Some individuals have an allergy or sensitivity to mercury or the other components of dental amalgam such as silver, copper, or tin. Dental amalgam might cause these individuals to develop oral lesions or other contact reactions. If you are allergic to any of the metals in dental amalgam, you should not get amalgam fillings. You can discuss other treatment options with your dentist.
For more information on FDA's scientific review and findings, see the new "Information for Use" statement required in dental amalgam labeling. Approximately half of a dental amalgam filling is liquid mercury and the other half is a powdered alloy of silver, tin, and copper. Mercury is used to bind the alloy particles together into a strong, durable, and solid filling.
Bioaccumulation refers to the build-up or steadily increasing concentration of a chemical in organs or tissues in the body. Mercury from dental amalgam and other sources e.
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Studies of healthy subjects with amalgam fillings have shown that mercury from exposure to mercury vapor bioaccumulates in certain tissues of the body including kidneys and brain. Studies have not shown that bioaccumulation of mercury from dental amalgam results in damage to target organs. For more information about bioaccumulation, please see Related Resources. There are several different chemical forms of mercury: elemental mercury, inorganic mercury, and methylmercury. The form of mercury associated with dental amalgam is elemental mercury, which releases mercury vapor.
The form of mercury found in fish is methylmercury, a type of organic mercury. Mercury vapor is mainly absorbed by the lungs. Methylmercury is mainly absorbed through the digestive tract. The body processes these forms of mercury differently and has different levels of tolerance for mercury vapor and methylmercury. If your fillings are in good condition and there is no decay beneath the filling, FDA does not recommend that you have your amalgam fillings removed or replaced.
Removing sound amalgam fillings results in unnecessary loss of healthy tooth structure, and exposes you to additional mercury vapor released during the removal process. However, if you believe you have an allergy or sensitivity to mercury or any of the other metals in dental amalgam such as silver, tin, or copper , you should discuss treatment options with your dentist. What is dental amalgam? What should I know before getting a dental amalgam filling? Benefits Potential Risks Why is mercury used in dental amalgam? What is bioaccumulation? Is the mercury in dental amalgam the same as the mercury in some types of fish?
If I am concerned about the mercury in dental amalgam, should I have my fillings removed? In the present study, we found positive but not significant correlations between reduction in mercury concentration in serum and reductions in subjective health complaints, which may be in agreement with the analyses presented in It is possible that some individuals are highly sensitive to mercury from dental amalgam and may benefit from reduced exposure The reference group received no treatment and was only followed up by questionnaires sent by post.
This makes it difficult to untangle the effects of the general care associated with amalgam replacement and follow-ups in the treatment group from the effects of the amalgam replacement itself. This may have contributed to the reduction in reported subjective health complaints as patient-centred communication has been shown to be associated with improved patient health outcomes 36 , In addition, participants in the treatment group no longer had to worry about possible adverse effects from their amalgam fillings.
This may also have played a part in the reduction in health complaints as worry has been found to lead to increased monitoring of complaints, which again may lead to an increased feeling of ill health Even so, replacement of amalgam fillings will usually take place in a treatment context where factors like these are present and, thus, potentially might influence the treatment results.
However, it is not likely that the participants would remember how they responded to the scales in the questionnaires several years ago. Factors mentioned above are linked to components related to placebo expectations, conditioning, learning, memory, motivation, somatic focus, reward, anxiety reduction and meaning , as defined as a genuine psychobiological event attributable to the overall therapeutic context In this context, it is also possible that for some patients, the presence of amalgam fillings has been associated with a nocebo effect.
Removal of amalgam fillings could therefore result in a discontinuation of this effect and consequently lead to a reduction in reported health complaints. Reduction in intra-oral health complaints may have been influenced by general effects of the dental treatment received during the amalgam replacement process. It does, however, seem unlikely that an effect of a generally improved dental health should be prominent 3 years after completed replacement, given that patients with need for complicated dental rehabilitation were excluded from the treatment group and that the removed amalgam fillings were described as sound and well-functioning.
