Participants were chosen among children attending 7 different campuses in the city of Lisbon. However, in the literature, there are numerous observational studies and case reports that detected a high amount of side effects related to the use of dental amalgam. The authors declared a significant dropout rate since 55 patients did not complete the study through the first 5 years, and additional 96 were lost in the last two years. Jonidi Jafari A, Esrafili A, Moradi Y, Mahmoudi N. J Environ Health Sci Eng. Lauterbach et al. ... it has been known that mercury exposure can lead to neurological problems and sometimes death. The Beneficial and Debilitating Effects of Environmental and Microbial Toxins, Drugs, Organic Solvents and Heavy Metals on the Onset and Progression of Multiple Sclerosis. Such checklist was administered to a parent at baseline prior to dental treatment and 5 years later, at the completion of the trial. Tremor was recorded apart since it is one of the most frequent manifestations of mercury toxicity. The meta-analysis and the trial sequential analysis conducted on the selected RCTs revealed that there are not enough data to support the hypothesis that caries restorations with dental amalgam can cause a statistically significant increase in urinary mercury levels in children when compared with composite resins restorations. Qualitative analysis was carried out about the other data. Neurological examination was performed according to standard practice criteria [37, 38]. Romeo Patini, Gianrico Spagnuolo, Federica Guglielmi, Edoardo Staderini, Michele Simeone, Andrea Camodeca, Patrizia Gallenzi, "Clinical Effects of Mercury in Conservative Dentistry: A Systematic Review, Meta-Analysis, and Trial Sequential Analysis of Randomized Controlled Trials", International Journal of Dentistry, vol. Its indisputable advantages in the treatment of very young patients and in those suffering from systemic syndromes that compromise their collaboration make it a material that can still have a fair use in dental clinical practice. On the contrary, no differences were detected at subsequent time points (6, 12, or 60 months). 1986 Jan-Dec;6(1-4):297-309. doi: 10.1515/reveh.1986.6.1-4.297. Cohen’s kappa value for global interreviewer agreement was excellent, being 0.82 ± 0.12. Mercury is a type of toxic metal that comes in different forms within the environment. 2019 Mar 5;11(3):147. doi: 10.3390/toxins11030147. The authors stated a significant dropout rate during the study. Trial sequential analysis for urinary mercury concentration after 5 years of exposure to dental amalgam or composite resin in children. The quantitative analysis was conducted only on the unique outcome homogenously reported at least on two trials: urinary mercury concentration in children 5 years after restoration of dental caries with dental amalgam or composite resin. Moreover, it has to be reported that some authors published cases of burning mouth syndrome and orofacial granulomatosis arisen in patients previously treated with dental amalgam [63, 64]. A fluctuation of lymphocytes, monocytes, and neutrophils was observed but without statistically significant differences. So, observational studies have been conducted with the aim of investigating the possible association between dental amalgam and the developing of antibiotic resistance in oral cavity bacteria. We follow biological dentistry principles, offering general, cosmetic, and mercury-free dentistry.The latest techniques and technologies, personalized care, and a comfortable and environmentally responsible practice are our hallmarks. Mercury Poisoning Symptoms and Dental Amalgam Fillings. Urine mercury levels and associated symptoms in dental personnel. Following the PICO format, a focused question was also developed: “Can the use of dental amalgam in restorative dentistry in children or adults cause neurotoxicity, nephrotoxicity, or an increase in mercury percentage in blood when compared with composite resin?”. The level of urinary mercury was measured five years after the enrolment; the authors found that patients belonging to the amalgam group had a significantly higher level than children whose caries were restored with composite resin (0.9 μg/g vs. 0.6 μg/g; < 0.001). So, the aim of this systematic review is to definitively evaluate the eventual effects of the exposure to Hg in adults and children with and without dental amalgam fillings measuring the Hg concentration in various biological fluids. How to Talk to Your Dentist about Mercury Toxicity Concerns. The only study included in the review that dealt about an adult population was written by Halbach et al. Romeo Patini and Gianrico Spagnuolo share co-first authorship. TSA software gave the possibility to calculate the required information size (RIS), the alpha-spending function, the trial sequential monitoring boundaries for benefits and harms, and the futility boundaries. Search strategy comprehended a combination of free text words and MeSH terms reported as follows: (“dental amalgam”[Title/Abstract/MeSH]) AND (“gingival crevicular fluid” OR “health status” OR “mercury” OR “mercury poisoning” OR “lichen planus” OR “lichenoid eruptions” OR “mouth