Wednesday, November 23, 2011

Oral Bacteria & Pneumonia - Is There A Link?


Oral bacteria linked with pneumonia risk
By Rabia Mughal, Contributing Editor
November 18, 2011 -- Oral microbiota could play a role in identifying patients at risk for healthcare-associated pneumonia, according to a study presented October 22 at the Infectious Diseases Society of America annual meeting in Boston.

"The bodies of healthy individuals are cohabited by an incredible number of bacteria, where bacterial cells outnumber human cells 10 to 1," said study author Samit Joshi, DO, MPH, from the department of internal medicine at the Yale University School of Medicine, in an interview with DrBicuspid.com.

Scientists are now learning how different communities of bacteria reside in different parts of the body and how they can directly or indirectly influence states of health or disease, including pneumonia.
“Changes in oral bacteria play a role in the risk for developing pneumonia.”
— Samit Joshi, DO, MPH
Dr. Joshi and his colleagues wanted to determine if an association existed between the oral microbial profile and subsequent development of pneumonia.
They used advanced DNA sequencing to show that the types of bacterial communities that normally reside in adults' mouths change substantially as their risk for developing pneumonia increases.

While presenting his study at the meeting, Dr. Joshi reported that there was a distinct divergence between the oral bacteria of mechanically ventilated intensive care unit (ICU) patients who developed pneumonia and those who did not.
"In the case of hospitalized adults on mechanical ventilators, the change in bacteria preceded the development of pneumonia," Dr. Joshi said. "This suggests that changes in oral bacteria play a role in the risk for developing pneumonia."

Streptococcaceae dominant

Healthcare-associated pneumonia is a growing public health problem, but strategies to identify high-risk patients remain problematic, according to Joshi and his colleagues. While impaired oral hygiene is a known modifiable risk factor, the precise alterations in oral microbiota are unknown, they added.

The researchers looked at 37 subjects who were prospectively followed for a one-month period. The subjects included healthy community-dwelling adults (19, average age 60) and those at risk for healthcare-associated pneumonia: nursing home residents (10, average age 86) and mechanically ventilated ICU patients (8, average age 51).

The authors used a technique called 16S rRNA gene pyrosequencing to compare the oral microbial profiles of the study participants.

They found that the dominant bacteria in the mouth were Streptococcaceae but that the proportion differed across the three clinical settings, with community dwellers averaging 65%, nursing home residents at 43%, and the mechanically ventilated ICU patients at 33% (p = 0.02 for ventilator patients versus community dwellers).

While the ICU subjects who subsequently developed pneumonia had a significantly smaller average proportion of oral Streptococcaceae (7%) at baseline compared with the ICU subjects who did not develop pneumonia (49%, p = 0.02), the proportions of three other groups -- the Enterococcaceae, the > Micrococcaceae, and the Mycoplasmataceae -- rose sharply in this group.

Also, the bacterial community composition among ICU subjects who developed pneumonia was significantly different from the ICU subjects who did not develop pneumonia.

"Oral microbial profiles differ in community-dwelling adults compared to those in healthcare settings at high risk for pneumonia," the authors concluded. "Mechanically ventilated ICU subjects who subsequently developed pneumonia had a distinct divergence of their oral microbial profiles compared to ICU subjects who did not develop pneumonia."
Pyrosequencing of oral microbiota could be helpful in identifying patients at high risk of healthcare-associated pneumonia, they added.

However, it will still be a number of years filled with additional intensive research before these preliminary findings can be used to improve prevention and clinical care for patients at high risk of developing pneumonia, he added.  "By discovering how microbial communities change prior to the development of pneumonia, physicians and scientists could develop new techniques to identify patients at risk for pneumonia and discover new ways to prevent pneumonia in the future," Dr. Joshi concluded.

Saturday, November 19, 2011

Fluoridated water - The Debate Continues


Budget challenges prompt some to rethink fluoridation
By Rob Gozkowski, Dr. Bicuspid.com


November 16, 2011 -- The issue of water fluoridation has flared up again in communities across the U.S. In October, an article in the New York Times contended that budget constraints and skepticism over fluoride's effectiveness were responsible for some 200 communities abandoning the practice. And MSNBC reported that tea party activists had hijacked a fluoridation debate in Pinellas County, FL, resulting in the end of fluoridated water for 700,000 people there.


More news from the fluoride front poured in on November 15, when the Santa Clara Valley Water District in California voted unanimously to fluoridate water to segments of San Jose, which will give access to more than 280,000 residents. The move was applauded by the Pew Children's Dental Campaign, which had teamed with two other organizations, Voices for America's Children and the American Academy of Pediatrics, to sound the alarm about "misinformation" being spread by antifluoridation activists through its new Campaign for Dental Health, also launched on November 15.

South of San Jose, the city of Watsonville's efforts to fluoridate its water have been conflicted for nearly a decade. In 2002, residents voted by a small margin to eliminate fluoridation. But a subsequent court battle, which Watsonville lost, led to a city council vote last year to accept $1.6 million in funding from the California Dental Association (CDA) to build a fluoridation system. Per state law, a California city with a population greater than 10,000 must fluoridate its water if outside funding is provided.

“The voters didn't feel fluoridation was necessary.”
— Steve Palmisano, city water division
     manager, Watsonville, CA
"The decision on whether or not to fluoridate was purely political, based on the efforts of the city council," Steve Palmisano, the city's water division manager told DrBicuspid.com. "Although it was 10 years ago, I think the primary objection was to putting additional substances in the water with potentially harmful side effects. The voters didn't feel it was necessary."

