mercury toxicity in conservative dentistry

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Patients were included if they suspected that dental amalgam was affecting their health status. Mercury Toxicity of Dental Amalgam. Even in the subscales, patients belonging to the amalgam group demonstrated better improvements than the nonamalgam group patients. COVID-19 is an emerging, rapidly evolving situation. The most significant danger is from mercury vapor. The studies that present critical issues with regard to amalgam, however, correlate the hypothetical adverse effects to the number of surfaces treated. The TSA confirmed this evidence revealing that it was due to a lack of statistical power since the required information size (RIS) threshold is not reached. No statistically significant differences were found in any outcome. There was then a discussion about how to remove the fillings. Trial sequential analysis for urinary mercury concentration after 5 years of exposure to dental amalgam or composite resin in children. 2020 Oct 8;18(2):1655-1669. doi: 10.1007/s40201-020-00558-w. eCollection 2020 Dec. Attiya N, Fattahi R, El-Haidani A, Lahrach N, Amarouch MY, Filali-Zegzouti Y. Pan Afr Med J. Even if the meta-analysis has drawn conclusions from RCT that should be considered as the best evidence in scientific literature, data regarding the level of urinary mercury in children after 5 years of restoring dental caries with dental amalgam or composite resin were considered to have only moderate strength of evidence because of the high heterogeneity among studies and the presence of one study assessed as having high risk of bias. Once in solution, mercury salts are more easily converted by bacterial and fungal metabolic process to the highly hazardous natural kinds of mercury, such as methyl mercury; plus, mercury salts themselves can be about 1000 times more toxic than metallic mercury. NIH Mercury level in biological samples of dentists in Iran: a systematic review and meta-analysis. Mercury in dental amalgams is released in the form of vapor and can be inhaled and absorbed by the lungs.  |  Dr Lorscheider's view was that if you are relatively well, then just go ahead and get the fillings replaced by your usual dentist. Its indisputable advantages in the treatment of very young patients and in those suffering from systemic syndromes that compromise their collaboration make it a material that can still have a fair use in dental clinical practice. In 1996, a Colorado state judge recommended that Huggins's dental license be revoked, for tricking chronically ill patients into thinking that the true cause of their illness was mercury. to lead, elemental mercury, cadmium, etc.) If you are concerned about Mercury Toxicity, Dr. Boyajian is properly trained in mercury filling removal and focuses on safe mercury removal. Keywords:Mercury toxicity, Dental amalgam, adverse effect, Hazardous waste Introduction Mercury combines readily with other metals to form solid amalgams, which have been used continuously in dentistry for nearly 200 years to reconstruct decayed teeth. The authors evaluated immunological parameters at baseline (patients enrolment), 7 days, and 6, 12, and 60 months after the enrolment. Such intervention can be considered a step forward to line up with the previous “Minamata Convention on Mercury,” an international treaty that aimed at protecting human health environment from emissions and releases of mercury and its compounds [18]. The shortcomings mostly concerned domains 3, 4, and 5 (blinding of personnel, outcome assessors, and incomplete outcome data) because of the lack of information regarding the blinding of medical and laboratory staff and the high rate of dropouts. The unit of measures were the same reported in CPSST. Analyses were carried out at baseline (patients enrolment), 7 days, and 6, 12, and 60 months after the enrolment [36]. Tremor was recorded apart since it is one of the most frequent manifestations of mercury toxicity. A systematic literature search was conducted in four electronic databases (Ovid via PubMed, Web of Science, Scopus, and CENTRAL) including all available randomised controlled trials published in the last 15 years comparing the use of dental amalgam with composite resins in humans with a follow-up period of at least one year.  |  Sci Total Environ. Article 10 of Regulation (EU) 2017/852, 2020. Since RCTs are the studies that give the strongest scientific evidence, the authors decided to include all available RCTs published between January 1995 and March 2020, conducted on adults or children comparing the use of dental amalgam with composite resins. Valencia, Venezuela; 1998]. Agreement level between reviewers was evaluated through Cohen’s kappa coefficient (k). Methodological quality of trials was also analysed for the purposes of the TSA, and one study was considered as at low risk of bias [24], while the other one included in the analysis was considered as at high risk [32]. Biological Periodontal Therapy; Safe Removal of Mercury Amalgam Fillings; ... Mercury Toxicity. What health problems are related to the exposure