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Kurt F, Akcil A, Cangur S, Yıldız M. Evaluation of mass mercury poisoning cases occurring in a center in Türkiye: symptomatology, treatment methods, and follow-up processes. Eur J Pediatr 2025; 184:309. [PMID: 40266418 PMCID: PMC12018509 DOI: 10.1007/s00431-025-06143-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2025] [Revised: 04/03/2025] [Accepted: 04/14/2025] [Indexed: 04/24/2025]
Abstract
Mercury (Hg) is a toxic heavy metal with extensive applications. In children, mercury exposure often occurs inadvertently through laboratories, thermometers, or fluorescent lamps. Inhalation of elemental mercury can affect the central nervous system and urinary system. Early diagnosis and treatment are crucial to prevent severe complications. A retrospective evaluation was conducted on 82 pediatric cases of mercury poisoning who presented to Bingöl State Hospital on January 15, 2020. Blood and urine mercury levels were measured. Patients with mercury levels > 10 μg/L received intravenous treatment with 2,3-dimercaptopropane sulfonic acid (DMPS) for 5 days. Plasma and urine mercury levels were analyzed before and after treatment. Adverse effects of treatment and follow-up processes were also examined. Of the patients, 43.9% were female, and 56.1% were male, with a mean age of 9.4 ± 3.2 years. A total of 42.7% of cases were symptomatic, with headache being the most common symptom (26.8%). Significant reductions in blood and urine mercury levels were observed after treatment (p < 0.001). Adverse effects of the drug were reported in 43.9% of cases, with nausea (50%) and itching (25%) being the most frequent.Conclusion: Chelation therapy was effective in significantly reducing mercury levels in cases of mercury poisoning. Adverse effects must be carefully managed, and long-term follow-up is essential. This study provides significant contributions to the literature on mass mercury poisoning cases.
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Affiliation(s)
- Fatih Kurt
- Pediatrics Clinic, Duzce University, Duzce, Turkey.
| | - Abdullah Akcil
- Pediatrics Clinic, Sakarya University Training and Research Hospital, Adapazarı, Sakarya, Turkey
| | - Sengul Cangur
- Biostatistics and Medical Informatics Department, Duzce University, Duzce, Turkey
| | - Mustafa Yıldız
- Pediatrics Clinic, Elazığ Fethi Sekin City Hospital, Elazığ, Turkey
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Rosa V, Silikas N, Yu B, Dubey N, Sriram G, Zinelis S, Lima AF, Bottino MC, Ferreira JN, Schmalz G, Watts DC. Guidance on the assessment of biocompatibility of biomaterials: Fundamentals and testing considerations. Dent Mater 2024; 40:1773-1785. [PMID: 39129079 DOI: 10.1016/j.dental.2024.07.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2024] [Revised: 07/22/2024] [Accepted: 07/24/2024] [Indexed: 08/13/2024]
Abstract
BACKGROUND Assessing the biocompatibility of materials is crucial for ensuring the safety and well-being of patients by preventing undesirable, toxic, immune, or allergic reactions, and ensuring that materials remain functional over time without triggering adverse reactions. To ensure a comprehensive assessment, planning tests that carefully consider the intended application and potential exposure scenarios for selecting relevant assays, cell types, and testing parameters is essential. Moreover, characterizing the composition and properties of biomaterials allows for a more accurate understanding of test outcomes and the identification of factors contributing to cytotoxicity. Precise reporting of methodology and results facilitates research reproducibility and understanding of the findings by the scientific community, regulatory agencies, healthcare providers, and the general public. AIMS This article aims to provide an overview of the key concepts associated with evaluating the biocompatibility of biomaterials while also offering practical guidance on cellular principles, testing methodologies, and biological assays that can support in the planning, execution, and reporting of biocompatibility testing.
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Affiliation(s)
- Vinicius Rosa
- Faculty of Dentistry, National University of Singapore, Singapore; ORCHIDS: Oral Care Health Innovations and Designs Singapore, National University of Singapore, Singapore.
| | - Nikolaos Silikas
- Dental Biomaterials, Dentistry, The University of Manchester, Manchester, United Kingdom.
| | - Baiqing Yu
- Faculty of Dentistry, National University of Singapore, Singapore.
| | - Nileshkumar Dubey
- ORCHIDS: Oral Care Health Innovations and Designs Singapore, National University of Singapore, Singapore; Division of Cariology and Operative Dentistry, Department of Comprehensive Dentistry, University of Maryland School of Dentistry, Baltimore, United States.
| | - Gopu Sriram
- Faculty of Dentistry, National University of Singapore, Singapore; ORCHIDS: Oral Care Health Innovations and Designs Singapore, National University of Singapore, Singapore.
| | - Spiros Zinelis
- School of Dentistry National and Kapodistrian University of Athens (NKUA), Greece.
| | - Adriano F Lima
- Dental Research Division, Paulista University, Sao Paulo, Brazil.
| | - Marco C Bottino
- School of Dentistry, University of Michigan, Ann Arbor, USA.
| | - Joao N Ferreira
- Center of Excellence for Innovation for Oral Health and Healthy Longevity, Faculty of Dentistry, Chulalongkorn University, Thailand.
| | - Gottfried Schmalz
- Department of Conservative Dentistry and Periodontology, University Hospital Regensburg, Regensburg, Germany; Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland.
| | - David C Watts
- School of Medical Sciences and Photon Science Institute, University of Manchester, United Kingdom.
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Netto BB, da Silva EP, de Aguiar da Costa M, de Rezende VL, Bolan SJ, Ceretta LB, Aschner M, Dominguini D, Gonçalves CL. Critical period of exposure to mercury and the diagnostic of autism spectrum disorder: A systematic review. J Neurochem 2024; 168:2092-2104. [PMID: 38344837 DOI: 10.1111/jnc.16076] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 01/23/2024] [Accepted: 01/24/2024] [Indexed: 10/04/2024]
Abstract
Autism spectrum disorder (ASD) is characterized by repetitive behaviors and deficits in social interaction. Its etiology is not completely clear, but both genetic and environmental factors contribute to and influence its development and course. The increased number of autism cases in recent years has been strongly associated with increased exposure to heavy metals. Mercury (Hg) has gained prominence in the scientific literature as a result of its presence as an urban pollutant and well-described neurotoxicity. This review assessed the relationship between Hg exposure in the pre- and post-natal period and ASD. The systematic review identified observational clinical studies and pre-clinical trials in journals indexed in the PubMed, Embase, ProQuest, and LILACS databases. The aim of this study was to investigate the association between exposure to Hg and ASD and to define the critical period of exposure. A total of 57 articles were selected for this review, with 35 articles (61.40%) identifying a positive association between ASD and Hg, while 22 articles (38.60%) did not find the same outcome. The biological samples most used to analyze Hg body burdens were hair (36.84%) and blood (36.84%). Most case-control studies found an increase in Hg levels in individuals with ASD who were exposed to a polluted environment in the post-natal period. Taken together, the studies suggest that these patients have a deficient detoxification system, and this could worsen the symptoms of the disorder. However, new studies addressing the influence of Hg on the post-natal nervous system and its relationship with ASD should be carried out.
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Affiliation(s)
- Bruna Bittencourt Netto
- Laboratory of Experimental Neurology, Graduate Program in Health Sciences, University of Southern Santa Catarina (UNESC), Criciúma, Brazil
- Medical School, University of Southern Santa Catarina (UNESC), Criciúma, SC, Brazil
| | | | - Maiara de Aguiar da Costa
- Laboratory of Experimental Neurology, Graduate Program in Health Sciences, University of Southern Santa Catarina (UNESC), Criciúma, Brazil
| | - Victória Linden de Rezende
- Laboratory of Experimental Neurology, Graduate Program in Health Sciences, University of Southern Santa Catarina (UNESC), Criciúma, Brazil
| | - Sofia Januário Bolan
- Laboratory of Experimental Neurology, Graduate Program in Health Sciences, University of Southern Santa Catarina (UNESC), Criciúma, Brazil
| | | | - Michael Aschner
- Department of Molecular Pharmacology, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Diogo Dominguini
- Program in Collective Health, University of Southern Santa Catarina (UNESC), Criciúma, Brazil
- Laboratory of Experimental Pathophysiology, Graduate Program in Health Sciences, University of Southern Santa Catarina (UNESC), Criciúma, SC, Brazil
- Translational Psychiatry Program, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, Houston, Texas, USA
| | - Cinara Ludvig Gonçalves
- Laboratory of Experimental Neurology, Graduate Program in Health Sciences, University of Southern Santa Catarina (UNESC), Criciúma, Brazil
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Forkel S, Schubert S, Corvin L, Heine G, Lang CCV, Oppel E, Pföhler C, Treudler R, Bauer A, Sulk M, Kränke B, Schäkel K, Heratizadeh A, Worm M, Witte J, Geier J, Buhl T. Contact allergies to dental materials in patients. Br J Dermatol 2024; 190:895-903. [PMID: 38123140 DOI: 10.1093/bjd/ljad525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 12/09/2023] [Accepted: 12/17/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Concerns regarding contact allergies and intolerance reactions to dental materials are widespread among patients. Development of novel dental materials and less frequent amalgam use may alter sensitization profiles in patients with possible contact allergy. OBJECTIVES To analyse current sensitization patterns to dental materials in patients with suspected contact allergy. METHODS This retrospective, multicentre analysis from the Information Network of Departments of Dermatology (IVDK) selected participants from 169 834 people tested in 2005-2019 and registered with (i) an affected area of 'mouth' (and 'lips'/'perioral'), (ii) with the dental material in question belonging to one of three groups (dental filling materials, oral implants or dentures or equivalents) and (iii) with patch-testing done in parallel with the German baseline series, (dental) metal series and dental technician series. RESULTS A total of 2730 of 169 834 tested patients met the inclusion criteria. The patients were predominantly women (81.2%) aged ≥ 40 years (92.8%). The sensitization rates with confirmed allergic contact stomatitis in women (n = 444) were highest for metals (nickel 28.6%, palladium 21.4%, amalgam 10.9%), (meth)acrylates [2-hydroxyethyl methacrylate (HEMA) 4.8%] and the substances propolis (6.8%) and 'balsam of Peru' (11.4%). The most relevant acrylates were HEMA, 2-hydroxypropyl methacrylate, methyl methacrylate, ethylene glycol dimethacrylate and pentaerythritol triacrylate. Few men were diagnosed with allergic contact stomatitis (n = 68); sensitization rates in men were highest for propolis (14.9%) and amalgam (13.6%). CONCLUSIONS Allergic contact stomatitis to dental materials is rare. Patch testing should not only focus on metals such as nickel, palladium, amalgam and gold, but also (meth)acrylates and the natural substances propolis and 'balsam of Peru'.
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Affiliation(s)
- Susann Forkel
- Department of Dermatology, Venereology and Allergology, University Medical Center Göttingen, Göttingen, Germany
| | - Steffen Schubert
- Information Network of Departments of Dermatology, Institute at the University Medical Center Göttingen, Göttingen, Germany
| | - Lisa Corvin
- Department of Dermatology, Venereology and Allergy, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Guido Heine
- Department of Dermatology, Venereology and Allergy, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Claudia C V Lang
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | - Eva Oppel
- Department of Dermatology and Allergy, LMU University Hospital, LMU Munich, Munich, Germany
| | - Claudia Pföhler
- Department of Dermatology, Saarland University Medical School, Homburg, Germany
| | - Regina Treudler
- Department of Dermatology, Venereology and Allergology, University Medical Center, Leipzig, Germany
| | - Andrea Bauer
- Department of Dermatology, University Allergy Center, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Mathias Sulk
- Department of Dermatology, University Hospital Münster, Münster, Germany
| | - Birger Kränke
- Department of Dermatology and Venereology, Medical University of Graz, Graz, Austria
| | - Knut Schäkel
- Department of Dermatology, Ruprecht Karls University, Heidelberg, Germany
| | - Annice Heratizadeh
- Department of Dermatology and Allergy, Hannover Medical School, Hannover, Germany
| | - Margitta Worm
- Division of Allergy and Immunology, Department of Dermatology and Allergology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Jana Witte
- Department of Dermatology and Venereology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Johannes Geier
- Information Network of Departments of Dermatology, Institute at the University Medical Center Göttingen, Göttingen, Germany
- Lower Saxony Institute of Occupational Dermatology, University of Göttingen, Göttingen, Germany
| | - Timo Buhl
- Department of Dermatology, Venereology and Allergology, University Medical Center Göttingen, Göttingen, Germany
- Lower Saxony Institute of Occupational Dermatology, University of Göttingen, Göttingen, Germany
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Park SB, Kim EK, Sakong J, Park EY. Association between dental amalgam restoration and urine mercury concentrations among young women: a cross-sectional study. JOURNAL OF YEUNGNAM MEDICAL SCIENCE 2023; 40:373-380. [PMID: 36941777 PMCID: PMC10626308 DOI: 10.12701/jyms.2022.00955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 01/12/2023] [Accepted: 01/25/2023] [Indexed: 03/23/2023]
Abstract
BACKGROUND The association between dental amalgam fillings and urine mercury concentrations was investigated in this study to assess the health risks associated with dental amalgams. METHODS This cross-sectional study included 99 women in their 20s who visited the dental clinic in Daegu, Korea. The 99 participants were composed of 68 subjects who had dental amalgam fillings (exposure group) and 31 subjects who did not have dental amalgam fillings (nonexposure group). Oral examinations were conducted by a single dental hygienist, sociodemographic features were investigated as confounding variables, and urine mercury concentrations were measured using an automatic mercury analyzer. RESULTS The mean±standard deviation of the urine mercury concentrations of the exposure and nonexposure groups were 1.50±1.78 μg/g creatinine and 0.53±0.63 μg/g creatinine, respectively. The exposure group showed significantly higher levels than the nonexposure group (p<0.01). The urine mercury concentration significantly increased with an increase in the number of teeth filled with amalgam, cavity surfaces involved, and number of defective amalgam fillings, and according to the latest exposure time (p<0.001). In the multiple regression analysis of amalgam-related factors and urine mercury concentrations after correction for confounding factors, the urine mercury concentration in the group with six or more amalgam-filled teeth, 11 or more cavity surfaces, and two or more defective amalgams was significantly higher than that in the nonexposure group (p<0.001). CONCLUSION According to this study, exposure to dental amalgams was confirmed to significantly affect urine mercury concentrations.
