IAOMT eNewsletter Vol. 1 #3

The President’s Message

Is it not, therefore, hypocritical for JAMA to publish
the severely flawed, ethically challenged children's
mercury exposure experiments?
more…

JAMA papers perpetuate the myth

Our physician colleagues at the American Medical Association, sadly and surprisingly, allowed two seriously flawed papers about mercury silver dental fillings to be published in its flagship journal, JAMA, on April 19, 2006
more…

NIDCR funded researchers looked for mercury in all the wrong places

Seven major flaws in the two studies, recently published in JAMA, invalidate the authors’ comparison of children with dental mercury fillings with youngsters who were amalgam free.
more…

IAOMT filed ethical complaints with IRBs of universities whose personnel conducted the children’s mercury exposure study of orphans and indigent children.

On the same day the two children mercury exposure studies above were published, the IAOMT filed 5 ethical complaints with the university Institutional Review Boards responsible for allowing these investigators to violate the very basic principles of informed consent and patient protection during human experiments.
more…

Safe removal of amalgam fillings

Mercury-free dentists have devised strategies to reduce the amount of mercury exposure to both patients and dental staff during amalgam removal. The strategies are the barrier and ventilation techniques as well as the “biological support” nutritional methods that “treat” the anti-oxidant and excretory systems stressed by heavy metal exposure.
more…

The Scientific Case Against Amalgam

Since its introduction early in the 19th century, dental amalgam has been controversial because of its poisonous mercury content. Throughout the years, those defending mercury fillings only could claim that the mercury exposure had to be too small to hurt anyone. Over time, though, a great body of evidence has accumulated showing that mercury is release from amalgam in significant quantities, that it spreads around the body, including from mother to fetus, and that the exposure causes physiological harm. A growing number of dentists, physicians, researchers, citizen activists, politicians, and regulators have concluded that the time has come to consign amalgam to the “dustbin of history.”
more…

President's Message

When I received what was then the latest edition of The Merck Manual, the compendium of differential diagnosis and treatment in internal medicine, I discovered that this centenary edition included a facsimile of the first publication printed in 1899. Recently, out of curiosity, I went to the index of that slender volume and counted 19 different mercury compounds listed for various therapeutic applications. Opening to the index in the 1999 edition, I found only one entry for mercury: Mercury Toxicity. Yet, the American Dental Association, in the manner of a strong trade organization, holds onto this 170-year-old technology through ignorance, deceit and denials.

How can it be that the medical profession has totally removed mercury from its pharmacopoeia in the past 100 years, even belatedly beginning to eliminate thimerosal, the ethyl-mercury preservative, from vaccines, while the dental profession is not far removed from the medieval practice our dental forefathers of shaving silver coins into elemental mercury?

Is it not, therefore, hypocritical of the JAMA to publish the severely flawed children’s amalgam trial (which I refer to as the children’s mercury exposure experiments)? How ironic that the AMA that expresses such concern about mercury in the environment and rejects its use in any form of medication, feels that it finds “safe haven” in the mouths of our patients.

To stretch the time line of one of Dr. Boyd Haley’s aphorisms: “is this what it’s like to have a 170-year-long argument with the town drunk?”

Opinion’s of IAOMT President Terrence Messerman <TMesserman@aol.com>

Smoking Teeth

Safe removal of amalgam fillings

Mercury-free dentists have devised strategies to reduce the amount of mercury exposure to both patients and dental staff during amalgam removal. The strategies are the barrier and ventilation techniques as well as the “biological support” nutritional methods that “treat” the anti-oxidant and excretory systems stressed by heavy metal exposure.

Full Article in Adobe Acrobat format from link:

The Scientific Case Against Amalgam

Dental amalgam has been controversial ever since it was introduced, early in the nineteenth century, because of its mercury content. People of the Napoleonic era knew full well that mercury was poisonous, and the best that anyone has ever claimed about amalgam is that the mercury exposure may be too small to hurt anyone. Over time, though, a great body of evidence has accumulated showing that mercury is release from amalgam in significant quantities, that it spreads around the body, including from mother to fetus, and that the exposure causes physiological harm.

Full Article in Adobe Acrobat format from link:

Ethical Complaint against 5 IRBs

The following ethical complaint was sent by the International Academy of Oral Medicine and Toxicology to the five academic institutions involved with the children’s amalgam trials. IAOMT has yet to receive a response from the institutions’ Institutional Review Boards .

April 18, 2006
Dear Sirs:

Leading scientific researchers, dentists and patient advocates and the entire Board of Directors of the International Academy of Oral Medicine and Toxicology (IAOMT) call upon each of you to immediately refer this letter to the appropriate Institutional Review Board (IRB) for investigation of a human experiment with mercury conducted on indigent and orphaned children and co-sponsored by your institutions.

On Wednesday, April 19, 2006, the Journal of the American Medical Association will publish articles about two studies we feel are unethical that were co-sponsored by your institutions. In the studies, hundreds of children – public health clinic visitors aged 6-10 in New England, and orphans aged 8-10 in Portugal – were given mercury-leaking dental fillings. They were then monitored for 5 to 7 years for signs of lowered IQ, diminished motor skills, and kidney damage.

Our academy ceased funding human studies into the toxic effects of mercury in humans in 1985 because of ethical concerns. We continued to experiment with animals, and virtually all published research to date confirms the fact that mercury silver dental fillings continuously leak mercury into the body of those who have this type of filling implanted in their teeth. In 1991, the World Health Organization reviewed the then-available research and concluded that dental amalgam is the predominant source of human exposure to mercury (WHO Criteria Document 118). This research only confirms what has already been thoroughly studied.

These studies were designed to fail to detect adverse health effects that take much longer to manifest than the time period of the studies. Two different genetic subsets of the population (APOe 4/4 or 4/3 and CPOX4) have been found exceptionally susceptible to the toxic effects of mercury. No attempt was made to protect these vulnerable subsets or even identify them in this research.

We are alarmed by the exposure to mercury borne by an uninformed population. We are also alarmed by the investigators’ patent failure to acknowledge and recognize the documented risks associated with the adverse effects attributable to dental amalgam. Finally, we are alarmed by the failure to acknowledge the vast body of science demonstrating that dental amalgam presents a profound risk of harm to those in whom it is implanted. (A documented discussion of the risks posed by dental amalgam is attached hereto as Exhibit 1.)

