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
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.
References
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3 United States Environmental Protection Agency. International Mercury Market Study and the Role and Impact of US Environmental Policy. 2004.
4 Ibid.
5 Health Canada. The Safety of Dental Amalgam. 1996. http://www.hc-sc.gc.ca/dhp-mps/alt_formats/hpfb-dgpsa/pdf/md-
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7 United States Food and Drug Administration. 2010 Meeting of the Dental Products Panel. December 14-15, 2010. http://www.fda.gov/AdvisoryCommittees/CommitteesMeetingMaterials/MedicalDevices/ MedicalDevicesAdvisoryCommittee/DentalProductsPanel/ucm235085
8 European Commission. Dental Amalgams 9: What further information is needed on the environmental risks of dental amalgam? Europa DG Health and Consumer Protection. http://ec.europa.eu/health/opinions/en/dental-amalgam/l-2/9- research-needed.htm#0
9 “Dental Mercury Use Banned in Norway, Sweden and Denmark because Composites are Adequate Replacements,” Reuters/PRNewswire-USNewswire Online. January 3, 2008. http://www.reuters.com/article/idUS108558+03- Jan-2008+PRN20080103
10 Working Group on Dental Amalgam for the United States Department of Health and Human Services. Dental Amalgam and Restorative Materials: An Update Report to the Environmental Health Policy Committee. (Washington, D.C.: update report, October 1997), 4-6. http://web.health.gov/environment/amalgam2/contents.html
11 Health Canada. The Safety of Dental Amalgam. 1996. http://www.hc-sc.gc.ca/dhp-mps/alt_formats/hpfb-dgpsa/pdf/ md-im/dent_amalgam-eng.pdf
12 Health and Environment Alliance. Mercury and Dental Amalgams. (Brussels, Belgium: fact sheet, May 2007): 3. http:// www.env-health.org/IMG/pdf/HEA_009-07.pdf
13 New York Academy of Sciences. Pollution Prevention and Management Strategies for Mercury in the NY/NJ Harbor. June 2002. http://www.nyas.org/Publications/Annals/Detail.aspx?cid=8454dd76-8998-4ee7-b7a2-5a97f68c790c
14 United States Environmental Protection Agency. Mercury in Dental Amalgam. August 5, 2011. http://www.epa.gov/ mercury/dentalamalgam.html
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16 Ibid.
17 Arenholdt-Bindslev,D., Larsen,AH. “Mercury Levels and Discharge in Waste Water from Dental Clinics.” Water, Air, Soil,
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21 Skare, I., Enqvist, A. “Amalgam Restorations: an important source of human exposure of mercury and silver.”
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23 Larose, Pierre. Position Paper. IAOMT Environmental Committee, 2011.
24 Institute of Environmental Medicine (Sweden). Karolinska Institute Report. IMM 1/92.
25 Rivola J; Krejci I; Imfeld T; Lutz F. “Cremation and the Environmental Mercury Burden.” Schweiz Monatsschr Zahnmed 100(11):1299-303, 1990.
26 Fdn for Toxic Free Dentistry, Dental and Health Facts Newsletter, 5(3), Sept 1992.
28 Ibid.
29 Rubin PG, Yu M-H, “Mercury vapor in amalgam waste discharged from the dental office vacuum units.” Arch Environ
Health 51(4):335-7, 1996 Jul-Aug. http://www.tandfonline.com/doi/abs/10.1080/00039896.1996.9936036 30 Ibid.
31 Health Canada. The Safety of Dental Amalgam. (Ottawa, Ontario: report, 1996), 4. http://www.hc-sc.gc.ca/dhp-mps/ alt_formats/hpfb-dgpsa/pdf/md-im/dent_amalgam-eng.pdf
32 Advisory Committee on Mercury Pollution. Dental Amalgam Fillings: Environmental and Health Facts for Dental Patients. (Waterbury, VT: online dental fact sheet, accessed October 27, 2010), 1. http://www.mercvt.org/PDF/ DentalAmalgamFactSheet.pdf
33 State of Connecticut Department of Environmental Protection. Fillings: The Choices You Have: Mercury Amalgam and Other Filling Materials. (Hartford, CT, USA: Brochure, Revised January 2006), 3. http://www.ct.gov/dep/lib/dep/mercury/ gen_info/fillings_brochure.pdf
34 United States Food and Drug Administration. 2010 Meeting of the Dental Products Panel. December 14-15, 2010. http://www.fda.gov/AdvisoryCommittees/CommitteesMeetingMaterials/MedicalDevices/ MedicalDevicesAdvisoryCommittee/DentalProductsPanel/ucm235085 Transcript available.