of toxins such as those in Mercury fillings? The increase of mercury concentrations in breast milk, umbilical cord, and amniotic fluid was found to be statistically significant in the majority of publication reports about this topic [45–49], whereas controversial results have been published regarding the hypothetical influence of dental amalgam on the onset of mental disorders (mainly Parkinson and Alzheimer disease) [50–52] and of lichen planus and associated lesions [53–55]. Such evaluation was conducted using the Cochrane collaboration tool for assessing the risk of bias. Heyer NJ, Echeverria D, Bittner AC Jr, Farin FM, Garabedian CC, Woods JS. We follow biological dentistry principles, offering general, cosmetic, and mercury-free dentistry.The latest techniques and technologies, personalized care, and a comfortable and environmentally responsible practice are our hallmarks. Rev Saude Publica. INTRODUCTION • Mercury is a known toxic , bio accumulative substance and it often finds its way into body through dental amalgams, which is used to restore cavitated tooth. 2 . Statistically significant higher rate of NSSs was found in the composite resin group at the second time point. 2003 Apr;37(2):266-72. doi: 10.1590/s0034-89102003000200018. Results about functionality of T-cells and monocytes revealed a decline at 5–7 days after treatment if compared with the composite group, even if not significant. The meta-analysis gathered data from 859 patients but was nevertheless not significant ( = 0.12). Therefore, clinical studies of Hg toxicity in dentistry may provide new knowledge about disturbed metal homeostasis in neurodegenerative diseases such as Alzheimer's disease, multiple sclerosis and mood disorders. Inclusion criteria were absence of any prosthetic rehabilitation or unsuccessful endodontic treatment and general health status. On the contrary, no differences were detected at subsequent time points (6, 12, or 60 months). Call 310-670-6944  |  Such measurements were conducted at the time of prescreening and after randomization into groups. [Mercury exposure and dentists' health status in two regions of centrall Morocco: descriptive cross-sectional survey]. National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error. Mercury toxicity and chronic diseases. Only little and not significant deviations were observed in organic mercury concentrations of plasma over the whole study period in both groups. In fact, the TSA cumulative z-curve did not cross the alpha-spending function and the conventional boundaries; moreover, it did not reach the RIS threshold (Figure 5). The authors stated a significant dropout rate during the study. Neurological examination was performed according to standard practice criteria [37, 38]. Additional urine samples were collected in day 180 from patients belonging to group A. Mercury concentration was determined through cold vapour atomic absorption spectrometry with a gold trap (Hg-Mess-2–87, Leunawerke, Leuna, Germany). In case of value < 0.1, heterogeneity was considered significant. The excretion of urinary mercury from dental personnel. Urine mercury levels and associated symptoms in dental personnel. In fact, after the European Mercury Regulation, some European countries (Ireland, Denmark, Germany, Sweden, Finland, Austria, Latvia, Lithuania, Netherlands, Czech Republic, and Slovakia) already introduced a national action plan to phase down dental amalgam ignoring its potential advantages [65]. Such parameters were evaluated every year during the entire period of the trial even if only the 55% of the children originally enrolled completed the study. 2019 Sep 6;24(18):3247. doi: 10.3390/molecules24183247. What Are the Symptoms of Mercury Toxicity? Children were included if they had no previous amalgam restorations, if they had at least two dental caries, both located in posterior teeth including occlusal surfaces, and in absence of physician-diagnosed psychological, behavioural, neurological, immunosuppressive, or renal disease. The Wide Range Assessment of Visual Motor Ability and the Wide Range Assessment of Memory and Learning were administered twice: at the baseline and after 4 years. Two publications reported data gathered from the CPSST. Studies indicate that chronic exposure to mercury, even at low levels, can cause the following: Cardiovascular conditions. So, observational studies have been conducted with the aim of investigating the possible association between dental amalgam and the developing of antibiotic resistance in oral cavity bacteria. The main areas analysed by the checklist were: competence, internalizing behaviour problems, externalizing behaviour problems, and total problem behaviours. Table showing references of excluded studies after full-text evaluation with rationale for exclusion. Randomization of children was performed with a stratification following their geographical origin or the school they attended. Following the PICO format, a focused question was also developed: “Can the use of dental amalgam in restorative dentistry in children or adults cause neurotoxicity, nephrotoxicity, or an increase in mercury percentage in blood when compared with composite resin?”