So, the aim of this systematic review is to definitively evaluate the eventual effects of the exposure to Hg in adults and children with and without dental amalgam fillings measuring the Hg concentration in various biological fluids. The purpose of this MiniReview is to evaluate the evidence of possible relevance between Hg exposure in dentistry and idiopathic disturbances in motor functions, cognitive skills and affective reactions, as well as dose-response relationships. Mercury poisoning refers to a toxicity from mercury consumption. Randomization of children was performed with a stratification following their geographical origin or the school they attended. The meta-analysis was conducted with a fixed-effects model comparing mean differences and standard deviations in case of continuous data. Neurological examination was performed according to standard practice criteria [37, 38]. Toxins (Basel). Bottom line: there is no “harmless” level of mercury vapor exposure. Even if the meta-analysis has drawn conclusions from RCT that should be considered as the best evidence in scientific literature, data regarding the level of urinary mercury in children after 5 years of restoring dental caries with dental amalgam or composite resin were considered to have only moderate strength of evidence because of the high heterogeneity among studies and the presence of one study assessed as having high risk of bias. For this reason, the design of longer RCTs for assessing various types of adverse effects linked to the use of dental amalgam is strongly suggested. Again, it is important to note that because mercury is a cumulative toxin, it is quite possible for a patient to have a mouthful of “silver fillings” and not be symptomatic. Analyses were carried out at baseline (patients enrolment), 7 days, and 6, 12, and 60 months after the enrolment [36]. Because of the different appearance of the materials to be evaluated in the trials, participants could not be blinded; for this reason, the reviewers decided to exclude participants’ blindness from the judgment regarding the performance bias. In fact, the TSA cumulative z-curve did not cross the alpha-spending function and the conventional boundaries; moreover, it did not reach the RIS threshold (Figure 5). A controversial issue (Part 1 of 2),”, M. E. Godfrey, D. P. Wojcik, and C. A. Krone, “Apolipoprotein E genotyping as a potential biomarker for mercury neurotoxicity,”, J. Leistevuo, H. Järvinen, M. Österblad, T. Leistevuo, P. Huovinen, and J. Tenovuo, “Resistance to mercury and antimicrobial agents in Streptococcus mutans isolates from human subjects in relation to exposure to dental amalgam fillings,”, F. L. Lorscheider, M. J. Vimy, A. O. Summers, and H. Zwiers, “The dental amalgam mercury controversy - inorganic mercury and the CNS; genetic linkage of mercury and antibiotic resistances in intestinal bacteria,”, M. Osterblad, J. Leistevuo, T. Leistevuo et al., “Antimicrobial and mercury resistance in aerobic gram-negative bacilli in fecal flora among persons with and without dental amalgam fillings,”, R. Pike, V. Lucas, P. Stapleton et al., “Prevalence and antibiotic resistance profile of mercury-resistant oral bacteria from children with and without mercury amalgam fillings,”, A. M. Brownawell, S. Berent, R. L. Brent et al., “The potential adverse health effects of dental amalgam,”. TSA software gave the possibility to calculate the required information size (RIS), the alpha-spending function, the trial sequential monitoring boundaries for benefits and harms, and the futility boundaries. Indeed, most of the evidence supporting the thesis of a link between oral mucosal reactions and dental amalgam are based on case reports [56–62]. in 2008 [36]. The aetiology of caries is multifactorial since several factors play a role in the onset and maintenance of the pathology and in its maintenance. mercury. L. Forsten, “Blood mercury content after chewing,”, W. L. Mortada, M. A. Sobh, M. M. El-Defrawy, and S. E. Farahat, “Mercury in dental restoration: is there a risk of nephrotoxicity?”, I. Sterzl, J. Prochazkova, P. Hrda, P. Matucha, J. Bartova, and V. Stejskal, “Removal of dental amalgam decreases anti-TPO and anti-Tg autoantibodies in patients with autoimmune thyroiditis,”, S. Eneström, P. Hultman, and P. Hultman, “Does amalgam affect the immune system? Our Nashville practice offers mercury-free fillings at the Centre for Holistic and Biological Dentistry. Qualitative analysis was carried out about the other data. The authors declare that there are no conflicts of interest regarding the publication of this paper. Starting from this evidence, Geier et al. Methodological quality of trials was also analysed for the purposes of the TSA, and one study was considered as at low risk of bias [24], while the other one included in the analysis was considered as at high risk [32]. The search strategy reported above was designed for MEDLINE PubMed and then adapted to the other three databases. Archive for Category: Mercury Toxicity Treatment. Trials took place in USA, Portugal, and Germany giving birth to three, two, and one publications, respectively. In NECAT also the social-behavioural outcomes contained into the Child Behaviour Checklist (CBCL) were analysed [39]. Make an appointment with Dr. James Groeber of Anderson Aesthetic & Family Dentistry today. 