Mercury
From
Amalgam Fillings:
A Major Factor in Periodontal Disease and Oral Health Problems
I.
Introduction &
Mercury Exposure Levels from Amalgam
Mercury is one of the most toxic
substances in existence and is known to bioaccumulate in the body of people and
animals that have chronic exposure. Mercury exposure is cumulative
and comes primarily from 3 main sources: occupational exposure, food
(mainly fish), and silver/mercury dental fillings. Whereas mercury exposure from
fish is primarily methyl mercury, mercury from occupational exposure and dental
fillings is primarily from elemental mercury vapor. But bacteria in the mouth
and intestines methylate other forms of mercury to methyl, and some
demethylation also occurs.
The most common type of occupational
exposure comes from dental office exposure and is documented to result in
significant adverse health effects (602). Mercury in amalgam
fillings, because of its high volatility and galvanic action due
to presence of dissimilar metals in the mouth, has been found to be
continuously vaporized and released into the body (192,600, etc.), and has
been found to be the
largest source of
mercury
in the
majority of people who have amalgam fillings (WHO:183,199,209,601,
18). The level of daily exposure commonly exceeds the U.S. EPA health
guideline for daily mercury exposure (2,217,601).
EMF and wi-fi
exposures
have been found to increase the mercury vapor release by amalgams and thus
increase toxicity effects. Metal crowns, amalgams, and metal implants also
cause an antenna effect regarding microwaves, etc.- causing additional adverse
effects along with the metals reactivity many have.
Concentrations of mercury in oral
mucosa for a population of patients with 6 or more amalgam fillings taken
during oral surgery were 20 times the level of controls
(174). Studies have shown mercury travels from amalgam into dentin,
root tips, and the gums, with levels in roots tips as high as 41 ppm
(192). Studies have shown that mercury in the gums such as from root caps for
root canaled teeth or amalgam tattoos result in chronic inflammation, including
proliferation of inflammatory cytokines in addition to migration to other
parts of the body (200,47,35, 86a,314a). Mercury and silver from
fillings can be seen in the tissues as amalgam tattoos, which have been found
to accumulate in the oral mucosa as granules along collagen bundles, blood
vessels, nerve sheaths, elastic fibers, membranes, striated muscle fibers, and
acini of minor salivary glands. Dark granules are also present
intracellularly within macrophages, multinucleated giant cells, endothelial
cells, and fibroblasts, and metals also accumulate in tooth roots and the
jaw bone
(47,35). There is in most cases
chronic inflammatory response or macrophagic reaction to the metals (47),
usually in the form of a foreign body granuloma with multinucleated giant cells
of the foreign body and
Langhans
types
(192). In a group of patients with amalgam tattoos that were tested, 74% of the
patients revealed high lymphocyte reactivity (positive MELISA test) to one or
more metal components of dental restorations(47k). The majority of MELISA
positive patients suffered from serious health problems (various allergies,
autoimmune diseases, Parkinson's syndrome etc.). Nickel and inorganic mercury
were the most common sensitizers in vitro. The cytokine assay revealed that
mercury chloride activated predominantly TH2 lymphocytes, while nickel chloride
activated mainly TH1 lymphocytes.
Most dentists are not aware of the
main source of amalgam tattoos, oral galvanism where electric currents caused
by mixed metals in the mouth take the metals into the gums and oral mucosa,
accumulating at the base of teeth with large fillings or metal crowns over
amalgam base (192). Such mercury including that in the commonly formed
amalgam tattoos moves to other parts of the body over time in significant
amounts and more rapidly than the other metals. Macrophages remove mercury by
phagocytosis and the mercury moves to other parts of the body through the blood
and along nerves (47). Another study (47l) demonstrated a dense
mononuclear inflammatory infiltrate associated with large and powdered debris
and positivity for HLA-DR and MT in inflammatory cells. While blood vessel
walls and connective fibers impregnated with powdered particles were negative
for HLA-DR, they were positive for MT. In addition, wherever epithelial
basement membrane impregnation by powdered amalgam particles was observed, a
strong positivity for MT was detected. These findings demonstrate that residual
elements of AT still have noxious local effects over tissues. Such
metals are documented to cause local and systemic lesions and health effects,
which usually recover after removal of the amalgam tattoo by surgery (47fghim).
The high levels of accumulated mercury also are dispersed to other parts of the
body
.
