Amalgam: to remove or not to remove?

Hi Everyone,

 Check out this article from my favorite dentist, Dr. Carliza Marcos in San Carlos.  We often refer to Dr. Marcos for those with mercury fillings and TMJ issues. Mercury is something not to be taken lightly. Read the article and see Dr. Marcos to remove your mercury fillings as soon as possible.

In Health,

Brien

by Dr. Carliza A. Marcos

(650) 593-9888

www.MarcosAndMarcosDDS.com

This article will describe what we know about amalgam, what we don’t know, and what we surmise. It is meant to provide patients with background scientific information about amalgam, so that they can make an educated, informed consent to treatment.

Amalgam is the commonly used silver filling material.  Its actual composition is approximately 50% silver alloy (containing silver, copper tin, zinc and other metals), and 50% liquid mercury. Most of the controversy surrounding amalgam concerns the mercury content.

Amalgam has been dentistry’s main filling material since the early 19^th century, and many dentists still use it routinely, although its use has been declining as the reliability of newer material has become accepted. It is very effective in restoring teeth and the American Dental Association (ADA) and allied authorities strongly proclaim its record of safety and effectiveness. The ADA has consistently claimed that mercury is stable within amalgam, and if it is released at all, it is in quantities too small to cause harm. The dental establishment condemns the practice of removing intact fillings to reduce a person’s exposure to mercury, in order to affect their overall health.

A great body of evidence regarding amalgam has been accumulated over time.  Research has established the chain of toxic events: 1) amalgam releases significant amounts of mercury; 2) the mercury distributes to tissues around the body, and is the biggest source of mercury body burden; 3) the mercury from amalgam crosses the placenta and into breast milk, resulting in significant pre- and post-partum exposures for infants; and 4) adverse physiological changes occur from that exposure on the immune, renal, reproductive and central nervous systems, as well as the oral and intestinal flora.

Amalgam releases significant amounts of mercury.

The current best accepted reference on absorbed dose of mercury from amalgam fillings comes from the World Health Organization proceedings of 1991[1], which was the report of a meeting of toxicologists and environmental health specialists (few dentists and no industry lobbyists, the opposite of the 1997 WHO meeting!). The conclusion of that group was that the average person in the industrial world with an average number of amalgam fillings, and no occupational exposure to mercury would absorb between 3 17 ?g per day, with an average of 10 ?g, from the fillings; 2.3 ?g from all dietary sources; and 0.3 ?g from all other environmental sources.

A chart summarized seventeen separate estimates of mercury exposure due to amalgam in adults. The range of the estimates intersects with limits recommended for non-occupational exposure by several agencies, including the Agency for Toxic Substances and Disease Registry of the US Public Health Service, Health Canada, and the US Environmental Protection Agency, as shown by the vertical red lines.

Mercury distributes to tissues around the body. 

Amalgam typically provides the greatest portion of mercury to be found in the human body. Several autopsy studies showed a correlation between the mercury concentration in various tissues and organs of the human cadavers and the number of fillings or surfaces of amalgam present.[2]  Blood levels of mercury correspond to amalgam exposure.

Maternal fetal transfer of mercury. 

Babies, with their still-developing nervous systems, are known to be more sensitive to the effects of mercury exposure than adults. Pediatric authorities say: The developing fetus and young children are thought to be disproportionately affected by mercury exposure, because many aspects of development, particularly brain maturation, can be disturbed by the presence of mercury. Minimizing mercury exposure is, therefore, essential to optimal child health.” And Mercury in all of its forms is toxic to the fetus and children, and efforts should be made to reduce exposure to the extent possible to pregnant women and children as well as the general population. ^[3]

This was made tragically clear in the case of the Minamata Bay methyl mercury poisoning, in Japan in the 1960’s, where children were born with profound developmental disturbances, while the adults suffered much less. There is substantial experimental literature on the neuro teratological effects of mercury, where both humans and animals exposed to low doses of mercury in utero and soon after birth show measurable deficits in intelligence, coordination, and other measures of neurological development (and hundreds more). And now there is an added controversy about vaccines preserved with thimerosal, a form of ethyl mercury, possibly causing neurological damage in infants, including autism.