2004 Oct;81(2):354-63. doi: 10.1093/toxsci/kfh220. Among them, dental amalgam is an excellent restorative material to be used for the caries conservative treatment in patients affected by systemic syndromes with CNS involvement [66] and in very young children [16], commonly considered uncooperative patients, which can prevent the dentist from the difficult challenge of using resins. Following the new directives of the European Union, which foresee the amalgam ban, the debate on its hypothetical toxicity has started again. Its indisputable advantages in the treatment of very young patients and in those suffering from systemic syndromes that compromise their collaboration make it a material that can still have a fair use in dental clinical practice. Mercury toxicity and chronic diseases. This site needs JavaScript to work properly. Sign up here as a reviewer to help fast-track new submissions. There was then a discussion about how to remove the fillings. No statistically significant differences were found in any outcome. Subsequent analyses took place for the first time in the dental session in which amalgam was removed (for group A) or in the first dental check-up after randomization (for group C); then, other samples were taken at days 60, 360, and 540 and additionally at days 1, 3, 9, and 30 in group A. reported data belonging to the two areas [24]. [Occupational exposure and health effects of metallic mercury among dentists and dental assistants: a preliminary study. In this regard, it should be noted that not all published studies are homogeneous as regards the number of filled surfaces (in some cases this information is not even reported) or that some do not involve an adequate follow-up period after exposure so that long-term effects are not visible. Yet mercury toxicity from dental amalgams is still not recognised as a factor in chronic health conditions within the established medical community. In both plasma and red cells, the levels of inorganic mercury showed a very similar trend: in the composite group, the levels decreased until reaching a steady-state (around day 60), while in the amalgam group, they remained constant. Special designed data extraction forms were used for this purpose. Please enable it to take advantage of the complete set of features! Jonidi Jafari A, Esrafili A, Moradi Y, Mahmoudi N. J Environ Health Sci Eng. Print this Checklist to take with you to your next dental appointment. GRADE summary of findings for meta-analysis on urinary mercury concentration after 5 years of exposure to dental amalgam or composite resin in children. Its lipid-soluble property allows for easy passage through the alveoli into the bloodstream and red blood cells (RBCs). Urine mercury levels and associated symptoms in dental personnel. We follow biological dentistry principles, offering general, cosmetic, and mercury-free dentistry.The latest techniques and technologies, personalized care, and a comfortable and environmentally responsible practice are our hallmarks. No additional publications were found through the manual search or in the bibliographies of the included studies. [Mercury and health in the dental practice]. A comprehensive systematic literature search was performed in four databases (Ovid via PubMed, Web of Science, Scopus, and CENTRAL) by two calibrated examiners (FG and AC). The trend of the NSSs followed the one of the NHSs except for the 2nd year of observation; in fact, in that time point, children whose caries were restored with composite resin demonstrated a statistically significant higher rate of NSSs (more than 10% with  = 0.02) with respect to the dental amalgam group. The evaluation of the risk of bias of the included studies is summarized in Figures 2 and 3. The enrolment phase took place between April 1998 and July 2002. The statistical analyses carried out in the present systematic review demonstrate the absence of sufficient evidence to ban the use of dental amalgam for caries conservative treatments both in adults and in children. So all data of the single trials were entered into the TSA software; the alpha error was set at 0.05 and the beta error at 20%. The most significant danger is from mercury vapor. The I2 test describing the heterogeneity-linked percentage of total variation across studies was considered as measure of heterogeneity, following the subsequent scheme:(i)0–40%: might not be important(ii)30–60%: may represent moderate heterogeneity(iii)50–90%: may represent substantial heterogeneity(iv)75–100%: considerable heterogeneity [21]. What health problems are related to the exposure of toxins such as those in Mercury fillings? 