Mercury and Tremor by Jeffrey Dach MD

Mercury and Tremor Dental work on a Sailor Amalgam Mercury drdachby Jeffrey Dach MD

This article is part one, for part two, click here.

Jim, a 53 year old violinist presented with a chief complaint of hand tremor. He is unable to hold the violin bow steady and lost his job with the symphony.  A number of neurologists examined Jim, and told him he has an “essential tremor of unknown etiology”, which means there is no known cause.

Upper Left image: Navy dentist placing mercury dental amalgam courtesy of wikimedia commons.

What is Causing the Tremor?

Since Jim’s neurologists had ruled out the common neurological disorders,  the diagnosis of environmental toxicity from mercury exposure was the obvious one to consider.  Indeed, Jim’s mouth was full of mercury dental fillings (see upper left image).

“Silver” dental fillings, also called amalgams, contain 50% mercury.(1-6)  Autopsy studies reveal the number of amalgam fillings corresponds with the amount of mercury deposited in the brain and other tissues. (6)  Higher mercury deposits in the brain are found with greater numbers of “silver” dental fillings. (6)  In addition, animal and human studies show that mercury  toxicity causes tremor.  Could the mercury dental fillings be the source of mercury causing Jim’s tremor?

Mercury Causes Tremor in Rabbits

A 1971 study by Dr Fukuda in the British Journal of Industrial Medicine showed that rabbits exposed to mercury vapor developed tremor and involuntary muscle movements/jerks  (also called clonus ). (1)

Mercury Causes Tremor in Humans- with Occupational Exposure

A 1983 report by Dr. Fawer measured hand tremor with an instrument called an “accelerometer” in factory workers exposed to mercury.  The authors found the frequency of tremors higher in the mercury exposed men compared to controls. And, the severity of tremor was related to the duration of exposure to mercury.  The authors suggested that the tremors might result from the tendency of metallic mercury to accumulate in the cerebellum and the basal ganglia of the brain.(2)

dental mercuryLeft image: Dental amalgams contain 50% mercury, courtesy of wikimedia commons. 

A 1986 study by Dr Verberk used a “tremor meter” to quantify tremor in 21 workers in a in a flourescent lamp factory. (3)  They also measured urinary mercury excretion in the workers. With increasing mercury excretion in urine samples, there was increased acceleration of the tremor, and increased score on the “tremor-meter”.   The study suggested that even low levels of mercury exposure could cause tremor, which correlates with the amount of mercury excretion in the urine.(3)

These findings were replicated in a 2001 study by Dr. McCullough using a computerized system for measuring hand tremor in mercury exposed workers. (4)  McCullough also measured urinary mercury excretion, and he found increased tremor correlating with higher levels of mercury in the urine.

ADA Claims that Dental Amalgams – Mercury Fillings Are Safe

The Amercian Dental Association has maintained in various position statements that mercury dental amalgams are safe and do not cause health problems.(11)  We know from current medical research that this is not true.  Mercury from dental amalgams is inhaled as mercury vapor  and can be recovered in various body tissues and fluids.(5)(28)(34)

The ADA Statement on Dental Amalgam: (August 2009)

“Dental amalgam is considered a safe, affordable and durable material that has been used to restore the teeth of more than 100 million Americans. It contains a mixture of metals such as silver, copper and tin, in addition to mercury, which binds these components into a hard, stable and safe substance. Dental amalgam has been studied and reviewed extensively, and has established a record of safety and effectiveness.” (11)

As we will see below, this ADA statement is nothing more than wishful thinking, intended to protect the financial interests of the dental industry.(13-14)

The FDA Contradicts the ADA

The FDA issued a statement in 2009 on dental amalgams which contradicted the ADA position.  The FDA white paper admits that mercury vapor gas is emitted from dental amalgams, is then inhaled, and absorbed by the lungs.  The inhaled mercury is then deposited in various tissues including the brain and then appears in the urine as increased urinary excretion of mercury.  All of this was demonstrated by a large body of science.  However, after admitting all the above, the FDA then concludes that the level of mercury in the body coming from dental amalgams is insufficient to cause health problems.   Obviously, I would disagree with this conclusion.  I would conclude that accumulation of Mercury in the body from any source is potentially toxic with adverse health consequences.

Autopsy Studies – Dental Amalgams and Mercury Toxicity (6)

Dental amalgam is by far the main source of human total mercury body burden. This is proven by autopsy studies which found 2-12 times more mercury in body tissues of individuals with dental amalgams compared to controls. (6)  Autopsy studies are  important for examining the amalgam-caused mercury body burden.  These autopsy studies have shown consistently that many individuals with amalgam have toxic levels of mercury in their brains or kidneys.(6)

Dental Amalgams Emit Mercury Vapor

Dental amalgams emit Mercury vapor which is then inhaled by the patient.(5)(28) (34)  This inhaled mercury vapor can be recovered from various body fluids, such as saliva and urine.  The amount of mercury recovered increases as the number of amalgams increases.  Dr. Kingman’s report published in 1998 found that “Mercury concentrations in urine and whole blood were associated with amalgam exposure in a US military population.” (28)(34)

Mercury from Dental Amalgams is Considered Hazardous Waste

Mercury reclaimed from removal of dental amalgams in the dental office is a major source of environmental contamination.  If allowed to go down the drain, the dental mercury enters the sewer system and contaminates the water table. Five states now require dental offices to obtain a permit which requires the use of a “separator” which separates out the mercury and prevents it from “going down the drain”.  The reclaimed mercury is later removed from the dental office by a licensed disposal company. (15-21)

HArzardous Waste Dental Amalgam Mercury drdachYou might ask the obvious question: “How can mercury be so safe in dental fillings in my mouth, yet then be considered hazardous waste at the dental office?”   Perhaps you are starting to see the light.

Banned in Norway Sweden Denmark-

Mercury Dental Amalgams Banned in Scandanavia in 2008

In 2008, Dental Mercury use was banned in Norway, Sweden and Denmark.    Norwegian Minister of the Environment Erik Solheim said , “Mercury is among the most dangerous environmental toxins. ”    In Sweden, health insurance stopped paying for amalgam dental fillings in 1999.  Instead, non mercury composites are readily available as material for dental fillings. from a Rueters press release. (22)

Banned in Canada

Canada- Dental Amalgams banned for children and pregnant women in 1996. (49)

Health Effects of Exposure to Low Dose Mercury

Following exposure to mercury vapor, the earliest clinically observed adverse effects are tremor, psychological disorder and impaired nerve conduction velocity , irritability, fatigue and anorexia. Proteinuria has also been observed. (5)

Health Effect of Low Dose Mercury Toxicity on various organ systems (7)

Toxic effects of mercury on various organ systems are well known:

Nervous System of Adults:

These symptoms include: Memory loss, including Alzheimer like dementia, deficit in attention, hypoesthesia, ataxia, dysarthrea, subclinical finger tremor, impairment of hearing and vision, sensory, disturbances, increased fatigue.