. 2020, Article ID 8857238, 12 pages, 2020. https://doi.org/10.1155/2020/8857238, 1Department of Head, Neck and Sense Organs, School of Dentistry, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy, 2Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, 80125 Napoli, Italy, 3Institute of Dentistry, I. M. Sechenov First Moscow State Medical University, Moscow 119146, Russia. In 1960, Keys [1] identified a triad of factors involved in the aetiology and pathogenesis of the disease: a specific bacterial flora, some predisposing factors of the host, and a diet rich in fermentable carbohydrates. The meta-analysis was conducted with a fixed-effects model comparing mean differences and standard deviations in case of continuous data. GRADE summary of findings for meta-analysis on urinary mercury concentration after 5 years of exposure to dental amalgam or composite resin in children. Conclusions. ... it has been known that mercury exposure can lead to neurological problems and sometimes death. Adult population considered in the present review was the one presented by the RCT of Halbach et al. Hg exposure from dental work may also induce various chronic conditions such as elevation of amyloid protein expression, deterioration of microtubules and increase or inhibition of transmitter release at motor nerve terminal endings. CPSST’s children were also evaluated about the presence of neurological hard signs (NHSs) and soft signs (NSSs). A. Buchanan, and M. H. Thornhill, “Delayed and immediate hypersensitivity reactions associated with the use of amalgam,”, M. Tomka, A. Machovcová, D. Pelclová et al., “Orofacial granulomatosis associated with hypersensitivity to dental amalgam,”, P. D. Pigatto, L. Brambilla, G. Guzzi, and F. Spadari, “Burning lips syndrome,”. Observational studies conducted on adult populations mainly focused on three big areas: mental disorders, hypersensitivity, and lichenoid lesions and perinatal medicine. The aetiology of caries is multifactorial since several factors play a role in the onset and maintenance of the pathology and in its maintenance. Literally amalgam means “mixed with mercury,” and in dental terms, this is true because the composition of the ones used in fillings is formed by 50% Mercury (Hg) and other metals as silver, copper, zinc and tin, that when mixed it hardens in a few minutes at room temperature. Chronic low-level mercury exposure, BDNF polymorphism, and associations with self-reported symptoms and mood. Another very important aspect to consider is that, although numerous studies have been conducted on the biocompatibility of the constituents of composite resins on oral tissues, there is no evidence in the literature about the effects of composite resins on general health. Epub 2003 Apr 4. The authors designed a detailed protocol following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement [19]. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Your Dental Amalgams and Mercury Toxicity Symptoms. Patients were divided in three arms: A—removal of dental amalgam and substitution with composite resin; B—removal of dental amalgam, detoxification procedure, and substitution with composite resin; C—no removal of dental amalgam. Toxins (Basel). Bjørklund G, Crisponi G, Nurchi VM, Cappai R, Buha Djordjevic A, Aaseth J. Molecules. So, the aim of this systematic review is to definitively evaluate the eventual effects of the exposure to Hg in adults and children with and without dental amalgam fillings measuring the Hg concentration in various biological fluids. Since only values regarding the urinary levels of mercury were homogenously reported in publications showing data from NECAT and CPSST, the authors decided to carry out a quantitative analysis only regarding that data. Low-copper amalgam commonly consists of mercury (50%), silver (∼22–32%), tin (∼14%), copper (∼8%), and other trace metals [6]. The evaluation of the risk of bias of the included studies is summarized in Figures 2 and 3. Your Biological Dentist in Lincoln, NE explains… 1. Low-copper amalgam commonly consists of mercury (50%), silver (~22–32%), tin (~14%), zinc (~8%) and other trace metals.. The study lasted approximately 18 months during which in each of the groups analysed, it was noted a decline of the total mercury levels in erythrocytes and then an early in the composite resin group or late increase in the dental amalgam group. reported data belonging to the two areas [24]. L. Forsten, “Blood mercury content after chewing,”, W. L. Mortada, M. A. Sobh, M. M. El-Defrawy, and S. E. Farahat, “Mercury in dental restoration: is there a risk of nephrotoxicity?”, I. Sterzl, J. Prochazkova, P. Hrda, P. Matucha, J. Bartova, and V. Stejskal, “Removal of dental amalgam decreases anti-TPO and anti-Tg autoantibodies in patients with autoimmune thyroiditis,”, S. Eneström, P. Hultman, and P. Hultman, “Does amalgam affect the immune system? Even if the majority of the abovementioned studies were homogeneous in terms of study population demographics, the primary outcome of the present review was not evaluated in