Holistic Dental Videos Cary NC
A guide to the dental amalgam controversy
Dr. Thomas Duplinsky | Assistant Clinical Professor – Yale University School of Medicine
I am Tom Duplinsky I am an Assistant Clinical Professor at Yale University School of Medicine. I also teach in the residency program at Yale Haven hospital. In 1993, I came to connect with the International Academy of Oral Medicine and Toxicology, and they were an organization that was new at the time that was interested in the effects of mercury because mercury being a known neurotoxin they were concerned that this was a problem in dentistry, at the time I was concerned because several colleagues had become mercury poisoned from practices that they purchased and I knew that this could probably be an occupational risk because for instance one person I know bought a practice and was completely fine and then had neurological defects and the later studies showed that he became mercury poisoned from the practice, environment that he had worked, because the previous dentist was not very good with mercury hygiene and there was mercury contamination in the entire office, and it was bad mercury hygiene is what I thought, but later my exposure to the organization and scientific studies based on science it became quite clear that mercury was constantly leaking form restorations in poisoning the patients and also was at high risk for dentist themselves.
Now the problem is that the average dentist is really not aware of the risk, and the study of- the current study brought things to light even for myself that the risk is pretty significant and most people are not aware of the risk and feel that while there is some minor mercury it is not a big deal, for their health. So that is why I originally designed this study so to actually see how mercury affects the health of dentists we just published a study on the health of dentists and just looked basically actual sterilization data, to see what type of medical issues dentists had compared to controls.
Basically previous studies looked at surveys or they looked at mortality studies and a lot of the data that people feel that dentists are as healthy as or are healthier than the average person of the general population, it is based on these and it flows basically in the number of these studies. Previous studies maybe larger surveys of what the dentist think is going on so that is another flawed aspect is you are asking someone to tell you what their health status is when that is basically it is purely subjective and our contention certainly after this study is that dentist may live slightly longer but they may not be healthier than the general population and the reason they can actually – they may have had a longer life span is because they had the finances and means to get medical care, whereas the general population may not. So we wanted to actually look for a method that would be able to look at what is really happening with the health of dentists and the best way to look at that is to look at their actual medical claims to what they are actually being treated for and this is fairy unique that they are able to do this study. We were able to get permission to look at 600 dentists, and controls that were actually matched for the entire whole insurance plan, the location even many of them have the same physician so the care was equal so let’s look at the population and equally look at – they have equal access to care and let’s see what the problems that they have compared to the general population had several categories, we had neurological, psychiatric, cardiac and respiratory – the 4 categories we looked at in this population and compared them to controls, looking at actual claims data so we were able to look at that, and findings were pretty significant, shows that the dentist was not as healthy as the general population or the controls.
The neurological conditions they were suffering from were 7.6 times higher than the general population, and in psychiatry, it is 2.4 times the general population and this makes sense because we are looking at mercury and mercury is a stronger neurotoxin so it is not surprising that if you have a higher body burden of mercury that you would have more health problems, and we showed that to be true so the science is there that mercury is leaking out of the fillings, your body is accumulating mercury and the disconnect is between the science and the opposition who says yeah well it leaks throughout the body but it does not cause an disease but the problem with mercury is that there is a whole spectrum of disease so it is not one thing and the same person may be exposed to same amount of envious – has a body burden that in one person will cause ill effects and in the other person that may be resistant to but so – it is very you know as far as linking a disease it is very hard to link up to a disease but the fact that mercury is leaking out of these fillings and accumulating in parts to your body is reason enough not to use it.
A guide to the dental amalgam controversy
Jim Love – Attorney, International Academy of Oral Medicine & Toxicology.
Hi, I am Jim Love I am the long-time attorney for the IAOMT – International Academy of Oral Medicine & Toxicology and I have done a lot of different things for the academy over the years. They mostly use me as a writer that is exactly what happened in 2009, when they asked me to prepare a petition to FDA following the issuance of the FDA’s 2009 final rule.