Nervous System of Children/infants :

Deficit in language (late talking) and memory deficit in attention, Autism

Motor system of Adults:

Disruption of fine motor function, decreased muscular strength, fatigue, tiredness

Motor System of Children/infants: Late walking

Renal system: Increases plasma creatinine level, renal impairment

Cardiovascular System:

Alters normal cardiovascular homoeostasis, Dilated Cardiomyopathy – Dr. Frustaci (8) . Atherosclerotic Coronary Artery Disease (9)

Immune system:

Decreases overall immunity of the body, exacerbates Lupus-like autoimmunity, multiple sclerosis, autoimmune thyroiditis and atopic eczema.  Removing mercury filling in Hashimotos patients results in decreasing thyroid antibody levels.

Reproductive system: Decreases rate of fertility.

How to Test for Mercury – Merc-Out

An inexpensive and handy online testing service called Merc-Out is available.(10)  They provide a home testing kit with instructions for a urine collection after taking a chelating capsule called DMPS.   The urine sample is collected at home and then sent to Doctors’ Data Lab for analysis of mercury content.  If high mercury levels are found, Merc-Out also offers a mercury detoxification program.(10) Go to the Merc Out web site to order the test kit.

Removing Dental Amalgams – What to Expect (29-31)

Most cases of mercury toxicity are caused by dental amalgams.  Mercury testing with the provoked urine test (from Merc-Out) will show elevated mercury excretion in the urine.  Removal of the dental amalgams will remove the exposure source, and after an initial increase of 30% in mercury excretion, the mercury body burdens will decrease to that of controls.   The half life of mercury in the body is about 100 days.(29-31) In 1994, Dr. Begerow published a study of urinary excretion of Mercury in 17 patients after removal of all dental amalgam fillings over 14 months.(31)  This is what he found:

Before removal the urinary mercury, Mercury excretion correlated with the number of amalgam fillings. In the immediate post-removal phase (up to 6 days after removal) a mean increase of 30% in Mercury Excretion was observed. Within 12 months the geometric mean of the mercury excretion was reduced by a factor of 5 .   After removal of dental amalgams the mean half-life was 95 days.  These results show that the release of mercury from dental amalgam contributes predominantly to the mercury exposure of non-occupationally exposed persons. The exposure from amalgam fillings thus exceeds the exposure from food, air and beverages. Within 12 months after removal of all amalgam fillings the participants showed substantially lower urinary mercury levels which were comparable to those found in subjects who have never had dental amalgam fillings. “(31)

Removing Dental Amalgams – The Mercury Free , Biologic Dentist

It is best to see a “biologic dentist” if you are contemplating removal of dental amalgams.  A conventional dentist is not equipped or trained to do a proper job.

Three recommended “mercury free” biologic dentists in South Florida:

1) Fredda Rosenbaum DDS
2925 Aventura Blvd., Suite 201
Aventura, Florida 33180

2) Aurel Chebanu, DMD, PhD
Integrated Dentistry –
333 NW 70th. Ave. Suite 207
Plantation, FL 33317
Phone: 954-792-6266

3) Hank Barreto, DMD
135 San Lorenzo Avenue
Suite 640
Coral Gables, FL 33146
Phone: 305-648-4998
Fax: 305-630-9575

Author of this article:

Jeffrey Dach MD
7450 Griffin Road, Suite 190
Davie, Fl 33314

Click Here for: Dr Dach’s Online Store for Pure Encapsulations Supplements
Click Here for: Dr Dach’s Online Store for Nature’s Sunshine Supplements

Links and References


Br J Ind Med. 1971 July; 28(3): 308–311. PMCID: PMC1069508

Metallic mercury induced tremor in rabbits and mercury content of the central nervous system

Katsuhiro Fukuda Department of Public Health, Hokkaido University School of Medicine, Hokkaido, Japan Fukuda, K. (1971).

Brit. J. industr. Med.,28, 308-311.

Metallic mercury induced tremor in rabbits and mercury content of the central nervous system. Tremor induced by metallic mercury was experimentally produced in rabbits by intermittent exposure to mercury vapour (average concentration of 4·0 mg/m3 for 6 hr/day on 4 days/week for 13 successive weeks). Two of six male rabbits exposed developed fine tremor and clonus in the fore- and hind-legs after 13 weeks’ exposure. Electromyographic records showed typical grouped voltages accompanying the clonus (amplitude 0·3 to 1·0 mV, duration 20 to 30 ms, frequency 14 to 15 per second).


Br J Ind Med. 1983 May; 40(2): 204–208. PMCID: PMC1009173

Measurement of hand tremor induced by industrial exposure to metallic mercury. R F Fawer, Y de Ribaupierre, M P Guillemin, M Berode, and M Lob

Hand tremor due to industrial exposure to metallic mercury vapour was recorded in 26 exposed and 25 non-exposed male workers by an accelerometer attached to the dorsum of the hand. The subjects were instructed to hold the hand and the forearm in the same position first without and then with a load of 1250 g supported by the hand. Analysis of the records showed that the highest peak frequencies (HPF) (the frequency corresponding to the highest acceleration) were higher in the exposed men than in the controls and were related to the duration of exposure to mercury and to age. The changes in HPF between rest and load were again higher in the exposed men than in the controls and again related to the duration of exposure and to age. The second moment (M2) (an index taking into account the whole recorded spectrum) was similar in the exposed men and controls at rest. The changes in M2 between rest and load were higher in the exposed men than in the controls but were related to duration of exposure and to the biological measurements (loge of mercury in urine or blood) and not to age. These neurophysiological impairments might result from the tendency of metallic mercury to accumulate in the cerebellum and the basal ganglia. These results are consistent with the hypothesis that metallic mercury, even at concentrations probably below the current TLV-TWA of 0.05 mg/m3, can lead to neurological disorders.


Am Ind Hyg Assoc J. 1986 Sep;47(9):559-62.

Tremor in workers with low exposure to metallic mercury.

Verberk MM, Sallé HJ, Kemper CH. In a fluorescent lamp production factory, a newly developed lightweight balance-tremor-meter was used to measure postural tremor of the finger in 21 workers (ages 28 to 61) exposed for 0.5-19 yr to metallic mercury. In addition, tremor was measured in an indirect way by means of a “hole-tremormeter.” The excretion of mercury in urine was 9-53 (average 20) mumol/mol creatinine. With increasing mercury excretion, the following parameters increased: the acceleration of the tremor, the contribution of the neuromuscular component (8-12 Hz) to the power spectrum of the acceleration, the width of the power-spectrum and the score on the hole-tremormeter. The study indicates that exposure to metallic mercury below the current TLV (50 micrograms/m3) may increase the tremor of the finger.


