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October 2009

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Mercury is a unique element that, unlike many metals, has no essential biological function. It is liquid at room temperature and is 13.6 times heavier than water. Its unique physical properties have been exploited for a variety of uses such as in mercury switches, thermostats, thermometers, and other instruments. Its ability to amalgamate with gold and silver are used in mining these precious metals and as a dental restorative. Its toxic properties have been exploited for medications, preservatives, antiseptics, and pesticides. For these reasons there have been many industrial uses of mercury, and occupational exposures of workers and industrial emissions and effluents contaminating air, water, soil, and ultimately food chains have long been a matter of great public health concern.

Mercury has been used since prehistoric times and has been known to be an occupation-related hazard at least since the middle ages.  As the use of mercury has changed, so have the populations at risk.

At first, mercurialism was mainly a disease of mercury miners. In the 16th and 17th centuries, mercury poisoning was an occupational disease among gilders, of gold, silver, or copper, who used mercury in the process of preparing a surface to be decorated.

Mercury was subsequently introduced into the manufacture of fur felt, and mercurialism became an occupational hazard of the hatting industry. The neurologic syndrome of tremor ("hatter’s shakes") and mental symptoms ("mad as a hatter") was well known in the 19th century.

While mercury poisoning is still seen in some occupations, there has been increasing concern over the potential health hazards brought about by the contamination of many ecosystems following several well-known outbreaks of methylmercury poisoning.

The most widely publicized episodes occurred in Japan, first in Minamata Bay in the 1950s and then in Niigata. In both cases local inhabitants developed severe, chronic organic mercury intoxication from the consumption of fish contaminated with mercury that had been discharged into the environment in the effluents from a fertilizer and a plastic factory. To date over a thousand cases of methylmercury poisoning have been reported from Japan.

In the early 1970s, there was a more extensive outbreak of mercury poisoning in Iraq resulting from the consumption of bread made from cereal grains that had been treated with organic mercury fungicides. Six thousand people were affected, and 500 died.

In the last two decades it has become clear that mercury released into the environment may be bioconcentrated and enter our food chain.

The three modern "faces" of mercury are the risk from the exposure of billions of people to methyl mercury in fish, mercury vapor from amalgam tooth fillings, and ethyl mercury in the form of thimerosal added as an antiseptic to widely used vaccines.

Bacteria in the bottom of bays and oceans can convert mercury compounds released from industrial wastes into highly neurotoxic organomercurials.

These compounds are then transferred up the food chain and are eventually concentrated in the large carnivorous fish that make up a large part of the diet in many countries.

While inorganic mercury is not efficiently absorbed in the gastrointestinal tract, organic mercurial compounds are readily absorbed because of their lipid solubility.

Both inorganic and organic mercury are preferentially concentrated in the kidney, and methylmercury also distributes to the brain.

Although the kidney is the principal target of the toxicity of inorganic mercury, the brain is damaged by organic mercurials.

At one time mercuric chloride was widely used as an antiseptic, and acute mercuric chloride poisoning was much more common.

The compound was ingested by accident or for suicidal purposes. Under such circumstances, proximal tubular necrosis was accompanied by oliguric renal failure.

Mercurial diuretics were also widely prescribed in the past, and a chronic mercury nephrotoxicity was a common complication of their chronic use. Today, chronic mercurial nephrotoxicity is almost always a consequence of chronic industrial exposure.

Proteinuria is common with chronic mercurial nephrotoxicity, and there may be a nephrotic syndrome with more severe intoxication.

Pathologically, there is a membranous glomeruolonephritis with subepithelial electron-dense deposits, suggesting immune complex deposition.

Clinically, the neurotoxicity of mercury, now known as Minamata disease, is manifested as a constriction of visual fields, paresthesias, ataxia, dysarthria, and hearing loss.

Pathologically, there is cerebral and cerebellar atrophy.

Microscopically, the cerebellum exhibits atrophy of the granular layer, without loss of Purkinje cells, and spongy softenings in the visual cortex and other cortical regions.