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Affiliation(s)
- Su-Bin Park
- Department of Public Health, Graduate School of Environment and Public Health Studies, Yeungnam University, Daegu, Korea
| | - Eun-Kyong Kim
- Department of Dental Hygiene, College of Science and Technology, Kyungpook National University, Sangju, Korea
| | - Joon Sakong
- Department of Preventive Medicine and Public Health, Yeungnam University College of Medicine, Daegu, Korea
| | - Eun Young Park
- Department of Dentistry, Yeungnam University College of Medicine, Daegu, Korea
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Torrey EF, Simmons W. Mercury and Parkinson's Disease: Promising Leads, but Research Is Needed. PARKINSON'S DISEASE 2023; 2023:4709322. [PMID: 37744289 PMCID: PMC10517869 DOI: 10.1155/2023/4709322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 08/21/2023] [Accepted: 08/29/2023] [Indexed: 09/26/2023]
Abstract
Environmental toxicants are thought to play a major role in the pathogenesis of Parkinson's disease. In reviewing the literature on heavy metals known to be toxicants, we noted several recent studies on mercury suggesting a possible role in the etiology of some cases of this disease. We therefore undertook a review of this association, focusing especially on peer-reviewed articles to avoid the bias inherent in much of the literature regarding mercury. For most people, our contemporary exposure to mercury comes from dental amalgam tooth restorations and from eating fish contaminated with mercury. In both cases, mercury is known to get into the brain in utero and at all ages. It remains in the brain for many years and is known to produce permanent neuropsychological deficits. Mercury toxicity can produce tremors and other Parkinsonian clinical symptoms. It can also produce neurochemical and neuropathological changes similar to those found in Parkinson's disease, including the loss of dopamine neurons, degeneration of tubulin and axons, dysfunction of mitochondria, and the aggregation of alpha-synuclein. Relatively few studies have assessed mercury in parkinsonian patients, but almost all reported a statistically significant association. Published studies suggest some promising leads in the relationship between mercury exposure and Parkinson's disease. However, studies of patients are relatively few, and the need for research is clear. A search of Parkinsonian research studies currently funded by the US National Institutes of Health, Parkinson's Foundation, and the Michael J Fox Foundation yielded no studies on mercury. We believe such studies should be supported.
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Affiliation(s)
- E. Fuller Torrey
- The Stanley Medical Research Institute, 9800 Medical Center, Suite C-050, Rockville, MD 20850, USA
| | - Wendy Simmons
- The Stanley Medical Research Institute, 9800 Medical Center, Suite C-050, Rockville, MD 20850, USA
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Dentino FC, Yepes JF, Jones JE, Scully AC, Eckert GJ, Downey T, Maupome G. Amalgam or composite in pediatric dentistry: Analysis of private insurance claims data. J Am Dent Assoc 2023; 154:705-714.e10. [PMID: 37500233 DOI: 10.1016/j.adaj.2023.04.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 03/26/2023] [Accepted: 04/20/2023] [Indexed: 07/29/2023]
Abstract
BACKGROUND Advancements in dental materials and changing parental preferences are modifying the frequency of use of restorative materials. This insurance claims analysis examined the trends in the use of amalgam and resin composite in the United States. METHODS Commercial dental insurance claims were analyzed to compare 505,994 restorations, corresponding with procedure codes for 1-, 2-, and 3-surface amalgam or resin restorations. Paid claims collected nationwide from January 2010 through March 2020 were analyzed. Data for children aged 3 through 12 years were used, resulting in 219,632 unique patient identification numbers. Generalized estimating equation models applied to logistic regression were used. All tests were conducted using a 2-sided 5% significance level. RESULTS In general, girls were less likely to receive amalgam than boys. A $20,000 increase in median household income was associated with a 16% decrease in the odds of amalgam being placed. Pediatric dentists (performing 15.1% of all restorations) were not as likely as general dentists (18.4%) to use amalgam. Having more surfaces in a restoration was associated with higher probability of amalgam placement. The percentage of amalgam restorations was higher for 2010 (26.9%) than for 2011 through 2020, and this pattern recurred in several of the years analyzed. Generally, patient age at time of amalgam restoration increased over time. CONCLUSION The use of amalgam is trending down; the sharpest decline was noted in 2014. Pediatric dentists were less likely to use amalgam than general dentists. Girls and patients with higher socioeconomic status were less likely to have amalgam. PRACTICAL IMPLICATIONS The findings of this study can inform and support clinical decisions and the formation of public policies.
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Essa AY, Ahmed S, Dyason A, Karjiker F, Adam RZ. Teaching and placement of dental amalgam restorations at South African dental schools. FRONTIERS IN ORAL HEALTH 2023; 4:1118361. [PMID: 37539092 PMCID: PMC10394513 DOI: 10.3389/froh.2023.1118361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 06/27/2023] [Indexed: 08/05/2023] Open
Abstract
Introduction This paper set out to investigate the relationship between teaching and clinical practice of direct posterior restoration placement at tertiary dental institutions in South Africa. Methods A cross-sectional study using a mixed methods approach was conducted, and all the South African dental schools were invited to participate. The quantitative phase of the study analyzed the Conservative Dentistry department's records of direct restorations at a single dental school. The number of amalgam and tooth-colored restorations placed by students in the fourth and fifth year of the program from 2004 to 2019 were compared. During the qualitative phase, semi-structured interviews were held with staff from the four dental schools involved with the teaching of direct posterior restorations. Results The predominant direct posterior restoration placed in student clinics over a 15-year period at a South African dental school was tooth colored (75%). Teaching times do not correspond to a decrease in the placement of dental amalgam restorations for both one-surface and two-surface posterior restorations and a concomitant increase in the tooth-colored restorations. Discussion Academic staff involved in teaching identified that South Africa's ratification of the Minamata Convention has consequences for dental education and training. However, all schools reported that dental amalgam would continue to be taught in the absence of an appropriate alternative.
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Kim M, Park C, Sakong J, Ye S, Son SY, Baek K. Association of heavy metal complex exposure and neurobehavioral function of children. Ann Occup Environ Med 2023; 35:e23. [PMID: 37614334 PMCID: PMC10442582 DOI: 10.35371/aoem.2023.35.e23] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 04/26/2023] [Accepted: 05/20/2023] [Indexed: 08/25/2023] Open
Abstract
Background Exposure to heavy metals is a public health concern worldwide. Previous studies on the association between heavy metal exposure and neurobehavioral functions in children have focused on single exposures and clinical manifestations. However, the present study evaluated the effects of heavy metal complex exposure on subclinical neurobehavioral function using a Korean Computerized Neurobehavior Test (KCNT). Methods Urinary mercury, lead, cadmium analyses as well as symbol digit substitution (SDS) and choice reaction time (CRT) tests of the KCNT were conducted in children aged between 10 and 12 years. Reaction time and urinary heavy metal levels were analyzed using partial correlation, linear regression, Bayesian kernel machine regression (BKMR), the weighted quantile sum (WQS) regression and quantile G-computation analysis. Results Participants of 203 SDS tests and 198 CRT tests were analyzed, excluding poor cooperation and inappropriate urine sample. Partial correlation analysis revealed no association between neurobehavioral function and exposure to individual heavy metals. The result of multiple linear regression shows significant positive association between urinary lead, mercury, and CRT. BMKR, WQS regression and quantile G-computation analysis showed a statistically significant positive association between complex urinary heavy metal concentrations, especially lead and mercury, and reaction time. Conclusions Assuming complex exposures, urinary heavy metal concentrations showed a statistically significant positive association with CRT. These results suggest that heavy metal complex exposure during childhood should be evaluated and managed strictly.
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Affiliation(s)
- Minkeun Kim
- Department of Occupational and Environmental Medicine, Yeungnam University Medical Center, Daegu, Korea
| | - Chulyong Park
- Department of Occupational and Environmental Medicine, Yeungnam University Medical Center, Daegu, Korea
- Department of Preventive Medicine and Public Health, College of Medicine, Yeungnam University, Daegu, Korea
| | - Joon Sakong
- Department of Occupational and Environmental Medicine, Yeungnam University Medical Center, Daegu, Korea
- Department of Preventive Medicine and Public Health, College of Medicine, Yeungnam University, Daegu, Korea
| | - Shinhee Ye
- Occupational Safety and Health Research Institute, Korea Occupational Safety and Health Agency, Incheon, Korea
| | - So young Son
- Department of Occupational and Environmental Medicine, Yeungnam University Medical Center, Daegu, Korea
| | - Kiook Baek
- Department of Occupational and Environmental Medicine, Yeungnam University Medical Center, Daegu, Korea
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Orlando MS, Love T, Harrington D, Dziorny AC, Shamlaye CF, Watson GE, van Wijngaarden E, Davidson PW, Myers GJ. The association of auditory function measures with low-level methylmercury from oceanic fish consumption and mercury vapor from amalgam: The Seychelles Child Development Study Nutrition 1 Cohort. Neurotoxicology 2023; 95:46-55. [PMID: 36621469 PMCID: PMC9998349 DOI: 10.1016/j.neuro.2022.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 12/21/2022] [Accepted: 12/29/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND Some authors have reported that low-level exposure to methylmercury (MeHg) adversely impacts measures of auditory function. These reports, however, are not consistent in their findings. Consequently, we examined auditory function in a population exposed to low-level methylmercury (MeHg) exposure from fish consumption and to mercury vapor (Hg0) from dental amalgams. We analyzed their associations with the participants hearing acuity, absolute and interwave ABR latencies, and otoacoustic emissions (distortion product/DPOAE and click evoked/CEOAE). DESIGN We administered an audiometry test battery to 246 participants from the Seychelles Child Development Study (SCDS) Nutrition Cohort 1 (NC1) at 9 years of age. The test battery included standard pure-tone audiometry, tympanometry, Auditory Brainstem Responses (ABR) and Distortion Product and Click Evoked Otoacoustic Emissions (DPOAE and CEOAE) testing. We measured prenatal MeHg exposure in maternal hair and postnatal MeHg in children's hair. We approximated prenatal Hg0 exposure using maternal amalgam surface area and postnatal Hg0 using children amalgam surface area. Complete exposure records and audiometric data were available on 210 participants and in them we analyzed the association of MeHg and Hg0 exposures with auditory outcomes using covariate-adjusted linear regression models adjusted for sex and tympanometric pressure. RESULTS Hg exposures were similar for both sexes. Seven of the 210 evaluable participants examined had either a mild (5) or moderate (2) hearing loss. Four had a mild monaural hearing loss and 3 had either a mild (1) or moderate (2) bilateral hearing loss. No participant had greater than a moderate hearing loss in either ear. Hg exposures were higher in participants with either a mild or moderate hearing loss, but these differences were not statistically significant. Among the 210 with complete data, neither prenatal nor postnatal MeHg nor Hg0 exposure was statistically significantly associated with any of the ABR endpoints (p > 0.05 for all 72 associations). Neither prenatal nor postnatal Hg0 exposure was associated with any of the OAE endpoints (p > 0.05). MeHg exposure was statistically associated with 6 of the 56 DPOAE endpoints (p-values between 0.0001 and 0.023), but none of the 40 CEOAE endpoints. Two of the associations occurred with prenatal MeHg exposures and 1 of those would suggest a beneficial effect. Four of the other associations occurred with postnatal MeHg exposures with only 2 found in left ears of both males and females and the other 2 in the left and right ear of females at only one frequency. CONCLUSION Overall, these data do not present a clear and consistent pattern to suggest that the auditory system is negatively affected by low-level methylmercury exposure due to dietary consumption of oceanic fish or mercury vapor exposure from dental amalgams.