J Occup Environ Med. 2001 Mar;43(3):295-300.

Chronic mercury exposure examined with a computer-based tremor system. McCullough JE, Dick R, Rutchik J. SourceNational Institute for Occupational Safety and Health, OH, USA.

Tremor is being increasingly evaluated by quantitative computer-based systems to differentiate its causes. In this study, a group of mercury-exposed workers were assessed to determine whether tremor characteristics differed by exposure level. Workers were classified into two groups: those with an average urine mercury concentration below the American Conference of Government Industrial Hygienist Biological Exposure Index of 35 micrograms/g creatinine, and those with an average urine mercury concentration above the Biological Exposure Index.

Tremor characteristics (including intensity, harmonic index, center frequency, standard deviation of the center frequency, and tremor index) were measured and recorded with a computer-based tremor system.

Sixteen of 17 workers who were potentially exposed to mercury participated in the study. Three workers had a mean urine mercury concentration of 27.0 micrograms/g-creatinine and were assigned to the low-exposure group, and 13 workers had a mean urine mercury concentration of 200.2 micrograms/g-creatinine and were assigned to the high-exposure group.

There was a statistically significant difference in the tremor index (which compiles five individual tremor parameters into a single value) between the two groups (P = 0.04; Wilcoxon’s rank sum test). Other tremor characteristics did not differ significantly between the groups.

Tremor index may be more useful than measures of individual tremor parameters in differentiating normal from subclinical pathological tremors among groups of workers with chronic mercury exposure.

Med Lav. 2002 May-Jun;93(3):139-47.

Mercury exposure and early effects: an overview. Kazantzis G.

OBJECTIVES: This paper was given as a keynote address at the conference on The Assessment of the Effects Due to Low Doses of Inorganic Mercury following Environmental and Occupational Exposures: Human and in vitro Studies on the Specific Mechanisms of Toxicity in Gargnano, Italy, in September 2001.

METHODS: The most relevant literature over the past 40 years has been reviewed, and in particular, the proceedings of the World Health Organisation conferences on the health effects of inorganic and organic mercury exposure have been considered.

RESULTS: In an uncontaminated environment the general population is exposed to mercury vapour from the atmosphere and from dental amalgam, while the diet, mainly from fish, is the principal source for methyl mercury absorption.

Mercury vapour release from amalgam fillings increases with chewing, with absorption and uptake by the brain and kidneys. Infants exposed to phenyl mercury from treated diapers and young children ingesting mercurous chloride in teething powders have developed acrodynia (pink disease), and Kawasaki disease and the use of mercurial skin lightening creams has been followed by the development of the nephrotic syndrome. Both mercury compounds and mercury vapour have given rise to contact dermatitis in the general population. Epidemics of mercury poisoning have followed release of mercury into the environment from industrial activity, with uptake of methyl mercury from fish eating in Minamata Bay and uptake of both inorganic and methyl mercury following release of mercury vapour and deposition into waterways from gold recovery procedures in the Amazon basin. The ingestion of wheat and barley seed treated with an alkyl mercury fungicide for sowing, by a largely illiterate population in Iraq, led to a major outbreak of poisoning with a high fatality rate. Following exposure to mercury vapour, the earliest clinically observed adverse effects at urine mercury levels of the order of 30-100 mg/g creatinine, are objectively detectable tremor, psychological disorder and impaired nerve conduction velocity in sensitive subjects, with subjective symptoms of irritability, fatigue and anorexia. At these and at lower levels, proteinuria has also been observed. Both glomerular and tubular damage may occur at exposure levels lower than those giving rise to central nervous system effects. An immunological effect has also been observed in studies on clinically asymptomatic workers with low level exposure.

CONCLUSIONS: As mercury can give rise to allergic and immunotoxic reactions which may be genetically regulated, in the absence of adequate dose-response studies for immunologically sensitive individuals, it has not been possible to set a level for mercury in blood or urine below which mercury related symptoms will not occur.

Dental Amalgams Are Major Source of Mercury and are Unsafe


J Occup Med Toxicol. 2011 Jan 13;6(1):2.

Is dental amalgam safe for humans? The opinion of the scientific committee of the European Commission. Mutter J. Source Department of Environmental and integrative medicine Lohnerhofstraße 2, 78467 Constance/Germany.

It was claimed by the Scientific Committee on Emerging and Newly Identified Health Risks (SCENIHR)) in a report to the EU-Commission that “….no risks of adverse systemic effects exist and the current use of dental amalgam does not pose a risk of systemic disease…” [1, available from:].SCENIHR

disregarded the toxicology of mercury and did not include most important scientific studies in their review. But the real scientific data show that

a) Dental amalgam is by far the main source of human total mercury body burden. This is proven by autopsy studies which found 2-12 times more mercury in body tissues of individuals with dental amalgam. Autopsy studies are the most valuable and most important studies for examining the amalgam-caused mercury body burden.

(b) These autopsy studies have shown consistently that many individuals with amalgam have toxic levels of mercury in their brains or kidneys.

(c) There is no correlation between mercury levels in blood or urine, and the levels in body tissues or the severity of clinical symptoms. SCENIHR only relied on levels in urine or blood.

(d) The half-life of mercury in the brain can last from several years to decades, thus mercury accumulates over time of amalgam exposure in body tissues to toxic levels. However, SCENIHR state that the half-life of mercury in the body is only “20-90 days”.(e) Mercury vapor is about ten times more toxic than lead on human neurons and with synergistic toxicity to other metals.

(f) Most studies cited by SCENIHR which conclude that amalgam fillings are safe have severe methodical flaws.

Effects of Low Dose Mercury on Human Health

(7) /Low dose Hg exposure.pdf

Environmental Toxicology and Pharmacology (2005)

Low dose mercury toxicity and human health by Farhana Zahir a,∗, Shamim J. Rizwi a, Soghra K. Haqb, Rizwan H. Khanb a Interdisciplinary Brain Research Centre, JN Medical College, AMU, Aligarh, U.P., India  Effect of low dose mercury toxicity on various organ systems

Mercury Accumulates in the Heart and Associated with/or Causes Dilated Cardiomyopthy

J Am Coll Cardiol, 1999; 33:1578-1583

Marked elevation of myocardial trace elements in idiopathic dilated cardiomyopathy compared with secondary cardiac dysfunction

Andrea Frustaci, MD*, Nicola Magnavita, MD{dagger}, Cristina Chimenti, MD*, Marina Caldarulo, MD{dagger}, Enrico Sabbioni, PhD{ddagger}, Romano Pietra, PhD{ddagger}, Carlo Cellini, MD§, Gian Federico Possati, MD§ and Attilio Maseri, MD*

METHODS: Myocardial and muscular content of 32 TE has been assessed in biopsy samples of 13 patients (pts) with clinical, hemodynamic and histologic diagnosis of idiopathic dilated cardiomyopathy (IDCM), all without past or current exposure to TE. One muscular and one left ventricular (LV) endomyocardial specimen from each patient, drawn with metal contamination-free technique, were analyzed by neutron activation analysis and compared with 1) similar surgical samples from patients with valvular (12 pts) and ischemic (13 pts) heart disease comparable for age and degree of LV dysfunction; 2) papillary and skeletal muscle surgical biopsies from 10 pts with mitral stenosis and normal LV function, and 3) LV endomyocardial biopsies from four normal subjects.

