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(Are your fillings killing you?) Page
1-2-3-4-5-6-7
| The following is my own "book report" of an extremely
well done and definitive study pertaining to
the safety of dental amalgam. It is written for the benefit of the general
public in the form of a simple translation of the original publication.
I have avoided using specific statistical information and substituted a
less confusing overview style in order to avoid confusion on the part of
readers without a background in statistics. (Note: The ads on this
site are placed by Google bots and help to defray the cost of web
hosting.) |
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I have also avoided confusing
terminology and have tried to define and explain medical concepts. While
this discussion excludes some information contained in the original study, the
excluded material does not detract from the overall sense and tone of the
original. This is a reasonably faithful translation of a scientific
paper for the interested lay public. For those interested in obtaining the
original study, the information is as follows:
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Serum mercury concentration in relation to survival, symptoms, and
diseases: results from the prospective population study of women in
Gothenburg, Sweden
Margareta Ahlqwist,
Calle Bengtsson, Leif Lapidus, Ingvar A: Bergdahl and
Andrejs Schutz
Departments of Oral
Diagnostic Radiology, Primary Health Care and Medicine, Goteborg
University, Gothenburg, Sweden; Department of Public Health and
Clinical Medicine, Section of
Occupational Medicine, Umeā University, Umeā, Sweden; Department of
Occupational and
Environmental Medicine, Lund University, Lund, Sweden
Acta Odontol Scand 1999,57:168-174. oslo ISSN 0001-6357 |
Purpose of study
"Because of their release of mercury, dental amalgam restorations have been
highlighted as a possible source of different health disturbances and have been
the root of vigorous debate. The purpose of this study is to analyze
potential associations between symptoms and diseases on the one hand, and Serum
Mercury levels on the other".
Note that this study deals primarily with correlations between serum levels
of mercury on the one hand, and signs, symptoms, complaints and physiological
factors exhibited by the study subjects on the other. The serum levels of
mercury result from a combination of the number of amalgam fillings in the
patients' mouths and the amount of mercury derived from the food, water and air
consumed by the patient.
How the study was done
This study, done in Sweden, involved a sample of 1462 women between 38 and 60 years old when
the study began in 1968. These women were followed over the course of 24
years until the study's end in 1993. The women were given dental and
medical examinations at the beginning of the study and periodically reexamined
at intervals throughout the study period. The number of teeth filled with
amalgam was recorded, as well as each woman's objective and subjective health status.
Blood work, including serum mercury
levels were also taken as a routine part of the medical examinations.
During the 1974-75 and 1980-81 phase of the study, and again at the end of
the study in 1992-93, the women answered a standardized, self administered
questionnaire which included 3o questions about different symptoms or complaints
. They included the following:
Dizziness
Eye complaints
Hearing defects
Headache
General fatigue
Sleep disturbances
Nervous symptoms
Sweating
Breathlessness
Chest pain
Cough
Irritability
Over-exertion
Reduced mental concentration capacity
Restlessness |
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Depressive symptoms Readiness to cry
Reduced capability of relaxing
Abdominal pain
Indisposition
Diarrhea
Constipation
Poor appetite
Loss of weight
Overweight
Sensitiveness to cold
Micturation disturbances
Joints complaints
Back complaints
Leg complaints |
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Along with serum levels of mercury, the following blood and serum variables
were recorded at intervals during the study.
Blood
Hemoglobin, Hematocrit, Leukocytes, Platelets, Glucose, ESR
(sedimentation rate)
Serum
TIBC (total iron binding capacity), Creatinine, Iron,
Chloride, Potassium, Sodium, Calcium, Cholesterol,
Triglycerides, Uric acid, Alkaline phosphatase, Bilirubin,
Protein, B 12, IgA, IgD, IgG, 1gM, IgE
(note: The last six variables above represent serum levels of
antibodies and measure the immune response of the body.)
Urine
Concentration capacity Protein
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In addition to the information noted above, statistics were kept during the
course of the study concerning the occurrence of disease states including the
following:
| Myocardial Infarction (heart attack) Stroke
Diabetes
Cancer
Mortality (death) |
What the researchers were looking for in this study
The point of this study was to look at a normal population and measure the
correlations between the amount of mercury they consume and the various signs,
symptoms, complaints and disease states mentioned above. This relates to
dental amalgam since the presence of these dental restorations contributes to
the total serum mercury level in any study participant who has them.
The controversy over the damage caused by ingested mercury from amalgam
fillings had been raging since the early nineteenth century. A large
percentage of the population of the industrialized world now had at least a few
teeth repaired using dental amalgam. Previous studies had established that
dental amalgams do contribute to the patient's overall serum mercury levels.
The
big question was; does the level of serum mercury contributed by dental amalgam
cause disease or even subtle symptoms in any percentage of the population?
This study sets out to answer this major question by answering the following
three questions:
1. Do higher serum levels of mercury correlate with an increase in
patients' symptoms and complaints, or in the presence of subtle disease
states?