They may ultimately get their wish. Watsonville's fluoridation project stalled last month when all five construction bids arrived between $1.2 and $1.9 million above the CDA's grant. The CDA is unlikely to get help from the city as it ponders its next move. Palmisano asserted that Watsonville won't build the fluoridation devices unless they are paid for with outside funding, and that the city is unable to chip in anyway.

"The decision really is in the hands of the CDA," he said. "I had a conversation with them, asked for an indication if it will go through, and they didn't give me any at all."

3 treatment plants, $10 million


Despite the November 15 vote endorsing fluoridation for the Santa Clara Valley Water District, Donald Gage, director of District 1 and 2011 chair, shared a similar view. 

"We have three things in our charter: One, provide clean, safe drinking water. Two, flood control. And three, environmental issues," Gage told DrBicuspid.com. "[Fluoridation] is not something we're supposed to do, and we don't have the money anyway."


Because it is a wholesaler, the Santa Clara Valley Water District is not beholden to the state's fluoridation law. But the district intends to move forward with water fluoridation anyway -- if the cost issues can be adequately addressed.

The equipment the Santa Clara Valley Water District needs to provide fluoridation at its three treatment plants will cost $10 million, Gage said. The district's looming priorities, per its charter, start with what Gage estimates to be $500 million needed to seismically retrofit aging area dams. Replacing antiquated levies around the region's delta may cost even more.
"What we're doing is setting up a general policy that will enable the people who want water fluoridation to move forward with it," Gage said. "There's some wording in there that needs to be changed because it doesn't allow public/private partnership." The details, he explained, will be addressed later.

Now the Health Trust, a Silicon Valley nonprofit promoting wellness, and the California Department of Public Health are working to identify potential funding sources for the equipment installation. Gage believes that the communities that will receive fluoridated water, such as San Jose and Sunnyvale, should foot the bill for operations and maintenance once the infrastructure is in place, at a cost of about $1 per person annually. That is where his opinion about fluoridation ends.
"If the majority wants it, because we're a democratic society, I'm willing to do it," he said. "But other than that, because I'm not scientist, I have to look to the federal and state government to tell me whether it's safe or not."

Science and Budget Concerns

For one Florida county commissioner, contradictions between federal agencies regarding fluoridation led to his determination that it should be ended. Norm Roche, who has an extensive background in Pinellas County Water Department policy research, became a national lightening rod for his stance on fluoridation when he led a successful effort to cease fluoridating the water supply for roughly 700,000 Floridians this year. But he believes his position has been mischaracterized.
Roche told DrBicuspid.com that he has expressed concerns about fluoridation since 2003, when the council first voted in favor of it.

"My issue back then, as it is today, is with the actual chemical we use to fluoridate the water, fluorosilicic acid," he explained. "On the one hand, the U.S. Centers for Disease Control and Prevention talks of fluoridation as a great concept. But the U.S. Food and Drug Administration will not approve fluorosilicic acid for human consumption. So there are competing federal agencies there on the issue."

He is also concerned by a lack of consensus among physicians, dentists, and chemists about which particular type of chemical should be used and whether ingesting fluoridated water was better than a topical delivery via dentifrice.
"Expecting seven politicians to watch experts, doctors, accuse each other of faulty information and then look at us saying, 'You make the call ...' -- I don't find that to be our role," he explained.

There were other complications with fluoridation as well. Pinellas switched to a regional water source about 10 years ago, and now receives a blended mix of desalinized water, ground water, and surface water from a local river.
"All of them have various degrees of naturally occurring fluoride, which made our plant operators almost daily have to tweak the fluorosilicic acid drip," he explained. "It became a complex issue -- and guesswork."

While the cost of fluoridation was not a major consideration, Roche acknowledged that it played a role in the issue. "It was born, if you will, of the budget discussion," he said. "But the fiscal impact was the least of my concerns."

A Philosophic Disagreement

Scott Tomar, DDS, DrPH, a professor at the department of community dentistry and behavioral science at the University of Florida College of Dentistry, is worried that other communities will take a similar tack while governments look to trim budgets.
“It came down more to a philosophic disagreement than a financial one.”
— Scott Tomar, DDS, DrPH, University
     of Florida College of Dentistry
"I think it certainly has emboldened opponents to fluoridation to seize on it," he told DrBicuspid.com. "What I'm seeing more of lately, and I think what happened in Pinellas County, it came down more to a philosophic disagreement than a financial one."

That is the sort of impression that has dogged the Pinellas County city commission's decision. After the narrow 4-3 vote, national attention ensued -- due primarily to the Associated Press describing the decision as a tea party victory for smaller government, according to Roche.

"I interviewed with the NY Times, "NBC Nightly News," Rachel Maddow, "The Daily Show" even, all based on the misinterpretation of the decision," he recalled. "And they all went, 'This isn't really the story we got on the AP wire.' "
The perception of tea party politicians blocking fluoridation has been aided by the way other districts have handled fluoridation. Dr. Tomar referenced a recent example in High Springs, FL, where fluoridation landed on the city council's agenda.

"In my testimony before the city council, I raised the point that of $8,000 that they might save, all they're really going to do is transfer it onto the backs of their citizens," he recalled. "But they said, it was never about the money, it was more a discussion of whether city or county government should be providing preventive services."