RESULTS: A large increase (>10,000 times for mercury and antimony) of TE concentration has been observed in myocardial but not in muscular samples in all pts with IDCM. Patients with secondary cardiac dysfunction had mild increase (≤5 times) of myocardial TE and normal muscular TE. In particular, in pts with IDCM mean mercury concentration was 22,000 times (178,400 ng/g vs. 8 ng/g), antimony 12,000 times (19,260 ng/g vs. 1.5 ng/g), gold 11 times (26 ng/g vs. 2.3 ng/g), chromium 13 times (2,300 ng/g vs. 177 ng/g) and cobalt 4 times (86,5 ng/g vs. 20 ng/g) higher than in control subjects.

CONCLUSIONS: A large, significant increase of myocardial TE is present in IDCM but not in secondary cardiac dysfunction. The increased concentration of TE in pts with IDCM may adversely affect mitochondrial activity and myocardial metabolism and worsen cellular function.


Mercury, Fish Oils, and Risk of Acute Coronary Events and Cardiovascular Disease, Coronary Heart Disease, and All-Cause Mortality in Men in Eastern Finland

Arterioscler Thromb Vasc Biol. 2005;25:228-233.
Jyrki K. Virtanen, Sari Voutilainen, Tiina H. Rissanen, Jaakko Mursu, Tomi-Pekka Tuomainen, Maarit J. Korhonen, Veli-Pekka Valkonen, Kari Seppa¨nen, Jari A. Laukkanen, Jukka T. Salonen
Objective—Mercury has been suggested to have negative effects on cardiovascular health. We investigated the effects of high mercury content

conclusions—High content of mercury in hair may be a risk factor for acute coronary events and CVD, CHD, and all-cause mortality in middle-aged eastern Finnish men. (Arterioscler Thromb Vasc Biol. 2005;25:228-233.)


How to Contact Us: 1-877-530-4800  email:
MercOut International, Ltd.     Box 7573     Ft. Lauderdale, FL 33338


ADA Says Mercury Amalgams Are Safe

ADA Council on Scientific Affairs ,
Statement on Dental Amalgam Revised: August 2009

Dental amalgam is considered a safe, affordable and durable material that has been used to restore the teeth of more than 100 million Americans. It contains a mixture of metals such as silver, copper and tin, in addition to mercury, which binds these components into a hard, stable and safe substance. Dental amalgam has been studied and reviewed extensively, and has established a record of safety and effectiveness.

NCAHF Position Paper on Amalgam Fillings (2002)

Mercury Fillings: A Time Bomb In Your Head by Charles W. Moore

Mercury on the Mind by Donald W. Miller, Jr., MD

Dental Water Water Permits Required to reduce Mercury in Environment


Effective February 2008, the California Regional Water Quality Control Board requires all Municipal and Industrial Wastewater Dischargers to San Francisco Bay to implement a mercury reduction program that includes reduction of amalgam from dental offices.

In response to this requirement, all dental practices within the service area of the San Jose/Santa Clara Water Pollution Control Plant are required to obtain a Dental Wastewater Discharge Permit (Per Municipal Code)


Program Overview
Dental practices that place or remove amalgam fillings are a controllable source of mercury impacting sanitary sewer systems.  Consequently, all dental practices located in the eight cities and unincorporated areas served by the San José/Santa Clara Water Pollution Control Plant are required to obtain and comply with a 5-year Dental Wastewater Discharge Permit.  This permit requires dental practices to implement mercury reduction Best Management Practices (BMPs) and to install an approved amalgam separator.


Manage Dental Amalgam Wastes

Dental Wastewater Must Be Pretreated

National and state tests indicate that dental wastewater contains as much as 100-2,000 parts per million (ppm) of mercury.  This greatly exceeds the state regulatory dangerous waste limit of 0.2 ppm.

Amalgam separators are required of dentists in the state of Washington, unless a dentist can prove that their discharge meets limits for mercury.  An amalgam separator is designed to remove waste amalgam from the rinse water in the vacuum line before it discharges to the sewer. These separator systems are used to capture scrap amalgam which is too fine to be removed by a trap or a screen.

Navy Medicine. AMalgam contains mercury and is HAzardous Waste requiring amalgam separators

Fact Sheet : Discharging Dental Wastewater into the King County Sewer System

20) Dental Mercury Amalgam Separator Programs Maine, Department of Environmental Protection

How do dental offices contribute to this problem?
Dental offices contribute an estimated 13 percent of the mercury released to Massachusetts waters, primarily through wastewater discharges. Dental offices can release mercury to the environment through wastewater (as drains discharge to sewers or septic systems) and through trash that includes products containing mercury (e.g., amalgam scraps).

22) Orthomolecular Medicine News Service, November 20, 2008
Mercury Dental Amalgams Banned in 3 Countries 

FDA, EPA, ADA Still Allow and Encourage Heavy-Metal Fillings

In 2008, Dental Mercury use was Banned in Norway, Sweden and Denmark.    Norwegian Minister of the Environment Erik Solheim said , “Mercury is among the most dangerous environmental toxins. ” said Solheim.    In Sweden, health insurance stopped paying for amalgam dental fillings in 1999.  Rueters press release.




Mercury in Health Care
Environment Canada estimates that more than one-third of the mercury load in sewage systems is due to dental practice.

According to a report submitted to the OSPAR Commission, in the United Kingdom, annually 7.41 tonnes of mercury from dental amalgam are discharged to the sewer, atmosphere or land, with another 11.5 tonnes sent for recycling or disposed with the clinical waste stream. Together, mercury contained in dental amalgam and in
laboratory and medical devices, account for about 53% of the total mercury emissions

Autopsy studies of Mercury and Amalgams


Swed Dent J. 1987;11(5):179-87.

Mercury concentrations in the human brain and kidneys in relation to exposure from dental amalgam fillings. Nylander M, Friberg L, Lind B. Source Department of Environmental Hygiene, Karolinska Institute, Sweden.