Mercury vapor given off
by amalgam fillings accumulates in the teeth, tooth roots, gums, jawbone, and
oral tissue. The number of amalgam surfaces has a statistically
significant correlation to the level of mercury in oral mucosa and
saliva (18,77,79,182,199,211,222,292). Those with dental amalgams commonly
have metal immune reactivity with corresponding immune, autoimmune, and
allergic conditions (60,313,369, etc.) The most common metals that patients
have immune reactivity to are nickel, gold, mercury, palladium, and titanium
(60). The immune reactivity and health problem usually
significantly improves after metal replacement. The Melisa immune
reactivity test was found more effective than the patch test in such
patients.
The amount of mercury in saliva averaged between 1.5 to 1.9
micrograms per Liter for each amalgam filling(199ab).
The amount of mercury released by a
gold alloy bridge over amalgam over a
10 year
period
was measured to be approx. 101 milligrams(mg) (60% of total) or 30
micrograms(ug) per day (18), and other studies have found similar results
(182). The average mercury levels in gum tissue near amalgam
fillings are often over 100 ppm (192), and levels in oral mucosa removed during
oral surgery averaged over 2
ppm(
over 20 times
controls ) and levels in root tips of 41 ppm(174,192,47).
Having dissimilar metals in
the teeth (
e.g.
‑gold and mercury) causes
galvanic action
, electrical
currents, and much higher mercury vapor levels and mercury levels in tissues.
(182,191,192,18,19,27, 30,47,48,8,174). The level of mercury
in the gums or
jaw bone
is often 1000 ppm near a gold
cap on an amalgam filling (30,25,35,48,58), and similar levels as high as 5600
ppm have been found in the jaw bone under large amalgam fillings or gold crowns
over amalgam by German oral surgeons (436). These levels are among
the highest levels ever measured in tissues of living organisms, exceeding the
highest levels found in chronically exposed
chloralkali
workers,
those who died from
mercury in
Minamata,
or animals that died from mercury poisoning. The FDA action level
for warnings of dangerous levels in fish or
food is
1
ppm and the EPA health criterion level is 0.3 ppm. In patients with
galvanic cell in their oral cavity we found decreased levels of anti-inflammatory
markers, such as secretory IgA, IgA 1, IgA 2, and lysozyme, and increased
levels of the proinflammatory marker albumin (192i).
Amalgam also releases significant
amounts of silver, tin, and copper which also have toxic effects, with organic
tin compounds formed in the body being even more neurotoxic than inorganic
mercury.
German
studies of mercury loss from vapor in unstimulated saliva found the saliva of
those with amalgams had at least 5 times as much mercury as for controls
(179,199]. Much mercury in saliva and the brain is also organic,
since mouth bacteria convert inorganic mercury to methyl mercury
(81,88,600). Oral bacteria
streptococommus
mitior,S
.mutans
, and
S.sanguis
were all found to methylate
mercury(81,600),as well as Candida albicans. Methyl mercury,
like mercury vapor, crosses the blood-brain barrier, and both forms are
converted to very neurotoxic inorganic compounds which have a long half-life in
the brain. The process also
results in
formation
of hydrogen sulfide and metal protein compounds that are involved in mouth
odor(334).
A
large U.S. Centers for Disease Control epidemiological study, NHANES
III, found
that those with more amalgam
fillings(more mercury exposure) have significantly higher levels of chronic
health conditions(543a).
A 2009
study found that inorganic mercury levels in people have been increasing
rapidly in recent years(543b). It used data from the U.S. Centers for
Disease Control and
Prevention�s
National Health
Nutrition Examination Survey (NHANES) finding that while inorganic mercury was
detected in the blood of 2 percent of women aged 18 to 49 in the 1999-2000
NHANES survey, that level rose to 30 percent of women by 2005-2006.
Surveys in all states using hair tests have found dangerous levels of mercury
in an average of 22 % of the population, with over 30% in some states like
Florida and New York(543c).
II.
Oral Health Effects
of Mercury from Amalgam
A large study
of 20,000 subjects at a German university found a significant relation between
the number of amalgam fillings with periodontal problems
(199).
Some of the oral effects documented in the
literature to be caused by amalgam include gingivitis, oral gum
tissue inflammation, bleeding gums, bone loss, mouth sores, oral lesions, pain
and discomfort, burning mouth(89), metallic taste, chronic sore throat, chronic
inflammatory response, lichen planus autoimmune response, oral keratosis, oral
cancer
(251,252)
, bad breath, mouth dryness, tender
teeth, trigeminal neuralgia, sinusitis, TMJ,
orafacial
granulomatosis, oral lichen planus
(86-90,95)
,
leukoplakia, amalgam tattoos,
etc. (27,29,48a,86-90,95,192a,
303,341,525a,582,5). Amalgams are also a factor in periodontal disease
(303, etc.).