Ethylmercury in the form of a preservative, thimerosal, added to certain vaccines, is the most recent form of mercury that has become a public health concern. 

                            

Significant mercury deposits in internal organs following the removal of dental amalgam, & development of pre-cancer on the gingiva and the sides of the tongue and their represented organs as a result of inadvertent exposure to strong curing light (used to solidify synthetic dental filling material) & effective treatment: a clinical case report, along with organ representation areas for each tooth.Acupunct Electrother Res. 1996 Apr-Jun;21(2):133-60.

Because of the reduced effectiveness of antibiotics against bacteria (e.g. Chlamydia trachomatis, alpha-Streptococcus, Borrelia burgdorferi, etc.) and viruses (e.g. Herpes Family Viruses) in the presence of mercury, as well as the fact that the 1st author has found that mercury exists in cancer and pre-cancer cell nuclei, the presence of dental amalgam (which contains about 50% mercury) in the human mouth is considered to be a potential hazard for the individual's health. In order to solve this problem, 3 amalgam fillings were removed from the teeth of the subject of this case study. In order to fill the newly created empty spaces in the teeth where the amalgams had formerly existed, a synthetic dental-filling substance was introduced and to solidify the synthetic substance, curing light (wavelength range reportedly between 400-520 nm) was radiated onto the substance in order to accelerate the solidifying process by photo-polymerization. In spite of considerable care not to inhale mercury vapor or swallow minute particles of dental amalgam during the process of removing it by drilling, mercury entered the body of the subject. Precautions such as the use of a rubber dam and strong air suction, as well as frequent water suctioning and washing of the mouth were insufficient. Significant deposits of mercury, previously non-existent, were found in the lungs, kidneys, endocrine organs, liver, and heart with abnormal low-voltage ECGs (similar to those recorded 1-3 weeks after i.v. injection of radioisotope Thallium-201 for Cardiac SPECT) in all the limb leads and V1 (but almost normal ECGs in the precordial leads V2-V6) the day after the procedures were performed. Enhanced mercury evaporation by increased temperature and microscopic amalgam particles created by drilling may have contributed to mercury entering the lungs and G.I. system and then the blood circulation, creating abnormal deposits of mercury in the organs named above. Such mercury contamination may then contribute to intractable infections or pre-cancer. However, these mercury deposits, which commonly occur in such cases, were successfully eliminated by the oral intake of 100 mg tablet of Chinese parsley (Cilantro) 4 times a day (for average weight adults) with a number of drug-uptake enhancement methods developed by the 1st author, including different stimulation methods on the accurate organ representation areas of the hands (which have been mapped using the Bi-Digital O-Ring Test), without injections of chelating agents. Ingestion of Chinese parsley, accompanied by drug-uptake enhancement methods, was initiated before the amalgam removal procedure and continued for about 2 to 3 weeks afterwards, and ECGs became almost normal. During the use of strong bluish curing light to create a photo-polymerization reaction to solidify the synthetic filling material, the adjacent gingiva and the side of the tongue were inadvertently exposed. This exposure to the strong bluish light was found to produce pre-cancerous conditions in the gingiva, the exposed areas of the tongue, as well as in the corresponding organs represented on those areas of the tongue, and abnormally increased enzyme levels in the liver. These abnormalities were also successfully reversed by the oral intake of a mixture of EPA with DHA and Chinese parsley, augmented by one of the non-invasive drug-uptake enhancement methods previously described by the 1st author, repeated 4 times each day for 2 weeks.

Mercury exposure and public health.Pediatr Clin North Am. 2007 Apr;54(2):237-69.

Mercury is a metal that is a liquid at room temperature. Mercury has a long and interesting history deriving from its use in medicine and industry, with the resultant toxicity produced. In high enough doses, all forms of mercury can produce toxicity. The most devastating tragedies related to mercury toxicity in recent history include Minamata Bay and Niagata, Japan in the 1950s, and Iraq in the 1970s. More recent mercury toxicity issues include the extreme toxicity of the dimethylmercury compound noted in 1998, the possible toxicity related to dental amalgams, and the disproved relationship between vaccines and autism related to the presence of the mercury-containing preservative, thimerosal.