Exposing children to a powerful neurotoxin is an egregious violation of the parents’ trust and morally and ethically wrong, but to expose them to this toxin without obtaining adequate informed consent is also illegal. The children and their parents were not adequately warned that mercury is suspected in autism, long-term neurological damage and Alzheimer’s Disease, as described in the attached summary of research findings, or that as many as 25% of the population is genetically predisposed to sustain greater damage from even minimal mercury exposure. They were not told that substantial amounts of mercury leak out of all mercury silver dental fillings. They were also not told that the mere act of placing a mercury silver dental filling exposes the child to a large bolus dose of mercury. In Portugal they weren’t even told that the fillings contained mercury. An extensive critique of the consent forms for these studies can be found at: http://www.toxicteeth.org/Critique-CACF.pdf

These studies are so ethically challenged that we cannot conceive how they were ever approved by an IRB that is familiar with the laws established to protect the innocent from such human experimentation. We request that you immediately forward this complaint to the IRBs which allegedly monitored the Children’s Mercury Exposure Studies, and obtain detailed reports thoroughly reviewing their evaluation of the informed consents that were to be obtained, the results of the ongoing safety monitoring, the questions which were raised, and conclusions made regarding the efficacy, safety and legality of these studies. We would like a copy of those reports and your position on the adequacy of the report related to your institution.

Sincerely,

Terrence Messerman, President
International Academy of Oral Medicine & Toxicology

Letter was sent to:

Lawrence H. Summers, President
Harvard University
Office of the President
Massachusetts Hall
Cambridge, MA 02138
Fax: (617) 495-8550
HYPERLINK "mailto:lawrence_summers@harvard.edu" lawrence_summers@harvard.edu

Robert A. Kennedy, President
University of Maine
Office of the President
5703 Alumni Hall Suite 200
Orono, ME 04469
Fax: (207) 581-1517

James Mandell, MD
President and Chief Executive Officer
Children’s Hospital Boston
Department of Urology, Hunnewell 3
300 Longwood Avenue
Boston, MA 02115
Fax: 617-730-0474

Sonja McKinlay, Ph.D.
New England Research Institute
Office of the President
9 Galen Street
Watertown, MA 02472
Fax: 617.926.8246
HYPERLINK "mailto:smckinlay@neriscience.com" smckinlay@neriscience.com

Mark A. Emmert, Ph.D., President
University of Washington
Office of the President
301 Gerberding Hall
Box 351230
Seattle, WA 98195-1230
Fax (206) 616-1784
HYPERLINK "mailto:pres@u.washington.edu" pres@u.washington.edu




FACT SHEET
SCIENTIFIC STUDIES CONCERNING MERCURY DENTAL FILLINGS

1. Mercury is a very toxic substance-- more toxic than lead, cadmium, or arsenic.

Sharma, RP,Obersteiner, EJ., Metals and Neurotoxic Effects: Cytotoxicity of Selected Metallic Compounds on Chick Ganglia Cultures, J Comp Pathol, 91(2): 235-44 (1981).

2. At least 17 separate studies have confirmed that dental patients absorb a daily dose of mercury derived from their mercury fillings. Mercury is not rendered chemically inert in dental fillings.

These studies were recently summarized in the following paper: Richardson, G.M., Inhalation of Mercury-Contaminated Particulate Matter by Dentists: An Overlooked Occupational Risk, Human and Ecological Risk Assessment, 9:1519-1531 (2003). A fact sheet on ADA's website says, "Minute amounts of mercury vapor (between 1‑3 micrograms per day) may be released from amalgam under the pressure of chewing or grinding." http://www.ada.org/public/media/releases/0207_release01.asp

3. On average, 80 percent of the mercury inhaled into the lungs is absorbed into the bloodstream.

Kudsk, F.N., Absorption of Mercury Vapour from the Respiratory Tract in Man, Acta Pharmacol. et Toxicol. 23:250-262 (1965).

4. The general population in America absorbs more mercury from dental fillings than from any other source. Studies demonstrate that two-thirds of the mercury absorbed by non-occupationally exposed populations is derived from amalgam fillings.

Aposhian, H.V., et al., Urinary mercury after administration of 2,3-dimercap-topropaane-1-sufonic acid: correlation with dental amalgam score, FASEB J, vol. 6 (April 1992), pp. 2472-2476. See also, Sandborgh-Englund, et al., Mercury in Biological Fluids After Amalgam Removal, J Dent Res, 77(4): 615-24 (Apr. 1998); World Health Organization, Environmental Health Criteria 118: Inorganic Mercury (1991) p. 36; Clarkson, T.W.; et al., Biological Monitoring of Toxic Metals: The Prediction of Intake of Mercury Vapor From Amalgams (1988) p. 256. (“The release of mercury from dental amalgams makes the predominant contribution to human exposure to inorganic mercury including mercury vapor in the general population.”); Lorscheider, FL; et al., Mercury Exposure from Silver Tooth Fillings: Emerging Evidence Questions a Traditional Dental Paradigm, FASEB J., 9:504‑8 (1995). (“[D]ental amalgam tooth fillings are the major source of Hg exposure for the general population.”)

5. The mercury absorbed from dental fillings exceeds published government toxic thresholds for mercury.

The Agency for Toxic Substances & Disease Registry minimum risk level for mercury is 2.4 µgs/day. (ATSDR, Toxicological Profile for Mercury.) The EPA’s reference dose for mercury is 3.84 µgs/day. (U.S. EPA. "Health Effects Assessment Summary Tables: FY‑1997 Update" (1997).) Health Canada’s tolerable daily intake for mercury is 1.4 ugs/day. (Health Canada, Assessment of Mercury Exposure and Risks From Dental Amalgam: Final Report, Medical Devices Bureau, Environmental Health Directorate.) The World Health Organization, Environmental Health Criteria 118: Inorganic Mercury (1991) p. 36, concludes that persons with mercury fillings absorb 3 to 17 micrograms of mercury per day. This document reflects that the consensus average estimate of 10 µgs absorbed per day, an uptake corroborated by a more recent daily estimate of 12 µgs/day. Skare, I, et al., Human Exposure to Mercury and Silver Released from Dental Amalgam Restorations, Archives of Environmental Health, vol. 49, no. 5, pp. 384‑394 (Sept.‑Oct. 1994). Levels for some individuals may be as high as 100 µgs/day. Lorscheider, FL, et al., Mercury Exposure from Silver Tooth Fillings: Emerging Evidence Questions a Traditional Dental Paradigm. FASEB J., 9:504‑8 (1995).

6. A specific no‑observed‑effect level (NOEL) cannot be established, meaning that no level can be established at which mercury does not adversely affect the body.

World Health Organization, Environmental Health Criteria 118: Inorganic Mercury (1991) p. 36.

7. Peer‑reviewed studies have established that adverse health affects have been associated with mercury vapor derived from amalgam fillings.

Summarized in: Lorscheider, FL, et al., Mercury Exposure from Silver Tooth Fillings: Emerging Evidence Questions a Traditional Dental Paradigm. FASEB J., 9:504‑8 (1995).

Ziff, M.F., Documented Clinical Side‑Effects to Dental Amalgam, Advanced Dental Research, 6:131‑4, 1992. An extensive list of diseases that have been linked to amalgam in the peer‑reviewed scientific literature, including periodontal disease (gum disease).
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=1292453&dopt=Abstract

8. Mercury is transferred from a mother to her fetus during pregnancy and is transferred postnatally through breast milk.