The final rule basically said that amalgam fillings are completely safe and that the amount of mercury coming off those fillings to a minimum certainly to a quantity well below in reference to those that were established by EPA back in 1995 I think it was, and so and they basically prepared a risk assessment in connection with amalgam fillings and they told us what the numbers were and what the references was and what the daily absorbed dose was – all the way up to a range of one to 10 fillings, and they said that as a result of the risk assessment and the clinical studies that were available they were going to classify dental amalgam in FDA’s class 2, and we identified somewhere between 20, 25 mistakes in their analysis, our petition was at least enough to induce FDA to consider scheduling advisory committee hearings in 2010. We have never gotten a response to our petition. We were told by FDA very candidly that the matter has been sent to HHS – for consideration and we don’t know what HHS – is really doing with all this, but recent communications have indicated that they are doing some kind of cost benefit analysis – and there is no indication of when that analysis might be concluded in view of the fact that so much time has gone by. Speaking today that is March 2013 – the response to a 2009 petition it became apparent to me that in view of the recent published science that we should supplement our petition and it became apparent that in view of the fact that these advisory committee hearings had already been held that we were obligated to submit a new petition and request leave of the commissioner who is Margaret Hamburger at this time. She was the commissioner back in 2009 when we sent our petition in and was also the commissioner at the time that the FDA issued its final rule. She tells us that she was not a part of that process – I guess we really have no way to know the doors are closed at the FDA but she recused herself publicly and said that as a result of her association within Re-shine which distributes mercury fillings that it was not appropriate for her to be part of the decision making process.
Let’s fast forward to March 7th 2013 the regulatory scheme requires that we seek the permission of the sitting commissioner to supplement our petition. It seems appropriate to me that if she was not a part of the decision making process in 2009, that she probably should not be in 2013 so my expectation is that despite regulatory scheme directing us to the commissioner that, that decision making should be handed off to somebody else.
The petition that I sent to FDA on March 7th incorporates 26 new papers but the impetus of this whole exercise was to get the gyres papers Richardson’s papers and with his new paper that came out last summer into the administrative record in my view everything else is an add on – so we send in this supplemental petition we have to wait for commissioner Hamburger to give us leave to send all this paperwork in and make it actually part of the administrative record – once that occurs that it is my understanding that the FDA has an additional 3 months to respond to these additional papers – the regulatory scheme is kind of fine the way it is written because the FDA has 3 months but if they need more time than that then they can have 6 months. Well if Margaret Hamburger gives us leave and then relatively in the near future my advice to IAOMT would be to delay an ensuing lawsuit another 3 months give FDA a fair chance to respond to all this – and then file a lawsuit just have a court compel FDA to prepare this response to our 2009 petition as supplemented, per judicial intervention has been soft. I am not aware of any case where it is the FDA for whatever reason is excused for preparing that response so if things unfold the way I hope they will and the way I expect them to then I would think that before the end of 2013, the court would require FDA to prepare this response.
Sure, I am Mark Richardson, Ph.D. in biology; my company is Risklogic Scientific, though I have worked for health Canada amongst other companies and departments All of this kind of started in 1994/1995 I was asked by Health Canada to do a risk assessment of dental amalgam. Well, why is that? Well – because you have just finished your Ph.D. studying mercury. I said well what has mercury got to do with dental amalgam? And that is when I learned in 1994 that dental amalgam is about 50 percent mercury by weight. Had never known it – kind of surprised by it but anyways that is what leads to all of my work, on dental materials.
So I had just finished all the work for the FDA looking at the US population when Statistics Canada made publicly available a new database that had been collected it was a population represented of sampling of the Canadian population – in which they had dentists count the exact number of filled amalgam surfaces in all the participants’ mouths, and it is the first population-based survey anywhere that made an accurate account of the number of amalgam fillings. The work I had done through the FDA – they had very good data on the number of dental restorations, in people’s mouths but they didn’t say it was dental amalgam or ceramic or gold or composite they just said it is restored so we were able to – based on some other information figure out how many of those restorations would have been amalgam or for Canada we did not have to do any of that figuring out because they had actually recorded the exact number of amalgam fillings in every body’s mouth.
So we were able to take that information, they also collected urine samples from the most of the people who were surveyed, and measured mercury in their urine so we would link the number of Amalgam surfaces directly to the urine mercury concentration – and through those relationships, do an extremely accurate probably the most accurate estimate of mercury exposure from dental amalgam that has been done to date, and that was completed all about 6 months ago I guess it was in September of 2012, I submitted that to a journal for publication it has been accepted and I am waiting for it to come out in print, so we have an update of the Canadian risk assessment for dental Amalga that is specific to the years 2007 to 2009 because that is when statistics Canada conducted their survey of the Canadian population for that particular study so that sort of allowed me to update that study has not changed the picture very much the levels of exposure that I predicted in 94, 95 – matched pretty closely with what we concluded for the US and it matches very closely with what came out of this most recent study the most accurate study so made me quite – I was quite pleased that the efforts done in 94, 95 were pretty accurate like there is not a lot of error introduced by uncertainties in the process that was used then.