A case series of children with apparent mercury toxic encephalopathies manifesting with clinical symptoms of regressive autistic disorders.J Toxicol Environ Health A. 2007 May 15;70(10):837-51.

Impairments in social relatedness and communication, repetitive behaviors, and stereotypic abnormal movement patterns characterize autism spectrum disorders (ASDs). It is clear that while genetic factors are important to the pathogenesis of ASDs, mercury exposure can induce immune, sensory, neurological, motor, and behavioral dysfunctions similar to traits defining or associated with ASDs. The Institutional Review Board of the Institute for Chronic Illnesses (Office for Human Research Protections, U.S. Department of Health and Human Services, IRB number IRB00005375) approved the present study. A case series of nine patients who presented to the Genetic Centers of America for a genetic/developmental evaluation are discussed. Eight of nine patients (one patient was found to have an ASD due to Rett's syndrome) (a) had regressive ASDs; (b) had elevated levels of androgens; (c) excreted significant amounts of mercury post chelation challenge; (d) had biochemical evidence of decreased function in their glutathione pathways; (e) had no known significant mercury exposure except from Thimerosal-containing vaccines/Rho(D)-immune globulin preparations; and (f) had alternate causes for their regressive ASDs ruled out. There was a significant dose-response relationship between the severity of the regressive ASDs observed and the total mercury dose children received from Thimerosal-containing vaccines/Rho (D)-immune globulin preparations. Based upon differential diagnoses, 8 of 9 patients examined were exposed to significant mercury from Thimerosal-containing biologic/vaccine preparations during their fetal/infant developmental periods, and subsequently, between 12 and 24 mo of age, these previously normally developing children suffered mercury toxic encephalopathies that manifested with clinical symptoms consistent with regressive ASDs. Evidence for mercury intoxication should be considered in the differential diagnosis as contributing to some regressive ASDs.

Mercury and autism: accelerating evidence?Neuro Endocrinol Lett. 2005;26(5):439-46.

The causes of autism and neurodevelopmental disorders are unknown. Genetic and environmental risk factors seem to be involved. Because of an observed increase in autism in the last decades, which parallels cumulative mercury exposure, it was proposed that autism may be in part caused by mercury. We review the evidence for this proposal. Several epidemiological studies failed to find a correlation between mercury exposure through thimerosal, a preservative used in vaccines, and the risk of autism. Recently, it was found that autistic children had a higher mercury exposure during pregnancy due to maternal dental amalgam and thimerosal-containing immunoglobulin shots. It was hypothesized that children with autism have a decreased detoxification capacity due to genetic polymorphism. In vitro, mercury and thimerosal in levels found several days after vaccination inhibit methionine synthetase (MS) by 50%. Normal function of MS is crucial in biochemical steps necessary for brain development, attention and production of glutathione, an important antioxidative and detoxifying agent. Repetitive doses of thimerosal leads to neurobehavioral deteriorations in autoimmune susceptible mice, increased oxidative stress and decreased intracellular levels of glutathione in vitro. Subsequently, autistic children have significantly decreased level of reduced glutathione. Promising treatments of autism involve detoxification of mercury, and supplementation of deficient metabolites.

The toxicology of mercury and its chemical compounds.Crit Rev Toxicol. 2006 Sep;36(8):609-62.

This review covers the toxicology of mercury and its compounds. Special attention is paid to those forms of mercury of current public health concern. Human exposure to the vapor of metallic mercury dates back to antiquity but continues today in occupational settings and from dental amalgam. Health risks from methylmercury in edible tissues of fish have been the subject of several large epidemiological investigations and continue to be the subject of intense debate. Ethylmercury in the form of a preservative, thimerosal, added to certain vaccines, is the most recent form of mercury that has become a public health concern. The review leads to general discussion of evolutionary aspects of mercury, protective and toxic mechanisms, and ends on a note that mercury is still an "element of mystery."