Samples from the central nervous system (occipital lobe cortex, cerebellar cortex and ganglia semilunare) and kidney cortex were collected from autopsies and analysed for total mercury content using neutron activation analyses. Results from 34 individuals showed a statistically significant regression between the number of tooth surfaces containing amalgam and concentration of mercury in the occipital lobe cortex (mean 10.9, range 2.4-28.7 ng Hg/g wet weight). The regression equation y = 7.2 + 0.24x has a 95% confidence interval for the regression coefficient of 0.11-0.37.

It is concluded that the cause of the association between amalgam load and accumulation of mercury in tissues is the release of mercury vapour from amalgam fillings.


Zentralbl Hyg Umweltmed. 1996 Feb;198(3):275-91.

[Study on the significance of mercury accumulation in the brain from dental amalgam fillings through direct mouth-nose-brain transport]. [Article in German]  Maas C, Brück W, Haffner HT, Schweinsberg F.

The transport of mercury (Hg) from the oro-nasal to the cranial cavity via a direct route was investigated. In 55 deceased persons, Hg concentrations were measured in the olfactory bulb and the trigeminal ganglion, and the number of dental amalgam fillings was assessed. For the purpose of comparison, Hg concentrations were also determined in the occipital lobe cortex, the pituitary gland and the kidney cortex. Quantitative Hg analysis was performed by cold vapor atomic absorption spectroscopy after acid digestion using high pressure microwave treatment. In the olfactory bulb (geom. mean 17.4 micrograms/kg w. w.), the Hg concentration was significantly higher than in the occipital lobe cortex (geom. mean 9.2 micrograms/kg w. w.) (p < 0.0001).

a statistically significant correlation exists between the number of dental amalgam fillings and the Hg concentration in the kidney cortex (r2 = 0.317; p < 0.0001), and, to a lesser extent, the Hg concentration in the occipital lobe cortex (r2 = 0.17; p = 0.0016).

Dental Staff Mercury Exposure

Swed Dent J. 1989;13(6):235-43.

Mercury accumulation in tissues from dental staff and controls in relation to exposure. Nylander M, Friberg L, Eggleston D, Björkman L.

Department of Environmental Hygiene, Karolinska Institute, Stockholm, Sweden.

Samples, mainly from occipital cortex and pituitary gland, but also from rental cortex, olfactory bulbs, thyroid gland and liver were collected from autopsies of 8 dental staff cases and 27 controls. These samples were analysed for total mercury content using radiochemical neutron activation analyses.

The results revealed high mercury concentrations (median 815, range 135-4,040 micrograms Hg/kg wet weight) in pituitaries from the dental staff cases compared to controls (N = 23, median 23 range 6-1, 170 micrograms Hg/kg).

In occipital cortex, the cases had a median of 17, range of 4-300 micrograms Hg/kg and the controls (N = 20) had a median of 10, range 2-29 micrograms Hg/kg. A few samples from olfactory bulbs show low mercury concentrations for both cases and controls. Renal cortex was analysed from three cases and contained clearly higher concentrations (945, 1,545, 2,110 micrograms Hg/kg) compared to controls (N = 12, median 180, range 21-810 micrograms Hg/kg). There is no control material for the other analysed samples, but one thyroid sample had an extremely high concentration of 28,000 micrograms Hg/kg.


Mercury in human brain, blood, muscle and toenails in relation to exposure: an autopsy study.  Björkman L, Lundekvam BF, Laegreid T, Bertelsen BI, Morild I, Lilleng P, Lind B, Palm B, Vahter M. Dental Biomaterials Adverse Reaction Unit, Department of Health/UNIFOB, Arstadveien 17, NO-5009 Bergen, Norway.

The main forms of mercury (Hg) exposure in the general population are methylmercury (MeHg) from seafood, inorganic mercury (I-Hg) from food, and mercury vapor (Hg0) from dental amalgam restorations. While the distribution of MeHg in the body is described by a one compartment model, the distribution of I-Hg after exposure to elemental mercury is more complex, and there is no biomarker for I-Hg in the brain. The aim of this study was to elucidate the relationships between on the one hand MeHg and I-Hg in human brain and other tissues, including blood, and on the other Hg exposure via dental amalgam in a fish-eating population. In addition, the use of blood and toenails as biological indicator media for inorganic and organic mercury (MeHg) in the tissues was evaluated.

Samples of blood, brain (occipital lobe cortex), pituitary, thyroid, abdominal muscle and toenails were collected at autopsy of 30 deceased individuals, age from 47 to 91 years of age. Concentrations of total-Hg and I-Hg in blood and brain cortex were determined by cold vapor atomic fluorescence spectrometry and total-Hg in other tissues by sector field inductively coupled plasma-mass spectrometry (ICP-SFMS).

The median concentrations of MeHg (total-Hg minus I-Hg) and I-Hg in blood were 2.2 and 1.0 microg/L, and in occipital lobe cortex 4 and 5 microg/kg, respectively. There was a significant correlation between MeHg in blood and occipital cortex. Also, total-Hg in toenails correlated with MeHg in both blood and occipital lobe. I-Hg in both blood and occipital cortex, as well as total-Hg in pituitary and thyroid were strongly associated with the number of dental amalgam surfaces at the time of death.

In a fish-eating population, intake of MeHg via the diet has a marked impact on the MeHg concentration in the brain, while exposure to dental amalgam restorations increases the I-Hg concentrations in the brain. Discrimination between mercury species is necessary to evaluate the impact on Hg in the brain of various sources of exposure, in particular, dental amalgam exposure.

“For decades the potential health risks from mercury exposure from dental amalgam restorations have been reviewed and evaluated [2-6]. It is well known that amalgam restorations continuously release elemental mercury vapor [7,8], which is inhaled and absorbed by the body and distributed to tissues including the brain [9-11]. ”

After Amalgam Removal – Decreasing Burden in Body Fluids

J Dent Res. 1998 Apr;77(4):615-24.
Mercury in biological fluids after amalgam removal. Sandborgh-Englund G, Elinder CG, Langworth S, Schütz A, Ekstrand J. Department of Basic Oral Sciences, Karolinska Institutet, Huddinge, Sweden.

Dental amalgam is the major source of inorganic mercury (Hg) exposure in the general population. The objective of the present study was to obtain data on changes in Hg levels in blood, plasma, and urine following removal of all amalgam fillings during one dental session in 12 healthy subjects. The mean number of amalgam surfaces was 18 (range, 13 to 34).

Frequent blood sampling and 24-hour urine collections were performed up to 115 days after amalgam removal, and in eight subjects additional samples of plasma and urine were collected up to three years after amalgam removal.

A transient increase of Hg concentrations in blood and plasma was observed within 48 hours after amalgam removal. In plasma, the peak concentrations significantly exceeded the pre-removal plasma Hg levels by, on average, 32% (1.3 nmol/L; range, 0.1 to 4.2). No increase in the urinary Hg excretion rate was apparent after amalgam removal.