We were pretty much bang on for the amount of mercury you get per amalgam filling and that sort of things, so that is due to come out in their journal – human and ecological risk assessment, hopefully within the next 3 to 4 months and that is the journal where I first published my health study for Canada back in 96 is when they published that so I went back to the same journal just to be able to provide that continuity and the update within the same journal that published the original work, and so and again we have got, we have about – one-tenth of the US population you have 300 million or so we have got 33 million citizens and it looks like the exposures are just about the same as in the US? Just factored down by 10 – it’s about a factor of 10 lower which is really what you would expect because we have similar standards of dental care we have countries that maintain their policies on dental amalgam safety as for uses of dental materials so our countries are very similar in terms of the amount of dental amalgam that is still being used, it is interesting that over the last decade both the US and Canada report about a 50 percent reduction, in the use of dental amalgam, which is as far as I am concerned
– a good news part of the story, this you know sort of debate if you want to call it going on about the safety of dental amalgam it is being going on for a long time, I said I got involved in 94 95 – I would not say that we have ever won a major argument or anything with the government about you know trying to take active some action some positive action to reduce the use of dental amalgam, but we have managed to affect the same things through increased knowledge, the – well the increased availability of aesthetical or white filling materials, that sort of thing – certainly added to the fact but you know really we are, I like to think we are winning the war, that dental amalgam users dropped off by 50 percent and it dropped off about 5 to 6 percent every year, it is just going to do that constant decline I am sure until there will be some base level, of use still not the population in 10 years’ time, but I get the feeling that it’s use will all but pretty much disappear for most applications which is good – it is going to happen in my lifetime which is kind of nice
A guide to the dental amalgam controversy
Mark Richardson, Ph.D. – Director, Risklogic Scientific Services Inc.
Hi, I am Mark Richardson, Ph.D. in biology; my company is Risklogic Scientific, though I have worked for health Canada amongst other companies and departments and I guess my claim to fame really is the risk assessment of mercury exposure on dental amalgam that I did for the health Canada in 1994, 95 and then that sort of led to a number of studies looking at the evaluation, or the risk posed by composite resins as a possible alternative to dental amalgam, that is spun off into looking at gold and ceramics dental materials and then you know trying to bring risk assessment I guess to the discussion table, not just exposure but not just efficacy as a dental material but looking at risks for potential health effects in the general population who might have dental amalgam fillings. How much mercury do you get from tuna fish sandwich if you eat a tuna fish sandwich vs. how much you would get from dental amalgam fillings and you would ask me to take a look at that question, and I was able to track down information on the internet from I believe a physician who made the claim that you get far more mercury from a tuna fish sandwich than you do from dental amalgam fillings, of course it was kind of a blanket statement, there was no definition by this person as to how many tuna fish sandwiches was he talking about because you have to know how many sandwiches you eat, how much tuna is actually in each sandwich, how much mercury is in the tuna that is in the sandwich and then you need to compare that to amalgam fillings, well how many fillings and etc. so the blanket statement really is not defensible there is no way to quantify or determine how this person this physician had reached their conclusion so I redid all the calculations and I would say that if you have no amalgam fillings, and you eat one tuna fish sandwich a day you know what you are going to have more mercury from tuna than you are from dental amalgam and likewise if you have one amalgam fillings but you never eat tuna you are going to get more mercury form your amalgam fillings than you are from tuna fish that just kind of makes sense, but in the scheme in the balance of the schemes of things in terms of the average rate of tuna fish consumption by the US population, compared to the average number of amalgam fillings held by members of the US population, you actually get way more amalgam exposure to mercury from amalgam than you do from tuna fish – the second aspect of that whole comparison is not just the levels of exposure but the risks – how does the amount of methyl mercury you get from tuna fish compare to the amount of methyl mercury that is safe to be taken in and the US environmental protection agency they define safe dose as a reference dose, or a reference concentration in this case for methyl mercury it is a reference dose. That is the amount that a person in the population can be exposed to every day without concern about health effects so how does the exposure from eating a tuna fish sandwich compare to that safe dose?
Then you can do exactly the same thing for dental amalgam in fact that is what I have been doing since 94 95 it is looking at the exposure and how it compares to the safe exposure level for the mercury vapor that it emanates from dental amalgam fillings, and the toxicity – if you look at those safe doses, the safe exposure levels as the general definition of a toxicity of a substance the safe level of exposure for mercury vapor, is much lower than it is for methyl mercury. I can’t define for you off the top of my head what those levels are. Probably around 0.2, micrograms per kilogram body weight per – I believe 4 for methyl mercury and if you look at the level of exposure associated with the US EPA’s reference exposure level it is about 10 times lower, so that would imply in general since mercury vapor is about 10 times more toxic or potentially toxic than is methyl mercury at least based on all the information we have right now on their toxicity. So not only do you get significant exposure to mercury vapor if you have amalgam fillings, the type of mercury you are being exposed to is generally about 10 times more toxic than the methyl mercury that is coming from fish, so you have got to combine those 2 things to get a proper sense of the comparison of relative exposers and relative risks of tuna fish consumption and methyl mercury exposure from tuna fish and then the mercury vapor that emanates from your amalgam fillings, so in general terms, you get more mercury from amalgam and it is a much more toxic form of mercury so those 2 combine to make the risk posed by dental amalgam probably rather much more significant!