Vimy, M.J.; Takahashi, Y.; Lorscheider, F.L., Maternal‑fetal distribution of mercury (203 Hg) released from dental amalgam fillings, The American Physiology Society, 0363‑6119/90 R939‑945. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=2331037

Vimy, M.J.; Hooper, D.E.; King, W.W.; Lorscheider, F.L., Mercury from Maternal "Silver" Tooth Fillings in Sheep and Human Breast Milk, Biological Trace Element Research, 56, 1997. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9164660&dopt=Abstract

9. The developing fetus and young children are disproportionately affected by mercury exposure, because many aspects of development, particularly brain maturation, can be disturbed by the presence of mercury.

Goldman LR, Shannon MW, Technical Report: Mercury in the Environment: Implications for Pediatricians. American Academy of Pediatrics: Committee on Environmental Health. Pediatrics (2001) Jul; 108(1): 197‑205.

10. Mercury derived from mercury fillings may impair kidney function.

Boyd, N.D.; Benediktsson, H.; Vimy, M.J.; Hooper, D.E.; Lorscheider, F.L., Mercury from dental "silver" tooth fillings impairs sheep kidney function, The American Physiological Society, 11: 1010‑1014, 1991.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=1928419&dopt=Abstract

11. Mercury has been linked to Alzheimer’s Disease.

Ehmann, et al., Brain Trace Elements in Alzheimer’s Disease, Neurotoxicology, 7(1): 195-206 (Spring 1986); Thompson, et al., Regional Brain Trace-element Studies in Alzheimer’s Disease, Neurotoxicology, 9(1): 107 (Spring 1988); Vance, Trace Element Imbalances in Hair and Nails of Alzheimer’s Disease Patients, Neurotoxicology, 9(2): 197-208 (Summer 1988); Wenstrup, et al., Trace Element Imbalances in Isolated Subcellular Fractions of Alzheimer’s Disease Brains, Brain Res, 12; 533 (1): 125-31 (Nov. 1990); Cornett, et al., Imbalances of Trace Elements Related to Oxidative Damage in Alzheimer’s Disease Brain, Neurotoxicology, 19(3):339-45 (June 1998); Mutter, Alzheimer Disease: Mercury as a Pathogenetic Factor and Apolipoprotein E as a Moderator, Neuroendocrinol Lett. 2004; 25(5): 275-283. (“Inorganic mercury [found in dental amalgam] may play a major role [in the pathogenesis of Alzheimer’s Disease.”]) Pendergrass, J. C., et al., Mercury Vapor Inhalation Inhibits Binding of GTP to Tubulin in Rat Brain: Similarity to a Molecular Lesion in Alzheimer's Disease Brain. Neurotoxicology 18(2), 315‑324 (1997); Pendergrass, J.C., Inhibition of Brain Tubulin‑Guanosine 5'‑Triphosphate Interactions by Mercury: Similarity to Observations in Alzheimer's Diseased Brain, Metal Ions in Biological Systems V34, Mercury and Its Effects on Environment and Biology, Chapter 16. Edited by H. Sigel and A. Sigel (1996); Duhr, E.F., et al., HgEDTA Complex Inhibits GTP Interactions With The E‑Site of Brain b‑Tubulin, Toxicology and Applied Pharmacology 122, 273‑288 (1993); Leong, CCW, et al., Retrograde Degeneration of Neurite Membrane Structural Integrity of Nerve Growth Cones Following In Vitro Exposure to Mercury, Neuroreport, vol.12, pps. 733-737 (2001); Duhr, E.; Pendergrass, C.; Kasarskis, E.; Slevin, J.; Haley, B., Hg2+ Induces GTP‑Tubulin Interactions in Rat Brain Similar to Those Observed in Alzheimer's Disease, Federation of American Societies for Experimental Biology (FASEB). 75th Annual Meeting. Atlanta, GA 21‑25 April 1991. Abstract 493; Palkiewicz, P.l; Zwiers, H.; Lorscheider, FL, ADP‑Ribosilation of Brain Neuronal Proteins Is Altered by In Vitro and In vivo Exposure to Inorganic Mercury, Journal of Neurochemistry 62: 2049‑2052, 1994. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?md=Retrieve&db=PubMed&list_uids=8158153&dopt=Abstract

12. Mercury has been linked to Parkinson’s Disease.

Ngim, C., Epidemiologic Study on the Association between Body Burden Mercury Level and Idiopathic Parkinson’s Disease, Neuroepidemiology, 8:128-141 (1989).

13. Mercury released from dental "silver" fillings provokes an increase in mercury and antibiotic resistant bacteria in oral and intestinal flora.

Summers, A.O.; Wireman, J.; Vimy, M.J.; Lorscheider, F.L.; Marshall, B.; Levy, S.B.; Bennett, S.; and Billard, L. "Mercury released from dental "silver" fillings provokes an increase in mercury and antibiotic resistant bacteria in primates oral and intestinal flora," Antimicrobial Agents and Chemotherapy, 37: 825‑834, 1993;
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=8280208; See also, Wireman, J.; Liebert, C.A.; Smith, T.; and Summers, A.O., Association of mercury resistance with antibiotic resistance in the gram‑negative fecal bacteria of primates, Applied Environmental Microbiology, 63/11: 4494‑4503, Nov 1997. http://aem.asm.org/cgi/content/abstract/63/11/4494

14. Animal studies demonstrate that exposure to mercury vapor can induce autoimmunity.

Hultman, P; et al., Adverse Immunological Effects and Autoimmunity Induced by Dental Amalgam and Alloy in Mice, FASEB J, 8:1183-90 (1994); Warfvinge, et al., Systemic Autoimmunity Due to Mercury Vapor Exposure in Genetically Susceptible Mice: Dose-Response Studies, Toxicol Appl Pharmacol, 132:299-309 (1995).

15. Mercury causes adverse health effects in dentists and dental personnel.

Echeverria, et al., Neurobehavioral Effects from Exposure to Dental Amalgam HgΕ: New Distinctions Between Recent Exposure and Hg Body Burden, FASEB J. 12, 971-980 (1998); Ngim, CH; et al., Chronic Neurobehavioral Effects of Elemental Mercury in Dentists, Brit J Indust Med, 49:782-90, 1992. Gonzalez-Ramirez, D; et al. Sodium 2,3-Dimercaptopropane-1-Sulfonate Challenge Test for Mercury in Humans: II. Urinary Mercury, Porphyrins and Neurobehavioral Changes of Dental Workers in Monterrey, Mexico. J Pharmocol Exper Therap, 272(1): 264-74 (1995); Echeverria, D; et al., Behavioral Effects of Low-Level Exposure to HgΕ Among Dentists. Neurotoxicol Teratol, 17(2): 161-8 (1995); Shapiro, I.M., et al., Neurophysiological and neuropsychological function in mercury-exposed dentists. The Lancet 1, 1147-1150 (1982); Uzzell, B.P., et al., Chronic low-level mercury exposure and neuropsychological functioning. J of Clin and Exper Neuropsych. 8, 581-593.
http://www.fasebj.org/cgi/content/full/12/11/971

16. The National Academy of Sciences estimates that 60,000 newborns a year could be at risk of learning disabilities because of mercury their mothers absorbed during pregnancy. Mercury in the tissues of fetuses and infants (11‑50 weeks of life) correlates significantly with the number of dental amalgam fillings of the mother.