An exponential decline of Hg was seen in all media. Sixty days after the amalgam removal, the Hg levels in blood, plasma, and urine had declined to approximately 60% of the pre-removal levels.

In seven subjects, who were followed for up to three years, the half-lives of Hg in plasma and urine were calculated. In plasma, a bi-exponential model was applied, and the half-life was estimated at median 88 days (range, 21 to 121).

The kinetics of Hg in urine (nmol/24 hrs) fit a mono-exponential model with a median half-life of 46 days (range, 35 to 67).

It is concluded that the process of removing amalgam fillings can have a considerable impact on Hg levels in biological fluids. After removal, there was a considerable decline in the Hg levels of blood, plasma, and urine, which slowly approached those of subjects without any history of amalgam fillings.


Toxicol Appl Pharmacol. 1997 May;144(1):156-62.
Mercury in saliva and feces after removal of amalgam fillings. Björkman L, Sandborgh-Englund G, Ekstrand J. Department of Basic Oral Sciences, Karolinska Institutet, Stockholm, Sweden.

The toxicological consequences of exposure to mercury (Hg) from dental amalgam fillings is a matter of debate in several countries. The purpose of this study was to obtain data on Hg concentrations in saliva and feces before and after removal of dental amalgam fillings. In addition Hg concentrations in urine, blood, and plasma were determined.

Ten subjects had all amalgam fillings removed at one dental session.

Before removal, the median Hg concentration in feces was more than 10 times higher than in samples from an amalgam free reference group consisting of 10 individuals (2.7 vs 0.23 mumol Hg/kg dry weight, p < 0.001).

A considerable increase of the Hg concentration in feces 2 days after amalgam removal (median 280 mumol Hg/kg dry weight) was followed by a significant decrease.

Sixty days after removal the median Hg concentration was still slightly higher than in samples from the reference group. In plasma, the median Hg concentration was 4 nmol/liter at baseline. Two days after removal the median Hg concentration in plasma was increased to 5 nmol/liter and declined subsequently to 1.3 nmol/liter by Day 60. In saliva, there was an exponential decline in the Hg concentration during the first 2 weeks after amalgam removal (t 1/2 = 1.8 days).

It was concluded that amalgam fillings are a significant source of Hg in saliva and feces. Hg levels in all media decrease considerably after amalgam removal. The uptake of amalgam mercury in the GI tract in conjunction with removal of amalgam fillings seems to be low.

Int Arch Occup Environ Health. 1994;66(3):209-12.
Long-term mercury excretion in urine after removal of amalgam fillings.
Begerow J, Zander D, Freier I, Dunemann L.  Medizinisches Institut für Umwelthygiene, Düsseldorf, Germany.

The long-term urinary mercury excretion was determined in 17   28- to 55-year-old persons before and at varying times (up to 14 months) after removal of all (4-24) dental amalgam fillings. Before removal the urinary mercury excretion correlated with the number of amalgam fillings. In the immediate post-removal phase (up to 6 days after removal) a mean increase of 30% was observed.

Within 12 months the geometric mean of the mercury excretion was reduced by a factor of 5 from 1.44 micrograms/g (range: 0.57-4.38 micrograms/g) to 0.36 microgram/g (range: 0.13-0.88 microgram/g). After cessation of exposure to dental amalgam the mean half-life was 95 days. These results show that the release of mercury from dental amalgam contributes predominantly to the mercury exposure of non-occupationally exposed persons. The exposure from amalgam fillings thus exceeds the exposure from food, air and beverages. Within 12 months after removal of all amalgam fillings the participants showed substantially lower urinary mercury levels which were comparable to those found in subjects who have never had dental amalgam fillings.

Autopsy Tissues

Am J Forensic Med Pathol. 2006 Mar;27(1):42-5.
Dental amalgam and mercury levels in autopsy tissues: food for thought.
Guzzi G, Grandi M, Cattaneo C, Calza S, Minoia C, Ronchi A, Gatti A, Severi G.
Italian Association for Metals and Biocompatibility Research (AIRME, Milan, Italy.

Eighteen cadavers from routine autopsy casework were subject to a study of tissue levels of total mercury in brain, thyroid, and kidney samples by atomic absorption. On these same cadavers, all dental amalgam fillings (the most important source of inorganic mercury exposure in the general population, according to the World Health Organization (WHO) were charted.

Total mercury levels were significantly higher in subjects with a greater number of occlusal amalgam surfaces (>12) compared with those with fewer occlusal amalgams (0-3) in all types of tissue (all P < or = 0.04). Mercury levels were significantly higher in brain tissues compared with thyroid and kidney tissues in subjects with more than 12 occlusal amalgam fillings (all P < or = 0.01) but not in subjects with 3 or less occlusal amalgams (all P > or = 0.07).


Mercury Amalgam –  IOAMT

NIDR Amalgam Study

J Dent Res. 1998 Mar;77(3):461-71.
Mercury concentrations in urine and whole blood associated with amalgam exposure in a US military population.  Kingman A, Albertini T, Brown LJ.  Oral Health Promotion, Risk Factors and Molecular Epidemiology Branch, National Institute of Dental Research, Bethesda, Maryland 20892, USA.

Minute amounts of mercury vapor are released from dental amalgams. Since mercury vapor is known to be associated with adverse health effects from occupationally exposed persons, questions regarding the margin of safety for exposure to mercury vapor in the general population continue to be raised. To address this issue, one needs information regarding exposure to mercury vapor from dental amalgam fillings and its possible consequences for health in the general population.

The NIDR Amalgam Study is designed to obtain precise information on amalgam exposure and health outcomes for a non-occupationally-exposed population of US adults. One hypothesis was that in a generally healthy population a significant association between amalgam exposure and Hg levels in urine and/or whole blood could be detected.

The cohort investigated was an adult military population of 1127 healthy males. Their average age was 52.8 years, and their ages varied from 40 to 78 years. Ninety-five percent of the study participants were white males, and slightly over 50% had some college education. Five percent were edentulous. The dentate participants, on average, had 25 natural teeth, 36.9 decayed or filled surfaces (DFS), and 19.9 surfaces exposed to amalgam, with amalgam exposure varying from 0 to 66 surfaces.

Their average total and inorganic urinary mercury concentrations were 3.09 microg/L and 2.88 microg/L. The average whole-blood total and inorganic mercury concentrations were 2.55 microg/L and 0.54 microg/L.

Significant correlations were detected between amalgam exposure and the total (r = 0.34, p < 0.001) and inorganic 0.34 (r = 0.34, p < 0.001) urinary mercury concentrations on the original scale.