Cases of mercury exposure, bioavailability, and absorption.Ecotoxicol Environ Saf. 2003 Sep;56(1):174-9.

Mercury is a unique element that, unlike many metals, has no essential biological function. It is liquid at room temperature and is 13.6 times heavier than water. Its unique physical properties have been exploited for a variety of uses such as in mercury switches, thermostats, thermometers, and other instruments. Its ability to amalgamate with gold and silver are used in mining these precious metals and as a dental restorative. Its toxic properties have been exploited for medications, preservatives, antiseptics, and pesticides. For these reasons there have been many industrial uses of mercury, and occupational exposures of workers and industrial emissions and effluents contaminating air, water, soil, and ultimately food chains have long been a matter of great public health concern. This paper examines briefly six cases representing various forms of exposure to different species of mercury, and indicates the methodological issues in estimating exposure, bioavailability and absorption; these cases include Minamata disease in Japan, organic mercury poisoning in Iraq, methylmercury (MeHg) exposure in the Amazon, dimethylmercury (PMM) in the laboratory, an elemental mercury spill in Cajamarca, Peru, and a mercury-contaminated building in Hoboken, NJ, USA. Other scenarios that are not described include occupational exposure to mercury salts, mercurial preservatives in vaccines, cultural and ritualistic uses of mercury, and mercury in dental amalgams.

Mercury exposure and early effects: an overview.Med Lav. 2002 May-Jun;93(3):139-47.

OBJECTIVES: This paper was given as a keynote address at the conference on The Assessment of the Effects Due to Low Doses of Inorganic Mercury following Environmental and Occupational Exposures: Human and in vitro Studies on the Specific Mechanisms of Toxicity in Gargnano, Italy, in September 2001. METHODS: The most relevant literature over the past 40 years has been reviewed, and in particular, the proceedings of the World Health Organisation conferences on the health effects of inorganic and organic mercury exposure have been considered. RESULTS: In an uncontaminated environment the general population is exposed to mercury vapour from the atmosphere and from dental amalgam, while the diet, mainly from fish, is the principal source for methyl mercury absorption. Mercury vapour release from amalgam fillings increases with chewing, with absorption and uptake by the brain and kidneys. Infants exposed to phenyl mercury from treated diapers and young children ingesting mercurous chloride in teething powders have developed acrodynia (pink disease), and Kawasaki disease and the use of mercurial skin lightening creams has been followed by the development of the nephrotic syndrome. Both mercury compounds and mercury vapour have given rise to contact dermatitis in the general population. Epidemics of mercury poisoning have followed release of mercury into the environment from industrial activity, with uptake of methyl mercury from fish eating in Minamata Bay and uptake of both inorganic and methyl mercury following release of mercury vapour and deposition into waterways from gold recovery procedures in the Amazon basin. The ingestion of wheat and barley seed treated with an alkyl mercury fungicide for sowing, by a largely illiterate population in Iraq, led to a major outbreak of poisoning with a high fatality rate. Following exposure to mercury vapour, the earliest clinically observed adverse effects at urine mercury levels of the order of 30-100 mg/g creatinine, are objectively detectable tremor, psychological disorder and impaired nerve conduction velocity in sensitive subjects, with subjective symptoms of irritability, fatigue and anorexia. At these and at lower levels, proteinuria has also been observed. Both glomerular and tubular damage may occur at exposure levels lower than those giving rise to central nervous system effects. An immunological effect has also been observed in studies on clinically asymptomatic workers with low level exposure. CONCLUSIONS: As mercury can give rise to allergic and immunotoxic reactions which may be genetically regulated, in the absence of adequate dose-response studies for immunologically sensitive individuals, it has not been possible to set a level for mercury in blood or urine below which mercury related symptoms will not occur.

Understanding the mercury reduction issue: the impact of mercury on the environment and human health. J Calif Dent Assoc. 2004 Jul;32(7):574-9.