Drasch et. al., “Mercury Burden of Human Fetal and Infant Tissues,” European Journal of Pediatrics (August 1994).

17. IAOMT's science contributed to Germany's ban on mercury fillings for women and children.

Germany's Ministry of Health decided to ban the use of mercury fillings in women and children in that country, following the International Academy of Oral Medicine and Toxicology conference in Düsseldorf in 1992.

Members of the dental profession had asked for an opportunity to present evidence of mercury fillings' safety. This conference consisted of 25 presenters and two moderators who are experts in mercury. The peer‑reviewed conclusions supported the German ban on exposure of children and women of childbearing age to mercury from mercury fillings.

Seven representatives of the IAOMT participated in the conference, giving peer‑reviewed presentations as follows:

F.L. Lorscheider, "Mercury Exposure from 'Silver' Dental Fillings: Current Research Findings about Uptake, Tissue Distribution, and Pathophysiology."
D.J. Pleva, "Mercury Release From Dental Amalgam."
D.C. Kennedy, "Biocompatible Restorative Dentistry," davidkennedy‑dds@cox.net
B.E. Haley & J.C. Pendergrass, "Mercury‑EDTA Complex Specifically Blocks Brain b‑Tubulin‑GTP Interactions: Similarity to Observations in Alzheimer's Disease," behaley@uky.edu
M.F. Ziff, "Dental amalgam: Status Quo, Political Aspects, International Situation."
J.V. Masi, "Corrosion of amalgams in restorative materials: the problem and the promise," HYPERLINK "mailto:jmasi@wnec.edu" jmasi@wnec.edu

18. Mercury vapor released by fillings is routinely measured in dentists' offices.

The Arizona Instrument Co. manufactures and sells a device that measures mercury vapor releases, the Jerome Mercury Vapor Analyzer. This device is used in dental offices nationwide and routinely records mercury vapors released from mercury fillings in the dental offices in which it is used. http://www.azic.com/products_431.aspx

The American Dental Association recommends that its members purchase such a device to determine their exposure to the vapor released by mercury fillings.
http://www.ada.org/prof/resources/pubs/jada/reports/report_mercury.pdf
The Jerome Mercury Vapor Analyzer is also widely relied on by government agencies such as Brookhaven National Laboratory and the U.S. Environmental Protection Agency. See for example http://www.bnl.gov/esh/shsd/ih/PDF/IH75530.pdf

19. There is more mercury in dental fillings than in all other products sold in America.

The U.S. Environmental Protection Agency states that 55% of all mercury in commerce today in the United States ‑ an estimated 1,088 tons of mercury ‑ resides in Americans' dental fillings, which have a typical lifespan of 10 years. An additional 34 tons of mercury is added in Americans' dental fillings every year. United States EPA International Mercury Market Study and the Role and Impact of US Environmental Policy 2004, referenced in Nov. 30, 2004 presentation by Linda Barr, EPA Office of Solid Waste, "EPA's Draft Mercury Use Reduction Program." See http://www.epa.gov/region5/air/mercury/meetings/Nov04/barr.pdf

20. The U.S. government has never tested mercury fillings for safety.

The U.S. Food and Drug Administration (FDA) regulates the constituents of dental filling materials, not mixed dental amalgam, the product used as a dental restorative material. Because mercury fillings were in use prior to passage of the 1976 Medical Devices Act, manufacturers were not required to present any evidence of safety and effectiveness, as is required of new materials. http://www.cdc.gov/oralhealth/factsheets/amalgam.htm

See also Washington State Department of Health, "Amalgam Dental Fillings." http://www.doh.wa.gov/ehp/oehas/amalgam_dental_fillings_12‑2003.htm#What%20are%20amalgam%20fillings

NIDCR funded research looked for mercury in all the wrong places

By Boyd Haley, Ph.D. Professor of Chemistry at the University of Kentucky

Anyone who cares about the health of our children would be wise to consider the flaws in the two recent JAMA papers about studies that were conducted in Portugal and New England and that compared youngsters with dental mercury fillings with those who were amalgam free[1] [2]. In designing their studies, the authors of these two papers evidently ignored recent research findings about mercury toxicity, particularly the results strongly suggesting that the level of mercury in blood, urine or feces may be influenced more by the child’s ability to excrete mercury than by his or her total mercury exposure.

The view that mercury toxicity can be traced to the child’s inability to excrete the metal comes from a wide range of studies, including research on autistic children[3]. These children are one of the subsets of the population that do not effectively excrete mercury. Scientists have shown that in comparison to non-autistic children, autistic children have less mercury in their blood, urine or feces but have much more in their body organs. Also, the aberrant porphyrin profiles of autistic children indicate that their ineffective mercury excretion is the result of an early exposure to this metal[4]. The almost normal porphyrin profiles that are produced in children who have undergone mercury chelation treatments supports the view that mercury toxicity is based on a child’s inability to excrete mercury, not on his or her total mercury exposure.

Why is the profile data relevant? Consider these facts: the inhibition of the porphyrin synthesis pathway curtails the production of the final product, heme, which binds and carries oxygen in the hemoglobin of blood Heme is also a necessary component of the P-450 enzymes that are critical for detoxifying the body of pesticides, herbicides and other organic toxins. In our body’s cells. heme is also critical for the electron transport system of mitochondria, the source of most of the body’s energy (ATP).

A report in the February issue of the Proceedings of the National Academy of Sciences established that heme is needed to flush beta-amyloid from the brain, and if insufficient heme is present, the beta-amyloid forms “large toxic clumps” called amyloid plaques, a major diagnostic hallmark of Alzheimer’s disease[5]. While many regard the amyloid plaques as the root of Alzheimer’s disease, several recent studies suggest that the primary cause is toxins such as mercury because they prevent the body’s normal removal, or excretion, of the amyloid protein.