Participants included in this study were recruited from patients referred to the Dental Biomaterials Adverse Reaction Unit. Consequently, participants are not representative of all patients with health complaints attributed to amalgam fillings. Not all patients with health complaints attributed to dental amalgam are referred to this unit. Some patients are directly treated by their own dentist or general practitioner or seek help from practitioners of alternative medicine.
Despite lack of objective signs of adverse reactions to dental amalgam, some patients nevertheless have all their amalgam fillings removed of their own accord because they are concerned about possible adverse effects of mercury released from amalgam fillings.
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The participants included in this study had not removed all amalgam fillings, either because they accepted that there were no indications for amalgam removal or because they did not have the financial means necessary for amalgam removal. Thus, the treatment group is not directly comparable with patients who remove amalgam restorations of their own accord The study was designed as a before-and-after study with a comparison group reference group.
Comparisons between the reference group and the treatment group must be interpreted with caution. Even though power calculations showed acceptable power of the study, the sample size is small and the results should be considered in context with results from comparable studies 8 , 24 , 25 , A larger sample size could provide more precise estimates and less-wide confidence intervals. In addition, there may be unknown factors that influence reporting of health complaints over time in the groups.
In the treatment group, all 20 participants completed replacement of amalgam fillings, and 19 of the participants were able to attend the 3-year follow-up. In the reference group, seven of the 20 participants were lost to follow-up or excluded because of completed removal of amalgam fillings Fig. The response rate in the reference group was influenced by the fact that only two reminders, by letter, is allowed by the Regional Committee for Medical Research Ethics. Exclusion criteria were initially not applied in the reference group.
The clinical examination necessary to fully apply these criteria could potentially lead to a renewed focus on amalgam fillings as a possible cause of ill health, thus increasing the risk of participants in the reference group initiating amalgam removal of their own accord. As no intervention was planned for the reference group, the participants were not asked to undergo a clinical examination.
The patients excluded from the treatment group were, based on their responses to Questionnaire 1, quite similar to the treatment group and the reference group, with the exception of per cent on sick leave or disability pension. For this variable, exclusion of the 10 patients resulted in a more equal occupational status for the treatment group and the reference group Table 2.
Changes in health complaints in the treatment group were compared with changes in both the initial reference group and changes in the reference group after post hoc application of exclusion criteria. No major differences were found between the two comparisons. However, as there was no clinical pre-treatment examination of patients in the reference group, there could still be differences between the groups.
The bias from differences between the groups at study start is expected to be limited. Treatment of patients with subjective health complaints attributed to amalgam fillings should only be considered after a thorough medical and dental examination has been carried out and other causes for the complaints have been eliminated or adequately treated The results from the present study, and other studies investigating the effects of amalgam replacement, indicate that replacement of amalgam fillings is associated with reductions in subjective health complaints at group level.
The mechanisms behind this are not known, and other treatment options than amalgam replacement should also be considered. In a recent randomised clinical trial, all investigated treatments amalgam removal, amalgam removal plus biological detoxification and health promotion without amalgam removal resulted in clinically relevant reductions in health complaints When considering replacement of intact amalgam fillings, potential benefits must be balanced with risks associated with the dental treatment e.
When removing amalgam fillings, measures should be taken in order to minimise exposure to mercury for both patients and dental personnel 29 , The results from the present study indicate that the replacement of amalgam fillings was associated with reductions in subjective health complaints at group level. Reduced exposure to mercury, patient-centred treatment and follow-ups, and elimination of worry are factors that may have influenced the results. In this study, we investigated changes in index scores. More knowledge is needed about changes in specific complaints included in the index scores after replacement of amalgam fillings, and a characterisation of the treatment group in this respect is warranted.
National Center for Biotechnology Information , U. Journal of Oral Rehabilitation. J Oral Rehabil. Author information Article notes Copyright and License information Disclaimer. E-mail: on. Accepted Mar Re-use of this article is permitted in accordance with the Creative Commons Deed, Attribution 2. This article has been cited by other articles in PMC. Abstract The aim of the present study was to investigate whether removal of all amalgam fillings was associated with long-term changes in health complaints in a group of patients who attributed subjective health complaints to amalgam fillings.