Mercury Exposure.info – a guide to the dental amalgam controversy
Mark Richardson, Ph.D. – Director, Risklogic Scientific Services Inc.
Hi, I am Mark Richardson, Ph.D. in biology, my company is Risklogic Scientific, though I have worked for health Canada amongst other companies and departments, ok back in – in what would be late 2009, early 2010, I got a call from a person at the US FDA – who was in the midst of trying to assemble materials and information, and panel members and that sort of thing to do a re-evaluation of dental amalgam, and all of that work culminated in the hearings that they had conducted in December of 2010. By the time he contacted me, first, he was inquiring as to whether or not I might be available to be hired as kind of an ex-officio employee of the FDA, to act as a kind of an advisor and aid them in the work, of course, I don’t have a US green card! and being a Canadian citizen it was impossible to set that up, but we talked about the fact that there was this need for if the panel the FDA was convening wanted to have a proper picture of exposures and potential risks, they needed a risk assessment done for the US population specific to the US population that could try and quantify the total numbers of people in the US population that might exceed, the dose that for all intents and purpose that we call the safe dose, defined by the US environmental protection agency or another agency, and it is very interested in that, and so I sent him a proposal said it was going to be I think it was going got be a 116,000 dollars to be able to put all the information together it is not a small undertaking, it took a team of – I had a team of 6 helping me on different aspects of the work, you needed a team of 6 because they needed it done in just a few months as opposed to allowing you a whole year to kind of compose the information.
So, we had this team, we put it together we put the proposal to them, and they said Mark it is a great proposal! But we can’t fund it without posting it on an open bidding system so that US-based contractors could bid on the same project, and since I had written the proposal it was my copyright more or less, and I said no you are not going to post that, because certainly anybody could just walk in and say yeah we will do it for a 115 thousand dollars and you know I would lose rights to the study I would lose rights to the proposal and this sort of thing so they said well if we can’t post it for external, for competitive bid they said their hands were tied and I understand that. I have worked in government agencies; they are looking to get the best value for their dollar so they like to go for the competitive bid, so since we can’t go on the competitive bid process the best I can do is if you can get the study done, and you can deliver it by the 14th of November this was in 2010 – it will be part of the package that goes to the FDA panel members, for review in preparation for the hearings that are going to be conducted in mid-December.
So, I was with you know, I was quite fortunate with the assistance of the International Academy of Oral Medicine and Toxicology. We found some, well I guess I always like to call them wealthy benefactors, or whatever how are willing to step forward and put some money up to fund the study, so we got that done, did that assessment of exposure to mercury vapor from amalgam fillings in the US populations the first one of it is kind, it was done and then that was published in the journal of Science of the Total Environment. We published it in scientific literature the following year, takes a little while for the publication process to occur so – they go through peer review and everything so it was in 2011, when that got published, well findings on that – basically roughly 60 million US citizens who have amalgam fillings, will exceed the safe dose that would be defined by the US environmental protection agency but if you rely on the California Environmental Protection Agency, for their perspective on the dose or exposure to mercury vapor that might be considered safe, have about a hundred and ten million Americans who exceed the California safe exposure level – so that is pretty significant, we have a population of around 300 or 330 million in the US you are looking at a good third of that population that is known to have amalgam fillings and will exceed what – the federal government might consider it to be a safe or acceptable exposure level and you know – that in it of itself is pretty significant and of course the more fillings a person has, the more they exceed the safe limit. So you could have 4 or 5 amalgam-filled surfaces, and be okay you would just sort of meet the exposure, that safe exposure level but if you go beyond that, of course, you would start to exceed exposure, and a person who has a mouth full of fillings and there are people in the data base, who have well they measure exposure they measure the number of restored teeth in terms of surfaces and you think a molar tooth has a top and 4 sides so it is a 5 sided tooth so you have 5 surfaces filled on that individual tooth, while there are people who had more than a hundred surfaces in their mouth, so that is at least 20 teeth you know probably more – they have a mouth full of amalgam and you know it is known to occur, people have very bad oral hygiene or other problems with their teeth well they get fillings or they get total crowns or whatever it is and a lot of that is mercury amalgam so you can have quite the dose of mercury from a mouthful of amalgam fillings.