Stronger correlations were found for total (r = 0.44, p < 0.001) and inorganic (r = 0.41, p < 0.001) urinary Hg on the log scale, as well as for creatinine-corrected total (r = 0.43, p < 0.001) and inorganic (r = 0.43, p < 0.001) urine concentrations. In whole blood, statistically significant, but biologically weak, correlations were detected for total (r = 0.09, p = 0.005) and inorganic (r = 0.15, p < 0.001) Hg concentrations, respectively. Based on these cross-sectional data, it is estimated that, on average, each ten-surface increase in amalgam exposure is associated with an increase of 1 microg/L mercury in urine concentration.

Mercury and Vascular Disease


The Role of Mercury and Cadmium Heavy Metals in Vascular Disease, Hypertension, Coronary Heart Disease, and Myocardial Infarction Mark C. Houston, MD, MS, FACP, FAHA


Thomas Levy on Mercury and vascular disease



The ADA was founded on the basis that mercury-containing amalgams are safe and useful for dental fillings.  This may have been an acceptable position in 1850.  However, modern science has proven that amalgams constantly emit unacceptable levels of mercury.  Especially as the average life span has increased from 50 to 75-78 years of age where AD and Parkinson’s become prevalent diseases.  The ADA can try to verify its position using selected epidemiological studies.  But the bottom line is that amalgams emit significant levels of neurotoxic mercury that are injurious to human health and would exacerbate the medical condition of those individuals with neurological diseases such as ALS, MS, Parkinson’s, autism and AD.

Boyd E. Haley
Professor and Chair
Department of Chemistry
University of Kentucky

Robert M. Anderton, D.D.S., President of the American Dental Association Responds to Testimony Given by Boyd Haley, Ph.D. at Rep. Burton’s Hearings

Schweiz Monatsschr Zahnmed. 1994;104(11):1336-40.
[Mercury concentrations in the urine of children with and without amalgam fillings].
[Article in German] Schulte A, Stoll R, Wittich M, Pieper K, Stachniss V. Source
Medizinisches Zentrum für Zahn-, Mund- und Kieferheilkunde, Universität Marburg.

Studies on adults documented that most of the urinary concentration in occupationally non-exposed persons is determined by the number and extent of their amalgam fillings. Very few data concerning the mercury exposure of children are available. In this study the mercury concentration in the urine of 3-15-year-old children with and without amalgam fillings was determined. The mean urinary mercury concentration for the children without amalgam (n = 93) was 0.17 microgram/l, and for the children with amalgam fillings (n = 86) it was 0.70 microgram/l. The creatinine adjusted values were 0.19 microgram/g and 0.64 microgram/g, respectively. This difference was significant (p < 0.001). Also, a significant correlation was found between the number of amalgam points (each amalgam surface had been given 1 to 3 points depending on its extent) and the urinary mercury concentration (r = 0.69).

Amalgam Illness Diagnosis and Treatment. A book on how to cure mercury poisoning  by Andrew Hall Cutler, PhD, PE.  Andrew Cutler is a health care consultant in the Seattle area. He has a PhD in chemistry from Princeton, a BS in physics from the University of California, is a patent agent and a registered professional chemical engineer. His research has led to a number of publications in chemistry, chemical engineering and space related journals.

Some of the “diseases” a modern physician might mistakenly misdiagnose chronic mercury poisoning as are:

Addison’s disease        Gastritis
Allergies                    Hypogonadism
Alzheimer’s’ disease    Hypothyroidism
Amylotrophic lateral sclerosis  Infertility
Ankylosing spondylitis   Insomnia
Anorexia nervosa          Irritable bowel syndrome
Anxiety                        Juvenile arthritis
Asthma                        Learning disabilities
Attention deficit hyperactivity disorder  Lupus erythromatosus
Autoimmune disease     Manic depression
Bipolar disorder            Multiple chemical sensitivities
Borderline personality disorder  Multiple sclerosis
Bulimia                        Myasthenia gravis
Candidiasis                   Obsessive-compulsive disorder
Chronic fatigue              Panic attacks
Colitis                         Parkinson’s disease
Crohn’s disease            Pervasive developmental disorder
Depression                  Psychosis
Endocrine disorders       Rheumatoid arthritis
Environmental illness    Schizophrenia
Fibromyalgia                Sciatica
Food allergies              Sleep disorders

Yeast syndrome

excerpt from the book:  The clinical picture of Mercury Toxicity:

In an overall lifestyle sense,  the fact that symptoms come and go leads to the victim having periods of weeks to years of being highly functional and productive,  interspersed with periods of being nonproductive and having a hard time getting anything done.  Life seems to progress in fits and starts. Great progress is made on projects which later get shelved for long periods. As the disease continues,  the productive periods become shorter,  fewer, and farther between.

There are emotional changes in mercury poisoning.  Depression slowly sets in.  Victims feel fatigued and listless.  They lack motivation – even for crucial tasks.  They lose interest in their surroundings and in their own life.  They do not enjoy life,  or experience happiness or joy.  They experience constant fear e. g. of losing their job.  They may be very tense.  They feel hopeless.  They have a sense of impending doom.  Every small problem is discouraging.  Minor difficulties seem overwhelming and insurmountable.

The altered emotional state of a mercury intoxicated person leads to impaired interpersonal relationships.  They become increasingly irritable and sensitive,  reacting strongly to relatively innocent remarks.  They may not be able to take orders,  instructions, or suggestions without losing their temper.  They resent criticism and may interpret innocent remarks critically.  They may have an exaggerated response to stimulation and become fearful or anxious and nervous.  They may project their fears and anxieties onto others,  making inappropriate criticisms or attacks.  They become shy and avoid dealing with strangers.  While timid,  they may unexpectedly lose self control with strangers.  They may wish to visit with friends and family extensively,  often wishing to engage in long,  repetitive conversations,  then withdraw for prolonged periods of time.  They withdraw more and more from social contacts.

Intelligence gradually deteriorates.  Previously bright persons become dull and slow in thinking.  They suffer from a progressive decline specifically affecting short term memory as well as the faculties for logical reasoning.  Thus their ability to do things like balance the checkbook,  do math,  or play chess suffers.  They lose the ability to concentrate. Memory problems may be more from distractability and inability to concentrate and pay enough attention to get things INTO their memory than an actual failure to remember things (thus they may complain of memory problems but do well on memory tests).  They cease being motivated towards their work or other tasks.  Thoughts become heavy, repetitive and pedantic. Creative thinking becomes progressively more difficult,  eventually becoming impossible.  They become unable to select the right words to convey their meaning,  and make stylistic and grammatical errors.  Their ability to express themselves declines progressively.

There is a distinctive cognitive symptom of being unable to think clearly without great effort.  The best description for people who have not experienced it is of a hangover without pain.  People who have experienced it will recognize the term “brain fog” as entirely descriptive.