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Affiliation(s)
- Mark S Orlando
- Department of Otolaryngology, University of Rochester School of Medicine and Dentistry, 601 Elmwood Ave, Rochester, NY 14642, USA.
| | - Tanzy Love
- Department of Biostatistics and Computational Biology, University of Rochester School of Medicine and Dentistry, 601 Elmwood Ave, Rochester, NY 14642, USA
| | - Donald Harrington
- Department of Biostatistics and Computational Biology, University of Rochester School of Medicine and Dentistry, 601 Elmwood Ave, Rochester, NY 14642, USA
| | - Adam C Dziorny
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, 601 Elmwood Ave, Rochester, NY 14642, USA; Department of Biomedical Engineering, University of Rochester School of Medicine and Dentistry, 601 Elmwood Ave, Rochester, NY 14642, USA
| | | | - Gene E Watson
- Eastman Institute for Oral Health, University of Rochester School of Medicine and Dentistry, 601 Elmwood Ave, Rochester, NY 14642, USA; Department of Environmental Medicine, University of Rochester School of Medicine and Dentistry, 601 Elmwood Ave, Rochester, NY 14642, USA; Department of Pharmacology and Physiology, University of Rochester School of Medicine and Dentistry, 601 Elmwood Ave, Rochester, NY 14642, USA
| | - Edwin van Wijngaarden
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, 601 Elmwood Ave, Rochester, NY 14642, USA; Eastman Institute for Oral Health, University of Rochester School of Medicine and Dentistry, 601 Elmwood Ave, Rochester, NY 14642, USA; Department of Environmental Medicine, University of Rochester School of Medicine and Dentistry, 601 Elmwood Ave, Rochester, NY 14642, USA; Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, 601 Elmwood Ave, Rochester, NY 14642, USA; Department of Community Health and Prevention, University of Rochester School of Medicine and Dentistry, 601 Elmwood Ave, Rochester, NY 14642, USA
| | - Philip W Davidson
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, 601 Elmwood Ave, Rochester, NY 14642, USA; Department of Environmental Medicine, University of Rochester School of Medicine and Dentistry, 601 Elmwood Ave, Rochester, NY 14642, USA; Department of Psychiatry, University of Rochester School of Medicine and Dentistry, 601 Elmwood Ave, Rochester, NY 14642, USA
| | - Gary J Myers
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, 601 Elmwood Ave, Rochester, NY 14642, USA; Department of Environmental Medicine, University of Rochester School of Medicine and Dentistry, 601 Elmwood Ave, Rochester, NY 14642, USA; Department of Neurology, University of Rochester School of Medicine and Dentistry, 601 Elmwood Ave, Rochester, NY 14642, USA
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11
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Yin L, Lin S, Summers AO, Roper V, Campen MJ, Yu X. Children with Amalgam Dental Restorations Have Significantly Elevated Blood and Urine Mercury Levels. Toxicol Sci 2021; 184:104-126. [PMID: 34453845 DOI: 10.1093/toxsci/kfab108] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Human exposure to organic mercury (Hg) as methylmercury (MeHg) from seafood consumption is widely considered a health risk because pure methylmercury is extremely neurotoxic. In contrast, the clinical significance of Hg exposure from amalgam (AMG) dental restorations, the only other major nonoccupational source of Hg exposure, has long been debated. Here, we examined data from the two most recent National Health and Nutrition Examination Surveys (NHANES) on 14 181 subjects to assess the contributions of seafood consumption versus AMG to blood total mercury (THg), inorganic mercury (IHg), and methyl mercury (MeHg) and to urine creatinine corrected mercury (UTHg). All subjects were also classified as to their self-reported qualitative consumption of seafood (59% fish and 44% shellfish). Subjects with restorations were grouped into three groups (0) those without AMG (64.4%), (1) those with 1-5 dental AMG restorations (19.7%), (2) those with more than five AMG (16%). Seafood consumption increased total mercury in urine (UTHg) and total mercury (THg) and methyl mercury (MeHg) in blood, but unlike AMG, seafood did not increase blood inorganic mercury (IHg). Using stratified covariate (ANOVA) and multivariate (GLM) analyses revealed a strong correlation of blood (THg and IHg) and urine (UTHg) levels with the number of AMGs. In a subpopulation without fish consumption, having more than five AMG restorations raised blood THg (103%), IHg (221%), and urine UTHg (221%) over the group without AMG. The most striking difference was noted in classification by age: subjects under 6 years old with more than five AMG restorations had the highest blood IHg and urine UTHg among all age groups. Elevation of bivalent IHg on a large scale in children warrants urgent in-depth risk assessment with specific attention to genetic- and gender-associated vulnerabilities.
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Affiliation(s)
- Lei Yin
- Reprotox Biotech, Science & Technology Park, University of New Mexico, Albuquerque, NM, USA
| | - Simon Lin
- The Center for Pediatric Dentistry, University of Washington, WA, USA
| | - Anne O Summers
- Department of Microbiology, University of Georgia, Athens, GA, USA
| | - Van Roper
- College of Nursing, University of New Mexico, Albuquerque, NM, USA
| | - Matthew J Campen
- College of Pharmacy, University of New Mexico College of Nursing, NM, USA
| | - Xiaozhong Yu
- College of Nursing, University of New Mexico, Albuquerque, NM, USA
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12
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Worthington HV, Khangura S, Seal K, Mierzwinski-Urban M, Veitz-Keenan A, Sahrmann P, Schmidlin PR, Davis D, Iheozor-Ejiofor Z, Rasines Alcaraz MG. Direct composite resin fillings versus amalgam fillings for permanent posterior teeth. Cochrane Database Syst Rev 2021; 8:CD005620. [PMID: 34387873 PMCID: PMC8407050 DOI: 10.1002/14651858.cd005620.pub3] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Traditionally, amalgam has been used for filling cavities in posterior teeth, and it continues to be the restorative material of choice in some low- and middle-income countries due to its effectiveness and relatively low cost. However, there are concerns over the use of amalgam restorations (fillings) with regard to mercury release in the body and the environmental impact of mercury disposal. Dental composite resin materials are an aesthetic alternative to amalgam, and their mechanical properties have developed sufficiently to make them suitable for restoring posterior teeth. Nevertheless, composite resin materials may have potential for toxicity to human health and the environment. The United Nations Environment Programme has established the Minamata Convention on Mercury, which is an international treaty that aims "to protect the [sic] human health and the environment from anthropogenic emissions and releases of mercury and mercury compounds". It entered into force in August 2017, and as of February 2021 had been ratified by 127 governments. Ratification involves committing to the adoption of at least two of nine proposed measures to phase down the use of mercury, including amalgam in dentistry. In light of this, we have updated a review originally published in 2014, expanding the scope of the review by undertaking an additional search for harms outcomes. Our review synthesises the results of studies that evaluate the long-term effectiveness and safety of amalgam versus composite resin restorations, and evaluates the level of certainty we can have in that evidence. OBJECTIVES To examine the effects (i.e. efficacy and safety) of direct composite resin fillings versus amalgam fillings. SEARCH METHODS An information specialist searched five bibliographic databases up to 16 February 2021 and used additional search methods to identify published, unpublished and ongoing studies SELECTION CRITERIA: To assess efficacy, we included randomised controlled trials (RCTs) comparing dental composite resin with amalgam restorations in permanent posterior teeth that assessed restoration failure or survival at follow-up of at least three years. To assess safety, we sought non-randomised studies in addition to RCTs that directly compared composite resin and amalgam restorative materials and measured toxicity, sensitivity, allergy, or injury. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. MAIN RESULTS We included a total of eight studies in this updated review, all of which were RCTs. Two studies used a parallel-group design, and six used a split-mouth design. We judged all of the included studies to be at high risk of bias due to lack of blinding and issues related to unit of analysis. We identified one new trial since the previous version of this review (2014), as well as eight additional papers that assessed safety, all of which related to the two parallel-group studies that were already included in the review. For our primary meta-analyses, we combined data from the two parallel-group trials, which involved 1645 composite restorations and 1365 amalgam restorations in 921 children. We found low-certainty evidence that composite resin restorations had almost double the risk of failure compared to amalgam restorations (risk ratio (RR) 1.89, 95% confidence interval (CI) 1.52 to 2.35; P < 0.001), and were at much higher risk of secondary caries (RR 2.14, 95% CI 1.67 to 2.74; P < 0.001). We found low-certainty evidence that composite resin restorations were not more likely to result in restoration fracture (RR 0.87, 95% CI 0.46 to 1.64; P = 0.66). Six trials used a split-mouth design. We considered these studies separately, as their reliability was compromised due to poor reporting, unit of analysis errors, and variability in methods and findings. Subgroup analysis showed that the findings were consistent with the results of the parallel-group studies. Three trials investigated possible harms of dental restorations. Higher urinary mercury levels were reported amongst children with amalgam restorations in two trials, but the levels were lower than what is known to be toxic. Some differences between amalgam and composite resin groups were observed on certain measures of renal, neuropsychological, and psychosocial function, physical development, and postoperative sensitivity; however, no consistent or clinically important harms were found. We considered that the vast number of comparisons made false-positive results likely. There was no evidence of differences between the amalgam and composite resin groups in neurological symptoms, immune function, and urinary porphyrin excretion. The evidence is of very low certainty, with most harms outcomes reported in only one trial. AUTHORS' CONCLUSIONS Low-certainty evidence suggests that composite resin restorations may have almost double the failure rate of amalgam restorations. The risk of restoration fracture does not seem to be higher with composite resin restorations, but there is a much higher risk of developing secondary caries. Very low-certainty evidence suggests that there may be no clinically important differences in the safety profile of amalgam compared with composite resin dental restorations. This review supports the utility of amalgam restorations, and the results may be particularly useful in parts of the world where amalgam is still the material of choice to restore posterior teeth with proximal caries. Of note, however, is that composite resin materials have undergone important improvements in the years since the trials informing the primary analyses for this review were conducted. The global phase-down of dental amalgam via the Minamata Convention on Mercury is an important consideration when deciding between amalgam and composite resin dental materials. The choice of which dental material to use will depend on shared decision-making between dental providers and patients in the clinic setting, and local directives and protocols.
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Affiliation(s)
- Helen V Worthington
- Cochrane Oral Health, Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Sara Khangura
- Canadian Agency for Drugs and Technologies in Health (CADTH), Ottawa, Canada
| | - Kelsey Seal
- Canadian Agency for Drugs and Technologies in Health (CADTH), Ottawa, Canada
| | | | - Analia Veitz-Keenan
- Department of Oral Maxillofacial Pathology, Radiology and Medicine, New York University College of Dentistry, New York, USA
| | - Philipp Sahrmann
- Clinic of Conservative and Preventive Dentistry, Center for Dental and Oral Medicine and Maxillo-Facial Surgery, University of Zurich, Zurich, Switzerland
| | - Patrick Roger Schmidlin
- Clinic of Conservative and Preventive Dentistry, Center for Dental and Oral Medicine and Maxillo-Facial Surgery, University of Zurich, Zurich, Switzerland
| | - Dell Davis
- Texas Medical Center Library, Houston Academy of Medicine, Houston, USA
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Frankenberger R, Winter J, Schmalz G. [Amalgam and alternatives-discussions on mercury reduction in the environment]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2021; 64:847-855. [PMID: 34143251 PMCID: PMC8212278 DOI: 10.1007/s00103-021-03355-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 05/17/2021] [Indexed: 11/06/2022]
Abstract
Dental amalgam has been successfully used for the restoration of carious lesions for more than 180 years. It is clinically characterized by high longevity and low technique sensitivity. For decades, dental amalgam has been discussed in the public, especially due to its roughly 50% mercury content. Since the Minamata Convention was published in 2013 with the primary goal of reducing the anthropogenic mercury release into the environment, the previously muted amalgam discussion has received fresh impetus. Another considerable disadvantage of amalgam is its silver/greyish color, which simply no longer matches patients' esthetic demands.The present paper describes the basic problems with amalgam against the background of multiple biological, clinical, and health policy factors. Possible consequences of the Minamata Convention concerning legal regulations as well as the use of dental biomaterials and therefore also relating to the future national healthcare system are discussed. Finally, possible amalgam alternatives and the urgent need for biomedical research towards restorative dentistry are presented, embedded into the crucial question of whether we are actually conducting the correct debate.
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Affiliation(s)
- Roland Frankenberger
- Abteilung für Zahnerhaltungskunde, Med. Zentrum für Zahn‑, Mund- und Kieferheilkunde, Philipps-Universität Marburg und Universitätsklinikum Gießen und Marburg, Georg-Voigt-Str. 3, 35039, Marburg, Deutschland.
| | - Julia Winter
- Abteilung für Zahnerhaltungskunde, Med. Zentrum für Zahn‑, Mund- und Kieferheilkunde, Philipps-Universität Marburg und Universitätsklinikum Gießen und Marburg, Georg-Voigt-Str. 3, 35039, Marburg, Deutschland
| | - Gottfried Schmalz
- Poliklinik für Zahnerhaltung und Parodontologie, Universitätsklinikum Regensburg, Regensburg, Deutschland
- Klinik für Parodontologie, ZMK-Kliniken, Universität Bern, Bern, Schweiz
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14
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Bapat RA, Parolia A, Chaubal T, Dharamadhikari S, Abdulla AM, Sakkir N, Arora S, Bapat P, Sindi AM, Kesharwani P. Recent update on potential cytotoxicity, biocompatibility and preventive measures of biomaterials used in dentistry. Biomater Sci 2021; 9:3244-3283. [PMID: 33949464 DOI: 10.1039/d1bm00233c] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Dental treatment is provided for a wide variety of oral health problems like dental caries, periodontal diseases, periapical infections, replacement of missing teeth and orthodontic problems. Various biomaterials, like composite resins, amalgam, glass ionomer cement, acrylic resins, metal alloys, impression materials, bone grafts, membranes, local anaesthetics, etc., are used for dental applications. The physical and chemical characteristics of these materials influence the outcome of dental treatment. It also impacts on the biological, allergic and toxic potential of biomaterials. With innovations in science and their positive results, there is also a need for awareness about the biological risks of these biomaterials. The aim of dental treatment is to have effective, yet safe, and long-lasting results for the benefit of patients. For this, it is important to have a thorough understanding of biomaterials and their effects on local and systemic health. Materials used in dentistry undergo a series of analyses before their oral applications. To the best of our knowledge, this is the first and original review that discusses the reasons for and studies on the toxicity of commonly used biomaterials for applications in dentistry. It will help clinicians to formulate a methodical approach for the selection of dental biomaterials, thus providing an awareness for forecasting their risk of toxic reactions.