Mercury Exposure.info – a guide to the dental amalgam controversy
Steve Koral, DDS
The International Academy of Oral Medicine and Toxicology
My name is Steve Koral, I am a dentist in Boulder Colorado, and I have been a dentist for over 30 years, and a member of IAOMT for over 20. I was an early converter to mercury-free dentistry back in 1983, as a matter of fact, today may very well be the 30th anniversary of the last time I placed an amalgam filling. Now the article that you see was published in a magazine called Compendium of Continuing Education in Dentistry, which is essentially a trade journal but it has peer-reviewed articles that appear in there in every issue, so it is – it verges on being a serious scholarly journal, and it goes out free to 90,000 dentists. The importance of that is that one of the big problems with dental amalgam with mercury in dentistry is a chronic information gap that affects the dentists of the world, United States and Canada.
The sources of information that dentists typically have access to have not taken the mercury issue seriously. They have uniformly swept it under the rug, they have adhered to the line that ‘oh there is nothing wrong with it’ or maybe we are using it less than we used to, but scientifically there is nothing wrong with it –the whole import of the mercury-free dental movement is to point out that scientifically there is everything wrong with it and the scientific evidence is voluminous and accessible accept it is not accessible in dental journals, so my main point in this article or the first point in this article was to – note that most of, if not all research that supports the notion that there is something scientifically wrong with mercury exposure from dental amalgam, most of that information appears outside of the dental literature. It appears in American literature and toxicology and environmental literature, but miraculously it all becomes neutralized and do not appear where dentists are looking so dentists are actually legitimately expressing an honest opinion when they say that there is no science behind worrying about mercury and amalgam.
I was very pleased that the editors of this journal the Compendium – were willing to accept an article like this and I was very pleased that they kept in certain of the key pieces of information, that those of us in the mercury-free movement that had access to for many years, in particular, those 2 photographs, the photographs of mercury droplets sweating out of a polished amalgam sample and the photograph of the autoradiogram of the sheep, that had been subject to amalgam fillings that were tagged with radioactive mercury, these were some hair raising bits of information that I saw many years ago – and I can’t tell you how many times that I have thought that this is it, that is the piece of information that is going to tip the world over and nobody is going to trust mercury and amalgam any more, and I have been disappointed every time, because those pieces of information don’t show up on the radar of the dentists. So that is the import of this particular article – the first article; serious scientific nature explaining some of the key points of the hazards of mercury and dental amalgam that will be seen by many dentists.
The approach taken in this article was to highlight the risk assessment aspects of exposure. Now one of the things you always hear is, from people who are excusing mercury exposure from dental amalgam is not that they deny that it happens, but they say that there is too little that comes out of the fillings to harm anybody, so how much is too little? Is it eeny weeny or is it actually quantifiable?
It turns out it is quantifiable and there is not a whole lot of disagreement with the quantities of mercury that are admitted by dental amalgam there is disagreement as to what that quantity means. The dentists of the world have been told, by the sources available to them – that it might take up to 450 fillings, to achieve an exposure that is actually a toxic level exposure, whereas people who are more – who are practicing risk assessment in a more scientific way – point out that the actual, the way you actually establish a toxic dose would yield a toxic exposure, to some segment of the population at a much lower rate, estimation of 450 fillings, or 450 filled surfaces, to get it – a toxic exposure level, comes from a very rough approximation of the accepted practices of risk assessment.
The people who wrote the article that proposed that number used, what is essentially a level of mercury exposure – that would cause a building to be evacuated in an industrial setting as their toxic level, and anybody who practices risk assessment, knows that you can’t use the worst-case scenario as your cut off level, as your regulatory exposure level – you have to factor in variations in the population, variations in susceptibility according to age, variation in susceptibility according to genetic predisposition, each of which cuts down the allowable level of exposure so that your placing no risk on the general population. So then – those are called uncertainty factors, uncertainty factors are arithmetic factors that are used to just reduce the levels of exposure, because of uncertainty in the data – in other words, if you have an affect level that you can determine on adult, male, industrial workers who are exposed to mercury vapor – you are not, and they are working 40 hours a week – you are not going to use that level of exposure as a safety factor for a 6-year-old how might be exposed to mercury from fillings a 168 hours a week. First of all the child is much more susceptible to the effects, much lower body weight so there is much more exposure per organ, and you have to cut down from that industrial panic button layer- to get a more realistic level of exposure that you can allow in a child, as opposed to 450 filled surfaces. Our friend Dr. Mark Richardson for example had a very detailed risk assessment that said that at an acceptable exposure to mercury vapor for a young child that child might achieve that level of exposure with only one or 2 surfaces of filling, my position would be in this modern age in the 21st century when you can use materials such as dental composites, which are known to be thousands of times less toxic than mercury – don’t use the mercury! Use the composite!
