 72% had immune reactions to low concentrations of HgCl2(