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Affiliation(s)
- Ranjeet Ajit Bapat
- Faculty, Division of Clinical Dentistry, School of Dentistry, International Medical University Kuala Lumpur, 126, Jalan Jalil Perkasa 19, Bukit Jalil, 57000 Bukit Jalil, Wilayah Persekutuan Kuala Lumpur, Malaysia
| | - Abhishek Parolia
- Faculty, Division of Clinical Dentistry, School of Dentistry, International Medical University Kuala Lumpur, 126, Jalan Jalil Perkasa 19, Bukit Jalil, 57000 Bukit Jalil, Wilayah Persekutuan Kuala Lumpur, Malaysia
| | - Tanay Chaubal
- Faculty, Division of Clinical Dentistry, School of Dentistry, International Medical University Kuala Lumpur, 126, Jalan Jalil Perkasa 19, Bukit Jalil, 57000 Bukit Jalil, Wilayah Persekutuan Kuala Lumpur, Malaysia
| | | | - Anshad Mohamed Abdulla
- Faculty, Department of Pediatric Dentistry and Orthodontic Sciences, College of Dentistry, King Khalid University, Abha, Kingdom of Saudi Arabia
| | - Nasil Sakkir
- Registrar Endodontist, Central Security Hospital, Abha, Kingdom of Saudi Arabia
| | - Suraj Arora
- Faculty, Department of Restorative Dental Sciences, College of Dentistry, King Khalid University, Abha, Kingdom of Saudi Arabia
| | - Prachi Bapat
- Dentist, Modern Dental College, Indore 453112, Madhya Pradesh, India
| | - Amal M Sindi
- Faculty, Oral Diagnostic Sciences Department, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Prashant Kesharwani
- Faculty, Department of Pharmaceutics, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi, 110062, India.
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15
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Gallusi G, Libonati A, Piro M, Di Taranto V, Montemurro E, Campanella V. Is Dental Amalgam a Higher Risk Factor rather than Resin-Based Restorations for Systemic Conditions? A Systematic Review. MATERIALS (BASEL, SWITZERLAND) 2021; 14:1980. [PMID: 33920968 PMCID: PMC8071234 DOI: 10.3390/ma14081980] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 04/12/2021] [Accepted: 04/12/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The aim of this study was to confirm the hypothesis that patients with one or more amalgam restorations have an increased risk for systemic diseases rather than patients with resin-based restorations. DATA The data search produced an initial 3568 total number of records. All titles and abstract were reviewed by five independent examiners, and only 36 records were selected for full text in depth examination. Out of these, only nine publications matched the inclusion criteria and were included in this systematic review. SOURCES Electronic databases (MEDLINE, Scopus, Embase, and Web of Knowledge) were searched up to June 2019. In addition, a manual search was carried out on journals related to this topic. STUDY SELECTION All selected human clinical studies compared patients with dental amalgam restorations to patients with non-amalgam restorations on restorative material related diseases/health conditions with at least 50 patients and a reasonable follow up. The systemic effects of dental restorations were analyzed. As for any systemic effects, there was no difference between amalgam and composite restoration. CONCLUSIONS With the limitations of the few available randomized controlled trials (RCTs) on the matter, amalgam restorations, similarly to other modern resin-based materials, were not related to an increased risk of systemic diseases or conditions. CLINICAL SIGNIFICANCE On the basis of the available RCTs, amalgam restorations, if compared with resin-based fillings, do not show an increased risk for systemic diseases. There is still insufficient evidence to exclude or demonstrate any direct influence on general health. The removal of old amalgam restorations and their substitution with more modern adhesive restorations should be performed only when clinically necessary and not just for material concerns. In order to better evaluate the safety of dental amalgam compared to other more modern restorative materials, further RCTs that consider important parameters such as long and uniform follow up periods, number of restorations per patient, and sample populations representative of chronic or degenerative diseases are needed.
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Affiliation(s)
| | | | | | - Virginia Di Taranto
- Department of Clinical Sciences and Translational Medicine, University of Rome “Tor Vergata”, Viale Oxford, 81, 00133 Rome, Italy; (G.G.); (A.L.); (M.P.); (E.M.); (V.C.)
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16
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Clinical Effects of Mercury in Conservative Dentistry: A Systematic Review, Meta-Analysis, and Trial Sequential Analysis of Randomized Controlled Trials. Int J Dent 2020; 2020:8857238. [PMID: 32849873 PMCID: PMC7441433 DOI: 10.1155/2020/8857238] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 07/22/2020] [Accepted: 07/29/2020] [Indexed: 11/24/2022] Open
Abstract
Methods A systematic literature search was conducted in four electronic databases (Ovid via PubMed, Web of Science, Scopus, and CENTRAL) including all available randomised controlled trials published in the last 15 years comparing the use of dental amalgam with composite resins in humans with a follow-up period of at least one year. The primary outcome was the Hg concentration in biological fluids (urine, hair, blood, and saliva) with the aim of assessing their reliability as biomarkers of Hg exposure. The risk of bias was assessed through the Cochrane Collaboration tool and the overall quality of evidence through the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) system. The results of the meta-analysis were expressed using a random-effects model, and their power was assessed through the trial sequential analysis (TSA). Results 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. Only two articles were eligible for quantitative analysis. The meta-analysis gathered data from 859 patients but was nevertheless not significant (p = 0.12). The TSA confirmed this evidence revealing that it was due to a lack of statistical power since the required information size (RIS) threshold is not reached. Conclusions The existing evidence revealed that there are not enough data to support the hypothesis that restorations with dental amalgam can cause nephrotoxicity when compared with composite resins restorations.
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17
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Sekovanić A, Piasek M, Orct T, Sulimanec Grgec A, Matek Sarić M, Stasenko S, Jurasović J. Mercury Exposure Assessment in Mother-Infant Pairs from Continental and Coastal Croatia. Biomolecules 2020; 10:biom10060821. [PMID: 32471193 PMCID: PMC7355586 DOI: 10.3390/biom10060821] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 05/20/2020] [Accepted: 05/21/2020] [Indexed: 12/31/2022] Open
Abstract
The main source of mercury (Hg) exposure in the general population is fish. Another possible source is dental amalgam. Here, we compare the levels of Hg and selenium (Se) in samples of maternal and fetal origin collected shortly after childbirth of healthy postpartum women in the coastal (n = 96) and continental (n = 185) areas of Croatia related to maternal seafood/fish consumption. We also evaluated Hg concentrations and maternal serum metallothionein (MT2) concentrations in relation to the number of dental amalgam fillings, and MT2A-5A/G (rs28366003) polymorphism. The levels of Hg and Se in maternal hair and blood/serum, placenta and cord blood/serum increased in relation to increasing fish consumption with the highest values in subjects from the coast. The concentrations of each element and between elements correlated across the matrices. Increasing amalgam number correlated linearly with increased Hg levels in maternal and cord serum and was not associated with serum MT2. No association of MT2A-5A/G polymorphism and Hg or Se levels were found. The results confirmed higher fish consumption in coastal vs. continental Croatia and increases of both Hg and Se related to fish consumption in all analyzed samples. Increased blood Hg reflected the predominant MeHg share from seafood, while increased serum Hg matched exposure from dental amalgams.
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Affiliation(s)
- Ankica Sekovanić
- Institute for Medical Research and Occupational Health, 10000 Zagreb, Croatia; (A.S.); (T.O.); (A.S.G.); (J.J.)
| | - Martina Piasek
- Institute for Medical Research and Occupational Health, 10000 Zagreb, Croatia; (A.S.); (T.O.); (A.S.G.); (J.J.)
- Correspondence:
| | - Tatjana Orct
- Institute for Medical Research and Occupational Health, 10000 Zagreb, Croatia; (A.S.); (T.O.); (A.S.G.); (J.J.)
| | - Antonija Sulimanec Grgec
- Institute for Medical Research and Occupational Health, 10000 Zagreb, Croatia; (A.S.); (T.O.); (A.S.G.); (J.J.)
| | | | - Sandra Stasenko
- Clinical Department of Obstetrics and Gynecology, Merkur University Hospital, 10000 Zagreb, Croatia;
| | - Jasna Jurasović
- Institute for Medical Research and Occupational Health, 10000 Zagreb, Croatia; (A.S.); (T.O.); (A.S.G.); (J.J.)
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18
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Ajiboye AS, Mossey PA, Fox CH. International Association for Dental Research Policy and Position Statements on the Safety of Dental Amalgam. J Dent Res 2020; 99:763-768. [PMID: 32315245 DOI: 10.1177/0022034520915878] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
- A S Ajiboye
- International Association for Dental Research, Alexandria, VA, USA
| | - P A Mossey
- Department of Orthodontics, University of Dundee, Dundee, UK
| | | | - C H Fox
- International Association for Dental Research, Alexandria, VA, USA
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Jones SL, Campbell B, Hart T. Laboratory tests commonly used in complementary and alternative medicine: a review of the evidence. Ann Clin Biochem 2019; 56:310-325. [PMID: 30813740 DOI: 10.1177/0004563218824622] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
It is increasingly easy for the general public to access a wide range of laboratory tests. Tests can be ordered online with little or no input from a health professional. The complementary and alternative medicine (CAM) community promote and sell a wide range of tests, many of which are of dubious clinical significance. Many have little or no clinical utility and have been widely discredited, whilst others are established tests that are used for unvalidated purposes. They range from the highly complex, employing state of the art technology, e.g. heavy metal analysis using inductively coupled plasma-mass spectrometry, to the rudimentary, e.g. live blood cell analysis. Results of 'CAM tests' are often accompanied by extensive clinical interpretations which may recommend, or be used to justify, unnecessary or harmful treatments. There are now a small number of laboratories across the globe that specialize in CAM testing. Some CAM laboratories operate completely outside of any accreditation programme whilst others are fully accredited to the standard of established clinical laboratories. In this review, we explore CAM testing in the United States, the United Kingdom and Australia with a focus on the common tests on offer, how they are reported, the evidence base for their clinical application and the regulations governing their use. We will also review proposed changed to in-vitro diagnostic device regulations and how these might impact on CAM testing.
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Affiliation(s)
- Stuart L Jones
- 1 Department of Clinical Biochemistry, King George's Hospital, Barking, Havering and Redbridge University Hospitals NHS Trust, London, UK
| | | | - Tanya Hart
- 3 Department of Clinical Biochemistry, Poole Hospital NHS Foundation Trust, UK
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20
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Cabaña-Muñoz ME, Parmigiani-Izquierdo JM, Camacho Alonso F, Merino JJ. Increased Systemic Malondialdehyde Levels and Decreased Mo/Co, Co/Fe 2+ Ratios in Patients with Long-Term Dental Titanium Implants and Amalgams. J Clin Med 2019; 8:jcm8010086. [PMID: 30642082 PMCID: PMC6352171 DOI: 10.3390/jcm8010086] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 12/19/2018] [Accepted: 01/02/2019] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION the biological safety of dental biomaterials has been questioned in human studies. MATERIAL AND METHODS Several heavy metals/oligoelements were compared by Inductive Coupled Mass Spectrometry (ICP-MS) in hair samples from 130 patients (n = 54 patients with long-term titanium dental implants and amalgams (A + I group), 51 patients with long-term dental amalgam alone (A group), as well as controls (n = 25: without dental materials) of similar age. All patients (except controls) had had titanium dental implants and/or dental amalgams for at least 10 years (average: 17). We evaluated whether A + I patients could present higher systemic malondialdehyde levels (MDA) as compared to the A group. RESULTS The A + I group have lower molybdenum levels (A + I) and reduced Mo/Co and Mo/Fe2+ ratios, which could predispose them to oxidative stress by raising MDA levels as compared to the A group alone; our findings suggest that higher Co levels could enhance oxidative stress in the A + I group. However, there were no differences on metals from titanium alloy (Ti-6Al), Cr from crowns or Hg2+, Sn, Zn2+, Cu2+ levels between the A + I and A groups. CONCLUSION patients with long-term dental titanium and amalgams have systemic oxidative stress due to rising MDA levels and lower Mo/Co and Mo/Fe2+ ratios than those with amalgams alone.
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Affiliation(s)
| | | | - Fabio Camacho Alonso
- Full Proffesor of Oral Surgery, Faculty of Medicine, University of Murcia, 30100 Murcia, Spain.
- Hospital General Universitario Morales Meseguer, University of Murcia, 30100 Murcia, Spain.
| | - José Joaquín Merino
- Centro CIROM, Centro de Implantología y Rehabilitación Oral Multidisciplinaria, 30001 Murcia, Spain.