Dr. Tomar cited other examples in which opposition to fluoridation centered on whether it is an essential service. While most are swayed by the notion that the savings end up coming out of the pockets of the community needing greater dental work, he said the role of government is an argument that's been coming up a lot.
"The science is on our side, fully supported by every legitimate health and medical organization," he said. "But if there's a political opposition to it that has nothing to do with the science, there isn't much you can do to change that."
While Roche has asserted that he's unconcerned with the political aspect of the issue, he sees inefficiency in the fluoridation process.

"If you want to reach 10,000 underprivileged people who aren't getting adequate access to dental care, do you publicly fluoridate the water for 1 million just to get to them?" he asked. "Or do you focus your resources in order to get them the help that they need?"

Trust also appears to be a factor.

"One of the other issues arising here is, even though cities and counties have been fluoridating for quite a long time, Florida still gets an 'F' for dental care for the indigent and underprivileged," Roche said, also noting that only 25% of dentists in the state will see Medicaid patients. "Is their position to keep fluoride in the water so that they won't have to see them? I think that's a valid part of the discussion."

Sunday, November 13, 2011

Gum Disease Can Increase the Time It Takes to Become Pregnant


Science Daily -- Professor Roger Hart told the annual meeting of the European Society of Human Reproduction and Embryology that the negative effect of gum disease on conception was of the same order of magnitude as the effect of obesity.

Prof Hart, who is Professor of Reproductive Medicine at the University of Western Australia (Perth, Australia) and Medical Director of Fertility Specialists of Western Australia, stated, "Until now, there have been no published studies that investigate whether gum disease can affect a woman's chance of conceiving, so this is the first report to suggest that gum disease might be one of several factors that could be modified to improve the chances of a pregnancy."  Researchers found that women with gum disease took an average of just over seven months to become pregnant -- two months longer than the average of five months that it took women without gum disease to conceive.

Periodontal (gum) disease is a chronic, infectious and inflammatory disease of the gums and supporting tissues. It is caused by the normal bacteria that exist in everyone's mouths, which, if unchecked, can create inflammation around the tooth; the gum starts to pull away from the tooth, creating spaces (periodontal pockets) that become infected. The inflammation sets off a cascade of tissue-destructive events that can pass into the circulation. As a result, periodontal disease has been associated with heart disease, type 2 diabetes, respiratory and kidney disease, and problems in pregnancy such as miscarriage and premature birth. Around 10% of the population is believed to have severe periodontal disease. Regular brushing and flossing of teeth is the best way of preventing it.


The researchers followed a group 3737 pregnant women, who were taking part in a Western Australian study called the SMILE study, and they analysed information on pregnancy planning and pregnancy outcomes for 3416 of them.  In addition, non-Caucasian women with gum disease were more likely to take over a year to become pregnant compared to those without gum disease: their increased risk of later conception was 13.9% compared to 6.2% for women without gum disease. Caucasian women with gum disease also tended to take longer to conceive than those who were disease-free but the difference was not statistically significant (8.6% of Caucasian women with gum disease took over one year to conceive and 6.2% of women with gum disease).  "Our data suggest that the presence of periodontal disease is a modifiable risk factor, which can increase a woman's time to conception, particularly for non-Caucasians. It exerts a negative influence on fertility that is of the same order of magnitude as obesity. This study also confirms other, known negative influences upon time to conception for a woman; these include being over 35 years of age, being overweight or obese, and being a smoker. There was no correlation between the time it took to become pregnant and the socio-economic status of the woman." professor Hart said.  Information on time to conception was available for 1,956 women, and of, these, 146 women took longer than 12 months to conceive -- an indicator of impaired fertility. They were more likely to be older, non-Caucasian, to smoked and to have a body mass index over 25 kg/m2. Out of the 3416 women, 1014 (26%) had periodontal disease.

Prof Hart said that the reason why pregnancies in non-Caucasian women were more affected by gum disease could be because these women appeared to have a higher level of inflammatory response to the condition."  All women about to plan for a family should be encouraged to see their general practitioner to ensure that they are as healthy as possible before trying to conceive and so that they can be given appropriate lifestyle advice with respect to weight loss, diet and assistance with stopping smoking and drinking, plus the commencement of folic acid supplements. Additionally, it now appears that all women should also be encouraged to see their dentist to have any gum disease treated before trying to conceive. It is easily treated, usually involving no more than four dental visits." he added.

The SMILE study was one of the three largest randomised controlled trials performed in Western Australia. It showed conclusively that although treatment of periodontal disease does not prevent pre-term birth in any ethnic group, the treatment itself does not have any harmful effect on the mother or fetus during pregnancy.

Obesity Link to Periodontal Disease

In a study titled "MicroRNA Modulation in Obesity and Periodontitis," lead author Romina Perri, University of North Carolina School of Dentistry, Oral Health Institute, conducted a pilot investigation to determine whether obesity or periodontal disease modified microRNA expression and whether there was any potential interaction between obesity and periodontitis that could involve microRNA modulation. This study is published in the Journal of Dental Research, the official publication of the International and American Associations for Dental Research (IADR/AADR). 

In this investigation, total RNA was extracted from gingival biopsy samples collected from 20 patients in 4 groups:

  • 5 non-obese [BMI < 30kg/m2] participants with a healthy periodontium
  • 5 non-obese participants with periodontitis
  • 5 obese [BMI > 30kg/m2] participants with a healthy periodontium
  • 5 obese participants with periodontitis).


Two microRNA species (miR-18a,miR-30e) were up-regulated among obese individuals with a healthy periodontium. Two microRNA species (miR-30e,miR-106b) were up-regulated in non-obese subjects with periodontal disease and in the presence of periodontal disease and obesity, nine microRNAs were significantly up-regulated (miR-15a,miR-18a,miR-22,miR-30d,miR-30e,miR-103,miR-106b, miR-130a,miR-142-3p,miR-185 and miR-210).