Removal of amalgam fillings led to
cure or significant improvement for most of such oral health
problems
(8,27,56,57,75,82,86,87,90,94,95,101,115,133,145, 167,168,
192abcf,212,222,233,303,313,317,320,321, 341,525a,582, etc.) and oral keratosis
(pre cancer) (87,251,252). For example, in one clinic (95) that replaced
amalgams for a large number of such patients, there was cure or significant
improvement in over 90% of cases for metallic taste, tender teeth, mouth sores,
and bad breath
and in
over 80% of
cases for bleeding gums and throat irritation. A Jerome meter was
used to measure mercury vapor level in the mouth, and many had over 50
micrograms mercury per cubic meter of air, far above the Government health
guideline for
mercury(
217).
Mercury accumulates
in the trigeminal ganglia (325,329ab,303) and can cause trigeminal
neuralgia from which most recover after amalgam
replacement(525a,192a,35d,222,437b,303). Temporomandibular joint
disorder (TMJ) is a common type of joint pain which can be caused by
accumulation of mercury in the joint due to the high amount of mercury in the
mouth area of those with amalgam fillings and due to inflammation, similar to
arthritic effects on other joints caused by mercury
(303). Accumulation of mercury in the cranial nerves is a common cause
of tinnitus, TMJ, cataracts, loss of smell, etc. (303).
Cavitations
from
improperly healed tooth extractions also commonly cause trigeminal neuralgia
and most such recover after
cavitation surgery(437b,35a). The periodontal ligament of
extracted teeth is often not fully removed and results in incomplete jawbone
regrowth resulting in a pocket (cavitation) where mouth bacteria in anaerobic
conditions along with similar conditions in the dead tooth produce extreme
toxins similar to botulism which like mercury are extremely toxic and
disruptive to necessary body enzymatic processes at the cellular level,
comparable to the similar enzymatic disruptions caused by mercury and
previously discussed(35,437ab).
Extremely toxic anaerobic bacteria
from root canals or
cavitations
formed at
incompletely healed tooth extraction
sites have
also
been found to be common factors in Fibromyalgia and other chronic neurological
conditions such as
Parkinson�s
and ALS, with
condensing osteitis which must be removed with a surgical burr along with 1 mm
of bone around it(35,200,437ab).
Cavitationshave
been found in 80% of sites from wisdom tooth extractions tested and 50% of
molar extraction sites
tested(
35,200,437ab). The
incidence is likely somewhat less in the general population.
. The
interruption of the ATP energy chemistry results in high levels of porphyrins
in the
urine(
260). Mercury,
lead, and other toxics have different patterns of high levels for the 5 types
of porphyrins, with pattern indicating likely source and the level extent of
damage. The average for those with amalgams is over 3 time
that of those without, and is over 20 times normal for some severely
poisoned
people(
232,260). The FDA has approved
a
test measuring porphyrins
as a test for
mercury poisoning.
However
some
other dental problems such as nickel crowns,
cavitations
,
and root canals also can cause high porphyrins.
Cavitations
are
diseased areas in bone under teeth or extracted teeth usually caused by lack of
adequate blood supply to the area. Tests by special equipment (
Cavitat
) found
cavitations
in
over 80% of areas under root canals or extracted wisdom teeth that have been
tested, and toxins such as anaerobic bacteria and other toxics which
significantly inhibit body enzymatic processes in virtually all
cavitations
(200,437ab). These toxins have
been found to have serious systemic health effects in many cases, and
significant health problems to be related such as arthritis, MCS, and
CFS. These have been found to be factors along with amalgam in
serious chronic conditions such as MS, ALS,
Alzheimer�s
,
MCS, CFS, etc. (35,200,204,222,292,437). The problem occurs in
extractions that
are not
cleaned
out properly after extraction. Supplements such as glucosamine
sulfate and avoidance of orange juice and caffeine have been found to be
beneficial in treating arthritic conditions as well (35).