Mercury Exposure.info – a guide to the dental amalgam controversy
Mike Fleming, DDS
2006 Consumer Representative, FDA dental Products panel
2010 Consultant and panel member, FDA dental products panel
Well, my name is Mike Fleming, and in 2006, I was appointed to the dental products panel as a panel member consumer representative. Then in 2010 I was brought back as a consultant to the FDA, and the background to the article came about as a result of my reading dental town magazine, and an article had appeared in there by the guy that runs it – Howard Ferron and I was looking at this string of dialog within their website, among the dentists discussing the article and how some loved Amalgam and some didn’t and I looked at it and I thought this is not really good to see a dialog based upon error and what I consider to be understanding how the derogatory process works and what it is that we should be concerned about with amalgam and not get confused with these other issues, of function and aesthetics and so forth so I wrote a little blog on there myself and within a day I got a call from Ferron and he said well lets – can you do an article for us to help us clarify some of the issues that you referred to – I said sure so I wrote the article and it appeared in the February issue of dental town magazine.
What I was interested in doing was helping to clarify what the essential issues were from the FDA’s point of view – and for my own opinion point of view and I made it clear that it was not the FDA speaking it was me giving me opinions on these matters as it is today. So, with amalgam the issue has always been safety but whenever you read about this issue in these publications there is always this discussion about well amalgam works so well and it has last so long and or it is some aesthetic argument, and I am in favor of composites but when you are discussing safety of amalgam you can’t talk about the aesthetics. It is a safety issue, not one that falls under some other rubric. One of the most prominent places where this error of confusing safety effectiveness and all these sorts of things together whether it is by design or by carelessness, I happen to think for the most part it is by design that for example the American Association of Public Health recently had a policy statement given to them, which in turn would be used in the International Treaty Negotiations – that have just finished up in overseas, and I pulled a quote from it – showing the confusion of these issues of effectiveness and aesthetics and longevity and all the rest, when really the central core issue is the safety of dental amalgam for example when you sit in this FDA meetings panel meetings you realize very quickly that effectiveness is never discussed.
It is a matter of the safety of the product, and a product can be pulled from the market for either reason of effectiveness or safety if it is determined that a product is really not effective to do its job then they can pull it for that reason, but in the case of amalgam, their argument has always been whether it is safe to use or not.
How about for those people who might think oh it should be a no-brainer that it is not safe because the mercury is going to why would, for an average person help them understand why that is not readily apparent to maybe FDA?
Well, I think the issue that is apparent to them from my point of view is, is there a level of mercury exposure below which one could have some assurance that the product was safe to use which is in fact what we were dealing with in 2010 on the meeting panels, we were trying to determine a level of exposure that more properly would reflect the exposures that a patient might get whether they are a kid medium-sized adult, large adult, that sort of thing.
So essentially the issue before the FDA is to determine what they call a minimum exposure level that would be – considered a safe level, that leads then to the second issue which is how do you determine what that is with amalgam since it is such great variability from person to person depending on how many amalgams they have what their personal habits are their genetics and everything else so the FDA was struggling with the matter of establishing a level because that is how they do it, they say well there is a level below which perhaps the product could be used, safely – the panel basically determined that we don’t think there is a level that you have identified that is below which it would be safe to use it. They didn’t say it was unsafe they just said we have not established there is not really a level that has been established yet because we don’t know how much mercury a patient is getting from their amalgams, with any degree of predictability so – the panel meetings in 2010, sort of ended on that note. With a couple of remarks including my own that my approach with the panel is to say well look if you have no data to prove safety which is what the FDA has to do – they have to be able to substantiate that a product is safe. Not necessarily prove harm, there is a difference which I pointed out in this article between proof of harm and proof of safety. A very distinct difference, some would look at it like well there is no difference but there is, regulatory wise there is a chasm between those two.
So, my suspicion then was what FDA would likely try to do is to bring some changes online – in the use of the product based simply on a lack of evidence to support safety in whatever populations they felt they didn’t have the evidence to prove safety. They would not have to admit to any health effects during that particular approach, they could just simply say we don’t have any evidence to support safety, so that is my suspicion that is what I believed the FDA will likely will do that is the course they will likely take if they are permitted to release whatever it is that they have decided.