The authors conclude that the data are consistent with the concept that miRNA that are induced by chronic nutritional stress leading to obesity may also non-parsimoniously modulate inflammatory pathways within periodontal tissues and affect disease expression. "The expression of specific microRNA species in obesity provides new insight into possible mechanisms of how risk factors might modify periodontal inflammation and may represent novel therapeutic targets," said JDR Editor-in-Chief William Giannobile. A perspective article titled "Obesity, Inflammation and Oral Infections: are microRNAs the Missing Link?" was co-authored by Francesco D'Aiuto and Jean Suvan, University College London Eastman Dental Institute. In it, the authors suggest that these data could represent a mechanistic breakthrough in our understanding of the modulatory effects of obesity on periodontal tissue destruction, but caution reproducibility of these findings is needed in larger and well-characterized cohorts. 

Saturday, November 12, 2011

Silver Fillings - The Untold Dangers That Lie Within

THE TOXIC EFFECTS OF THE MERCURY IN DENTAL AMALGAM FILLINGS ON THE ENVIRONMENT AND HUMAN HEALTH

A FACT SHEET PREPARED BY
The International Academy of Oral Medicine and Toxicology
www.iaomt.org
“For medical reasons, amalgam should be eliminated in dental care as soon as possible. As a result, one of our largest sources of mercury in the environment can be eliminated.’’1--Dr. Maths Berlin, the Dental Material Commission of Sweden, 2003
Brief Overview of Mercury Used in Dentistry
Millions of dentists around the world routinely use dental amalgam as a filling material to repair decayed teeth. Often referred to as “silver” fillings, amalgam fillings actually consist of 45-55% metallic mercury.2
According to the United States Environmental Protection Agency (EPA), there are currently over 1,000 tons of mercury in the mouths of Americans, which is more than half of all the mercury being used in the U.S. today.3 Also according to the EPA, dentistry accounts for 14% of the U.S. domestic usage of mercury annually.4
Controversy has surrounded the use of mercury in dentistry since the 1800’s, when the neurotoxin was first widely introduced as a filling material. The American Society of Dental Surgeons, the predecessor to the American Dental Association, made its members pledge not to use mercury because of its known toxicity,5 and in more recent years, government officials, scientists, dentists, consumers, and many others have raised serious concerns about the threats dental mercury poses to humans and to the environment at large.
Today, authorities including the United Nations Environmental Programme (UNEP), the United States Food and Drug Administration (FDA), and the European Commission (EC) are actively assessing health risks associated with dental amalgam. 6-8
However, the governments of Norway, Sweden, and Denmark have already banned the use of mercury fillings in dentistry,9 Germany and Canada have limited their use for pregnant women,10,11 and France, Finland, and Austria have recommended that alternative dental materials be used for pregnant women.12
Meanwhile, scientific studies continue to demonstrate the harm that mercury in dentistry inflicts upon each one of us and our environment.
Dental Amalgam Pollutes the Environment in a Variety of Ways:
A 2002 report from the New York Academy of Sciences found that
40-60% of the mercury in New York/New Jersey harbor is a result of discharges from dental offices.13
1) Wastewater from Dental Offices
According to the EPA, dental offices were found to have been the source of 50% of all mercury pollution entering publically-owned treatment works in 2003.14
Studies in the United States, Canada, and other countries have also shown that dental offices play a significant role in causing mercury to enter the environment.15 In the United States, the dental industry is the third largest user of mercury, accounting for over 45 tons of mercury per year,16 and the discharge per dentist ranges from 270 to 484 milligrams per day.17,18
Because wastewater treatment facilities are designed to process human waste, not heavy metals, the mercury from dental discharges is separated out into sludge, or biosolids.19 These biosolids are usually incinerated or used as fertilizer, with the mercury content again being directly emitted into the environment.20
“If the average fecal excretion was applied to the entire Swedish population,
a total emission of 150 kg/yr (330 lb/year) can be estimated.
 This is roughly comparable to the yearly mercury leakage from a modern chloralkali plant.”21 --Skare and Enqvist, 1992
2) Human Waste
Research has shown that the average person with amalgam excretes approximately .1 mg of mercury per day in his/her feces.22 In the United States, this amounts to over eight tons of mercury per year eventually being flushed out to sewers, streams, and lakes.23
“In Sweden, scientists have estimated that as much as 620 pounds of
dental amalgam mercury are released into the atmosphere each year from cremation.”24 --The Institute of Environmental Medicine, Sweden, 1992
3) Cremation
Cremation of bodies with amalgam fillings adds to air emissions and deposition onto land and waterways. A Swiss study confirmed that cremation released over 65 kilograms of mercury per year as emissions, often exceeding site air mercury standards.25 In 1991, cremation of 320,372 bodies added an estimated 2,800 pounds of mercury into the atmosphere in the United States.26
“Hg vapor release to the atmosphere from dental vacuums can be substantial and can exceed human exposure levels.”27
--Stone, Cohen, and Debban, Naval Institute for Dental and Biomedical Research, 2007
4) Mercury Vapor
In offices with air/water separator tanks as part of the central vacuum system, mercury vapor has been found in air vented to the outside of the dental office.28,29 Dr. Paul G. Rubin of IAOMT explains, “[M]ercury-containing material is discharged into waste streams via the dental office vacuum-pump system. This system also discharges large quantities of air, either into the atmosphere exterior to the office building or into the sewer system, depending on the type of equipment used.”30
Furthermore, mercury vapor is continuously emitted from amalgam fillings,31 which means that people are directly exposed to the mercury in their mouths. The output of mercury vapor can be intensified by the number of fillings present and other activities associated with the human mouth, such as chewing, teeth-grinding, and the consumption of hot liquids.32,33
Dental Amalgam Harms Humans in a Variety of Ways:
“There is really no place for mercury in children.”34
--Dr. Suresh Kotagal, FDA Dental Products Panel, December 2010
1) Pregnant Women and Children
International legislation has already warned of the clear and present danger that the mercury in dental amalgam fillings poses to pregnant women and children: as stated earlier in this document, the governments of Norway, Sweden, and Denmark have banned the use of mercury fillings in dentistry,35 while Germany and Canada have limited their use for pregnant women,36,37 and France, Finland, and Austria have recommended that alternative dental materials be used for pregnant women.38
Additionally, 19 members of the United States Congress wrote a letter to the FDA in 2009 to express their concern about mercury used in amalgam fillings, with a focus on potential dangers to pregnant women and children,39 and when Representative Diane Watson of California introduced the Mercury Filling Disclosure and Prohibition Act (H.R. 2101), she explained, “It is, in fact, children who are at greatest risk from these fillings.”40
Scientific studies proving the devastating impact of mercury on pregnant woman and children are abundant, which is why pregnant women and children are advised not to eat certain types of seafood that might contain methylmercury.41-43