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Bjørklund G, Lindh U, Aaseth J, Mutter J, Chirumbolo S. Mercury in dental amalgams: A great concern for clinical toxicology in developing countries? J Trace Elem Med Biol 2019; 51:9-11. [PMID: 30466944 DOI: 10.1016/j.jtemb.2018.09.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Revised: 09/02/2018] [Accepted: 09/05/2018] [Indexed: 12/25/2022]
Affiliation(s)
- Geir Bjørklund
- Council for Nutritional and Environmental Medicine, Mo i Rana, Norway.
| | - Ulf Lindh
- Biology Education Centre, Uppsala University, Uppsala, Sweden
| | - Jan Aaseth
- Research Department, Innlandet Hospital Trust, Brumunddal, Norway; Inland Norway University of Applied Sciences, Elverum, Norway
| | - Joachim Mutter
- Environmental Medicine, Konstanz, Germany and Paracelsus Clinica al Ronc, Castaneda, Switzerland
| | - Salvatore Chirumbolo
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
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McKelvey W, Alex B, Chernov C, Hore P, Palmer CD, Steuerwald AJ, Parsons PJ, Perlman SE. Tracking Declines in Mercury Exposure in the New York City Adult Population, 2004-2014. J Urban Health 2018; 95:813-825. [PMID: 30117056 PMCID: PMC6286276 DOI: 10.1007/s11524-018-0269-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Mercury is a toxic metal that can be measured in human blood and urine. Population-based biomonitoring from 2004 guided New York City (NYC) Department of Health and Mental Hygiene (DOHMH) efforts to reduce exposures by educating the public about risks and benefits of fish consumption-a predominant source of exposure in the general population-and removing mercury-containing skin-lightening creams and other consumer products from the marketplace. We describe changes in exposures over the past decade in relation to these local public health actions and in the context of national changes by comparing mercury concentrations measured in blood (1201 specimens) and urine (1408 specimens) from the NYC Health and Nutrition Examination Survey (NYC HANES) 2013-2014 with measurements from NYC HANES 2004 and National Health and Nutrition Examination Surveys (NHANES) 2003-2004 and 2013-2014. We found that NYC adult blood and urine geometric mean mercury concentrations decreased 46% and 45%, respectively. Adult New Yorkers with blood mercury concentration ≥ 5 μg/L (the New York State reportable level) declined from 24.8% (95% CL = 22.2%, 27.7%) to 12.0% (95% CL = 10.1%, 14.3%). The decline in blood mercury in NYC was greater than the national decline, while the decline in urine mercury was similar. As in 2004, Asian New Yorkers had higher blood mercury concentrations than other racial/ethnic groups. Foreign-born adults of East or Southeast Asian origin had the highest prevalence of reportable levels (29.7%; 95% CL = 21.0%, 40.1%) across sociodemographic groups, and Asians generally were the most frequent fish consumers, eating on average 11 fish meals in the past month compared with 7 among other groups (p < 0.001). Fish consumption patterns were similar over time, and fish continues to be consumed more frequently in NYC than nationwide (24.7% of NYC adults ate fish ten or more times in the past 30 days vs. 14.7% nationally, p < 0.001). The findings are consistent with the hypothesis that blood mercury levels have declined in part because of local and national efforts to promote consumption of lower mercury fish. Local NYC efforts may have accelerated the reduction in exposure. Having "silver-colored fillings" on five or more teeth was associated with the highest 95th percentile for urine mercury (4.06 μg/L; 95% CL = 3.1, 5.9). An estimated 5.5% of the adult population (95% CL = 4.3%, 7.0%) reported using a skin-lightening cream in the past 30 days, but there was little evidence that use was associated with elevated urine mercury in 2013-14.
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Affiliation(s)
- Wendy McKelvey
- Bureau of Environmental Surveillance and Policy, New York City Department of Health and Mental Hygiene, 125 Worth Street, 3rd floor, CN-34E, New York, NY, 10013, USA.
| | - Byron Alex
- Public Health/Preventive Medicine Residency, New York City Department of Health & Mental Hygiene, Long Island City, NY, 11101, USA
| | - Claudia Chernov
- Division of Epidemiology, New York City Department of Health & Mental Hygiene, New York, NY, 11101, USA
| | - Paromita Hore
- Division of Environmental Health, New York City Department of Health & Mental Hygiene, New York, NY, 10013, USA
| | - Christopher D Palmer
- Laboratory of Inorganic and Nuclear Chemistry, Wadsworth Center, New York State Department of Health, Albany, NY, 12201, USA
- Department of Environmental Health Sciences, School of Public Health, University at Albany, State University of New York, Albany, NY, 12201, USA
| | - Amy J Steuerwald
- Laboratory of Inorganic and Nuclear Chemistry, Wadsworth Center, New York State Department of Health, Albany, NY, 12201, USA
| | - Patrick J Parsons
- Laboratory of Inorganic and Nuclear Chemistry, Wadsworth Center, New York State Department of Health, Albany, NY, 12201, USA
| | - Sharon E Perlman
- Division of Epidemiology, New York City Department of Health & Mental Hygiene, New York, NY, 11101, USA
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Laimer J, Henn R, Helten T, Sprung S, Zelger B, Zelger B, Steiner R, Schnabl D, Offermanns V, Bruckmoser E, Huck CW. Amalgam tattoo versus melanocytic neoplasm - Differential diagnosis of dark pigmented oral mucosa lesions using infrared spectroscopy. PLoS One 2018; 13:e0207026. [PMID: 30399191 PMCID: PMC6219804 DOI: 10.1371/journal.pone.0207026] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Accepted: 10/22/2018] [Indexed: 12/14/2022] Open
Abstract
Background Dark pigmented lesions of the oral mucosa can represent a major diagnostic challenge. A biopsy is usually required to determine the nature of such intraoral discolorations. This study investigates the potential use of infrared spectroscopy for differential diagnosis of amalgam tattoos versus benign or malignant melanocytic neoplasms. Materials and methods For this retrospective study, formalin-fixed paraffin-embedded tissue (FFPE) specimens of dark pigmented lesions concerning the oral mucosa or the lip were investigated using mid infrared spectroscopy. The samples were chosen from patients who had undergone a mucosal biopsy at the University Hospital Innsbruck (Austria) between the years 2000 and 2017. Principal component analysis was used for data exploration. Evaluation was based on the superimposition of the recorded spectra and the corresponding histologic slides. Results In total, 22 FFPE specimens were analyzed. Clear differences were found between amalgam and non-amalgam samples. A general weakening of the penetrating infrared radiation allowed for unspecific discrimination between these two classes. An overall accuracy in predicting the correct class of 95.24% was achieved. Conclusion Infrared spectroscopy appears to be a suitable technique to differentiate between amalgam tattoos and melanocytic lesions in FFPE samples. It could potentially be applied in vivo, too, serving as a non-invasive diagnostic tool for intraoral dark pigmented lesions.
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Affiliation(s)
- Johannes Laimer
- University Hospital for Craniomaxillofacial and Oral Surgery, Innsbruck, Austria
| | - Raphael Henn
- Institute of Analytical Chemistry and Radiochemistry, Innsbruck, Austria
| | - Tom Helten
- University Hospital for Craniomaxillofacial and Oral Surgery, Innsbruck, Austria
| | - Susanne Sprung
- Institute of Pathology, Medical University, Innsbruck, Austria
| | - Bettina Zelger
- Institute of Pathology, Medical University, Innsbruck, Austria
| | - Bernhard Zelger
- University Hospital for Dermatology, Venereology and Allergology, Innsbruck, Austria
| | - René Steiner
- University Hospital for Dental Prosthetics and Restorative Dentistry, Innsbruck, Austria
| | - Dagmar Schnabl
- University Hospital for Dental Prosthetics and Restorative Dentistry, Innsbruck, Austria
| | - Vincent Offermanns
- University Hospital for Craniomaxillofacial and Oral Surgery, Innsbruck, Austria
| | | | - Christian W. Huck
- Institute of Analytical Chemistry and Radiochemistry, Innsbruck, Austria
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Policy Development Fosters Collaborative Practice: The Example of the Minamata Convention on Mercury. Dent Clin North Am 2018; 60:921-42. [PMID: 27671962 DOI: 10.1016/j.cden.2016.05.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
This article provides an example of interprofessional collaboration for policy development regarding environmental global health vis-à-vis the Minamata Convention on Mercury. It presents an overview of mercury and mercury-related environmental health issues; public policy processes and stakeholders; and specifics including organized dentistry's efforts to create global policy to restrict environmental contamination by mercury. Dentistry must participate in interprofessional collaborations and build on such experiences to be optimally placed for ongoing interprofessional policy development. Current areas requiring dental engagement for interprofessional policy development include education, disaster response, HPV vaccination, pain management, research priorities, and antibiotic resistance.
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Santa Maria MP, Hill BD, Kline J. Lead (Pb) neurotoxicology and cognition. APPLIED NEUROPSYCHOLOGY-CHILD 2018; 8:272-293. [DOI: 10.1080/21622965.2018.1428803] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
| | - Benjamin D. Hill
- Department of Psychology, University of South Alabama, Mobile, AL, USA
| | - Joshua Kline
- Department of Psychology, University of South Alabama, Mobile, AL, USA
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26
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Zheng LY, Sanders AP, Saland JM, Wright RO, Arora M. Environmental exposures and pediatric kidney function and disease: A systematic review. ENVIRONMENTAL RESEARCH 2017; 158:625-648. [PMID: 28727988 PMCID: PMC5821495 DOI: 10.1016/j.envres.2017.06.029] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 05/29/2017] [Accepted: 06/23/2017] [Indexed: 05/24/2023]
Abstract
BACKGROUND Environmental chemical exposures have been implicated in pediatric kidney disease. No appraisal of the available evidence has been conducted on this topic. METHODS We performed a systematic review of the epidemiologic studies that assessed association of environmental exposures with measures of kidney function and disease in pediatric populations. The search period went through July 2016. RESULTS We found 50 studies that met the search criteria and were included in this systematic review. Environmental exposures reviewed herein included lead, cadmium, mercury, arsenic, fluoride, aflatoxin, melamine, environmental tobacco, bisphenol A, dental procedures, phthalates, ferfluorooctanoic acid, triclosan, and thallium/uranium. Most studies assessed environmental chemical exposure via biomarkers but four studies assessed exposure via proximity to emission source. There was mixed evidence of association between metal exposures, and other non-metal environmental exposures and pediatric kidney disease and other kidney disease biomarkers. The evaluation of causality is hampered by the small numbers of studies for each type of environmental exposure, as well as lack of study quality and limited prospective evidence. CONCLUSION There is a need for well-designed epidemiologic studies of environmental chemical exposures and kidney disease outcomes.
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Affiliation(s)
- Laura Y Zheng
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY 10029, United States.
| | - Alison P Sanders
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY 10029, United States; Department of Pediatrics, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY 10029, United States.
| | - Jeffrey M Saland
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY 10029, United States.
| | - Robert O Wright
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY 10029, United States; Department of Pediatrics, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY 10029, United States.
| | - Manish Arora
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY 10029, United States.
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Lin PY, Wang J, Chiang YC, Lai CY, Chang HJ, Chi LY. Risk of subsequent attention-deficit/hyperactivity disorder among children and adolescents with amalgam restorations: A nationwide longitudinal study. Community Dent Oral Epidemiol 2017; 46:47-53. [PMID: 28782290 DOI: 10.1111/cdoe.12327] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 07/06/2017] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Dental amalgam has been used as a common restorative material since the 1800s, but concerns have been raised regarding its purported neuropsychological effects due to the neurotoxicity of mercury. In this study, a nationwide population-based database was employed to investigate the association of dental amalgam restoration with the risk of attention-deficit/hyperactivity disorder (ADHD). METHODS After matching, 88 068 young people with at least one tooth restoration during 2002-2010 and no ADHD history before 2001 were selected and then collected the further information until the end of 2011. Cox proportional hazard models were employed to estimate the possible effect of amalgam restorations on the risk of ADHD during the period of 2002-2011. Subgroup analyses were performed according to age, sex and number of amalgam restorations. RESULTS In total, 2073 people (2.4%) received an ADHD diagnosis during the study period, yielding an incidence rate of 32.4 per 100 000 person-years. Those who had 6 or more amalgam restorations had a higher risk of future ADHD in the unadjusted Cox proportional hazard regression model (hazard ratio=1.20, 95% confidence interval [CI]=1.04-1.38, P=.015) than those who had received composite resin or glass ionomer restorations. However, after adjustment for potential confounding factors, the result was found to be confounded by age. CONCLUSIONS The univariate analysis results showed that those who had 6 or more amalgam restorations had a 20% higher risk of future ADHD; however, the association disappeared after the model was adjusted for age. Despite this study analysing a larger sample than those analysed in previous studies, no association was observed between young patients' having received amalgam restorations and a future ADHD diagnosis. Further research aimed at evaluating the association between dental amalgam and other subsequent neuropsychological effects is warranted, especially for people who are vulnerable to mercury exposure.
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Affiliation(s)
- Po-Yen Lin
- Department of Dentistry, School of Dentistry, National Yang-Ming University, Taipei, Taiwan.,Department of Dentistry, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Jui Wang
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Yu-Chih Chiang
- Department of Restorative and Aesthetic Dentistry, School of Dentistry, National Taiwan University and National Taiwan University Hospital, Taipei, Taiwan
| | | | - Hong-Ji Chang
- Department of Dentistry, Cheng Hsin General Hospital, Taipei, Taiwan
| | - Lin-Yang Chi
- Department of Dentistry, School of Dentistry, National Yang-Ming University, Taipei, Taiwan.,Department of Education and Research, Taipei City Hospital, Taipei, Taiwan
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Spadola F, Morici M. The use of silver amalgam for treatment of shell ulcerations in turtles: 60 cases. J Small Anim Pract 2017; 58:720-723. [PMID: 28612926 DOI: 10.1111/jsap.12701] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Revised: 07/12/2016] [Accepted: 07/27/2016] [Indexed: 11/26/2022]
Abstract
Shell ulcers were diagnosed based on clinical appearance in 60 turtles. Under general anaesthesia, surgical curettage was performed using a burr mounted on a micro-grinder. A calcium hydroxide paste was applied to the debrided lesions before the application of restorative material. Lesions were completely filled with rapidly hardening silver amalgam. Treated terrapins were hospitalised in dry containers and later were housed in tanks with controlled temperature 24 hours. Fillings were found spontaneously expulsed at various periods after placement. No signs of mercury poisoning or tissue reaction to the prosthesis were apparent.