Immune System: 

The allergic hypersensitivity to mercury issue is interesting. The North American Contact Dermatitis Group, in 1972, determined that 5 – 8% of the US population demonstrates allergy to mercury by skin patch testing. [4] Djerassi and Berova [5] patch tested 180 subjects with amalgam fillings, and found that 16.1% of those without allergic disease, and 22.5% of those with allergic disease, tested positive for mercury allergy. Of sixty subjects without amalgam fillings, none tested positive for mercury allergy.

Dentists have developed no method of screening patients for contact dermatitis or for their susceptibility to metal sensitive autoimmune responses. However, naturopath doctors can test for mercury allergies.

Renal System: 

Mercury, we now know, concentrates in the kidneys, and experimental evidence shows that it can inhibit kidney function. Mercury is known to concentrate in the proximal tubules, which are the primary site of sodium re-uptake, so it makes sense that urinary sodium excretion is increased if the mercury is inhibiting the function of those cells.  Although these effects could be described as subclinical, in that overt disease was not induced, it demonstrates how much stress is placed upon the kidneys by the presence of amalgam, and suggests how patients with kidney malfunction may be endangered by amalgam fillings.

Intestinal Flora: 

A study was done at the Department of Microbiology, University of Georgia, investigating resistance to antibiotics among intestinal bacteria.  They discovered an unexpectedly high percentage of resistance in the flora of individuals who had had no recent exposure to antibiotics. They found that the genes for antibiotic resistance in these bugs were linked, on plasmids, to a gene for resistance to mercury toxicity. Therefore, subjects with a high percentage of mercury resistant bacteria in their intestines were significantly more likely to have bacteria with multiple antibiotic resistances as well. It was ecological pressure for mercury resistance that seemed to be maintaining the high prevalence of resistance in these gut flora samples. But where was the mercury coming from? 

To test the hypothesis that dental amalgam could provide enough mercury exposure to drive this ecological selection, monkeys were given amalgam fillings. Their intestinal flora showed a marked increase in the proportion of mercury resistant bacteria, and the increase was maintained until the amalgams were removed. Most of the mercury resistant microbes also possess resistance to one or more antibiotics.[6]

The implication of this finding for human medicine is unproven. But at the very least, it shows again that amalgam, while perhaps not causing overt disease, has a detectable effect upon the homeostasis of the body that is not benign.

The unique neurotoxicity of mercury, and the Alzheimer’s connection.

Researchers Markesbury, Ehmann, Vance, and associates published a series of papers in which they described a variety of trace mineral changes in the Alzheimer brain as compared to controls from patients with other psychiatric diseases or normal brains. They consistently found elevated concentrations of mercury, in various regions and subcellular fractions in the Alzheimer brain samples. Other labs found elevated mercury in the blood and cerebrospinal fluid of Alzheimer patients.[7]

Dental amalgam has never been formally approved by the FDA, and the Environmental Protection Agency considers discarded amalgam to be toxic waste.

In my office, I have decided that there is no longer any justification for using amalgam. Besides the controversial scientific background surrounding mercury, there are so many modern, more predictable and more esthetic restoration choices available now. Having said that, I feel it is important that patients be aware of all risks, benefits and options for treatment. When existing fillings are mechanically intact, it must be the patient’s exclusive, personal choice to have them replaced with other materials.

Risks of Replacing Amalgam Fillings

Treatment Options

1. It is always an option to do nothing, to undergo no treatment.
2. Replacement of amalgam fillings can be performed as they break down in the normal course of events, as a matter of routine dentistry.
3. A treatment program to deliberately remove and replace amalgam fillings can be designed for the individual, including:

o A comprehensive examination and treatment plan to assure the best dental outcome

o  An effort to determine which new dental materials would be the most biologically compatible to the patient. 

For more information and/or an evaluation, please feel free to contact me:

Dr. Carliza Marcos (650)593-9888 or email: [email protected]