The dangers of fetal and infant exposure to mercury via maternal dental amalgam have likewise been scientifically established.44-55
Although two studies (commonly referred to as the “New England Children‘s Amalgam Trial”56 and the “Casa Pia Children’s Amalgam Trial”57) have repeatedly been referenced to defend the use of amalgam in children, researchers and commentators have demonstrated that these studies failed to take essential factors such as long-term effects, genetic predisposition, detection of smaller effects, and measurement errors into account.58-64
Furthermore, the most up-to-date science continues to expose the havoc that the mercury in dental amalgam fillings wreaks upon pregnant women and children. A study published in the April 2011 edition of Environmental Monitoring and Assessment notes, “As we showed, the number of amalgam filled teeth in breast-feeding mothers strongly influences the mercury level in their milk. Take it into consideration that maternal milk is the only source of nutrition during the first few months after birth.”65 Another recent study published in Science of the Total Environment cautions, “Changes in dental practices involving amalgam, especially for children, are highly recommended in order to avoid unnecessary exposure to Hg.”66
Meanwhile, mercury has been found to be a factor in autism,67-76 and as such dental amalgam fillings (maternal) have been directly linked to autism as well.77-81
“Dental amalgam fillings are the primary source of mercury exposure for the general population (Skare,1995; Health Canada, 1997).”82
--Cited in paper published under the joint sponsorship of the United Nations Environment Programme, the International Labour Organization, and the World Health Organization
2) The General Population
An extensive number of international research studies thoroughly document the human health risk associated with the use of dental amalgam. Scientific data from reputable scientists all over the world has investigated how the mercury in amalgam fillings can relate to dysfunction of the immune system,83-90 multiple sclerosis,91-96 kidney ailments,97-101 chronic
fatigue syndrome,102-105 allergies,106-109 reproductive issues,110-112 cardiovascular problems,113,114 absorption of heavy metals in the brain,115,116 Gehrig’s disease,117,118 Alzheimer’s disease,119,120 antibiotic resistance,121,122 hearing loss,123 and a myriad of other health problems.124-139
“Provide pre-placement and periodic medical exams for those regularly exposed to mercury with emphasis directed to CNS-central nervous system, skin, lungs, liver, kidneys, and G.I. tract.”140 --Material Safety Data Sheet (MSDS), Safe Handling and Use Section,
provided with dental amalgam product by Original D Wykle
3) Dentists and Dental Personnel
Dentists and their staffs are occupationally exposed to constant levels of mercury released from
dental amalgam on a routine basis, and thus, researchers have also raised concerns about the safety of dental personnel who work with dental amalgam.141-155
“...we urge you to consider the many ill effects of mercury amalgam...
Even though dental amalgam is the predominant source of human exposure to mercury, it is not regulated by the FDA.”156
--Letter to the FDA from 19 Members of Congress, 2009
4) Additional Considerations about Dental Amalgam and Human Health
Reference Exposure Levels
After Health Canada was sued by a group of consumer activists over safety of medical devices, they hired Dr. G. Mark Richardson to make recommendations about dental amalgam. Dr. Richardson presented a chart summarizing seventeen separate estimates of mercury exposure due to amalgam in adults. If the US Agency for Toxic Substances and Disease Registry (ATSDR) minimal risk level
(MRL) for non–occupational exposure of .014 μg Hg0/m3 in air standard is used, even one amalgam filling would expose the individual to more mercury than would be allowed by Dr. Richardson’s proposed tolerable daily intake.157
In new research published this year, Dr. Richardson reports that more than 67 million Americans aged 2 years and older exceed the intake of mercury vapor considered “safe” by the U.S. EPA due to the presence of dental amalgam fillings, whereas over 122 million Americans exceed the intake of mercury vapor considered “safe” by the California EPA due to their amalgam fillings.158
Methylization of Mercury in the Human Body
Research has also already begun to explore how the mercury in amalgam and its vapor can be altered into methylmercury (commonly accepted to be the most toxic form of mercury) within the human body. Bacteria in soil and water can convert mercury into methylmercury, a form of the element sometimes consumed by fish and shellfish,159 and as noted above, pregnant women and children are advised not to eat seafood that might contain methylmercury.160-162
Several studies have documented the ability of metallic mercury rooted in the human system (such as that from amalgam fillings) to be transformed into methylmercury in the mouth163-165 and by specific strains of yeast and bacteria that dwell in the gut,166-168 thus revealing that the problem already addressed in maritime environments is one which even more intimately impacts human health.
Genetic Predisposition
The issue of genetic predisposition to mercury poisoning has also been noted in several studies.169-175  One study specifies that roughly 25% of the U.S. population is polymorphic for a specific genotype associated with sensitivity to mercury toxicity,176 which amounts to 78 million Americans today.
Mercury allergies
In 1972, the North American Contact Dermatitis Group determined that 5 - 8% of the U.S. population demonstrates allergy to mercury by skin patch testing,177 which would amount to approximately 21 million Americans today. Since dentists do not test their patients for mercury allergies prior to using amalgam, this would mean that millions of Americans are unknowingly allergic to the fillings in their mouths.
Other scientific research offers even more startling results. In one study, 180 subjects with amalgam fillings were patch tested, and 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.178 In another study of 29 patients with oral lichen planus, 62% were positive for mercury allergy.179 And at Baylor College of Dentistry, of 171 dental students patch tested, 32% were positive for mercury allergy. The percentage of positive tests correlated with the students’ own amalgam scores and with the length of time they had been in dental school.180
Co-existing Factors
Finally, it should be noted that mercury influences each individual differently based on a wide-range of co-existing factors. Thoughtful research has explored how the number of amalgam fillings in the mouth,181-189 various routes of exposure from mercury fillings,190-192 gender,193,194 plaque,195 consumption of selenium,196 milk,197-199 or alcohol,200-202 and other circumstances203-207 can play a role in each person’s unique reaction to mercury.
“Dental treatment without mercury is becoming the norm.”207--Carsten Lassen and Jakob Maag, Nordic Council of Ministers, INC1, June 2010
Suggested Solutions to Mercury Risks Caused by Dental Amalgam
Since some countries have successfully eliminated dental mercury, banning mercury from dentistry has already proven to be both feasible and economical.208
Various considerations should be part of any effort to end the use of mercury in dental amalgam:
1) Amalgam Separators
Amalgam separators can successfully reduce the amount of mercury discharge in wastewater from dental offices209,210 and are essential in stopping mercury from entering the environment. However, it would be helpful to enforce maintenance requirements for amalgam separators, as the Royal College of Dental Surgeons has done in Ontario, Canada.211 It should also be remembered that amalgam separators only contribute to solving the problem of dental mercury in wastewater and not the additional burdens placed by amalgam fillings on the environment and human health.
