Dental Mercury Amalgams

Mercury amalgams are alloys of mercury (a heavy metal which can produce severe organ damage)
with other metals. They are used in dentistry as filling materials for treatment of dental caries. In
some countries dental mercury amalgams are classified as medicines, and therefore subjected to
rigorous regulations. In other countries (among them, the United States) they are considered
devices; therefore they have not been submitted to the strict official government testing required for
medicines.
Although mercury toxicity is well known, scientific studies on the potential health effects of
mercury amalgams used in dentistry have come to opposite conclusions.

Mercury

Mercury is, after plutonium, the most toxic substance on the earth. If mercury is ingested or inhaled,
it is quickly assimilated and accumulates in various tissues, affecting primarily the nervous, the
immune and the urinary system. In fact, in past centuries, as mercury was widely used in the felt hat
industry, hatters often drooled, trembled and had bouts of paranoia: this gave origin to the saying
"mad as a hatter".
Mercury can increase production of free radicals, diminish availability of antioxidants and
increase retention of other toxins, causing rapid oxidation, dysfunction and cell death.
The US Environmental Protection Agency, aware of mercury‘s toxicity, and concerned
about mercury release in the environment (for instance from incinerators, crematoria and coal-fired
power plants), designated this substance as constituting a waste disposal hazard - in fact, mercury
can pollute the environment, imposing health risks upon the population. For this reason, in order to
limit damage to the environment, some countries arrange for the purification of mercury from waste
water, and other countries ban the release of mercury into the public sewer system.
However, as regards mercury emissions, some studies reported controversial results:
whereas a 1992 study showed that 86 % of discarded mercury was released from batteries, and only
0.56 % from dental amalgam, in 2005 the World Health Organization (WHO) reported that mercury
from dental offices and laboratories accounts for one-half of total mercury emissions. Despite this,
many countries (among them the United States) do not regulate the use of mercury in dentistry.

Use of Mercury in Dentistry

Mercury has been used as a component of amalgam fillings in Europe since 1603, and in the United
States since 1833. Compared with other dental restorative materials this compound has several
advantages: strength, durability, ability to limit growth and reproduction of bacteria, easy
application and low cost. For these reasons mercury-containing amalgams have been widely
employed in the United States since the mid 1800s; yet a controversy over their use in dentistry
dates back to the 1840s. In fact, already in 1845, all the members of the American Society of Dental
Surgeons pledged not to use amalgam fillings, fearing mercury poisoning in both patients and
dentists. Yet the American Dental Association (ADA), founded in 1859, did not ban the use of
amalgams and still holds this position.
Amalgam fillings are frequently called “silver fillings”, but contain much more mercury
than silver: on average, 50% mercury, 35% silver, 13% tin, and minimal quantities of copper and
zinc. However, a 2006 poll performed in the United States found that only 28% of interviewees
were aware of the mercury percentage in "silver fillings".
Furthermore, WHO reported in 2005 that, as many countries do not impose specific waste
disposal procedures for mercury-containing waste products, these are nearly always flushed down
the drain, accounting for one-third of the mercury present in the sewage system. Already in 2002
the Association of Metropolitan Sewerage Agencies (AMSA) found that dentistry mercury
represented 40% of the total mercury content in wastewater treatment plants, and dental offices and
laboratories were by far the heaviest contributors to this load.

Health Effects from Amalgam Fillings

In the last seventy-five years, several studies have reported that changes in health may result from
exposure to amalgam fillings. Among them:
- fatigue, weakness, tremors
- lack of concentration and memory, irritability, insomnia
- taste, appetite and digestion problems
- hoarse voice
- skin alterations, destructive changes in the mucous membranes
- oral lesions, inflammatory periodontal tissue reactions
- hearing loss, tinnitus, vertigo
- changes in visual system, double vision, graying of the lens of the eye
- cardiovascular, chest, joint, mouth, and throat pain, painful swallowing and menstruation,
headaches
- fine motor capability deterioration, neurobehavioral changes

These symptoms led researchers to hypothesize a connection between mercury poisoning

from amalgam fillings and various disorders:
- chronic viral illnesses: Epstein-Barr virus (EBV), cytomegalovirus (CMV), human
immunodeficiency virus (HIV), herpes zoster and genital herpes, chronic fatigue and
immune dysfunction syndrome (CFIDS)
- chronic fungal illnesses: thrush and others
- recurrent episodes of bacterial infections: chronic sinusitis, tonsillitis, bronchitis,
bladder/prostate infections, HIV related infections
- autoimmune disorders: multiple sclerosis, lupus erythematosus, thyroiditis and eczema
- mental disorders: dementia, anorexia
- disorders of the Central Nervous System: Alzheimer’s disease, amyotrophic lateral sclerosis
(ALS), autism, epilepsy and seizures, migraines, paralysis, Parkinson’s disease
- cancer
- emotional diseases: mood depression, timidity, erethism
- haematopoietic diseases: leukaemia, Hodgkin’s disease
- cardiovascular system diseases
- disorders of the respiratory system: asthma
- diseases of the genito-urinary system
- skin disorders: acne
- allergies

Actually, the ADA maintains that there is no consistent evidence of adverse health effects
attributed to mercury amalgams used in dentistry.
However, in 2006, considering the question of the safety of "silver fillings", a panel of
doctors and dentists recommended special caution in using amalgam as restorative material with
specific populations: children under the age of six, girls and women of reproductive age, pregnant
women, subjects with mercury allergy or hypersensitivity, and dental personnel.

Controversial Positions
Many countries, such as Canada, Austria, Germany, Denmark, and Norway have already banned the
use of „silver fillings“, and other countries, such as Japan, Finland and Sweden have severely
restricted it.
On the contrary, in July 2009 the US Food and Drug Administration (FDA) issued a new
regulation on dental fillings, classifying mercury amalgams as class II medical devices, like other
filling materials (for instance composite and gold). In this way FDA affirmed that, according to the
present scientific standpoint, dental mercury amalgams are effective and safe. Anti-amalgamists
hypothesized however that one of the reasons for this resolution was to avoid a massive class-action
lawsuit for mercury amalgams.

Alessandra Padula
University of L’Aquila (Italy)

See Also: Environmental Illness and Chemical Sensitivity; Mercury Role in Green Health; Oral
Diseases; Solid Waste Management; US Environmental Protection Agency

Bibliography
FDA, “Medical Devices.” Available online at:
http://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/DentalProducts/DentalAmalga
m/ucm171120.htm (accessed February 2010)

Public Health Service, Department of Health and Human Services, “Dental Amalgam: A Scientific
Review and Recommended Public Health Service Strategy for Research, Education and
Regulation.”; Available online at: http://web.health.gov/environment/amalgam1/ct.htm (accessed
February 2010)

"What Patients Don’t Know: Dentists' Sweet Tooth for Mercury." Available online at:
http://www.nrcm.org/documents/dental_mercury_report.pdf (accessed February 2010)