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Affiliation(s)
- F Spadola
- Department of Veterinary Science, University of Messina, 98168 Messina, Italy
| | - M Morici
- Department of Veterinary Science, University of Messina, 98168 Messina, Italy
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Bjørklund G, Bengtsson U, Chirumbolo S, Kern JK. Concerns about environmental mercury toxicity: do we forget something else? ENVIRONMENTAL RESEARCH 2017; 152:514-516. [PMID: 27616662 DOI: 10.1016/j.envres.2016.08.038] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 08/20/2016] [Accepted: 08/24/2016] [Indexed: 05/24/2023]
Affiliation(s)
- Geir Bjørklund
- Council for Nutritional and Environmental Medicine (CONEM), Toften 24, 8610 Mo i Rana, Norway.
| | - Ulf Bengtsson
- Ret. Department of Management and Engineering, Linköping University, Linköping, Sweden
| | - Salvatore Chirumbolo
- Department of Neurological and Movement Sciences, University of Verona, Verona, Italy
| | - Janet K Kern
- Institute of Chronic Illnesses, Inc, and CoMeD, Silver Spring, MD, USA; CONEM US Autism Research Group, Allen, TX, USA
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Yin L, Yu K, Lin S, Song X, Yu X. Associations of blood mercury, inorganic mercury, methyl mercury and bisphenol A with dental surface restorations in the U.S. population, NHANES 2003-2004 and 2010-2012. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2016; 134P1:213-225. [PMID: 27639196 DOI: 10.1016/j.ecoenv.2016.09.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2016] [Revised: 08/30/2016] [Accepted: 09/01/2016] [Indexed: 05/09/2023]
Abstract
The potential adverse health effects of mercury from amalgam and bisphenol A (BPA) from composite resin have been significant concerns. It is unclear whether dental restorative materials significantly contribute to mercury or BPA levels. The purpose of this study is to use NHANES data including 14,703 subjects (2003-2004: n=7514; 2011-2012: n=7189) to examine the association between Dental Surface Restorations (DSR) and blood total mercury (THg), inorganic mercury (IHg), methyl mercury (MeHg) and urinary BPA through the stratification of covariates and multivariate analysis. Subjects were divided into three groups based on the number of dental surface restorations (DSRs, 0, 1-8, >8). Blood THg and IHg in 2003-2004 were significantly higher in the subjects with DSR (geometric mean of 0.48, 0.69 and 1.17μg/l for THg; 0.32, 0.33 and 0.39μg/l for IHg with DSR 0, 1-8 and >8). Similarly, increases of THg, IHg and MeHg were also observed in 2013-2014 (geometric mean of 0.51, 0.69 and 0.99μg/l for THg; 0.40, 0.49 and 0.66μg/l for MeHg; 0.20, 0.22 and 0.29μg/l for IHg with DSR 0, 1-8 and >8). Linear regression model analysis revealed blood THg and IHg in 2003-2004 and THg, IHg and MeHg in 2011-2012 were quantitatively associated with the number of DSRs. A dramatic decrease in urinary BPA from 2003 to 2004-2011-2012 was observed, but no significant increase with DSRs in either period of study. In conclusion, significant increases in blood THg, IHg, and MeHg in the subjects with DSRs are confirmed in a nationally representative population, a critical step in assessing the potential risk of adverse effects from dental restorative materials, but no association between dental fillings and urinary BPA was found.
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Affiliation(s)
- Lei Yin
- Department of Environmental Health Science, University of Georgia, Athens, GA, USA
| | - Kevin Yu
- Department of Environmental Health Science, University of Georgia, Athens, GA, USA
| | - Simon Lin
- The Center for Pediatric Dentistry, University of Washington, USA
| | - Xiao Song
- Department of Epidemiology and Biostatistics, University of Georgia, Athens, GA, USA
| | - Xiaozhong Yu
- Department of Environmental Health Science, University of Georgia, Athens, GA, USA.
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Mortazavi S, Mortazavi G, Paknahad M. Dental metal-induced innate reactivity in keratinocytes. Toxicol In Vitro 2016; 33:180-1. [DOI: 10.1016/j.tiv.2016.02.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 02/22/2016] [Indexed: 02/06/2023]
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Ohlander J, Huber SM, Schomaker M, Heumann C, Schierl R, Michalke B, Jenni OG, Caflisch J, Muñoz DM, von Ehrenstein OS, Radon K. Mercury and neuromotor function among children in a rural town in Chile. INTERNATIONAL JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HEALTH 2016; 22:27-35. [PMID: 27078174 DOI: 10.1080/10773525.2015.1125585] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Mercury (Hg) exposure from artisanal gold mining has adverse effects on the neuromotor function in adults. However, few studies have examined this relationship in children. OBJECTIVES To investigate the impact of Hg exposure on children's neuromotor function. METHODS Cross-sectional data on Hg risk factors and demographics were collected from n = 288 children (response = 68.9%). Based on complete cases (CCs) (n = 130) and multiple imputations (n = 288), associations between fingernail Hg and four different neuromotor function components were calculated using multiple logistic regression adjusted for confounders. RESULTS Of the children, 11.1, 14.9, 63.9, and 10.4% had pathologic pure motor skills, adaptive fine motor skills, adaptive gross motor skills, and static balance, respectively. No significant association between fingernail Hg and any neuromotor component was found. However, Hg burning in the household was significantly associated with children's pathologic pure motor skills (OR 3.07 95% CI 1.03-9.18). CONCLUSION Elemental Hg exposure in the household might have adverse long-term effects on children's pure motor skills.
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Affiliation(s)
- Johan Ohlander
- a Center for International Health Ludwig-Maximilians-University (LMU) at the Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine , University Hospital Munich (LMU) , Munich , Germany
| | - Stella Maria Huber
- a Center for International Health Ludwig-Maximilians-University (LMU) at the Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine , University Hospital Munich (LMU) , Munich , Germany
| | - Michael Schomaker
- b Centre for Infectious Disease Epidemiology and Research , University of Cape Town , Cape Town , South Africa
| | - Christian Heumann
- c Department for Statistics , Ludwig-Maximilians-University Munich , Munich , Germany
| | - Rudolf Schierl
- a Center for International Health Ludwig-Maximilians-University (LMU) at the Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine , University Hospital Munich (LMU) , Munich , Germany
| | - Bernhard Michalke
- d Research Unit Analytical BioGeoChemistry , Helmholtz Center Munich - German Research Center for Environmental Health GmbH , Neuherberg , Germany
| | - Oskar G Jenni
- e Department of Pediatrics, Child Development Center , University Children's Hospital Zürich , Zürich , Switzerland
| | - Jon Caflisch
- e Department of Pediatrics, Child Development Center , University Children's Hospital Zürich , Zürich , Switzerland
| | - Daniel Moraga Muñoz
- f Facultad de Medicina , Universidad Diego Portales , Santiago , Chile.,g Past staff of Facultad de Medicina, Latin American Center of the Center for International Health Ludwig-Maximilians-University , Universidad Católica del Norte , Coquimbo , Chile
| | - Ondine S von Ehrenstein
- h Department of Community Health Sciences , University of California Los Angeles , Los Angeles , CA , USA
| | - Katja Radon
- a Center for International Health Ludwig-Maximilians-University (LMU) at the Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine , University Hospital Munich (LMU) , Munich , Germany
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Baek HJ, Kim EK, Lee SG, Jeong SH, Sakong J, Merchant AT, Im SU, Song KB, Choi YH. Dental amalgam exposure can elevate urinary mercury concentrations in children. Int Dent J 2016; 66:136-43. [PMID: 26833490 DOI: 10.1111/idj.12214] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVES Owing to its cost-effectiveness and operative convenience, dental amalgam remains in use as a restorative material for tooth caries in children in many countries. The aim of this study was to evaluate the relationship between dental amalgam exposure and urinary mercury (U-Hg) concentrations in children. METHODS In this longitudinal study, 463, 367 and 348 children, 8-11 years of age, were evaluated at baseline, and at the first and second follow-up visits, respectively. The interval between each survey was 6 months. For the oral examination and urine sample, the amalgam-filled tooth surface (TS), and U-Hg and creatinine concentrations of participants were determined, and the cumulative amalgam-filled TS and cumulative creatinine-adjusted U-Hg were calculated. To assess potential covariates, socio-demographic factors, oral health behaviour and dietary factors were surveyed by questionnaire. Data were analysed by the t-test, correlation analysis and mixed-model analysis. The statistical analyses were performed using SPSS 18.0. RESULTS Children with more than one amalgam-filled TS exhibited significantly higher creatinine-adjusted U-Hg concentrations than those without, in all three survey periods (P < 0.001). The results for the current and cumulative amalgam-filled TS significantly correlated with those for the current and cumulative creatinine-adjusted U-Hg concentration, respectively, in all surveys (P < 0.001). In the repeated-measures mixed model analysis, current and cumulative amalgam-filled TS was significantly related to current and cumulative creatinine-adjusted U-Hg concentration, respectively (P < 0.001). CONCLUSIONS Amalgam-filled TS was significantly correlated with U-Hg concentrations in children. Therefore, dental amalgam exposure can affect the systemic mercury concentration in children.
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Affiliation(s)
- Hye-Jin Baek
- Department of Dental Hygiene, Taegu Science University 47 Yeongsong-ro Buk-gu, Daegu, Korea
| | - Eun-Kyong Kim
- Department of Dental Hygiene, College of Science & Technology, Kyungpook National University, Daegu, Korea
| | - Sang Gyu Lee
- Department of Hospital Management, Graduate School of Public Health, Yonsei University, Seodaemun-gu, Seoul, Korea
| | - Seong-Hwa Jeong
- Faculty of Health Science, Daegu Haany University 1 Haanydae-ro, Gyeongsan-si, Gyeongsangbuk-do, Korea
| | - Jun Sakong
- Department of Preventive Medicine and Public Health College of Medicine, Yeungnam University 170 Hyunchung-ro, Nam-gu, Daegu, Korea
| | - Anwar T Merchant
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Sang-Uk Im
- Department of Preventive Dentistry, School of Dentistry, Kyungpook National University, Daegu, Korea
| | - Keun-Bae Song
- Department of Preventive Dentistry, School of Dentistry, Kyungpook National University, Daegu, Korea
| | - Youn-Hee Choi
- Department of Preventive Dentistry, School of Dentistry, Kyungpook National University, Daegu, Korea
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Abstract
OBJECTIVE To examine whether greater exposure to resin-based composite materials, which may intra-orally release bisphenol A (BPA), is associated with worse renal function outcomes in children. DESIGN Prospective multi-centre study. SETTING Community health dental clinics in Boston and Maine from 1997-2005.Subjects and methods Five hundred and thirty-four New England Children's Amalgam Trial participants aged six to ten years were randomised to treatment with amalgam or resin-based composite restorations over five years of follow-up. INTERVENTIONS Restorations were placed according to treatment arm, and sealants placed per standard of care. Cumulative composite exposure was calculated using surface-years (each treated surface weighted by number years present). MAIN OUTCOME MEASURES Urinary excretion of albumin, gamma-glutamyl transpeptidase (gamma-GT), and N-acetyl-β-D-glucosaminidase (NAG) were available for 417 children. RESULTS Analysis of covariance showed no association between exposure to dental composites, polyacid-modified compomer, or flowable composite dental sealants and preventative resin restorations with levels of renal function. There was no association between composite materials and thresholds indicating renal damage in logistic regression models. CONCLUSIONS This study found no harmful associations between dental composite materials and renal function in children. Therefore, concerns about renal function need not be a consideration in the choice of dental restoration material or placement of preventative dental sealants.
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Cabaña-Muñoz ME, Parmigiani-Izquierdo JM, Bravo-González LA, Kyung HM, Merino JJ. Increased Zn/Glutathione Levels and Higher Superoxide Dismutase-1 Activity as Biomarkers of Oxidative Stress in Women with Long-Term Dental Amalgam Fillings: Correlation between Mercury/Aluminium Levels (in Hair) and Antioxidant Systems in Plasma. PLoS One 2015; 10:e0126339. [PMID: 26076368 PMCID: PMC4468144 DOI: 10.1371/journal.pone.0126339] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 04/01/2015] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The induction of oxidative stress by Hg can affect antioxidant enzymes. However, epidemiological studies have failed to establish clear association between dental fillings presence and health problems. OBJECTIVES To determine whether heavy metals (in hair), antioxidant enzymes (SOD-1) and glutathione levels could be affected by the chronic presence of heavy metals in women who had dental amalgam fillings. MATERIALS AND METHODS 55 hair samples (42 females with amalgam fillings and 13 female control subjects) were obtained. All subjects (mean age 44 years) who had dental amalgam filling for more than 10 years (average 15 years). Certain metals were quantified by ICP-MS (Mass Spectrophotometry) in hair (μg/g: Al, Hg, Ba, Ag, Sb, As, Be, Bi, Cd, Pb, Pt, Tl, Th, U, Ni, Sn, Ti) and SOD-1 and Glutathione (reduced form) levels in plasma. Data were compared with controls without amalgams, and analyzed to identify any significant relation between metals and the total number of amalgam fillings, comparing those with four or less (n = 27) with those with more than four (n = 15). As no significant differences were detected, the two groups were pooled (Amlgam; n = 42). FINDINGS Hg, Ag, Al and Ba were higher in the amalgam group but without significant differences for most of the heavy metals analyzed. Increased SOD-1 activity and glutathione levels (reduced form) were observed in the amalgam group. Aluminum (Al) correlated with glutathione levels while Hg levels correlated with SOD-1. The observed Al/glutathione and Hg/SOD-1 correlation could be adaptive responses against the chronic presence of mercury. CONCLUSIONS Hg, Ag, Al and Ba levels increased in women who had dental amalgam fillings for long periods. Al correlated with glutathione, and Hg with SOD-1. SOD-1 may be a possible biomarker for assessing chronic Hg toxicity.