2) Alternatives to Amalgam as a Filling Material
Many consumers choose composite fillings because the coloring matches the tooth better, and the American Dental Association (ADA) explains that the cost for a composite filling is moderate.212 The ADA also offers ionomers, indirect restorative dental materials, all porcelain (ceramic) dental materials, gold alloys, and indirect composites, among other alternatives to amalgam.213
Although a poll showed that just less than half of dentists are using amalgam in the U.S. today,214 a recent survey published in the Journal of the American Dental Association offers statistics demonstrating that mercury fillings are still being used routinely on ethnic minority groups, including 53.4% of Black/African Americans and 72.9% of American Indians/Alaska Natives/Asians/Pacific Islanders.215
Additionally, a study about new recruits to the U.S. Navy and Marines, also published in the Journal of the American Dental Association, notes that while the use of resin composite among dentists is increasing, “Our data show that dental amalgam remains the predominant material in use, accounting for more than 75 percent of all posterior restorations among new recruits.”216
3) Safe Removal of Existing Amalgam Fillings
Unsafe removal of amalgam fillings can cause more mercury-related health problems to patients because mercury vapor is released in greater quantities as a result of drilling. IAOMT funds and studies international research about the safety of dental materials and has created a safe protocol for taking mercury fillings out of patients’ mouths.217
4) Educating Dentists
While some dentists have already stopped using amalgam, others will require training in mercury-free dentistry. Since Norway, Sweden, and Denmark have banned dental mercury, their dental schools shed light upon how to make a transition away from amalgam.
5) Economic Perspective
In a report entitled “The Economics of Dental Amalgam Regulation,” the authors note that amalgam use is already declining and that restrictions on mercury are inevitable.218 The authors conclude, “We can then make the case that the overall health care expenditures necessary to deal with diseases and conditions, known or unknown, arising from the continued installation of amalgam could far exceed the relatively manageable cost increases to the consumer for the alternatives...This is not to mention the cost to the U.S. economy of lost work time owing to concomitant illness and disability.”219
An international timeline to ban dental mercury would save people and the environment, while also fostering a cooperative global effort.
"Mercury is among the most dangerous environmental toxins. Satisfactory alternatives to mercury in products are available,
and it is therefore fitting to introduce a ban."220
--Erik Solheim, Norway’s Minister of Environment and Development, 2007
About IAOMT
Representing a network of dental, medical, and research professionals with members in North America and affiliated chapters in over fourteen other countries, the International Academy of Oral Medicine and Toxicology (IAOMT) has been researching the damage dental mercury inflicts on the environment and humans since the non-profit organization was created in 1984.
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4 Ibid.
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105 Wojcik, DP et al. “Mercury toxicity presenting as chronic fatigue, memory impairment and depression: diagnosis, treatment, susceptibility, and outcomes in a New Zealand general practice setting: 1994-2006,” Neuro Endocrinol Lett. 27:4 (August 2006): 415-423. Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/16891999
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107 Stejskal, I. et al. “Metal-specific lymphocytes: biomarkers of sensitivity in man,” Neuroendocrinol Lett 20:5 (Prague, Czech Republic, 1999): 289-298. http://i-gap.info/app/dokumente/Melisa%20as%20biomarkerof%20T%20cell%20related %20immunity.pdf
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110 Rowland, AS; et al. “The Effect of Occupational Exposure to Mercury Vapour on the Fertility of Female Dental Assistants.” Occupat Environ Med., 51:28-34, 1994. Abstract available at http://oem.bmj.com/content/51/1/28.short
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115 Eggleston, DW, Nylander, M. “Correlation of dental amalgam with mercury in brain tissue,” J Prosthet Dent 58:6 (December 1987): 704-707. http://www.nvbt.nl/hot-metalen4.html
116 Nylander, M., Friberg, L, Lind, B. “Mercury concentrations in the human brain and kidneys in relation to exposure from dental amalgam fillings,” Swed Dent J 11:5 (1987): 179-187. Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/ 3481133
117 Mutter, J. et al. “Amalgam risk assessment with coverage of references up to 2005,” Gesundheitswesen 67:3 (Review in German, March 2005): 204-216. Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/15789284
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152 Gordon, H. “Pregnancy in Female Dentists: A Mercury Hazard.” Proceedings of International Conference on Mercury Hazards in Dental Practice. Glasgow, Scotland, 2-4 Sep 1981.
153 Panova, Z; Dimitrov, G. “Ovarian Function in Women Having Professional Contact With Metallic Mercury.” Akusherstvoi Ginekologiya, 13(1):29-34, 1974.
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171 Godrey, ME, Wojcik, DP, Krone, CA. “Apolipoprotein E genotyping as a potential biomarker for mercury toxicity,” Journal of Alzheimer’s Disease 5 (2003): 189-195. Abstract available at http://iospress.metapress.com/content/ 2bpp5fdar3r06e11/
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173 Wojcik, DP et al. “Mercury toxicity presenting as chronic fatigue, memory impairment and depression: diagnosis, treatment, susceptibility, and outcomes in a New Zealand general practice setting: 1994-2006,” Neuro Endocrinol Lett. 27:4 (August 2006): 415-423. Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/16891999
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177 North American Contact Dermatitis Group. “Epidemiology of contact Dermatitis in North America,” Arch Dermatol, 1972, 108:537-40.
178 Djerassi, E; Berova, N. “The possibilities of allergic reactions from silver amalgam restorations,” Internat Dent J, 1969, 19(4):481-8, 1969. Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/5262217
179 Finne, K; et al. “Oral Lichen Planus and Contact Allergy to Mercury.” Int J Oral Surg., 11:236-9, 1982. Abstract available at http://www.sciencedirect.com/science/article/pii/S0300978582800732
180 Miller, EG, et. al. “Prevalence of mercury hypersensitivity in dental students.” J Dent Res. 64: Special Issue, p. 338, Abstact #1472, (1985). Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/2957496
181 Rothwell, Janet A; Boyd, Paul J. “Amalgam fillings and hearing loss,” International Journal of Audiology 47: 12 (December 1, 2008): 771. Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/19085401
182 Geier, David A, Kern, Janet K., Geier, Mark R. “A prospective study of prenatal mercury exposure from dental amalgams and autism severity,” Neurobiolgiae Experimentals Polish Neuroscience Society 69 (2009): 1, 4, 6 & 7. http:// www.iaomt.org/news/files/files302/Amalgam_Autism_Geier_2009.pdf
183 Barregard, L. et al. “Cadmium, mercury, and lead in kidney cortex of living kidney donors: impact of different exposure sources,” Environ, Res. 110 (Sweden, 2009): 47-54. Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/19931045
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185 Eggleston, DW, Nylander, M. “Correlation of dental amalgam with mercury in brain tissue,” J Prosthet Dent 58:6 (December 1987): 704-707. http://www.nvbt.nl/hot-metalen4.html