Nickel
and beryllium are 2 other metals commonly used in dentistry that are very
carcinogenic, toxic, and cause DNA malformations (35,456). Nickel
ceramic crowns, root canals and
cavitations
have
also been found to be a factor in some breast cancer and other cancers and some
have recovered after TDR, which includes amalgam replacement, replacement of
metal crowns over amalgam, nickel crowns, extraction of root canaled teeth, and
treatment of
cavitations
where necessary
(35,200,228a,486,530). Similarly nickel crowns and gold crowns over
amalgam have been found to be a factor in lupus (456,35,229) and
Belle�s
Palsy from which some have recovered after TDR
and
Felderkrais
exercises
(35). An analysis of the large U.S. NHANESIII population found that
the age-adjusted geometric mean urine Cadmium concentration was significantly
higher among participants with periodontal disease (241.) Smoking
is known to be a common source of elevated cadmium level.
Toxic/allergic
reactions to toxic metals such as mercury/amalgam often result in autoimmune
conditions such as lichen planus lesions in oral mucosa or gums, eczema,
pustulosis, dermatitis and play a
roll
in
pathogenesis of periodontal disease (85-88,90,313, 314,303, etc.). A high
percentage of patients with oral mucosal problems along with other autoimmune
problems such as chronic fatigue (CFS)
have
significant immune reactions to mercury, palladium, gold, and nickel (313,118,369). 94%
of such patients had significant immune reactions to inorganic mercury (MELISA
test) and 72% had immune reactions to low concentrations of
HgCl2(<0.5 ug/ml). 61% also had immune reaction to
phenylHg
, which has been commonly used in root canals
and cosmetics (313). Removal of amalgam fillings usually
results in cure of such lesions. [75,82,86,87,90,94,101,118,133,
145,167,168,313]. Patients with other systemic neurological or
immune symptoms such as arthritis, myalgia, eczema, CFS, MS, diabetes, etc.
also often recover after amalgam replacement (313,118,369,86,600,
etc.) 10% of controls had significant immune reactions to
HgCl
and 8.3% to palladium.
In a recent study
of patients with OLP, 60 % showed sensitization to 1 or more
allergens using a patch test (85). The greatest frequency of positive reactions
was to dental metals. The order of tested metals according to
frequency of positive reactions was mercury, amalgam, nickel, palladium,
cobalt, gold, chrome, and indium. However, patch tests have been found to not
be a reliable indicator of mercury immune reactivity or allergy (303,
etc.). In large number of clinical trials by doctors treating OLP,
between 39 and 53% of patients tested by patch tests were indicated to be
reactive to mercury. However, when patients had amalgams
replaced, the majority recovered or significantly improved in a relatively
short time period-
irregardless
of patch
test results. Thus, the authors recommend replacement of amalgam in all
cases of OLP and similar conditions. The MELISA blood lymphocyte
immune reactivity test appears to be a more accurate indicator of immune
reactivity than the patch test. When patch tests are to be used it
should be noted that the clinical trials found that mercury immune reactivity
is often a delayed reaction, with positive patch test observed only later on
the 10th or 17
th
day of the test. Patients with OLP
also commonly have been found to be immune reactive to gold or nickel so that
replacement of gold or nickel crowns may be beneficial in such patients when
amalgam replacement is not sufficient to resolve the problem (85).
Oral
lichen planus and oral lesions, caused most commonly by reactivity to mercury,
are inflammatory pre-cancerous conditions that have been well
documented in the literature to often develop into oral squamous cell carcinoma
(OSCC
)(
85). Infection and
chronic inflammation have been found to contribute to
carcinogenesis through inflammation-related mechanisms (85). Inflammatory
bowel diseases are associated with
colon carcinogenesis and inflammatory oral conditions such as
oral lichen planus (OLP) and leukoplakia are associated with OSCC.
Mercury (as well as toxins from root
canals and
cavitations
) interact with brain
tubulin and disassembles microtubules that maintain neurite structure
(207b,258,35,200,303,437). Thus, chronic exposure to low level
mercury vapor can inhibit polymerization of brain tubulin and creatinine kinase
which are essential to formation of microtubules. Reviews of mercury
studies on animals give results similar to that found the Alzheimer
brain. The effects of mercury with other toxic metals have also been
found to be
synergistic
, having much more
effect than with individual exposure (35).