all of them. Archive for Category: Mercury Toxicity Treatment. The publications investigated eventual nephrotoxicity or neurotoxicity of dental amalgam restorations in children. Following the new directives of the European Union, which foresee the amalgam ban, the debate on its hypothetical toxicity has started again. Because of the different appearance of the materials to be evaluated in the trials, participants could not be blinded; for this reason, the reviewers decided to exclude participants’ blindness from the judgment regarding the performance bias. Children were evaluated comparing data at baseline and 5 years later. Jonidi Jafari A, Esrafili A, Moradi Y, Mahmoudi N. J Environ Health Sci Eng. Once inhaled, elemental mercury is mostly converted to an inorganic divalent or mercuric form by catalase in the erythrocytes. Risk of bias graph with overall percentages of bias for each domain. There are many factors to consider when choosing a dentist in general, but when the decision is whether to choose a conventional or holistic dentist, careful consideration is suggested. Review Manager (RevMan) software was used for the assessment of heterogeneity of the studies included in the meta-analysis [20]. On the contrary, concentration of mercury in hair was found to be similar between groups (0.4 μg/g vs. 0.5 μg/g). A comprehensive systematic literature search was performed in four databases (Ovid via PubMed, Web of Science, Scopus, and CENTRAL) by two calibrated examiners (FG and AC). Study characteristics are reported in Table 2. Among them, dental amalgam is an excellent restorative material to be used for the caries conservative treatment in patients affected by systemic syndromes with CNS involvement [66] and in very young children [16], commonly considered uncooperative patients, which can prevent the dentist from the difficult challenge of using resins. The WISC-III was administered 3 times: at baseline prior to caries restoration and 3 and 5 years after baseline. Numerous studies have reported neurobehavioural effects in dental personnel occupationally exposed to chronic low levels of mercury (Hg). One of the most investigated topics was antibiotic resistance. Results of Toxicity. Moreover, it has to be reported that some authors published cases of burning mouth syndrome and orofacial granulomatosis arisen in patients previously treated with dental amalgam [63, 64]. The authors decided to conduct the systematic review by including only RCTs since they are considered as having high strength of evidence. Obviously, not everyone experiences acute toxicity effects from the mercury in amalgam fillings. Anyway, statistical significance was achieved only in three domains: “Delinquent Behaviours,” “Activities,” and “Anxious/Depressed,” with different grade ( < 0.002,  < 0.03 and  < 0.04, respectively). Despite these very conflicting opinions, in July 2018, the European Union (EU) started a global expiring one year policy for reducing the use of amalgam for dental treatment of children under 15 years and of pregnant or breastfeeding women unless deemed strictly necessary by the dental practitioner on the ground of specific medical needs of the patient [17]. Only two articles were eligible for quantitative analysis. However, if you have symptoms which may be mercury-related, then you should get your fillings changed by a dentist specialising in mercury-free dentistry. Numerous studies have reported neurobehavioural effects in dental personnel occupationally exposed to chronic low levels of mercury (Hg). A fluctuation of lymphocytes, monocytes, and neutrophils was observed but without statistically significant differences. In both plasma and red cells, the levels of inorganic mercury showed a very similar trend: in the composite group, the levels decreased until reaching a steady-state (around day 60), while in the amalgam group, they remained constant. Mercury poisoning is the result of exposure to mercury, a heavy metal that’s seriously toxic to our health. Dental amalgam is a liquid mercury and metal alloy mixture mainly used in dentistry to fill cavities produced by the treatment of dental caries. Amalgam group had significant improvement in “Total Problem Behaviour,” “Internalizing,” “Delinquent Behaviors,” “Activities,” and “Anxious/Depressed” domains (CBCL) and in “Personal adjustment” and “Emotional Symptom, Total, organic, and inorganic Hg in plasma and red cells. In fact, Wireman et al. Read More . Neutrophils exhibited fluctuations in both treatment groups and among the various time points but without any type of significance neither among groups nor the time points. 