186 Nylander, M., Friberg, L, Lind, B. “Mercury concentrations in the human brain and kidneys in relation to exposure from dental amalgam fillings,” Swed Dent J 11:5 (1987): 179-187. Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/ 3481133
187 Kraub, P. and Deyhle, M. “Field study on the mercury content of saliva,” Universitat Tubingen-Institut for Organische Chemie (1997). http://www.xs4all.nl/~stgvisie/AMALGAM/EN/SCIENCE/tubingen.html
188 Godrey, ME, Wojcik, DP, Krone, CA. “Apolipoprotein E genotyping as a potential biomarker for mercury toxicity,” Journal of Alzheimer’s Disease 5 (2003): 189-195. Abstract available at http://iospress.metapress.com/content/ 2bpp5fdar3r06e11/
189 Craelius, W., “Comparative epidemiology of multiple sclerosis and dental caries,” Journal of Epidemiology and Community Health 35 (1978): 155-165. Abstract available at http://jech.bmj.com/content/32/3/155.abstract
190 Mercola, Joseph and Klinghardt, Dietrich. “Mercury toxicity and systemic elimination agents,” Journal of Nutritional and Environmental Medicine 11 (2001) 53-62. http://www.scribd.com/doc/32403160/Mercury-Toxicity-and-Systemic- Elimination-Agents
191 Bjorkman, L., Sanborgh-Englund, G., Ekstrand, J. “Mercury in saliva and feces after removal of mercury fillings,” Toxicology and Applied Pharmacology 144:1 (May 1997): 156-162. Abstract available at http://www.ingentaconnect.com/ content/ap/to/1997/00000144/00000001/art08128
192 Bergerow, J. et al. “Long-term mercury excretion in urine,” International Archives of Occupational and Environmental Health 66:3 (1994): 209-212. Abstract available at http://www.springerlink.com/content/w5274366726q6020/
193 Rothwell, Janet A; Boyd, Paul J. “Amalgam fillings and hearing loss,” International Journal of Audiology 47: 12 (December 1, 2008): 771. Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/19085401
194 Richardson, G. Mark et al. “Mercury vapour: Continuing toxicological uncertainties, and establishing a Canadian reference exposure level,” Regulatory Toxicology and Pharmacology 53. (January 2008): 32. Abstract available at http:// www.ncbi.nlm.nih.gov/pubmed/18992295
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197 Haley, Boyd. Affidavit: An Evaluation of Dental Amalgam and Its Ability to Injure Human Health, 5.
198 Mata, l., Sanchez, L. and Calvo, M. “Interaction of mercury with human and bovine milk proteins,” Biosci Biotechnol
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200 State of Massachusetts Department of Environmental Protection. Appendix D-Mercury Toxicity: Technical Overview. (Boston, MA: website appendix, accessed on October 27, 2010), 3. http://www.mass.gov/dep/toxics/stypes/appd.htm
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202 Nylander, M., Friberg, L, Lind, B. “Mercury concentrations in the human brain and kidneys in relation to exposure from dental amalgam fillings,” Swed Dent J 11:5 (1987): 179-187. Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/ 3481133
203 Chang, Louis W., Hartmann, Henrik. “Blood-drain barrier dysfunction in experimental mercury intoxication,” Acta Neuropathologica 21:2 (April 4, 1972): 179-184. Abstract available at http://www.springerlink.com/content/ m631756162455150/
204 Chang, Louis, Hartmann, Henrik. “Electron microscopic histochemical study of the localization and distribution of mercury in the nervous system after mercury intoxification,” Experimental Neurology 35:1 (April 1972): 122-137. Abstract available at http://www.sciencedirect.com/science/article/pii/0014488672900T6h4e7Toxic
205 Skare, I. “Mass balance and systemic uptake of mercury released from dental fillings,” Water, Air and Soil Pollution 80:1-4 (1995): 59-67. Abstract available at http://www.springerlink.com/content/h5gr2031316857vt/
206 Barregard, L., Sallsten, G., and Jarvholm, B. “People with high mercury uptake from their own dental fillings,” Occup Envir Med 52 (1995): 124-128. Abstract available at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1128166/
207 Lassen, Carsten, Maag, Jakob for the Nordic Council of Ministers. Mercury Reductions are Feasible: Reducing Mercury Releases with Known Technologies and Management Solutions. (INC1, Stockholm). 8 June 2010. www.norden.org
208 Ibid.