2019 Mar 5;11(3):147. doi: 10.3390/toxins11030147. In 1960, Keys [1] identified a triad of factors involved in the aetiology and pathogenesis of the disease: a specific bacterial flora, some predisposing factors of the host, and a diet rich in fermentable carbohydrates. In the 18th and 19th centuries, hatters would use mercury compounds in order to manufacture felt. In 1996, a Colorado state judge recommended that Huggins's dental license be revoked, for tricking chronically ill patients into thinking that the true cause of their illness was mercury. Low-copper amalgam commonly consists of mercury (50%), silver (~22–32%), tin (~14%), zinc (~8%) and other trace metals.. The authors evaluated immunological parameters at baseline (patients enrolment), 7 days, and 6, 12, and 60 months after the enrolment. (1)Case report, case series, any type of observational studies, letters, and narrative or systematic reviews(2)Studies published before January 1995(3)Grey literature(4)In vitro studies(5)Animal studies(6)Studies conducted on nonhealthy subjects in the enrolment phase(7)Studies with less than 1 year of follow-up. Such intervention can be considered a step forward to line up with the previous “Minamata Convention on Mercury,” an international treaty that aimed at protecting human health environment from emissions and releases of mercury and its compounds [18]. USA.gov. In recent years, however, the use of dental amalgam has decreased considerably as some scientific evidence has revealed that amalgam vapours can be released during chewing and penetrate the systemic circulation by raising blood Hg levels above the threshold values [7]; other studies have correlated urinary Hg concentrations with possible nephrotoxicity and immune system pathologies [8–10]; more recent evidence, moreover, has focused on the hypothesis of neurotoxicity linked to the use of dental amalgam [11] or to the possibility of generating bacterial resistance to Hg and that these resistances can then transmit to other subjects through the exchange of oral fluids [12–15]. A. Buchanan, and M. H. Thornhill, “Delayed and immediate hypersensitivity reactions associated with the use of amalgam,”, M. Tomka, A. Machovcová, D. Pelclová et al., “Orofacial granulomatosis associated with hypersensitivity to dental amalgam,”, P. D. Pigatto, L. Brambilla, G. Guzzi, and F. Spadari, “Burning lips syndrome,”. WBC, T-cell, B-cell, and neutrophil and monocyte responsiveness, Quality assessment and outcome: urinary mercury levels after 5 years of exposure to dental amalgam or composite resin in children. Mercury Toxicity. The total mercury concentrations in plasma demonstrated an initial decline until they reached a steady-state level in the composite group, while they continued to decrease in the amalgam group. Dent. Difference between groups was around 1.5 μg/g in the first 3 years of follow-up, and then, it declined to around 1.0 μg/g in the subsequent years. Randomization of patients was performed stratifying them according to the total number of tooth surfaces filled with amalgam (1–12, 13–18, and 19–25 surfaces) within each group. Literally amalgam means “mixed with mercury,” and in dental terms, this is true because the composition of the ones used in fillings is formed by 50% Mercury (Hg) and other metals as silver, copper, zinc and tin, that when mixed it hardens in a few minutes at room temperature. All trials had a parallel group design, except for Halbach et al. The same analytic method as per urinary mercury was also used for the analysis of mercury deposits in hair. Clinical Effects of Mercury in Conservative Dentistry: A Systematic Review, Meta-Analysis, and Trial Sequential Analysis of Randomized Controlled Trials Romeo Patini , 1 Gianrico Spagnuolo , 2 , 3 Federica Guglielmi , 1 Edoardo Staderini , 1 Michele Simeone , 2 Andrea Camodeca , 1 and Patrizia Gallenzi 1 Study characteristics are reported in Table 2. 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