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Affiliation(s)
- María Eugenia Cabaña-Muñoz
- Centro CIROM, Centro de Implantología y Rehabilitación Oral Multidisciplinaria, Murcia, Spain
- Facultad de Medicina, Universidad de Murcia, UMU, Unidad Docente de Ortodoncia, Murcia, Spain
- * E-mail: (JJM); (MEC)
| | | | | | - Hee-Moon Kyung
- Department of Orthodontics, Dental School, Kyungpook Nacional University, Daegu, Korea
| | - José Joaquín Merino
- IUIN, Instituto de Investigación Neuroquímica, Universidad Complutense de Madrid, (U.C.M), Madrid, Spain
- * E-mail: (JJM); (MEC)
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Kampalath RA, Jay JA. Sources of Mercury Exposure to Children in Low- and Middle-Income Countries. J Health Pollut 2015; 5:33-51. [PMID: 30524768 PMCID: PMC6221478 DOI: 10.5696/i2156-9614-5-8.33] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Many children in low- and middle-income countries face enhanced risks of exposure to contaminants via the environment, parental occupation, and other routes. While mercury (Hg) is a global pollutant whose transport properties allow it to have an impact even in pristine areas, the presence of significant Hg sources in the developing world can cause localized effects that are more severe than those observed in other areas. OBJECTIVES This paper provides a narrative review of sources of Hg exposure to people in the developing world with a particular focus on children, and presents an overview of key aspects to this important issue. METHODS We searched Web of Knowledge and Google Scholar using keywords including combinations of "mercury" and one or more of the following: "children," "exposure," "breast milk," "artisanal mining," "prenatal," "religion," "medicine," "dental amalgam," "chlor-alkali," "VCM," "vaccine," "e-waste," "industry," "beauty," "cosmetics," "strategies," "child labor," "costs," and "developing countries" to find peer-reviewed articles pertaining to Hg exposure in the developing world. RESULTS Sources of Hg exposure include mining, consumption, industrial operations, religious practices, traditional medicines, beauty products, vaccines, dental amalgams, and waste scavenging and recycling. CONCLUSION Children in the developing world are often subject to higher levels of Hg exposure than those living in developed countries due to the higher prevalence of Hg-intensive industrial processes and consumer products, lack of environmental regulation, and limits in mobility and food choices, among other factors. This issue can be addressed through additional research to fill in data gaps on exposure sources, establish sound and enforceable policies, and increase education and participation in affected communities. Challenges to addressing this problem include limited resources for needed equipment, training, and manpower to implement solutions.
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Affiliation(s)
| | - Jennifer Ayla Jay
- Civil and Environmental Engineering, Department, U.C.L.A., Los Angeles, CA, U.S.A
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Patidar R, Rebary B, Paul P. Colorimetric and Fluorogenic Recognition of Hg2+ and Cr3+ in Acetonitrile and their Test Paper Recognition in Aqueous Media with the Aid of Rhodamine Based Sensors. J Fluoresc 2015; 25:387-95. [DOI: 10.1007/s10895-015-1524-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Accepted: 01/20/2015] [Indexed: 10/24/2022]
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Zwicker JD, Dutton DJ, Emery JCH. Longitudinal analysis of the association between removal of dental amalgam, urine mercury and 14 self-reported health symptoms. Environ Health 2014; 13:95. [PMID: 25404430 PMCID: PMC4273453 DOI: 10.1186/1476-069x-13-95] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Accepted: 11/03/2014] [Indexed: 05/09/2023]
Abstract
BACKGROUND Mercury vapor poses a known health risk with no clearly established safe level of exposure. Consequently there is debate over whether the level of prolonged exposure to mercury vapor from dental amalgam fillings, combining approximately 50% mercury with other metals, is sufficiently high to represent a risk to health. The objective of our study is to determine if mercury exposure from amalgam fillings is associated with risk of adverse health effects. METHODS In a large longitudinal non-blind sample of participants from a preventative health program in Calgary, Canada we compared number of amalgam fillings, urine mercury measures and changes in 14 self-reported health symptoms, proposed to be mercury dependent sub-clinical measures of mental and physical health. The likelihood of change over one year in a sample of persons who had their fillings removed was compared to a sample of persons who had not had their fillings removed. We use non-parametric statistical tests to determine if differences in urine mercury were statistically significant between sample groups. Logistic regression models were used to estimate the likelihood of observing symptom improvement or worsening in the sample groups. RESULTS At baseline, individuals with dental amalgam fillings have double the measured urine mercury compared to a control group of persons who have never had amalgam fillings. Removal of amalgam fillings decreases measured urine mercury to levels in persons without amalgam fillings. Although urine mercury levels in our sample are considered by Health Canada to be too low to pose health risks, removal of amalgam fillings reduced the likelihood of self-reported symptom deterioration and increased the likelihood of symptom improvement in comparison to people who retained their amalgam fillings. CONCLUSIONS Our findings suggest that mercury exposure from amalgam fillings adversely impact health and therefore are a health risk. The use of safer alternative materials for dental fillings should be encouraged to avoid the increased risk of health deterioration associated with unnecessary exposure to mercury.
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Affiliation(s)
- Jennifer D Zwicker
- />School of Public Policy, University of Calgary, Calgary, AB T2P 1H9 Canada
| | - Daniel J Dutton
- />School of Public Policy, University of Calgary, Calgary, AB T2P 1H9 Canada
| | - John Charles Herbert Emery
- />School of Public Policy, University of Calgary, Calgary, AB T2P 1H9 Canada
- />Department of Economics, University of Calgary, Social Sciences Building, Room 554, 2500 University Dr. NW, Calgary, AB T2N 1 N4 Canada
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Woods JS, Heyer NJ, Russo JE, Martin MD, Farin FM. Genetic polymorphisms affecting susceptibility to mercury neurotoxicity in children: summary findings from the Casa Pia Children's Amalgam clinical trial. Neurotoxicology 2014; 44:288-302. [PMID: 25109824 DOI: 10.1016/j.neuro.2014.07.010] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Revised: 07/29/2014] [Accepted: 07/30/2014] [Indexed: 12/15/2022]
Abstract
Mercury (Hg) is neurotoxic, and children may be particularly susceptible to this effect. A current major challenge is identification of children who may be uniquely susceptible to Hg toxicity because of genetic predisposition. We examined the possibility that common genetic variants that are known to affect neurologic functions or Hg handling in adults would modify the adverse neurobehavioral effects of Hg exposure in children. Three hundred thirty subjects who participated as children in the recently completed Casa Pia Clinical Trial of Dental Amalgams in Children were genotyped for 27 variants of 13 genes that are reported to affect neurologic functions and/or Hg disposition in adults. Urinary Hg concentrations, reflecting Hg exposure from any source, served as the Hg exposure index. Regression modeling strategies were employed to evaluate potential associations between allelic status for individual genes or combinations of genes, Hg exposure, and neurobehavioral test outcomes assessed at baseline and for 7 subsequent years during the clinical trial. Among boys, significant modification of Hg effects on neurobehavioral outcomes over a broad range of neurologic domains was observed with variant genotypes for 4 of 13 genes evaluated. Modification of Hg effects on a more limited number of neurobehavioral outcomes was also observed for variants of another 8 genes. Cluster analyses suggested some genes interacting in common processes to affect Hg neurotoxicity. In contrast, significant modification of Hg effects on neurobehavioral functions among girls with the same genotypes was substantially more limited. These observations suggest increased susceptibility to the adverse neurobehavioral effects of Hg among children, particularly boys, with genetic variants that are relatively common to the general human population. These findings advance public health goals to identify factors underlying susceptibility to Hg toxicity and may contribute to strategies for preventing adverse health risks associated with Hg exposure.
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Affiliation(s)
- James S Woods
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, USA.
| | - Nicholas J Heyer
- Battelle Centers for Public Health Research and Evaluation, Seattle, WA, USA
| | - Joan E Russo
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Michael D Martin
- Departments of Oral Medicine and Epidemiology, University of Washington, Seattle, WA, USA
| | - Federico M Farin
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, USA
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Maserejian NN, Shrader P, Brown OA, Trachtenberg FL, Soncini J, Hauser R, Shenker BJ. Dental sealants and composite restorations and longitudinal changes in immune function markers in children. Int J Paediatr Dent 2014; 24:215-25. [PMID: 24033362 PMCID: PMC4593059 DOI: 10.1111/ipd.12064] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Resins used in dental composites, derived from bisphenol-A (BPA), have been shown to alter immune cells. The objective of this study was to explore children's immune function changes in relation to resin composite treatment. DESIGN We conducted secondary data analysis of the New England Children's Amalgam Trial immune function substudy (N = 59). Immune function was measured pre-treatment and up to five times post-treatment through 5-year follow-up. Multivariable generalized linear regression models were used to estimate the association between three classes of resin composites (bisphenol-A-diglycidyl-dimethacrylate [BisGMA]-based flowables used for preventive sealants; urethane dimethacrylate [UDMA]-based compomer restorations; bisGMA-based restorations) and changes in immune function markers measured annually. RESULTS Total white blood cell counts and responsiveness of T cells or neutrophils were not appreciably altered by composite treatment levels. Changes in B cell responsiveness were greater throughout follow-up among children with more bisGMA-based composite restorations, which opposed findings for amalgam treatment levels. Monocyte responsiveness changes were decreased at 6 months with greater treatment, but not over longer follow-up. CONCLUSIONS Results of this analysis showed no overt immune function alterations associated with resin composites. Additional research regarding lymphocyte activation may be warranted given the consistency of results within these analyses and with a prior study showing increased B cell activation.
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Affiliation(s)
- NN Maserejian
- Department of Epidemiology, New England Research Institutes, Watertown, MA, USA
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Rasines Alcaraz MG, Veitz-Keenan A, Sahrmann P, Schmidlin PR, Davis D, Iheozor-Ejiofor Z. Direct composite resin fillings versus amalgam fillings for permanent or adult posterior teeth. Cochrane Database Syst Rev 2014:CD005620. [PMID: 24683067 DOI: 10.1002/14651858.cd005620.pub2] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Amalgam has been the traditional material for filling cavities in posterior teeth for the last 150 years and, due to its effectiveness and cost, amalgam is still the restorative material of choice in certain parts of the world. In recent times, however, there have been concerns over the use of amalgam restorations (fillings), relating to the mercury release in the body and the environmental impact following its disposal. Resin composites have become an esthetic alternative to amalgam restorations and there has been a remarkable improvement of its mechanical properties to restore posterior teeth.There is need to review new evidence comparing the effectiveness of both restorations. OBJECTIVES To examine the effects of direct composite resin fillings versus amalgam fillings for permanent posterior teeth, primarily on restoration failure. SEARCH METHODS We searched the Cochrane Oral Health Group's Trials Register (to 22 October 2013), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2013, Issue 9), MEDLINE via OVID (1946 to 22 October 2013), EMBASE via OVID (1980 to 22 October 2013), and LILACs via BIREME Virtual Health Library (1980 to 22 October 2013). We applied no restrictions on language or date of publication when searching the electronic databases. We contacted manufacturers of dental materials to obtain any unpublished studies. SELECTION CRITERIA Randomized controlled trials comparing dental resin composites with dental amalgams in permanent posterior teeth. We excluded studies having a follow-up period of less than three years. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by The Cochrane Collaboration. MAIN RESULTS Of the 2205 retrieved references, we included seven trials (10 articles) in the systematic review. Two trials were parallel group studies involving 1645 composite restorations and 1365 amalgam restorations (921 children) in the analysis. The other five trials were split-mouth studies involving 1620 composite restorations and 570 amalgam restorations in an unclear number of children. Due to major problems with the reporting of the data for the five split-mouth trials, the primary analysis is based on the two parallel group trials. We judged all seven trials to be at high risk of bias and we analyzed 3265 composite restorations and 1935 amalgam restorations.The parallel group trials indicated that resin restorations had a significantly higher risk of failure than amalgam restorations (risk ratio (RR) 1.89, 95% confidence interval (CI) 1.52 to 2.35, P value < 0.001 (fixed-effect model) (low-quality evidence)) and increased risk of secondary caries (RR 2.14, 95% CI 1.67 to 2.74, P value < 0.001 (low-quality evidence)) but no evidence of an increased risk of restoration fracture (RR 0.87, 95% CI 0.46 to 1.64, P value = 0.66 (moderate-quality evidence)). The results from the split-mouth trials were consistent with those of the parallel group trials.Adverse effects of dental restorations were reported in two trials. The outcomes considered were neurobehavioral function, renal function, psychosocial function, and physical development. The investigators found no difference in adverse effects between composite and amalgam restorations. However, the results should be interpreted with caution as none of the outcomes were reported in more than one trial. AUTHORS' CONCLUSIONS There is low-quality evidence to suggest that resin composites lead to higher failure rates and risk of secondary caries than amalgam restorations. This review reinforces the benefit of amalgam restorations and the results are particularly useful in parts of the world where amalgam is still the material of choice to restore posterior teeth with proximal caries. Though the review found insufficient evidence to support or refute any adverse effects amalgam may have on patients, new research is unlikely to change opinion on its safety and due to the decision for a global phase-down of amalgam (Minamata Convention on Mercury) general opinion on its safety is unlikely to change.