Teeth are
living tissue and have massive communication with the rest of the body via
blood, lymph, and nerves. Mercury vapor (and bacteria in teeth) have
paths to the rest of the body. (34,325, etc.) Mercury has direct
routes from the teeth and gums to the brain and CNS, where it accumulates to
high levels in those with a large number of amalgam fillings
(34,327,329). Cytotoxic effects of dental amalgam, measured by
the frequency of micronuclei (MN) in oral
mucosal cells, as it is a promising tool for studying the genotoxic effect of
clastogenic agents on them, were significantly higher than for composite
restorations, and higher for multiple restorations than for single restorations
(59).
Due
to galvanism of mixed metals, amalgam fillings produce electrical currents
which increase mercury vapor release and may have other harmful effects
(14,19,27-30,35,47, 100,192, 600). These currents are measured
in micro amps, with some measured at over 4 micro amps. The central nervous
system operates on signals in the range of nana-amps, which is 1000 times less
than a micro amp (28). The metals also have electrical potentials which
can be measured in millivolts(mV). One clinical study
determined that electrical potential differences of over 50 mV were
pathological(48b), causing galvanism, leukoplakia, oral lichen planus, or
toxic or allergic reactions to restorations (48a, etc.). In most subjects
with amalgam fillings, potential differences of more than 50 mV are
present between restorations(48a), with potentials ranging from -417 mV to +150
mV. Negative potentials may be more pathological than positive
ones. The average potential for metal crowns and bridges was
154 mV and for brace brackets was 74 mV(48a).
Negatively
charged fillings or crowns push electrons into the oral cavity since saliva is
a good electrolyte and cause higher mercury vapor losses
(35,192). Patients with autoimmune conditions like MS, or
epilepsy, depression, etc. are often found to have a lot of high negative
current fillings (35). The Huggins total dental revision
(TDR) protocol calls for teeth with the highest negative charge to be replaced
first (35). Other protocols for amalgam removal are available from
international dental associations like IAOMT (153) and mercury poisoned
patient�s
organizations like
DAMS
(447). For
these reasons it is important that no new gold dental work be placed in the
mouth until at least 6 months after replacement. Some
studies have also found persons with chronic exposure to
electromagnetic fields (EMF) to have higher levels of mercury exposure and
excretion (28).
The post MRI saliva
mercury levels for a sample of patients was on average 31% higher after MRI
than before(28e).
In a large
German study of MS patients after amalgam revision, extraction resulted in 80%
recovery rate versus only 16% for filling replacement alone (302,308). Other
cases have found that recovery from serious autoimmune diseases, dementia, or
cancer may require more aggressive mercury removal techniques
than simple filling replacement due to body burden. This appears to be due
to
migration of mercury into roots and gums that is not eliminated by
simple amalgam replacement.
, providing a lasting residue for
chronic mercury exposure. That such mercury (and similarly
bacteria) in the teeth and gums have direct routes to the brain and CNS has
been documented by several medical studies (34,325, etc.).
Periodontal
offices also often are a source of exposure to mercury for staff and
patients. Both dental hygienists and patients get high doses of mercury
vapor when dental hygienists polish or use ultrasonic scalars on amalgam surfaces
(240). Pregnant women or pregnant hygienist especially should
avoid these practices during pregnancy or while nursing since maternal mercury
exposure has been shown to affect the fetus and to be related to birth defects,
SIDS, etc. (38,61,272), and breast milk contains up to 6 times higher mercury
than in the mother's blood (20,186). There is considerable exposure as well
when polishing amalgam fillings and hygienists are generally advised not to
polish amalgam fillings.
The component
mix in amalgams has also been found to be an important factor in mercury vapor
emissions. The level of mercury and copper released from high copper
amalgam is as much as 50 times that of low copper amalgams
(191). Studies have consistently found modern high copper
non gamma
-two amalgams have greater release of mercury vapor
than conventional silver amalgams (298). While the
non gamma
-two amalgams were
developed to be less corrosive and less prone to marginal fractures than
conventional silver amalgams, they have been found to be unstable in a
different mechanism when subjected to wear/polishing/ chewing/
brushing/bleaching, etc. they form droplets of mercury on the surface of the
amalgams (297,136,182,192). This has been found to be a factor in
the much higher release of mercury vapor by the modern
non
gamma
-two amalgams. Recent studies have concluded that
because of the high mercury release levels of modern amalgams,
mercury levels higher than Government health guidelines are being
transferred to the lungs, blood, brain, CNS, kidneys, liver, etc. of large
numbers of people with amalgam fillings and widespread neurological, immune
system, and endocrine system effects are
occurring(
34,35,199,212,222,313,118,600).
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