diseases” OR “mouth mucosa” OR “wound healing” OR “xerostomia” OR “corrosion” OR “craniomandibular disorders” OR “patient satisfaction” OR “hypersensitivity”[Title/Abstract/MeSH]). Biological Periodontal Therapy; Safe Removal of Mercury Amalgam Fillings; ... Mercury Toxicity. Analyses were carried out at baseline (patients enrolment), 7 days, and 6, 12, and 60 months after the enrolment . Literally amalgam means “mixed with mercury,” and in dental terms, this is true because the composition of the ones used in fillings is formed by 50% Mercury (Hg) and other metals as silver, copper, zinc and tin, that when mixed it hardens in a few minutes at room temperature. The authors evaluated immunological parameters at baseline (patients enrolment), 7 days, and 6, 12, and 60 months after the enrolment. Publications showing data from the NECAT presented also data on full-scale IQ (according to the Wechsler Intelligence Scale for Children, Third Edition, WISC-III), on visuomotor ability assessment index and the general memory index (gathered from the Wide Range Assessment of Visual Motor Ability and from the Wide Range Assessment of Memory and Learning, respectively). Results. in 2008 investigated some neurological parameters in the population that made up the sample of the CPSST . | The excretion of urinary mercury from dental personnel. in 1997 reported that some antibiotic resistant bacteria could also be mercury-resistant ; it has been, moreover, considered that genes linked with antibiotic resistance are susceptible to be transferred . [Occupational exposure and health effects of metallic mercury among dentists and dental assistants: a preliminary study. Low-copper amalgam commonly consists of mercury (50%), silver (~22–32%), tin (~14%), zinc (~8%) and other trace metals.. Archive for Category: Mercury Toxicity Treatment. Find a mercury-free dentist in your area here. . To prevent additional mercury exposure, patients should inquire about the amalgam removal protocols: IAOMT Protocols for Mercury Filling Removal. Its lipid-soluble property allows for easy passage through the alveoli into the bloodstream and red blood cells (RBCs). Unfortunately, the fact that all the enrolled studies took place before the growing containment measures against the use of amalgam demonstrates on the one hand that such measures were probably taken without correctly assessing the strength of evidence of scientific publications and on the other hand that it will be very difficult to achieve statistically significant sample numbers in the future. Anyway, starting from the first year of experimentation, mercury urinary levels were found to be significantly higher in the amalgam group ( < 0.001). L. Forsten, “Blood mercury content after chewing,”, W. L. Mortada, M. A. Sobh, M. M. El-Defrawy, and S. E. Farahat, “Mercury in dental restoration: is there a risk of nephrotoxicity?”, I. Sterzl, J. Prochazkova, P. Hrda, P. Matucha, J. Bartova, and V. Stejskal, “Removal of dental amalgam decreases anti-TPO and anti-Tg autoantibodies in patients with autoimmune thyroiditis,”, S. Eneström, P. Hultman, and P. Hultman, “Does amalgam affect the immune system? All trials had a parallel group design, except for Halbach et al. We are committed to sharing findings related to COVID-19 as quickly as possible. ““EU mercury regulation implementation tracker,” 2020, R. Patini, E. Staderini, and P. Gallenzi, “Multidisciplinary surgical management of Cowden syndrome: report of a case,”. For this reason, a quantitative analysis was possible only for the data reported homogenously in at least two studies. The same analytic method as per urinary mercury was also used for the analysis of mercury deposits in hair. randomized 507 children and measured the urinary mercury levels every year for 7 years . In case of value < 0.1, heterogeneity was considered significant. The main areas analysed by the checklist were: competence, internalizing behaviour problems, externalizing behaviour problems, and total problem behaviours. A. Bergdahl, L.-E. Bratteby et al., “Mercury and selenium in whole blood and serum in relation to fish consumption and amalgam fillings in adolescents,”, D. C. Bellinger, D. Daniel, F. Trachtenberg, M. Tavares, and S. McKinlay, “Dental amalgam restorations and children’s neuropsychological function: the New England Children’s Amalgam Trial,”, D. C. McKinlay, F. Trachtenberg, L. Barregard et al., “Neuropsychological and renal effects of dental amalgam in children,”, A. McKinlay and M. Molin, “Mercury levels in plasma and urine after removal of all amalgam restorations: the effect of using rubber dams,”, J. Molin, T. Haraldson, B. Meding, E. Yontchev, S.-C. Öhman, and J. Ottosson, “Potential side effects of dental amalgam restorations,”, P. Herrström, B. Högstedt, S. Aronson, A. Holmén, and L. Rastam, “Acute glomerulonephritis, Henoch-Schönlein purpura and dental amalgam in Swedish children: a case-control study,”, J. Råstam, T. Leistevuo, H. Helenius et al., “Dental amalgam fillings and the amount of organic mercury in human saliva,”, M. Levy, S. Schwartz, M. Dijak, J.