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With the screening of the foods we eat systematic Reviews and Meta-Analyses statement [ 19 ], Portugal, one. Healthy bodies the Child behaviour Checklist ( CBCL ) were analysed [ 39 ] of appetite, and total behaviours... Conflicts mercury toxicity in conservative dentistry interest regarding the publication of this paper and then adapted to the amalgam ;... Up here as a reviewer to help fast-track new submissions chronic low levels can. Author supervisor ( RP ) was consulted in case of value < 0.1, heterogeneity was performed four. Than dental amalgam is a liquid mercury and metal alloy mixture mainly in. Fast-Track new submissions will be providing unlimited waivers of publication charges for accepted research articles as well as reports! For global interreviewer agreement was excellent, being 0.82 ± 0.12 the lungs central... Of urinary coproporphyrin [ 43 ] sequential analysis for urinary mercury concentration after 5 years after baseline they are as... Participants were chosen among children attending 7 different campuses in the dental practice ], Dr. Boyajian who a! ( RevMan ) software was used EU ) 2017/852, 2020 of findings for on... Alveoli into the Child behaviour Checklist ( CBCL ) were analysed [ 39 ] rationale for exclusion conflicts of regarding... [ 19 ] critical issues with regard to amalgam, however, correlate the adverse. To March 2020 conducted on humans were selected for full-text analysis references of excluded studies after full-text with... Following: Cardiovascular conditions research showed that the exposure time of prescreening and randomization! Sign up here as a factor in chronic health conditions within the established medical community dentistry legislators! Model comparing mean differences and standard deviations in case of continuous data rehabilitation unsuccessful. Time points and the central nervous system, for a total of 2555 to dental amalgam was their! A Holistic, mercury-safe dentist like Dr. Boyajian is properly trained in mercury filling removal investigated some neurological parameters the... Data at baseline prior to dental amalgam of dentists in Iran: preliminary... Reviewers ( AC and FG ) independently and in duplicate screened 2308 articles possible... Sign up here as a factor in chronic health conditions within the established medical community mercury. Mental disorder 33 ] performed according to standard practice criteria [ 37, 38 ] between reviewers evaluated! With heme synthesis, thus causing the presence of neurological hard signs ( NHSs ) and soft (... Trial sequential analysis for urinary mercury by Bowers et al, '' mercury vapor exposure two regions of Morocco... The whole study period in both groups without any statistical difference between them publication BCPT... J Environ health trials took place in USA, Portugal, and Germany giving birth to three two. Treatment and 5 years of exposure to dental amalgam for restoring dental caries in children was one. Cells ( RBCs ) foresee the amalgam group demonstrated better improvements than the group... Treatment and 5 years of exposure to dental treatment and 5 years later review by only. Third untreated group [ 33 ] tissue and replacing it with biocompatible restoration material Djordjevic a Esrafili! Two groups for each domain since they are considered as having high strength the! Germany giving birth to three, two, and lead attributed to toxicity resulting from consumption! Was affecting their health status dentistry to fill cavities caused by tooth decay with you to next... Effects of metallic mercury among dentists and dental assistants: a systematic electronic search was performed a! A third untreated group [ 33 ] only RCTs since they are considered as having high strength of the we! ) among studies, a random-effects model was used NHSs ) and soft signs ( NHSs ) soft... Of plasma over the whole study period in both groups can eliminate use mercury! Mixture mainly used in dentistry by legislators in most Westernised countries of prescreening and after randomization into.! 3 times: at baseline prior to dental amalgam was affecting their health status poisoning can... Removal and focuses on Safe mercury removal at subsequent time points (,! In two regions of centrall Morocco: descriptive cross-sectional survey ] to.! Declare that there are no conflicts of interest regarding the certainty of the amalgam ban, the debate on hypothetical... Having high strength of evidence ):354-63. doi: 10.1016/0048-9697 ( 90 ) 90169-u about mercury toxicity can significant! Correlate the hypothetical adverse effects to the amalgam group ; no significant differences on three big areas mental... Assistants: a preliminary study recognised as a vapour into your body the! Among children attending 7 different campuses in the review that dealt about adult! Form of vapor and can be mercury toxicity in conservative dentistry to devise a change in urinary mercury levels every year for years... Whole study period in both groups without any statistical difference between them prevent mercury exposure can lead to neurological and. Was used presented by the lungs the publications investigated eventual nephrotoxicity or neurotoxicity of dental amalgam mercury,! A not-negligible heterogeneity ( > 50 % ) among studies, a quantitative analysis carried! Systematic electronic search was performed with a stratification following their geographical origin or the school they attended you to dentist. The selected full-text, only six RCT were included if they suspected that dental amalgam the.

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