2. Do higher serum levels of mercury correlate with measurable
physiologic changes in blood values?
3. Do higher serum levels of mercury correlate with higher morbidity
(suffering) and mortality (death) by increasing the rate of heart attack,
stroke, diabetes, cancer, or death?
More succinctly, "In a normal population of persons, most with amalgam
fillings in their teeth, does a higher level of serum mercury (some of which is
contributed by the amalgam fillings) actually correlate with an increase in
patient disease, discomfort or early death?"
To understand this study, it is also necessary to reiterate that dental
amalgams do contribute to the serum mercury blood level. It is also
necessary to understand just how the levels of mercury contributed by dental
amalgam relate to mercury from other sources (ordinary food, water and air).
Previous studies had already established that there IS a correlation between the number of amalgam
fillings in a patient's mouth and the level of serum mercury. The more
amalgam fillings a particular group of patients had, the higher the average
serum level of mercury in their blood. This does not mean that amalgam
fillings were the sole source of mercury in the study subjects' blood.
This study was, after all, done in Sweden where the population tends to eat more
fish than many other nations. A study subject who habitually eats large
quantities of fish would have a much higher serum mercury level than one who
eats little fish, regardless of the presence or absence of amalgam fillings in
either subject's mouths.
Mercury blood levels measured in another
study (not this one) indicated that the average level in patients with amalgam was 0.7 ng/mL
compared with a value of 0.3 ng/mL for subjects with no amalgam. This difference
was also found to be statistically significant (P 0.01). However, one
should be aware of another study in Sweden that demonstrated that one saltwater
seafood meal per week raised average blood levels of mercury from 2.3 to 5.1 ng/mL,
a sevenfold increase (2.8 ng/mL) compared with that (0.4 ng/mL) associated with
amalgam restorations. In other words, the actual serum level of mercury
contributed by the presence of amalgam fillings was so small that on any given
day, it could be completely overwhelmed by the mercury contained in normal food
and water.
| Clarification: The term "ng" refers to nanograms, or billionths
of a gram. It almost always refers to the level of mercury
found in a milliliter of blood or serum. The term
"μg" refers to micrograms, or
millionths of a
gram. It generally refers to the level of mercury inhaled or
ingested into the body. |
Results of the study
1. Symptoms and complaints
In 1975, the following symptoms and complaints showed NO statistical
increase or decrease in occurrence since the study began in 1968, and no
statistical correlation with the level of mercury measured in the study
participant's blood:
Dizziness
Eye complaints
Hearing defects
Headache
General fatigue
Sleep disturbances
Nervous symptoms
Sweating
Chest pain
Cough
Irritability
Over-exertion
Reduced mental concentration capacity
Restlessness |
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Depressive symptoms
Reduced capability of relaxing
Abdominal pain
Indisposition
Diarrhea
Constipation
Poor appetite
Loss of weight
Overweight
Sensitiveness to cold
Micturation disturbances
Joints complaints
Back complaints
Leg complaints |
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The following symptoms and complaints did show a statistical
negative correlation in occurrence".
breathlessness
readiness to cry
A negative correlation means that these symptoms were
actually less likely to occur with higher serum concentrations of
mercury. This should not be taken to mean that mercury should be used
to "cure" these symptoms. Even though the correlation was considered
significant, the actual correlation was still very small (p=0.004 and
p-0.016 respectively). These correlations disappeared when the
patient's age and education level were included in the analysis.
In 1980-81, the same correlation analyses were carried out
with similar results. The following symptoms and complaints showed no
statistical increase or decrease in occurrence since the study began in 1968:
Dizziness
Eye complaints
Hearing defects
Headache
General fatigue
Sleep disturbances
Nervous symptoms
Sweating
Breathlessness
Chest pain
Cough
Irritability
Reduced mental concentration capacity
Restlessness |
|
Depression symptoms Readiness to
cry
Reduced capability of relaxing
Abdominal pain
Indisposition
Diarrhea
Constipation
Loss of weight
Overweight
Sensitiveness to cold
Micturation disturbances
Joints complaints
Back complaints
Leg complaints |
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The following statistical complaints did show another
negative correlation in occurrence:
Over-exertion
Poor appetite
Once again, a negative correlation means that these symptoms
are less likely to occur in a population with a higher serum mercury.
Unlike the negative correlations seen in 1975, these correlations did not
disappear when the patient's age and education level were included in the
analysis. Even so, this should not be taken to mean that mercury
should be used to "cure" these symptoms.
2. Blood serum and urine variables in relation to serum
mercury levels
In the 1968-69 study, several blood related variables showed
statistically significant differences that varied with the serum mercury
levels, while the 1980-81 study showed the following:
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Blood hemoglobin concentration showed a positive
correlation in 1968-69, and a negative correlation in 1980-81.