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Oliveira MT, Constantino HV, Molina GO, Milioli E, Ghizoni JS, Pereira JR. Evaluation of mercury contamination in patients and water during amalgam removal. J Contemp Dent Pract 2014; 15:165-168. [PMID: 25095837 DOI: 10.5005/jp-journals-10024-1508] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
AIM The aim of this study was to evaluate mercury levels in wastewater and in patients during the removal of dental amalgam restorations. MATERIALS AND METHODS To test for mercury levels, patients were tested before and after amalgam restoration removal. To test for mercury emissions, samples of constant volume of wastewater from high-speed drills were collected before and during amalgam restoration removal. RESULTS Although the systemic mercury levels were lower than the limit of biological tolerance, all patients had increased levels after dental restorations. All samples of wastewater had increased mercury levels too. CONCLUSION The urinary levels of mercury increased with dental amalgam removal using a high-speed drill. During the process of amalgam removal, water used for cooling the dental drill was contaminated with mercury. CLINICAL SIGNIFICANCE The mercury released by the physical action of the drill, the replacement material and especially the final destination of the amalgam waste can increase contamination levels that can be a risk for human and environment health.
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Affiliation(s)
- Marcelo Tomás Oliveira
- Professor, Department of Dental Materials, University of Southern Santa Catarina, UNISUL, Santa Catarina, Brazil
| | - Henrique Vieira Constantino
- Undergraduate Student, Department of Dental Materials, University of Southern Santa Catarina, UNISUL, Santa Catarina, Brazil
| | - Gustavo Otoboni Molina
- Professor, Department of Peridontics, University of Southern Santa Catarina, UNISUL, Santa Catarina, Brazil
| | - Elysa Milioli
- Undergraduate Student, Department of Dental Materials, University of Southern Santa Catarina, UNISUL, Santa Catarina, Brazil
| | - Janaina Salomon Ghizoni
- Professor, Department of Oral Pathology, University of Southern Santa Catarina, UNISUL, Santa Catarina, Brazil
| | - Jefferson Ricardo Pereira
- Professor, Department of Prosthodontics, University of Southern Santa Catarina - UNISUL, Santa Catarina, Brazil
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Homme KG, Kern JK, Haley BE, Geier DA, King PG, Sykes LK, Geier MR. New science challenges old notion that mercury dental amalgam is safe. Biometals 2014; 27:19-24. [PMID: 24420334 PMCID: PMC3905169 DOI: 10.1007/s10534-013-9700-9] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2013] [Accepted: 12/29/2013] [Indexed: 01/29/2023]
Abstract
Mercury dental amalgam has a long history of ostensibly safe use despite its continuous release of mercury vapor. Two key studies known as the Children's Amalgam Trials are widely cited as evidence of safety. However, four recent reanalyses of one of these trials now suggest harm, particularly to boys with common genetic variants. These and other studies suggest that susceptibility to mercury toxicity differs among individuals based on multiple genes, not all of which have been identified. These studies further suggest that the levels of exposure to mercury vapor from dental amalgams may be unsafe for certain subpopulations. Moreover, a simple comparison of typical exposures versus regulatory safety standards suggests that many people receive unsafe exposures. Chronic mercury toxicity is especially insidious because symptoms are variable and nonspecific, diagnostic tests are often misunderstood, and treatments are speculative at best. Throughout the world, efforts are underway to phase down or eliminate the use of mercury dental amalgam.
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Affiliation(s)
- Kristin G Homme
- International Academy of Oral Medicine and Toxicology, ChampionsGate, FL, 33896, USA,
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Wahl MJ, Swift EJ. Critical appraisal: dental amalgam update--part II: biological effects. J ESTHET RESTOR DENT 2013; 25:433-7. [PMID: 24320063 DOI: 10.1111/jerd.12075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Dental amalgam restorations have been controversial for over 150 years. In Part I of this Critical Appraisal, the clinical efficacy of dental amalgam was updated. Here in Part II, the biological effects of dental amalgam are addressed.
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Affiliation(s)
- Michael J Wahl
- Private practice, 2003 Concord Pike, Wilmington, DE 19803, USA
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Allergological and toxicological aspects in a multiple chemical sensitivity cohort. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2013; 2013:356235. [PMID: 24367721 PMCID: PMC3866722 DOI: 10.1155/2013/356235] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Accepted: 05/11/2013] [Indexed: 11/30/2022]
Abstract
Background. Multiple chemical sensitivity (MCS) is a chronic condition characterized by an exaggerated response to toxicants. We ascertained the prevalence of allergy to metals and toxicological aspects in MCS patients. Methods. We conducted a retrospective review of medical records of 41 patients with MCS. We performed patch testing (n = 21) for dental series and did lymphocyte transformation test (n = 18) for metals. We measured mercury in samples of blood (n = 19), urine (n = 19), saliva (n = 20), and scalp hair (n = 17) to investigate the association between mercury levels and cases of MCS. Results. The prevalence of metal immune hypersensitivity in a subset of 26 patients was 92.3 percent. Elevations of mercury occurred in 81.2 percent (26 of 32). The mean (±SD) in blood concentrations of mercury was 7.6 ± 13.6 μg/L; mean in urine was 1.9 ± 2.5 μg/L; mean in scalp hair was 2.2 ± 2.5 μg/g; mean in saliva was 38.1 ± 52.1 μg/L. Subgroup analyses showed that elevation of mercury levels in biological matrices were associated with mercury amalgams in patients with MCS (22 patients), compared with controls (8 patients) (odds ratio 11 : 95 percent confidence interval 1.5 to 81.6; P = 0.023). Conclusions. Our data show an increased prevalence of metal allergy and elevation of mercury levels in bioindicators among patients with MCS.
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Kim S, Arora M, Fernandez C, Caruso J, Landero J, Chen A. Lead, mercury, and cadmium exposure and attention deficit hyperactivity disorder in children. ENVIRONMENTAL RESEARCH 2013; 126:105-10. [PMID: 24034783 PMCID: PMC3847899 DOI: 10.1016/j.envres.2013.08.008] [Citation(s) in RCA: 93] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Revised: 08/07/2013] [Accepted: 08/19/2013] [Indexed: 05/22/2023]
Abstract
BACKGROUND There is limited research examining the relationship between lead (Pb) exposure and medically diagnosed attention deficit hyperactivity disorder (ADHD) in children. The role of mercury (Hg) and cadmium (Cd) exposures in ADHD development is even less clear. OBJECTIVES To examine the relationship between Pb, Hg, and Cd and ADHD in children living inside and outside a Lead Investigation Area (LIA) of a former lead refinery in Omaha, NE. METHODS We carried out a case-control study with 71 currently medically diagnosed ADHD cases and 58 controls from a psychiatric clinic and a pediatric clinic inside and outside of the LIA. The participants were matched on age group (5-8, 9-12 years), sex, race (African American or Caucasians and others), and location (inside or outside LIA). We measured whole blood Pb, total Hg, and Cd using inductively coupled plasma mass spectrometry. RESULTS Inside the LIA, the 27 cases had blood Pb geometric mean (GM) 1.89 µg/dL and the 41 controls had 1.51 µg/dL. Outside the LIA, the 44 cases had blood Pb GM 1.02 µg/dL while the 17 controls had 0.97 µg/dL. After adjustment for matching variables and maternal smoking, socioeconomic status, and environmental tobacco exposure, each natural log unit blood Pb had an odds ratio of 2.52 with 95% confidence interval of 1.07-5.92. Stratification by the LIA indicated similar point estimate but wider CIs. No associations were observed for Hg or Cd. CONCLUSIONS Postnatal Pb exposure may be associated with higher risk of clinical ADHD, but not the postnatal exposure to Hg or Cd.
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Affiliation(s)
- Stephani Kim
- Division of Epidemiology and Biostatistics, Department of Environmental Health, University of Cincinnati College of Medicine, Cincinnati, OH, 45267 USA
| | - Monica Arora
- Department of Psychiatry, Creighton University School of Medicine, Omaha, NE, 68131, USA
| | - Cristina Fernandez
- Department of Pediatrics, Creighton University School of Medicine, Omaha, NE, 68131, USA
| | - Joseph Caruso
- Metallomics Center, Department of Chemistry, University of Cincinnati, Cincinnati, OH, 45221 USA
| | - Julio Landero
- Metallomics Center, Department of Chemistry, University of Cincinnati, Cincinnati, OH, 45221 USA
| | - Aimin Chen
- Division of Epidemiology and Biostatistics, Department of Environmental Health, University of Cincinnati College of Medicine, Cincinnati, OH, 45267 USA
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Nicolae A, Ames H, Quiñonez C. Dental amalgam and urinary mercury concentrations: a descriptive study. BMC Oral Health 2013; 13:44. [PMID: 24015978 PMCID: PMC3847647 DOI: 10.1186/1472-6831-13-44] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Accepted: 08/29/2013] [Indexed: 11/16/2022] Open
Abstract
Background Dental amalgam is a source of elemental and inorganic mercury. The safety of dental amalgam in individuals remains a controversial issue. Urinary mercury concentrations are used to assess chronic exposure to elemental mercury. At present, there are no indications of mercury-associated adverse effects at levels below 5 μg Hg/g creatinine (Cr) or 7 μg Hg/L (urine). The purpose of the present study is to determine the overall urinary mercury level in the Canadian general population in relation to the number of dental amalgam surfaces. Methods Data come from the 2007/09 Canadian Health Measures Survey, which measured urinary mercury concentrations in a nationally representative sample of 5,418 Canadians aged 6–79 years. Urinary mercury concentrations were stratified by sex, age, and number of dental amalgam surfaces. Results The overall mean urinary mercury concentration varied between 0.12 μg Hg/L and 0.31 μg Hg/L or 0.13 μg Hg/g Cr and 0.40 μg Hg/g Cr. In general, females showed slightly higher mean urinary mercury levels than men. The overall 95th percentile was 2.95 μg Hg/L, the 99th percentile was 7.34E μg Hg/L, and the 99.9th percentile was 17.45 μg Hg/L. Expressed as μg Hg/g Cr, the overall 95th percentile was 2.57 μg Hg/g Cr, the 99th percentile was 5.65 μg Hg/g Cr, and the 99.9th percentiles was 12.14 μg Hg/g Cr. Overall, 98.2% of participants had urinary mercury levels below 7 μg Hg/L and 97.7% had urinary mercury levels below 5 μg Hg/g Cr. All data are estimates for the Canadian population. The estimates followed by the letter “E” should be interpreted with caution due to high sampling variability (coefficient of variation 16.6%-33.3%). Conclusions The mean urinary mercury concentrations in the general Canadian population are significantly lower than the values considered to pose any risks for health.
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Affiliation(s)
- Alexandra Nicolae
- Community Dental Health Services Research Unit, University of Toronto, 124 Edward Street, M5G 1G6, Toronto, ON, Canada.
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Donovan TE, Anderson M, Becker W, Cagna DR, Carr GB, Albouy JP, Metz J, Eichmiller F, McKee JR. Annual Review of selected dental literature: Report of the Committee on Scientific Investigation of the American Academy of Restorative Dentistry. J Prosthet Dent 2013; 110:161-210. [DOI: 10.1016/s0022-3913(13)60358-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Watson GE, van Wijngaarden E, Love TMT, McSorley EM, Bonham MP, Mulhern MS, Yeates AJ, Davidson PW, Shamlaye CF, Strain JJ, Thurston SW, Harrington D, Zareba G, Wallace JMW, Myers GJ. Neurodevelopmental outcomes at 5 years in children exposed prenatally to maternal dental amalgam: the Seychelles Child Development Nutrition Study. Neurotoxicol Teratol 2013; 39:57-62. [PMID: 23856391 PMCID: PMC3917122 DOI: 10.1016/j.ntt.2013.07.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Revised: 06/12/2013] [Accepted: 07/02/2013] [Indexed: 11/19/2022]
Abstract
Limited human data are available to assess the association between prenatal mercury vapor (Hg⁰)) exposure from maternal dental amalgam restorations and neurodevelopment of children. We evaluated the association between maternal dental amalgam status during gestation and children's neurodevelopmental outcomes at 5 years in the Seychelles Child Development Nutrition Study (SCDNS). Maternal amalgam status was determined prospectively in a longitudinal cohort study examining the associations of prenatal exposure to nutrients and methylmercury (MeHg) with neurodevelopment. A total of 236 mother-child pairs initially enrolled in the SCDNS in 2001 were eligible to participate. Maternal amalgam status was measured as number of amalgam surfaces (the primary metric) and number of occlusal points. The neurodevelopmental assessment battery was comprised of age-appropriate tests of cognitive, language, and perceptual functions, and scholastic achievement. Linear regression analysis controlled for MeHg exposure, maternal fatty acid status, and other covariates relevant to child development. Maternal amalgam status evaluation yielded an average of 7.0 surfaces (range 0-28) and 11.0 occlusal points (range 0-40) during pregnancy. Neither the number of maternal amalgam surfaces nor occlusal points were associated with any outcome. Our findings do not provide evidence to support a relationship between prenatal exposure to Hg⁰ from maternal dental amalgam and neurodevelopmental outcomes in children at 5 years of age.
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Affiliation(s)
- Gene E Watson
- Eastman Institute for Oral Health, University of Rochester, 601 Elmwood Avenue, Box 705, Rochester, NY 14642, USA; Department of Environmental Medicine, University of Rochester, 601 Elmwood Avenue, Box EHSC, Rochester, NY 14642, USA; Department of Pharmacology and Physiology, University of Rochester, 601 Elmwood Avenue, Box 705, Rochester, NY 14642, USA.
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