A guide to the dental amalgam controversy
The childhood amalgam trial which was a prospective randomized study which is the top-level study you can do in science, it means taking a whole group of children, dividing them randomly – some of them you get amalgams, some of them you get composites, furthermore, they said we were going to test on series of parameters urinary mercury, profaners, kidney damage – neurological damage, they decided all that before they ever tested a single child, this is what we are going to do – it collected all the data – prospectively and what it reveals is damage to every single domain study. Every single outcome that they were looking at that they said – this might be a concern so we want to study it to see if it is related to amalgam, all of them – are being linked to amalgam exposure.
Outcomes from the Children’s Amalgam Trials – what happens to these children in the course of the study? And what we found looking at first urinary mercury, then urinary profaners then eventually kidney dysfunction markers is that mercury exposure from dental amalgams and a dose-dependent fashion meaning – the amount of mercury being released from the amalgams significantly negatively impact each of those measurements, so turns out that amalgams based on the number, the size, how many you have, all of those things – is related to how much urinary mercury you have, it is related to how much poor friends you have for the mercury associated profaners, perhaps worse – associated with kidney dysfunction. It actually seems to be causing ongoing kidney damage at the level proximal tubules where one study’s kidney dysfunction chronic damage to the proximal tubules – is associated with chronic kidney disease which is the number one kind of kidney disease in the United States.
In considering the childhood amalgam trial findings that has been discovered since they are telling a very compelling story. A story of damage to the kidney of mercury building up in the body causing kidney damage, brain damage – this is a story that makes sense, very direct – very simple to understand. Those- if I had somebody from the American Dental Association sitting next to me and trying to tell their story – what would they say now?
Well Amalgams are safe, they always say that but how do you explain that in light of these findings? Well, we have to suspend the laws of chemistry and physics and physiology to say yeah it just happens, it is a coincidence, that we found damage to the kidney, it is really safe. Well, it contributes to mercury body burden that is a coincidence, they are actually safe – well we can find it in the urine, it happens to be coincidence, it must be safe. There is no story, the story that we are telling is one that is based on over a hundred years of signs without mercury. We know that mercury is released from amalgams; we know that mercury is toxic to almost every organ system in the body. This is what was plausible before the study now it is overwhelmingly plausible. They have no story to tell other than we think it is safe because we think it is safe – and if you need me to say it again, I think it is safe is what they would say.
Mercury is one of the most toxic elements and a persistent traveler through our environment, so who is the travel agent for this elemental poison? Cold fire power plants most definitely. Mining operations, of course. Your neighborhood dental office? Surprisingly yes! The UN environment program reports that 10 percent of global mercury usage is for amalgam tooth fillings. This sums up about 340 tons of dental mercury journeying into the environment each year. In the US dentists are currently the second largest users of elemental mercury, this accounts for roughly 32 tons of mercury used daily to place amalgam restorations otherwise known as silver fillings. Although the number of amalgams placed has decreased over the last few decades. Dentists still use amalgam without precautions, so the threat of mercury exposure continues.
Dental mercury travels many pathways on its journey back into the environment. It starts when a dentist receives pre-capsulated dental amalgam. Each capsule up to 900mg of elemental mercury is separated from the other alloys.
To make the final product the capsule is vigorously shaken in a trituration to thoroughly mix all the elements. Occupational safety concerns arise because this heats the mercury creating thousands of micrograms of mercury vapor which are relapsed upon opening the capsule. The used amalgam capsule still contains a small amount of mercury, so the ADA recommends the capsules to be stored in an air-tight container and collected by a hazardous waste company. Unfortunately, the majority of dentists toss the capsules into the trash. This mercury-contaminated trash will eventually travel to a landfill where the mercury will continue its trickle down into the soil.
Back at the dental office, the freshly mixed amalgam is placed into the tooth. The dentist then carves away any excess material while patients swallow some amalgam waste, most are suctioned off and flows through a filtration system, but this system only captures a small percent of the larger pieces. The vast majority of much smaller pieces, escape into the wastewater. A similar scenario plays out when dentists replace amalgam fillings. Many dentists not realizing the environmental harm, clean out their filtration systems by dumping the captured mercury tainted sludge down the drain, a study funded by the ADA estimated that amalgam fillings contribute up to 50 percent of the mercury found in wastewater. This contaminated water then flows to publicly owned water treatment plans.