Therefore, mercury inhibition of the heme producing porphyrin pathway could have major effects secondary to the primary site of mercury inhibition. Previous scientific papers by other investigators have reported that, when exposed to dental amalgam, the subset of the adult population with the genetic polymorphism (CPOX4) is at risk for developing aberrant porphyrin excretion profiles that significantly modify the effect of mercury exposure on urinary porphyrin excretion[6] [7]. Because some of the CPOX4 adults were more affected than others, it is likely that a smaller subset with an even stronger genetic susceptibility to mercury toxicity also exists. The authors of the two JAMA papers should have acknowledged these findings, and, of course, they should have included the porphyrin profile data on the children rather than dismissing this information with only brief comments. Those of us who are aware of the previous scientific papers on the impact of the CPOX4 genetic polymorphism on an adult’s porphyrin profile have a hard time understanding why children – such as those in the two studies reported in JAMA –would not have been similarly at risk for the CPOX4 effect and thus tested to identify those with the polymorphism.

Below are my more ‘other’ comments about the two JAMA studies. The end of this summary provides information about the research publications relevant to my comments.

1. In the first line of the Portugal based study entitled, “Neurobehavioral Effects of Dental Amalgam in Children,” Dr. Timothy A. DeRouen, et al., wrote that dental amalgam “emits small amounts of mercury vapor". This is not a scientific or quantitative statement, because what is a “small” amount of mercury? Reporting the exposure level of a toxin in any study is absolutely needed. It is a dereliction of duty to place a toxic material into any patient, but especially a child, and particularly if the level of toxic exposure is not defined or known. That the authors totally ignored the exposure level invalidated their conclusion that the measurements of the urine mercury levels demonstrated the safety of the mercury fillings.

The authors also did not report the level of mercury vapor to which the children in the studies were exposed daily. This is an irresponsible omission considering the fact that the material implanted in the children’s teeth was 50% mercury, and previous studies have indicated that such fillings emit mercury vapors[8]. However, the authors’ omission is not surprising since both the ADA and the FDA have steadfastly refused to conduct and publish the results of well-designed experiments on the impact of mercury vapor on human health. Have they stonewalled these experiments because they suspect that the level of mercury vapor emission from amalgams is too high to be accepted as safe? (Now it appears that the IRB boards of several prestigious medical schools are following ADA and FDA’s lead.)

2. Since previous research has well documented that the amount of mercury in urine does not reflect a child’s or adult’s exposure under many conditions, it is baffling that the authors of the JAMA papers used urine, not fecal, samples to measure the children’s mercury exposure[9]. It has been published and verified that over 90% of mercury that is excreted by humans is through the bilary transport system of the liver and that mercury is found in the feces, not the urine. One study reported that mercury in fecal materials was 13 times higher than the levels of the metal in the urine of the same patients[10] [11]. Also, most mercury excreted in the urine is bound to cysteine or other soluble, small molecule containing compounds. Therefore, the urine mercury excretion levels depend as much on the blood levels of cysteine or other small sulfur compounds as they do on mercury exposure. In addition, cysteine levels are influenced by diet. The bottom line is that these studies looked for mercury in all the wrong places. The take-home message from these JAMA papers is that if a researcher doesn’t want to find data indicating excess exposure to mercury, he or she should look where the metal isn’t -- in the urine.

3. Since the IRB of several prestigious universities approved this research even though it exposed children to an unknown daily level of mercury vapor, the public should be outraged and should demand that these institutions perform experiments on the same brand of amalgams, made outside of the mouth, of known weight and surface area and determine the amount of mercury that these amalgams released per day (with and without abrasion to mimic the daily effects of chewing). If these experiments were ever conducted, the public and the scientific community would have the data that the two studies described in JAMA failed to provide: determinations of the daily exposure of the children to mercury from these amalgams and the fraction of the amount excreted in the urine that did not account for the bulk of the mercury.

Research in my laboratory and studies by other scientists have demonstrated that the emissions of mercury vapors were much higher than the “estimates” made by pro-amalgam individuals. Chew et al.[12] showed that a study of long-term dissolution of mercury from a non-mercury releasing amalgam totaled 43.5 microgram/cm2/day Hg and this measure remained constant for 2 years. It should be noted that different amalgam preparations release mercury at vastly different levels, and the modern high copper amalgams have been shown to release much higher levels than other older type amalgams.

4. In Figure 2 on page 1788 [13], the authors of the two JAMA papers reported data that are quite damning of their conclusion that amalgams are safe to place in children. On the figure, the authors plotted the urine mercury levels at each year of the study. As expected, years 1 and 2 showed a steady increase in mercury exposure in the amalgam bearers when compared to the amalgam free children. Yet, during years 3 to 7, the level of mercury in the urine of the children with amalgam continuously dropped, approaching the levels of the amalgam free children. The authors implied, but failed to explain their reasoning, that restorative treatment in years 6, 7 and 8 would have increased, or at least maintained, the urine mercury levels. (The average life span of an amalgam before replacement is less than 10 years.) In the Chew study mentioned above, the amount of mercury released was steady for the study’s two-year period.



Readers of the two JAMA papers also should consider the fact that 1 gram of filling contains 500,000 micrograms of mercury -- which over 100,000 days should emit a toxic 5 micrograms per day[14]. That is, before all of the mercury has been emitted, about 275 years have passed! Therefore, since amalgams do not stop releasing mercury vapor within 7 years, do you not wonder what caused the urinary excretion to drop after year 2? Urine mercury levels are, in my opinion, a measure of the amount of mercury being excreted by this route. After two years of exposure, the kidney route of mercury excretion appears to become less effective -- a development consistent with the well-known fact that increased mercury exposure inhibits its own excretion. However, the drop in urinary mercury could also be due to the fact that the mercury filled teeth were extracted during the course of the study, but that would invalidate the entire basis of these studies.

The mercury levels that have been measured in the body tissues of young athletes, nuns and other groups indicate that this toxic metal can be detected long after the dental mercury fillings have been installed. For example, in the heart tissue of young people who died from idiopathic dilated cardiomyopathy while under physical stress in athletic events, scientists have found 178,400 ng/g mercury -- 22,000 times more than the quantities measured in the heart and muscle tissue of individuals with other forms of cardiac disease[15]. For another example, consider the study published in the Journal of the American Dental Association regarding amalgams and Alzheimer’s disease[16]. That paper, amazingly, reported no correlations between amalgams and brain mercury levels. Yet, in about 15% of the nuns in this study, brain mercury levels were in the micromolar range -- a very toxic level of mercury since much less (even 1,000 fold less) of mercury can kill neurons in culture. Again, even if everyone lived in the same location and ate the same food, certain individuals would appear to have less ability to excrete mercury when compared to their family members and neighbors, The reason: mercury collects in certain tissues at levels much higher than have ever been found in blood, urine or hair, and it is primarily the retention of mercury (or the inability to excrete mercury) that boosts its toxicity from continuous, low level exposures.

Thus, the data in Figure 2 strongly indicates that after two years exposure to dental amalgam mercury, the children seem to lose their ability to excrete mercury through their urine pathway. Have they also lost the ability to excrete mercury through the fecal pathway, the major way that the body eliminates the metal? If the authors of the papers had answered this question, would they still have concluded that there was no health reason for discontinuing placing amalgams in children?