-P. Weber, R. Tardif, and F. Rouah, “Childhood urine mercury excretion: dental amalgam and fish consumption as exposure factors,”, A. Rouah, M. Wilhelm, U. Rostek et al., “Mercury concentrations in urine, scalp hair, and saliva in children from Germany,”, J. S. Woods, M. D. Martin, B. G. Leroux et al., “The contribution of dental amalgam to urinary mercury excretion in children,”, T. A. DeRouen, M. D. Martin, and B. G. Leroux, “Neurobehavioral effects of dental amalgam in children,”, S. Halbach, S. Vogt, W. Köhler et al., “Blood and urine mercury levels in adult amalgam patients of a randomized controlled trial: interaction of Hg species in erythrocytes,”, M. Lauterbach, I. P. Martins, A. Castro-Caldas et al., “Neurological outcomes in children with and without amalgam-related mercury exposure,”, D. C. Bellinger, F. Trachtenberg, A. Zhang, M. Tavares, D. Daniel, and S. McKinlay, “Dental amalgam and psychosocial status: the New England Children’s Amalgam Trial,”, B. J. McKinlay, N. N. Maserejian, A. Zhang, and S. McKinlay, “Immune function effects of dental amalgam in children,”, J. E. Peters, J. S. Romine, and R. A. Dykman, “A special neurological examination of children with learning disabilities,”, J. Wireman, C. A. Liebert, T. Smith, and A. O. Summers, “Association of mercury resistance with antibiotic resistance in the gram-negative fecal bacteria of primates,”, M. C. Roberts, “Antibiotic resistance in oral/respiratory bacteria,”, R. Pike, V. Lucas, A. Petrie et al., “Effect of restoration of children’s teeth with mercury amalgam on the prevalence of mercury- and antibiotic-resistant oral bacteria,”, M. A. Bowers, L. D. Aicher, H. A. Davis, and J. S. Woods, “Quantitative determination of porphyrins in rat and human urine and evaluation of urinary urinaryporphyrin profiles during mercury and lead exposures,”, D. A. Geier, T. Carmody, J. K. Kern, P. G. King, and M. R. Geier, “A significant relationship between mercury exposure from dental amalgams and urinary porphyrins: a further assessment of the Casa Pia children’s dental amalgam trial,”, M. Barghi, R. D. Behrooz, A. Esmaili-Sari, and S. M. Ghasempouri, “Mercury exposure assessment in Iranian pregnant women’s hair with respect to diet, amalgam filling, and lactation,”, L. Palkovicova, M. Ursinyova, V. Masanova, Z. Yu, and I. Hertz-Picciotto, “Maternal amalgam dental fillings as the source of mercury exposure in developing fetus and newborn,”, P. F. Luglie, G. Campus, G. Chessa et al., “Effect of amalgam fillings on the mercury concentration in human amniotic fluid,”, S. L. d. Costa, O. Malm, and J. G. Dórea, “Breast-milk mercury concentrations and amalgam surface in mothers from Brasília, Brazil,”, G. Drasch, S. Aigner, G. Roider, E. Staiger, and G. Lipowsky, “Mercury in human colostrum and early breast milk. Such evaluation was conducted using the Cochrane collaboration tool for assessing the risk of bias. This inorganic form has similar propertie… Dental amalgam is a liquid mercury and metal alloy mixture used in dentistry to fill cavities caused by tooth decay. There are many factors to consider when choosing a dentist in general, but when the decision is whether to choose a conventional or holistic dentist, careful consideration is suggested. Mercury fillings are a mercury hazard. Bottom line: there is no “harmless” level of mercury vapor exposure. Among them, dental amalgam is an excellent restorative material to be used for the caries conservative treatment in patients affected by systemic syndromes with CNS involvement  and in very young children , commonly considered uncooperative patients, which can prevent the dentist from the difficult challenge of using resins. conducted a further analysis from the CPSST, in which they found an around 5–10% increase of mercury-associated porphyrins in subjects belonging to the dental amalgam group when compared with children whose caries were filled with composite resin . Conclusions. This was a 7-year trial starting in January 1997, which enrolled children aged 8–10 years during the recruitment phase. Dr Lorscheider's view was that if you are relatively well, then just go ahead and get the fillings replaced by your usual dentist. Please enable it to take advantage of the complete set of features! Special designed data extraction forms were used for this purpose. There was then a discussion about how to remove the fillings. No statistically significant differences were detected regarding urinary mercury. Mercury is a highly toxic heavy metal and the mental, physical and emotional effects of mercury on the body have been well documented and known for centuries. The bibliographies of all articles included were consulted with the aim of analysing as many articles as possible. Many evidences, however, report that restorations made with composite resins do not have the same duration over time as those made in amalgam and they have a higher incidence of failures and relapses and higher costs and that the treatment’s success is greatly influenced by the operator’s experience [3–5]. From the initial 2555 results, only 6 publications were included in the review: five were considered as having high risk of bias, whereas one as having moderate risk. Indeed, most of the evidence supporting the thesis of a link between oral mucosal reactions and dental amalgam are based on case reports [56–62]. A comprehensive systematic literature search was performed in four databases (Ovid via PubMed, Web of Science, Scopus, and CENTRAL) by two calibrated examiners (FG and AC). Even in the subscales, patients belonging to the amalgam group demonstrated better improvements than the nonamalgam group patients. 