While efforts are made to remove the mercury from wastewater, most of it settles down into the sewage sludge which is then taken and spread on landfills as fertilizer or deposited in a landfill, and in both scenarios, the mercury constantly off-gasses into the atmosphere and seeps into the ground. A percentage of the sewage sludge is also sent packing into incinerators. With over 200 tons of dental mercury continually off-gassing mercury vapor in the mouths of Americans, even exhaling is a contributor of mercury to our atmosphere. Additionally, people with amalgam fillings serve as hosts for mercury’s passage back into our environment through the excretion of human wastes. Mercury’s ride continues even after death.
Crematoriums which are unregulated and contain no filtration processes are growing in their transportation of mercury back into the atmosphere, and all the various pathways are accounted for. Dental mercury from the US contributes roughly 28 and a half tones into the environment each year. The governments of the world are actively working together to reduce the amount of mercury released globally to protect human health. The first and most powerful step to eliminate the mercury release from dental amalgam is to discontinue the use of this toxic material with the threat so great and solutions so simple. It is time to restrict mercury’s passport.
Evidence-Of-Harm.com – a documentary exposing the hazards of MERCURY DENTAL FILLINGS.
Sue Casteel – Environmental Health Scientist.
I am Sue Casteel; I am an environmental health scientist with ATSDR. ATSDR stands for the Agency for Toxic Substances and Disease Registry. People should be concerned about elemental mercury because most people don’t realize just how dangerous it can be and what serious health effects it can have. Elemental mercury is toxic primarily through inhalation exposure. It is very important to recognize that you cannot see it, you cannot smell it and there is no way to know that it is there except that it volitalizes into air. Volitalize – cause a substance to evaporate or disperse in vapor.
Eric Nold – EPA/The Environmental Protection Agency Emergency Response and Removal Coordinator.
You will see it in the literature all the time, it volitalizes at room temperature and higher that is a very bad misconception people have. It will volitalize at anything above negative 38 degrees. The higher the temperature the more readily it will volitalize and quicker it will volitalize.
When a woman is pregnant we hope that she is never exposed to mercury vapor because we know that it can pass the placenta and cause neurological problems in the unborn baby.
This is an amalgamator. This is the instrument that is going to mix the mercury with the other ingredients to form the amalgam filling. Keep in mind that we are taught in dental school that once they combine the mercury becomes relatively inert at that point. So let’s try this.
And if we see residences or buildings that have 10 micrograms per cubic meter or more of mercury then we consider that houses are health risk and we recommend that people don’t stay in the building or the residence.
10 micrograms is generally considered inhabitable but they should not be living there without some kind of respiratory protection and the goal to make sure that everything is completely removed to the point where it can never pose a threat to anyone, even to small children with health problems is 0.3 micrograms.
As you know a lot of us have dental amalgams that contain mercury and the amalgams can be as much as 50 percent mercury and research indicates that anywhere from 4 to 19 micrograms of mercury per day can leak out of your amalgams into your body. If you are exposed to mercury chronically for a long period of time, then we start seeing much more serious health effects, and these health effects would be damage to the central nervous system – fatigue, irritability being very emotional, memory loss, Shyness, blushing, tingling or tremors in your hands, tingling and shooting pains in your feet, Anorexia, you may have gingivitis, you might have some serious respiratory problems. They are just a lot of really serious health problems associated with chronic exposure.
Typically in most dental schools, it has been taught that the mercury is trapped within the matrix of the Amalgam and so therefore we are trying to visualize here and prove that there is a significant amount that comes off in the mixing and the packing, and then we had some teeth with the amalgam that has been set for a while and we are going to be removing that with a high-speed dental drill in order to visualize how much vapor comes off during that procedure as well.
And what this research that we are doing here visually shows that when you drill on an amalgam filling that it dramatically exposes the patient and the dentist and the dental technician to huge amounts of mercury vapor that enters the body. It is even worse than what they imagined. 2483 micrograms per cubic meter and I have never seen levels of mercury this high. That is pretty much unheard of in any type of work environment. It definitely shows with just absolutely fact – hard science that amalgams when they are heated with a drill, by drilling on them we lose copious amounts of mercury vapor into the air. Clearly if you are not measuring it, you are not monitoring it and you are not educating these employees then the OSHEA regulations are not being upheld.
As dentists drill over the filling, their dental drill runs at about 400,000 RPM and it sends a shower of micron size and sub-micron-sized particles. 10s of thousands of particles in the air. There is literature actually that measures the amount, the particular matter in the air space or the breathing zone of the dentist during removals, and a researcher had studied this using mannequins into which they had put in fake teeth with fillings in them, and then drilled them out and taken all the measurements, and the dose of the particular matter is explained by dentists if they don’t take precautions is huge.