Hemoglobin is essentially a measure of iron in the blood, and a positive
correlation means that the presence of higher levels of mercury in the
serum of these study subjects tended to be correlated with MORE iron in
the blood. In other words, these patients with higher serum levels
of mercury were were less likely to be anemic than those with lower
levels. Once again, mercury does NOT cure anemia. This
correlation, while significant, was still relatively small. In the
1981 study, this correlation reversed itself and became a negative
correlation. The meaning of these contradictory results is not
apparent.
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Erythrocyte Sedimentation Rate (ESR) was
negatively correlated with serum mercury levels in 1968-69,but not
correlated in 1980-81. Sedimentation rate is a clinical
laboratory test that is roughly correlated with the level of
inflammation found in various disease processes (especially autoimmune
diseases). This test is non
specific in nature, and is used in conjunction with other tests to
measure the severity of inflammatory diseases. Negative
correlation suggests that higher levels of mercury tend to reduce the
level of non specific inflammation. Once again this result does
not suggest that mercury acts as an anti-inflammatory drug. since
the correlation disappeared in the later study, the meaning of the
earlier correlation is not apparent.
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Serum levels of potassium were negatively correlated
with serum mercury levels in the 1968-69 study, but not correlated in
the 1980-81 study. The actual decrease in in potassium levels
caused by higher serum mercury levels is extremely small and the
practical significance of this finding is uncertain.
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Serum levels of triglycerides were negatively
correlated with higher levels of serum mercury in the 1968-69 study, but
not correlated in the 1980-81 study. Triglycerides are a
measure of lipids (soluble fats) in the serum. Triglycerides are
medically associated with cholesterol, which is also a form of soluble
fat. A negative correlation suggests that the levels of
triglycerides decreases with increasing levels of serum mercury.
Once again, the decrease in the earlier study is of little practical
significance, especially since the correlation disappeared in the later
study.
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Serum levels of vitamin B-12 were positively
correlated with the level of serum mercury. This factor was
measured only in the 1968-69 study. Vitamin B-12 is actively
involved in the metabolism of mercury, and the authors assumed that this
fact accounts for this correlation.
-
Serum levels of IgE and IgA showed positive
statistical correlation with the level of serum mercury, however, this
correlation was somewhat confused disappearing in one case when
background variables were included in the analysis, and appearing in the
other case only when background variables were included. IgE
and IgA are different types of antibodies and as such are an indication
of the function of the immune system. The correlations are small,
and judging by the lack of consistent correlation between serum levels
of mercury versus the list of symptoms and complaints above, they do not
appear to have a measurable practical effect on the general health of
the subjects.
3. Endpoints (disease states developed) during the
follow-up period
A total of 253 women (out of the original 1462) died during
the 24 year study and follow-up. 87 women developed myocardial infarction
(heart attack) and of those, 39 died. new signs of stroke were
observed in 77 women, 77 developed diabetes, and 208 were diagnosed with
cancer.
There was no statistically significant correlation between
serum mercury levels and the different diseases (heart attack, stroke, diabetes and cancer). On
the other hand there was a statistically significant negative
correlation between mortality (death) and serum mercury levels when
background factors were included in the analysis. This means that
higher serum levels of mercury were correlated with a lesser likelihood of
death during the study period. Again, we are talking relatively weak
correlations and readers should not infer that mercury somehow prolongs life
or immunizes against death!
Discussion
The following discussion is composed of quotes from the
original paper:
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The present study does not indicate any unfavorable
influence of serum mercury on symptoms experienced, incidence of
disease, or mortality in the general population.
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In three previous reports, the authors have related the
number of amalgam fillings to different symptoms, incidence of early
death and certain diseases, and to laboratory variables without finding
any adverse effects of amalgam fillings as far as these variables are
concerned.
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The only positive statistically significant correlations
with symptoms and complaints were those observed between over-exertion
and poor appetite, on the one hand, and serum mercury on the other, both
being negative, thus indicating a lower prevalence of the symptom with
higher serum mercury.
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One possible reason for the correlation between higher serum mercury and lower
mortality may be the result of the protective effect from fish
consumption.
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The positive correlation between increased serum levels
of mercury and increased levels of serum vitamin B-12 could be a result
of vitamin B-12's roll in the metabosism of mercury, or it may reflect
the fact that fish is a dietary source of both mercury and vitamin B-12.
-
IgA is responsible for mucosal immunity and is thus the
first line of defense for the majority of infections. The fairly
weak association between serum IgA concentration and serum mercury
levels in the present study may be a chance finding, but it could also
indicate an immunological response to mercury from amalgam fillings.
However, from the authors' data, they cannot reveal any impact of
clinical significance of mercury uptake from amalgam fillings as
reflected by serum mercury or number of fillings.
-
We conclude that there were some associations between
biological variables (serum concentrations of IgA and B-12) and serum
mercury levels. Our main conclusion from our prospective
population study, however, is that it gives no support for an
unfavorable influence of the serum mercury levels on experienced
symptoms, mortality, or incidence of diseases in a general population of
middle-aged or older women.
(Are your fillings killing you?) Page
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