35 “Dental Mercury Use Banned in Norway, Sweden and Denmark because Composites are Adequate Replacements,” Reuters/PRNewswire-USNewswire Online. January 3, 2008. http://www.reuters.com/article/idUS108558+03- Jan-2008+PRN20080103
36 Working Group on Dental Amalgam for the United States Department of Health and Human Services. Dental Amalgam and Restorative Materials: An Update Report to the Environmental Health Policy Committee. (Washington, D.C.: update report, October 1997), 4-6. http://web.health.gov/environment/amalgam2/contents.html
37 Health Canada. The Safety of Dental Amalgam. 1996. http://www.hc-sc.gc.ca/dhp-mps/alt_formats/hpfb-dgpsa/pdf/ md-im/dent_amalgam-eng.pdf
38 Health and Environment Alliance. Mercury and Dental Amalgams. (Brussels, Belgium: fact sheet, May 2007): 3. http:// www.env-health.org/IMG/pdf/HEA_009-07.pdf
39 Watson, Diane and 18 other members of Congress. “Dear Acting Commissioner Dr. Joshua
Sharfstein...” (Washington, D.C.: Congressional letter, May 14, 2009). Copy of letter available upon request to john.donnelly@mail.house.gov
amalgamillness.com/Text_DCAct.html.
27 Stone, ME, Cohen, ME, Debban, BA, “Mercury vapor levels in exhaust air from dental vacuum systems,” Dental Materials, 23 (5): 527-532, May 2007. Abstract available at http://www.sciencedirect.com/science/article/pii/ S0109564106000881
40 Watson, Diane, Congresswoman, Mercury in Dental Filling Disclosure and Prohibition Act, November 5, 2001, http://
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43 United States Food and Drug Administration. What You Need to Know about Mercury in Fish and Shellfish, 2009. http:// www.fda.gov/Food/ResourcesForYou/Consumers/ucm110591.htm
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51 Windham, Bernard, “New studies into effect of dental amalgam,” The Natural Recovery Plan. www.thenaturalrecoveryplan.com
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61 Haley, Boyd. Response to the NIDCR Funded Children’s Amalgam Testing publications in the JAMA 2006. IAOMT document. http://www.iaomt.org/articles/category_view.asp?intReleaseID=280&month=9&year=2006&catid=30
62 Geier, David A. et al. “A significant relationship between mercury exposure from dental amalgams and urinary porphyrins: a further assessment of the Casa Pia children’s dental amalgam trial,” Biometals (5 November 2010) DOI 10.1007/s10534-010-9387-0. Abstract available at http://www.springerlink.com/content/5g21682n2857w5p0/
63 Duffy, Sandra. Critique of the Children’s Amalgam Study Consent Forms (American forms and Portuguese forms). IAOMT document. http://www.iaomt.org/articles/files/files280/CAT_Duffy_legal_critique.pdf
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177 North American Contact Dermatitis Group. “Epidemiology of contact Dermatitis in North America,” Arch Dermatol, 1972, 108:537-40.
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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
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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
195 Lyttle, H.A. and Bowden, G.H. “The level of mercury in human dental plaque and interaction in vitro between biofilms of streptococcus mutans and dental amalgam,” Journal of Dental Research 72:9 (September 1993): 1320-1324. http:// jdr.sagepub.com/content/72/9/1320
196 Raymond, Laura J., Ralston, Nicholas VC. “Mercury: selenium interactions and health complications,” Seychelles Medical and Dental Journal 7:1 (November 2004): 72-77. http://www.wfoa-tuna.org/health/ralstonraymond.pdf
197 Haley, Boyd. Affidavit: An Evaluation of Dental Amalgam and Its Ability to Injure Human Health, 5.
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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
201 Grandjean, Philippe, et al. “Neurobehavioral Epidemiology: Application in Risk Assessment,” Environmental Health Perspectives 104:2 (April 1996): 398. http://www.ehp.niehs.nih.gov/realfiles/members/1996/Suppl-2/grandjean.html
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
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