By revealing that children with amalgam may slowly lose their ability to excrete mercury after about two years of amalgam exposure, the studies reported in JAMA do add to the body of scientific knowledge about mercury toxicity. However, these experiments should have been conducted on nonhuman primates, not children. That children were “used” presents a question of ethics in medicine.

5. Except to state that there was no indication of kidney damage, the authors of the JAMA papers provide minimal information about porphyrin’s effects in the amalgam bearers. A more important question concerns the children’s ability to make heme: were their porphyrin profiles as aberrant as those that have characterized adults exposed to amalgams or autistic children? One has to question why this data was not included and discussed in detail by the authors.

6. Several scientific papers have revealed that mercury is a potent immune system suppressor[17]. Testing the immune response is an easy procedure to perform. Since the authors of the JAMA papers failed to conduct these tests, readers did not learn whether the children’s immune system showed the abnormalities, such as the inability of macrophage phagocytosis of microbes at very low levels, that were determined by previous research on mercury exposure. That the authors checked mercury’s effects on IQ but not the immune system, is questionable science since the study’s purpose was to determine whether mercury from amalgams is “safe” for use in children.

7. The research reported in JAMA excluded those children most susceptible to mercury toxicity -- a major failing of the studies’ design.

Excluded from the studies were children with “interfering health conditions,” which could be assumed to have included, autism and prior neurological disorders, even though the CDC has reported that 1 in 6 children in the U.S. has a neurodevelopmental disorder. However, in determining that amalgams should remain a viable clinical option in dental restorative treatment, the authors did not point out that their conclusion cannot apply to children with neurodevelopmental disorders.

In summary, the major problems with the studies published in JAMA is they:
1. Neglected to measure the amount of mercury exposure to children by first determining the amount of mercury emitted from an average sized amalgam outside of the mouth.
2. Used urine and blood mercury levels even though 90% plus of mercury is excreted in the feces. This obviates their conclusions (and what their data shows) that urine mercury levels are unreliable with regards to exposure.
3. Did not select the most sensitive clinical testing parameters for detecting mercury toxicity but instead used testing parameters that are known to fluctuate without known cause, or parameters that require long-term low level exposure to show an affect.
4. Did not state that their conclusions of amalgam safety should not include children with any prior neurodevelopmental or systemic illness.
5. Ignored the drop in mercury excretion in the urine after year 2 even though the mercury exposure from amalgams remained the same or increased. The drop in excretion is a sure sign that the body is losing its ability to excrete mercury in reaction to increased exposure to this toxic metal.

REFERENCES:

[1] T A DeRouen et al Neurobehavioral Effects of Dental Amalgam in children a Randomized Clinical Trial JAMA, April 19, 2006_Vol. 295, #15 pp.1784-1792
[2] D C Bellinger et al. Neuropsychological and Renal Effects of Dental amalgam in Children A Randomized Clinical Trial JAMA April 19, 2006 Vol. 295 #15 pp.1775-1783
[3] Amy S. Holmes, Mark F. Blaxill, Boyd E. Haley Reduced Levels of Mercury in First Baby Haircut of Autistic Children, International Journal of Toxicology 22:277-285, 2003
[4] GET FRENCH PORPHYRIN REFERENCE FROM BOYD
[5] Hani Atamna and William H. Frey II, A roll for heme in Alzheimer's disease: Heme binds amyloid Beta and has altered metabolism Proceedings of the National Academy of Sciences (PNAS) July 27, 2004 Vol. 101 #30 pp.11153-11158 www.pnas.org/cgi/doi/10.1073/pnas.0404349101
[6] Escheverria, D., Woods, JS et al. Chronic low-level mercury exposure, BDNF (brain derived neurotrophic factor) polymorphism, and associations with cognitive and motor function. Neurotoxicol. Teratol, 2005 Nov-Dec; 27(6) 781-96
[7] Escheverria, D. Woods, JS, et al. The association between a genetic polymorphism of coproporphyrinogen oxidase, dental mercury exposure and neurobehavioral response in humans. Neurotoxicol. Teratol. 2005 Dec 8
[8] Vimy MJ, Lorscheider FL: Serial measurements of intra-oral air mercury; Estimation of daily dose from dental amalgam. J Dent Res 64(8):1072-5, 1985
[9] Kingman et al. J. Dental Research 77(3) 461, 1998. In a study of 1,127 military personnel by NIH the level of mercury in the urine of amalgam bearers was 4.5 times that of amalgam free controls. Some with extensive amalgams had levels 8 times or high than the amalgam free controls.
[10] Kingman et al. J. Dental Research 77(3) 461, 1998. In a study of 1,127 military personnel by NIH the level of mercury in the urine of amalgam bearers was 4.5 times that of amalgam free controls. Some with extensive amalgams had levels 8 times or high than the amalgam free controls.
[11] Skare I & Engqvist A. Amalgam restorations - an important source of human exposure of mercury and silver. LÄKARTIDNINGEN 15:1299-1301, 1992
[12] Chew et al. Clinical Preventive Dentistry 13(3) 5-7, 1991. In a study of long term dissolution of mercury from an non-mercury releasing amalgam it was determined that 43.5 microgram/cm2/day Hg was released and this remained constant for 2 years
[13] NOTICE: In accordance with Title 17 U.S.C., section 107, some material in this email broadcast is provided without permission from the copyright owner, only for purposes of criticism, comment, news reporting, teaching, scholarship and research under the "fair use" provisions of federal copyright laws. These materials may not be distributed further, except for "fair use" non-profit educational purposes, without permission of the copyright owner.
[14] Wataha et al. Dental Materials 10 298-303, 1994. The amalgam material with the trade name Dispersal Alloy made solutions in which it was soaked severely cytotoxic.
[15] Frustaci et al. J American College of Cardiology 33(6) 1578, 1999. Data showed that individuals who died with IDCM (idiopathic dilated cardiomyopathy, the cause of young athletes dying during physical stress) had 22,000 times more mercury in their heart tissues than individuals who died of other forms of heart disease. Never has there been a urine or blood level reported that comes to the level of 178,400 ng/g tissue which is the same as 178.4 micrograms/g and one milliliter water weighs 1 gram. In the study under discussion they were talking about 3-5 micrograms/liter (1,000 milliliters) or so which compares to 178.400 micrograms/1000g in IDCM. Where does this mercury come from as this disease kills intercity kids as much as anyone and they are not big seafood eaters.
[16] Saxe SR, Snowdon DA, Wekstein MW, et al. Dental amalgam and cognitive function in older women: findings from the nun study. JADA 1995;126:1495-1501
[17] Hultman, P. et al. Adverse immunological effects and autoimmunity induced by dental amalgam and alloy in mice. The FASEB Journal 8 Nov 1183-1190, 1994

Critique Childrens Mercury Exposure Studies

Our physician colleagues at the American Medical Association, sadly and surprisingly, allowed two flawed papers about mercury silver dental fillings to be published in its flagship journal, JAMA, on April 19, 2006 [1] [2]. Financed with $11 million from the U.S. taxpayer supported NIDCR, the two studies purported to examine in a prospective fashion whether or not installing these mercury fillings in young children adversely affects their neurobehavioral, neuropsychological, and renal functioning. Concluding that no statistically significant differences existed between the children who had mercury fillings, and the children who did not, the two JAMA papers perpetuate the myth that amalgam is a safe and effective treatment for children[3].