Mercury has been used in both medicine and dentistry for centuries. Recent media attention regarding the increased levels of mercury in dietary fish, high levels of mercury in air emissions, and conjecture that certain diseases may be caused by mercury exposure has increased public awareness of the potential adverse health effects of high doses of mercury. Dentistry has been criticized for its continued use of mercury in dental amalgam for both public health and environmental reasons. To address these concerns, dental professionals should understand the impact of the various levels and types of mercury on the environment and human health. Mercury is unique in its ability to form amalgams with other metals. Dental amalgam--consisting of silver, copper, tin, and mercury--has been used as a safe, stable, and cost-effective restorative material for more than 150 years. As a result of this use, the dental profession has been confronted by the public on two separate health issues concerning the mercury content in amalgam. The first issue is whether the mercury amalgamated with the various metals to create dental restorations poses a health issue for patients. The second is whether the scraps associated with amalgam placement and the removal of amalgam restorations poses environmental hazards which may eventually have an impact on human health. Despite the lack of scientific evidence for such hazards, there is growing pressure for the dental profession to address these health issues. In this article, the toxicology of mercury will be reviewed and the impact of amalgam on health and the environment will be examined.

Thimerosal and autism? A plausible hypothesis that should not be dismissed.Med Hypotheses. 2004;62(5):788-94.

The autism-mercury hypothesis first described by Bernard et al. has generated much interest and controversy. The Institute of Medicine (IOM) reviewed the connection between mercury-containing vaccines and neurodevelopmental disorders, including autism. They concluded that the hypothesis was biologically plausible but that there was insufficient evidence to accept or reject a causal connection and recommended a comprehensive research program. Without citing new experimental evidence, a number of observers have offered opinions on the subject, some of which reject the IOM's conclusions. In a recent review, Nelson and Bauman argue that a link between the preservative thimerosal, the source of the mercury in childhood vaccines, is improbable. In their defense of thimerosal, these authors take a narrow view of the original hypothesis, provide no new evidence, and rely on selective citations and flawed reasoning. We provide evidence here to refute the Nelson and Bauman critique and to defend the autism-mercury hypothesis.

Mercury in the environment: sources, toxicities, and prevention of exposure.Pediatr Ann. 2004 Jul;33(7):437-42.

Acute and chronic exposure to mercury can significantly affect the health of a population, specifically the children. Methylmercury may pose the highest threat, as it is ubiquitous in the environment and it is a potent neurotoxicant. Methylmercury easily passes through the placenta to the developing fetus. Elemental mercury, or quicksilver, also poses a threat to children because it may be found readily in schools, hospitals, and medicine cabinets, and its intriguing liquid nature may be enticing to children. Pediatricians must be diligent in informing patients of possible exposure sources, and alerting them to new government advisories and recommendations. They should also be knowledgeable regarding classic clinical presentations of mercury toxicity. It is only in cases involving a knowledge of mercury that appropriate historical information is obtained and correct diagnoses are made. Preventing mercury exposure and consequent toxicity is of importance because therapies are controversial and long-term consequences may be significant.

Mercury exposure in children: a review.Toxicol Appl Pharmacol. 2004;198(2):209-30.

Exposure to toxic mercury (Hg) is a growing health hazard throughout the world today. Recent studies show that mercury exposure may occur in the environment, and increasingly in occupational and domestic settings. Children are particularly vulnerable to Hg intoxication, which may lead to impairment of the developing central nervous system, as well as pulmonary and nephrotic damage. Several sources of toxic Hg exposure in children have been reported in biomedical literature: (1) methylmercury, the most widespread source of Hg exposure, is most commonly the result of consumption of contaminated foods, primarily fish; (2) ethylmercury, which has been the subject of recent scientific inquiry in relation to the controversial pediatric vaccine preservative thimerosal; (3) elemental Hg vapor exposure through accidents and occupational and ritualistic practices; (4) inorganic Hg through the use of topical Hg-based skin creams and in infant teething powders; (5) metallic Hg in dental amalgams, which release Hg vapors, and Hg2+ in tissues. This review examines recent epidemiological studies of methylmercury exposure in children. Reports of elemental Hg vapor exposure in children through accidents and occupational practices, and the more recent observations of the increasing use of elemental Hg for magico-religious purposes in urban communities are also discussed. Studies of inorganic Hg exposure from the widespread use of topical beauty creams and teething powders, and fetal/neonatal Hg exposure from maternal dental amalgam fillings are reviewed. Considerable attention was given in this review to pediatric methylmercury exposure and neurodevelopment because it is the most thoroughly investigated Hg species. Each source of Hg exposure is reviewed in relation to specific pediatric health effects, particularly subtle neurodevelopmental disorders.