209 Hylander, Lars D. et al. “Mercury recovery in situ of four different amalgam separators.” Science of the Total
Environment. 2006. http://www.sciencedirect.com/science/article/pii/S0048969705004961
210 Arenholt-Bindslev, D., et al., Mercury Levels and Discharge in Waste Water from Dental Clinics, Water Air Soil
Pollution, 86(1-4):93-9 (1996). Abstract available at http://www.springerlink.com/content/pp65v404t276p450/
211 Royal College of Dental Surgeons in Ontario. “Amalgam Waste Disposal.” Standard of Practice. November 2003.
www.rcdso.org
212 American Dental Association. Restoring Your Smile: Dental Filling Choices. Available online at http://www.ada.org/ 3094.aspx#comfillings
213 Ibid.
214 Poll available online at http://thewealthydentist.com/survey/surveyresults/16_MercuryAmalgam_Results.htm . Poll cited in Fleming, M and Janosky, J. The Economics of Dental Amalgam Regulation. Report Submitted for Review and Publication to “Public Health Reports.” Available online at http://www.iaomt.org/articles/files/files303/The%20Economics %20of%20Dental%20Amalgam%20Regulation.pdf
215 Makhija, SK et al. “Dental Practice-Based Research Network restorative material: Findings from the characteristics associated with type of Practitioner, patient and carious lesion,” J Am Dent Assoc 2011; 142: 622-632. Available online at http://jada.ada.org/content/142/6/622
216 Simececk, JW, Diefenderfer, KE, Cohen, ME. “An Evaluation of Replacement Rates for Posterior Resin-Based Composite and Amalgam Restorations in U.S. Navy and Marine Recruits,” J Am Dent Assoc 2009; 140 (2): 200-209. Available online at http://www.jada.info/content/140/2/200.full
217 IAOMT. Safe Removal of Amalgam Fillings. Available online at http://www.iaomt.com/articles/files/files288/Safe %20Removal%20of%20Amalgam%20Fillings.pdf
218 Fleming, M and Janosky, J. The Economics of Dental Amalgam Regulation. Report Submitted for Review and Publication to “Public Health Reports.” Available online at http://www.iaomt.org/articles/files/files303/The%20Economics %20of%20Dental%20Amalgam%20Regulation.pdf
219 Ibid.
220 Norway Ministry of the Environment. Minister of the Environment and International Development Erik Solheim Bans Mercury in Products. Press Release. 12/21/2007. http://www.regjeringen.no/en/dep/md/press-centre/Press-releases/ 2007/Bans-mercury-in-products.html?id=495138