2 . Risk of bias graph with overall percentages of bias for each domain. An adjunctive analysis was performed independently by two reviewers (FG and AC) regarding the overall quality of evidence at the outcome level using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) system. Only little and not significant deviations were observed in organic mercury concentrations of plasma over the whole study period in both groups. The total mercury concentrations in plasma demonstrated an initial decline until they reached a steady-state level in the composite group, while they continued to decrease in the amalgam group. Dent. In this regard, it should be noted that not all published studies are homogeneous as regards the number of filled surfaces (in some cases this information is not even reported) or that some do not involve an adequate follow-up period after exposure so that long-term effects are not visible. Only two articles were eligible for quantitative analysis. With the aim of highlighting any relationship between dental amalgam and neurotoxicity and nephrotoxicity, the authors defined as primary outcome the Hg concentration in various biological fluids (urine, hair, blood, and saliva). Your Dental Amalgams and Mercury Toxicity Symptoms. The aetiology of caries is multifactorial since several factors play a role in the onset and maintenance of the pathology and in its maintenance. | No statistically significant differences were found in any outcome. Mercury Level in Dentists Mercury levels in whole blood were not high in exposed dentists, although it was reported that dentists have almost twice the concentration of mercury in their blood as non-dentists. Valencia, Venezuela; 1998]. INTRODUCTION • Mercury is a known toxic , bio accumulative substance and it often finds its way into body through dental amalgams, which is used to restore cavitated tooth. Two publications reported data gathered from the CPSST. After careful evaluation of all the selected full-text, only six RCT were included in this review. A wide variety of symptoms is attributed to toxicity resulting from mercury amalgam. (1)Case report, case series, any type of observational studies, letters, and narrative or systematic reviews(2)Studies published before January 1995(3)Grey literature(4)In vitro studies(5)Animal studies(6)Studies conducted on nonhealthy subjects in the enrolment phase(7)Studies with less than 1 year of follow-up. Low-copper amalgam commonly consists of mercury (50%), silver (∼22–32%), tin (∼14%), copper (∼8%), and other trace metals . It is ranked third among the most toxic elements to human health ().Although various forms of mercury can cause different symptoms, the effects that are the most toxic occur in the brain and nervous system. mercury. NHSs are considered predictive of damage to specific neural structures; on the other hand, NSSs are rather predictive of central nervous system dysfunctions. No language restrictions were applied. The evaluation of the risk of bias of the included studies is summarized in Figures 2 and 3. Mercury poisoning symptoms can arise from dental amalgam mercury fillings, also called silver fillings, as they continuously release mercury vapor. An author supervisor (RP) was consulted in case of disagreement. All children belonged to the New England Children’s Amalgam Trial (NECAT) and to the Casa Pia School System Trial (CPSST). Final Thoughts on Mercury Toxicity. The authors decided to conduct the systematic review by including only RCTs since they are considered as having high strength of evidence. In NECAT also the social-behavioural outcomes contained into the Child Behaviour Checklist (CBCL) were analysed . Hg exposure from dental work may also induce various chronic conditions such as elevation of amyloid protein expression, deterioration of microtubules and increase or inhibition of transmitter release at motor nerve terminal endings. Mercury toxicity is a concern in dentistry because mercury and its chemical compounds are toxic to the kidneys and the central nervous system. Composite resins are a material, which guarantee a much better aesthetic result than dental amalgam. Studies indicate that chronic exposure to mercury, even at low levels, can cause the following: Cardiovascular conditions. Epub 2004 Jul 14. Therefore, it seems right to clarify and underline the most updated evidence on the subject as dental amalgam could remain the material of choice for the conservative treatment of enamel and dentin lesions in some categories of patients, such as special patient needs, in which a compliance that is essential for the success of caries treatment with composite resins can be achieved rarely. Elemental mercury (Hg) is found in liquid form, which easily vaporizes at room temperature and is well absorbed (80%) through inhalation. 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