Dr. Herbert Needleman wrote in his editorial in the same issue of JAMA commenting about the two studies, "It is predictable that some outside interests will expand the modest conclusions of these studies to assert that use of mercury amalgam in dentistry is risk free. This conclusion would be unfortunate and unscientific[4]."

Even if the authors had reported that their studies proved that mercury fillings have serious medical consequences in children, their two papers should have been rejected by JAMA because no valid conclusions, pro or con amalgam, can be drawn from such poorly designed experiments and minimal data. Below in bold type is a list of the findings from previous studies that, unlike the two JAMA papers, were well designed and data-rich. After each of these findings are my comments in italics text about the deficiencies in the research reported in the two JAMA papers.

In other studies, substantial amounts of elemental mercury vapor have been measured coming off mercury silver dental fillings in the mouths of amalgam bearers. These vapors contributed substantially to the daily dose that was detected in these individuals[5] [6] [7] [8]. However, the authors of the two JAMA papers failed to report whether they had measured the amount of mercury released or estimate the daily dose from the fillings installed in the children’s mouths.

Even though mercury comprises approximately 50% of each, the scientists conducting the two studies published by JAMA neglected to measure the amount of mercury actually installed in each child. Without these measurements, it is impossible to correlate the dose of mercury implanted with the urinary excretion or symptoms of neurological impairment.

The functioning of the immune system especially the B-cells and T-cells has been reported in other investigations to be depressed in people who have mercury fillings[9] [10]. However, the two JAMA papers did not mention whether the clinical trials had examined mercury’s impact on the children’s T-cells.

Mercury sensitization can be measured in the B-cells[11]. However, mercury sensitization was not reported and apparently not measured in either of the two JAMA papers.

Although mercury vapor can induce autoimmunity in lab animals[12], the authors apparently did not attempt to test the children for signs of autoimmunity.

People who have inherited the CPOX and APOe genotypes are unusually susceptible to the toxic effects of mercury. Considering the scientific and medical community’s embrace of genomics medicine[13] [14], and the fact that James Woods was one of the authors, it’s baffling that NIDCR did not require that the authors identify these vulnerable subsets of the population and correlate neurophysiological and neuropsychological results to the genotypes. Dr. Woods has published extensively about how abnormal porphyrin profiles can be used as an indicator of mercury intoxication and linked to accelerated neurological impairment.

Despite the fact that mercury is excreted primary through the bilary (liver) system into the feces, the authors did not report any measures of mercury in the children’s feces.

In non-human primates as well as humans, mercury alters the gut flora so that they become antibiotic resistant. But, the JAMA papers did not report measurements of gut flora[15] [16].

In laboratory studies with sheep, mercury silver dental fillings have been shown to inhibit inulin clearance[17]. Inulin clearance tests not conducted in the clinical trials.

Mercury selectively accumulates in several organs, especially the kidneys. No measurments of body burden of mercury in any tissue were reported in the JAMA papers.

Since research has shown that a subset of the population does not effectively excrete mercury[18], those children with the lowest urinary mercury would seem to have been the most likely to be injured because of their more rapidly increasing body burden from chronic exposure. It would have been instructive, therefore, if the authors had compared the children with the lowest urine mercury to those with the highest, to determine whether the treated and control groups of children differed in urinary mercury.

Mercury from dental fillings has been found to cause or accelerate bone loss in jawbones and cause or contribute to periodontal disease[19]. No examinations of jawbone mercury or periodontal integrity were reported in the JAMA papers.

An abnormal porphyrin can be detected in the urine of mercury-exposed people. Although the authors wrote that the children’s urine was measured for porphyrin, they did not report the results in their JAMA papers but note that these findings will be published elsewhere at an unspecified later date.

Although mercury exposure and body burden is not related to urinary mercury, only a spot urinary mercury was reported.

Chronic low-level exposure to mercury over many years has been shown to impair nerve conduction in amalgam bearers as well as dental personnel[20]. But, oddly, the authors wrote that at the end of the seven years, the time period that the children were followed, the mercury exposure of the control group and the children with the mercury fillings did not differ.

Autopsies have found that the body burden of mercury is proportional to the number and surfaces of dental amalgam in the teeth at the time of death[21]. However, the authors did not correlate the neurophysiological test results to children’s mercury burden or daily dose.

Even though mercury has been shown to inhibit the prosthetic molecule heme, tests that would measure or quantify any inhibition of heme synthesis were not mentioned in the JAMA papers[22].

Affinity labeling has shown that mercury’s inhibit tubulin, but the authors did not use this modern technology to evaluate tubulin .

As a result of fetal exposure to mercury from their mothers, an estimated 60,000 children in the U.S. may be at risk for developing learning disabilities. Mercury affects the developing fetus disproportionately[23]. But the authors did not examine the effects on maternal-fetal transfer of mercury from the mother’s fillings to either the control or test children in this study.

Since chronic mercury toxicity results from prolonged low exposure to mercury for many decades, it is not surprising that the scientists concluded that mercury fillings were not toxic to the health of children who were followed for only seven years as an aggregated averaged whole?

Those investigators who have examined the mercury levels in urine have unanimously concluded that little correlation exists between urine mercury and exposure, body burden and any physiological or psychological effects[24]. The two studies did not address even one of the known short term effects and inaccurately relied upon urine mercury as the only measurement of exposure. Statistical significance is irrelevant if the investigators are comparing the wrong things.

Even though the authors of the two JAMA papers concluded that mercury fillings did not produce any adverse medical consequences, any dental or medical professional who carefully examines the minimal data of the two papers likely will be seriously concerned about the impact of mercury on the children in the studies’ treated groups. On page 1788 of the Casa Pia study in Portugal, a graph of urinary mercury is displayed in Table 2.



In the article authors reported that the children received 1.7 mercury silver dental fillings of permanent teeth initially and about 1 additional filling per year thereafter. Therefore, at the conclusion of this 7-year experiment, the average child in the studies would have approximately 8.7 fillings. Figure 2 above shows a clear tendency for urinary mercury to decline over time with a peak at about 2 years of exposure. This is particularly disconcerting because the authors reported increasing mercury silver dental filling burden during this same period.