Mercury in vaccines. Bull Acad Natl Med. 2003;187(8):1501-10.

Thiomersal, also called thimerosal, is an ethyl mercury derivative used as a preservative to prevent bacterial contamination of multidose vaccine vials after they have been opened. Exposure to low doses of thiomersal has essentially been associated with hypersensitivity reactions. Nevertheless there is no evidence that allergy to thiomersal could be induced by thiomersal-containing vaccines. Allergy to thiomersal is usually of delayed-hypersensitivity type, but its detection through cutaneous tests is not very reliable. Hypersensitivity to thiomersal is not considered as a contraindication to the use of thiomersal-containing vaccines. In 1999 in the USA, thiomersal was present in approximately 30 different childhood vaccines, whereas there were only 2 in France. Although there were no evidence of neurological toxicity in infants related to the use of thiomersal-containing vaccines, the FDA considered that the cumulative dose of mercury received by young infants following vaccination was high enough (although lower than the FDA threshold for methyl mercury) to request vaccine manufacturers to remove thiomersal from vaccine formulations. Since 2002, all childhood vaccines used in Europe and the USA are thiomersal-free or contain only minute amounts of thiomersal. Recently published studies have shown that the mercury levels in the blood, faeces and urine of children who had received thiomersal-containing vaccines were much lower than those accepted by the American Environmental Protection Agency. It has also been demonstrated that the elimination of mercury in children was much faster than what was expected on the basis of studies conducted with methyl mercury originating from food. Recently, the hypothesis that mercury contained in vaccines could be the cause of autism and other neurological developmental disorders created a new debate in the medical community and the general public. To date, none of the epidemiological studies conducted in Europe and elsewhere support this assumption. Although any effort should be made to avoid useless exposure of vaccinees to a potentially toxic compound, it should be emphasized that 1) public communication on this issue has led to a decrease in the hepatitis B vaccination coverage of children born to HBs Ag positive mothers in the US; 2) this issue was not really relevant in France where until 2002, apart from two hepatitis B vaccines, all childhood vaccines were thiomersal-free, and 3) in developing countries using multidose vaccine vials, moving to thiomersal-free vaccines in unidose presentations would represent such an incremental cost that millions of children would no more have access to vaccination. Therefore the World Health Organisation still recommends the use of thiomersal-containing vaccines as part of the expanded programme of immunisation.

The three modern faces of mercury.Environ Health Perspect. 2002 Feb;110 Suppl 1:11-23.

The three modern "faces" of mercury are our perceptions of risk from the exposure of billions of people to methyl mercury in fish, mercury vapor from amalgam tooth fillings, and ethyl mercury in the form of thimerosal added as an antiseptic to widely used vaccines. In this article I review human exposure to and the toxicology of each of these three species of mercury. Mechanisms of action are discussed where possible. Key gaps in our current knowledge are identified from the points of view both of risk assessment and of mechanisms of action.

Autism: a novel form of mercury poisoning.Med Hypotheses. 2001 Apr;56(4):462-71.

Autism is a syndrome characterized by impairments in social relatedness and communication, repetitive behaviors, abnormal movements, and sensory dysfunction. Recent epidemiological studies suggest that autism may affect 1 in 150 US children. Exposure to mercury can cause immune, sensory, neurological, motor, and behavioral dysfunctions similar to traits defining or associated with autism, and the similarities extend to neuroanatomy, neurotransmitters, and biochemistry. Thimerosal, a preservative added to many vaccines, has become a major source of mercury in children who, within their first two years, may have received a quantity of mercury that exceeds safety guidelines. A review of medical literature and US government data suggests that: (i) many cases of idiopathic autism are induced by early mercury exposure from thimerosal; (ii) this type of autism represents an unrecognized mercurial syndrome; and (iii) genetic and non-genetic factors establish a predisposition whereby thimerosal's adverse effects occur only in some children.