Keywords: health complaints, amalgam, before-and-after study, dental, restoration. Introduction For decades, dental amalgam has been extensively used in the treatment of caries lesions. Materials and methods Design The study was designed as a before-and-after study with a comparison group reference group comparing changes in health complaints in a treatment group, which had all amalgam fillings replaced with other restorative materials, with changes in health complaints in a comparable reference group, which did not receive any intervention.
Table 1 Eligibility criteria and number of patients not included. Open in a separate window. Exclusion criteria treatment group and reserves Numbers excluded Severe medical disorders e. Initial examination — At the initial examination at the unit 22 , patients underwent a medical and dental examination. Questionnaire 1 — Questionnaire 1 included questions regarding current health complaints, treatment since the initial examination and demographic variables.
Pre-treatment examination In September , participants in the treatment group underwent a pre-treatment examination consisting of medical and dental examinations and collection of samples of blood serum and urine. Intervention The assigned intervention in the treatment group was removal of all amalgam fillings.
Follow-up Treatment group Routines for the follow-ups were similar to the pre-treatment examination. Reference group Follow-ups in this group were limited to questionnaires sent by post. Outcome variables Primary outcome measures were changes in local oro-facial complaints and general health complaints from Questionnaire 1 inclusion into study to the 3-year follow-up in the treatment group and to Questionnaire 3 in the reference group. Power calculation Number of participants included in this study was limited by available patients. Results Participant flow and numbers analysed Treatment group All 20 participants in the treatment group received the assigned intervention replacement of all amalgam fillings.
Reference group Questionnaire 2, which was sent to all 20 participants in the reference group in , was returned by 15 participants. Initial examination and Questionnaire 1 Data from the initial examination and Questionnaire 1 were used as baseline values in the study. Table 2 Descriptive background data. Concentration of mercury, mean s. Comparisons of changes in health complaints in the treatment group and the reference group Per-protocol comparisons of changes in health complaints, from Questionnaire 1 to the 3-year follow-up in the treatment group and Questionnaire 3 in the reference group, showed that changes in mean index scores for intra-oral and general health complaints were significantly different in the two groups, whereas changes in extra-oral health complaints were not significantly different Table 3.
Table 3 Comparisons of changes in health complaints in the treatment group and the reference group. Changes in health complaints in the treatment group In the treatment group, there were significant reductions in mean index scores for intra-oral and general health complaints from Questionnaire 1 to the 3-year follow-up Table 3.
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Table 4 Repeated measures analysis of changes in health complaints over time. Mean s. Changes in health complaints in the reference group In the reference group, there was a slight, but not statistically significant, increase in mean index scores for intra-oral, extra-oral and general health complaints from Questionnaire 1 to Questionnaire 3 Table 3. Mercury concentration in serum and urine There was a significant decrease in mercury concentration in serum and urine following the removal of amalgam fillings.
Changes in health complaints related to changes in mercury concentration in serum Secondary explorative analyses of correlations between reduction in mercury in serum and reduction in health complaints 3 years after treatment showed positive but not significant correlations. Adverse events Seven participants in the treatment group experienced increased health complaints in connection with removal of amalgam fillings.
Discussion The aim of this study was to investigate long-term changes in subjective health complaints after the removal of all amalgam fillings in a group of patients who attributed health complaints to amalgam fillings. References 1. Powers J, Sakaguchi R. In: Powers J, Sakaguchi R, editors. Craig's restorative dental materials. Louis: Mosby Elsevier; Physical and mental problems attributed to dental amalgam fillings: a descriptive study of 99 self-referred patients compared with controls.
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Eur J Oral Sci. Health promoting effects of the physician-patient encounter. Psychol Health Med. Stewart M. Effective physician-patient communication and health outcomes: a review. Can Med Assoc J. Brosschot JF. Cognitive-emotional sensitization and somatic health complaints. Scand J Psychol. Placebo response in environmental disease. Chelation therapy of patients with symptoms attributed to amalgam fillings.
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Getting the Mercury Out
No diagnosed contact allergy to substances in resin-based dental materials. Health complaints from at least three different organ systems. Data on mercury in blood and urine from initial examination.