Mercury has a well-known history of contributing to its own accumulation.

The kidney’s ability to excrete mercury depends upon the blood level of small sulfur containing molecules such as cysteine. It is quite possible that the authors of the JAMA papers have demonstrated that chronically exposing young children to mercury can exhaust in just two years their bodies’ ability to remove mercury from the blood circulation. In such a state, mercury exposure increases and excretion decreases, accelerating the rise in the body burden of mercury. Considering the violent and cumulative nature of mercury and its long history of poisoning humankind, the findings reported in the two JAMA papers are not at all reassuring. Clearly assurances from dental trade associations with a vested interest in the continued use of mercury-leaking fillings cannot and should not be relied upon in selecting dental filling materials that by today’s standards are safe for our children and families.

Full disclosure of all conflicts and potential conflicts of interest is norm in scientific circles today and remains the voluntary responsibility of scientists involved in research. The NIDCR reportedly, by contract, retained final editorial privileges over the publication of these studies. Also, at least one investigator was appointed during the study to a position with a trade association that has always advocated the safety of mercury in dental fillings.

In addition, other factors that might have added a confounding variable unrelated to the present study should be disclosed as well so that the other scientists reading the research can be fully aware of the circumstances in which the research was conducted. The Casa Pia orphanage is the site of a 30-year child molestation ring that was unearth during this study. One reading this paper would have no knowledge that these children were under other enormous psychological stresses that may or may not have skewed the relevant data.

All mercury dental fillings leak substantial amounts of mercury, therefore, it is the conclusion of the International Academy of Oral Medicine and Toxicology that implanting time-release mercury silver dental fillings in children or adults is neither safe nor necessary since numerous suitable alternatives already exist. These two studies add little to the knowledge base and due to their lack of adequate informed consent and prospective design are, in our opinion, a clear violation of the human research protection act. We have filed complaints with the respective university Institutional Review boards and are awaiting responses. For more detailed information and additional references see A Scientific Argument Against the Use of Amalgam at www.IAOMT.org


Prepared by:
David Kennedy, DDS
4380 Monaco Street
San Diego, CA 92107
Email: davidkennedy-dds@cox.net
Phone: (619) 222-8177




References:


[1] T A DeRouen et al Neurobehavioral Effects of Dental Amalgam in children a Randomized Clinical Trial JAMA, April 19, 2006_Vol. 295, #15 pp.1784-1792
[2] D C Bellinger et al. Neuropsychological and Renal Effects of Dental amalgam in Children A Randomized Clinical Trial JAMA April 19, 2006 Vol. 295 #15 pp.1775-1783
[3] Letter by Fax from the American Dental Association to Congressman Dan Burton April 20, 2006
[4] Herbert Needleman, MD Mercury in Dental Amalgam--A Neurotoxic Risk? JAMA April 10, 2006_Vol. 295 #15
[5] Stock A: (The dangerousness of mercury vapor) Die Gefahrlichkeit des quecksilberdampfes. Zeitschrift Angewandte Chemie, (Journal of Applied Chemistry), 39: 461-466 (1926)
[6] Gay DD, Cox RD, Reinhardt JW: Chewing releases mercury from fillings. Lancet 1(8123):985-6, 1979.
[7] Svare CW, Peterson LC, Reinhardt JW, Boyer DB, Frank CW, Gay DD, Cox RD: The effect of Dental Amalgams on mercury levels in expired air. J Dent Res. 60:1668-71, 1981
[8] Vimy MJ, Lorscheider FL: Intra-oral air mercury released from dental amalgam. J Den Res 64:1069-71, 1985
[9] Weening JJ et al. Mercury induced immune complex glomerulopathy: an experimental study. Chapter 4: pp 36-66. VanDendergen, 1980
[10] Eggleston DW: Effect of dental amalgam and nickel alloys on T-lymphocytes: Preliminary report. J Prosthet Dent 51:617-23, 1984
[11] Stejskal V; Evaluating the Systemic Immune Response to Mercury Compounds International Academy of Oral Medicine and Toxicology Annual Scientific Session Seattle, Wash 9/1991
[12] Weening JJ et al. Autoimmune reactions and glomerulonephritis caused by heavy metals and other toxins Dev Toxicol Environ Sci, 11: 211-216, 1983
[13] Echeverria, D.; Aposhian, H.V.; Woods, J.S.; Heyer, NJ; Aposhian MM; Bitner, AC, Jr; Mahurin, RK; Cianciola, M., Neurobehavorial effect from exposure to dental amalgam Hgo: New distinctions between recent exposure and Hg body burden FASEB J., Vol. 12 pp. 971-980, 1998
[14] Diana Echeverria, James Woods et al. The assosciation between a genetic polymorphism of coproporphyrinogen oxidase, dental mercury exposure and neurobehavorial response in humans. Neurotoxicology and Teratology In Press
[15] Summers, A.O., Wireman, J., Vimy, M.J., Lorscheider, F.L. Marshall, B., Levy, S.B., Bennett, S., and Billard, L. Mercury released from dental "silver" fillings provokes an increase in mercury and antibiotic resistant bacteria in primates oral and intestinal flora. Antimicrobial Agents and Chemotherapy, Vol. 37 pp. 825-834, 1993
[16] J Wireman, CA Liebert, T Smith and AO Summers; Association of mercury resistance with antibiotic resistance in the gram-negative fecal bacteria of primateAppl. Environ. Microbiol., Nov 1997, 4494-4503, Vol 63, No. 11
[17] Boyd, N.D.;Benediktsson, H.;Vimy, M.J.; Hooper, D.E.;Lorscheider, F.L. Mercury from dental “silver” tooth fillings impairs sheep kidney function The American Physiological Society 0363-6119 P R1010-R1014 11/1991
[18] Haley, Amy S. Holmes, Mark F. Blaxill, Boyd E. Haley Reduced Levels of Mercury in First Baby Haircut of Autistic Children, International Journal of Toxicology 22:277-285, 2003
[19] Ziff, MF. Documented Clinical Side-Effects to Dental Amalgam. Adv Dent Res, 6:131-4, 1992.
[20] Echeverria op cit
[21] Eggleston DW, Nylander M, Suffin SC, Martinoff JT, Rieders, MF. Correlation of dental amalgam with mercury in brain tissue. J Pros Dent 58:704-7, 1987
[22] Hani Atamna and William H. Frey II, A roll for heme in Alzheimer's disease: Heme binds amyloid B and has altered metabolism Proceedings of the National Academy of Sciences (PNAS) July 27, 2004 Vol. 101 #30 pp.11153-11158 www.pnas.org/cgi/doi/10.1073/pnas.0404349101
[23] US EPA 2005
[24] Goldwater LJ: Occupational exposure to mercury. J R Inst Pub Health 27:279-301, 1964