Human exposure to mercury: a critical assessment of the evidence of adverse health effects.J Toxicol Environ Health. 1996 Oct 25;49(3):221-70.

The ubiquitous nature of mercury in the environment, its global atmospheric cycling, and its toxicity to humans at levels that are uncomfortably close to exposures experienced by a proportion of the population are some of the current concerns associated with this pollutant. The purpose of this review is to critically evaluate the scientific quality of published reports involving human exposures to mercury and associated health outcomes as an aid in the risk evaluation of this chemical. A comprehensive review of the scientific literature involving human exposures to mercury was performed and each publication evaluated using a defined set of criteria that are considered standards in epidemiologic and toxicologic research. Severe, sometimes fatal, effects of mercury exposure at high levels were primarily reported as case studies. The disasters in Minamata, Japan, in the 1950s and in Iraq in 1971-1972 clearly demonstrated neurologic effects associated with ingestion of methylmercury both in adults and in infants exposed in utero. The effects were convincingly associated with methylmercury ingestion, despite limitations of the study design. Several well-conducted studies have investigated the effects of methylmercury at levels below those in the Iraq incident but have not provided clear evidence of an effect. The lower end of the dose-response curve constructed from the Iraq data therefore still needs to be confirmed. The studies of mercury exposure in the workplace were mainly of elemental or inorganic mercury, and effects that were observed at relatively low exposure levels were primarily neurologic and renal. Several studies have investigated effects associated with dental amalgam but have been rated as inconclusive because of methodologic deficiencies. In our overall evaluation, 29 of 110 occupational studies and 20 of 54 studies where exposure occurred in the natural environment provided at least suggestive evidence of an exposure-related effect.

Dental mercury--a public health hazard.Rev Environ Health. 1994 Jan-Mar;10(1):1-27.

The aim of this review is to point out the health hazards of the uncontrolled global use of implanted mercury-leaking dental amalgam fillings. In spite of the pandemic use of amalgam, most dentists and doctors are still ignorant about the levels of mercury exposure and its health implications. This review discusses the following chronically neglected aspects in clinical practice: The use of materials science in calculating the mercury exposure levels, which may exceed the TLVs by an order of magnitude; Microbial dissolution and methylation of mercury from amalgam by oral and intestinal bacteria; Diagnostic problems and effects of chronic mercury exposure with emphasis on intestinal, cardiovascular, mental and neurologic symptoms and disorders; Diagnostic value of faeces--instead of urine examination--as the main indicator of Hg exposure; Lack of control groups unexposed to Hg (amalgam free) for epidemiologic investigations of health problems; Contribution of dental mercury to environmental pollution. In conclusion, a lack of interdisciplinary research and of a critical approach to established clinical routine appears to be the reason for the failure of the dental profession to protect the patient from Hg exposure when saving the tooth.

Risk assessment of mercury exposure from dental amalgams.J Public Health Dent. 1988 Summer;48(3):172-7.

Much attention is being focused upon the issue of mercury exposure from dental amalgam restorations and the potential for adverse health effects. This controversy has grown beyond the confines of the dental profession itself and is becoming an emotional public health issue. In hope of regaining good health, many dental patients with chronic systemic diseases are considering replacement of their amalgams. Dentists are increasingly being challenged to prove the safety of amalgams. Recently, systematic methods have been established for quantitative evaluation of environmental risks. This study brings together the quantitative methodologies of risk assessment and the knowledge of mercury exposure from dental amalgams to estimate the safety of dental amalgam restorative therapy. Analysis concludes that the margin of safety for mercury toxicity in humans from dental amalgams is approximately 8- to 30-fold. There are many uncertainties involved in this estimate, and further studies are warranted to improve its precision.

 

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