As the victim’s level of intoxication waxes and wanes they go through periods of life when they do or do not dream.  Dreaming may be in black and white.

Early physical symptoms include dizziness,  tinnitus (ringing in the ears), insomnia,  daytime drowsiness,  loss of appetite,  a tendency towards diarrhea – often alternating with constipation,  cold hands and feet,  a tendency towards sweating (some people have the opposite symptom and do not sweat at all), flushing or reddening of the skin – particularly on the face and neck. Some people blush frequently, but others do not blush at all.  Asthma is a symptom of chronic mercury poisoning.  Digestive disturbances are also common.

The skin becomes dry,  athlete’s foot and toenail fungus progress,  and the insides of the ankles, particularly behind the ankle bone and a bit above it become dry,  itchy,  flaky and peel.  This often becomes painful and annoying enough to keep the victim up at night.  Even after fungus and yeast infection has been eliminated hyperkeratosis,  often with papular erythema and itching are common.

The hair becomes thinner,  dryer,  duller,  less strongly colored,  slower growing,  and more brittle.

The biological clock is disturbed.  Waking up late and staying up late is more common than being an “early bird.” Try as they might,  the mercury poisoned person simply cannot control their circadian rhythm.

Victims may become photophobic and find bright light uncomfortable and unpleasant.  There may be visual disturbances,  including alterations in color perception leading to reduced sensitivity to the color red,  or color blindness.  The ability to focus on distant objects may be sporadically impaired. Peripheral vision may be reduced in the most severe cases.

The hands and feet often become distinctly cold.  This can occur suddenly and is most distinctive when combined with sweating.  Later in more severe poisoning they may also tingle or lose feeling.

The effects of mercury on the mouth are receding,  sometimes spongy gums that bleed easily and teeth that are ‘loose’ in their sockets and can be wiggled very slightly.  It also causes excessive salivation and unusually bad breath.

Mercury interferes with the sense of smell which becomes less acute,  and later with hearing,  in which perception of sounds does not diminish as notably as the patient’s ability to understand and interpret them – e. g. to understand speech directed at them even though they hear it clearly.

Victims often experience discomfort that feels like a “tight band around their head.”  They may also experience sharp points of discomfort in their ear canals at bedtime.

Mercury also interferes with the body’s ability to regulate temperature. Victims may alternate between being hot and cold when the temperature isn’t changing,  or have to wear more clothes than other people,  or have more difficulty than other people in staying comfortable while the temperature changes.  Temperature disregulation also leads to ‘night sweats.’




FDA, U S Food and Drug Administration – About Dental Amalgam Fillings

42) FDA NEWS RELEASE – For Immediate Release: July 28, 2009

FDA Issues Final Regulation on Dental Amalgam

The U.S. Food and Drug Administration today issued a final regulation classifying dental amalgam and its component parts – elemental mercury and a powder alloy—used in dental fillings. While elemental mercury has been associated with adverse health effects at high exposures, the levels released by dental amalgam fillings are not high enough to cause harm in patients.

The regulation classifies dental amalgam into Class II (moderate risk).

Specifically, the FDA recommended that the product labeling include:

A warning against the use of dental amalgam in patients with mercury allergy;
A warning that dental professionals use adequate ventilation when handling dental amalgam;
A statement discussing the scientific evidence on the benefits and risk of dental amalgam, including the risks of inhaled mercury vapor. The statement will help dentists and patients make informed decisions about the use of dental amalgam.


Dental Amalgam Effluent Guideline

EPA is initiating an effluent guideline rulemaking for dental facilities to reduce discharges of mercury to the environment. The agency intends to focus its technology assessment on amalgam separators. EPA expects to propose a rule in 2011 and finalize in 2012.

Across the United States, many states and municipal wastewater treatment plants (publicly owned treatment works (POTWs)) are working toward the goal of reducing discharges of mercury to POTWs.

Mercury is a concern to human health because it is a persistent bioaccumulative toxic element. Many studies have been conducted in an attempt to identify the sources of mercury entering these POTWs.

According to the 2002 Mercury Source Control and Pollution Prevention Program Final Report prepared for the National Association of Clean Water Agencies (NACWA), dental clinics are the main source of mercury discharges to POTWs.

A study funded by the American Dental Association (ADA) estimated in 2003 that 50 percent of mercury entering POTWs was contributed by dental offices. EPA estimates that dentists discharge approximately 3.7 tons of mercury each year to POTWs. EPA estimates there are approximately 160,000 dentists working in over 120,000 dental offices who use or remove amalgam in the United States – almost all of whom discharge their wastewater exclusively to POTWs.

The Environmentally Responsible Dentist Dental Amalgam Recycling: Principles, Pathways and Practice

Research evidence does not support the notion of amalgam safety:


Mercury exposure from “silver” tooth fillings: emerging evidence questions a traditional dental paradigm .  FRITZ L. L0RSCHEIDF.R, MURRAYJ. VIMY,f and ANNE 0. SUMMERS Department of Medical Physiology and Department of Medicme, Faculty of Medicine,University of Calgary, Alberta, 1.N 4N1, Canada, and Department o(Mkrobiology, University of Georgia, Athens, Georgia, 30602,

FASEB J. 1995 Apr;9(7):504-8.
Mercury exposure from “silver” tooth fillings: emerging evidence questions a traditional dental paradigm. Lorscheider FL, Vimy MJ, Summers AO. Department of Medical Physiology, Faculty of Medicine, University of Calgary, Alberta, Canada.

For more than 160 years dentistry has used silver amalgam, which contains approximately 50% Hg metal, as the preferred tooth filling material. During the past decade medical research has demonstrated that this Hg is continuously released as vapor into mouth air; then it is inhaled, absorbed into body tissues, oxidized to ionic Hg, and finally covalently bound to cell proteins.

Animal and human experiments demonstrate that the uptake, tissue distribution, and excretion of amalgam Hg is significant, and that dental amalgam is the major contributing source to Hg body burden in humans.

Current research on the pathophysiological effects of amalgam Hg has focused upon the immune system, renal system, oral and intestinal bacteria, reproductive system, and the central nervous system. Research evidence does not support the notion of amalgam safety.

FDA White Paper on Dental Amalgams


FDA white paper on amalgams

Dental amalgam releases low levels of mercury vapor, with higher amounts released with mastication and gum chewing (Ref. 3). Higher levels of exposure to elemental mercury vapor are also associated with placement and removal of dental amalgams.

After inhalation, approximately 70-80% of a mercury vapor dose is absorbed by the lung, enters the systemic circulation, distributes to several organ systems in varying amounts, and excretion occurs generally via the urinary route (Ref. 70).

The first signs of mercury vapor toxicity at high doses are subtle effects on the nervous system, such as changes in nerve conduction, slight tremor, abnormalities in electroencephalography (EEG) patterns, and changes in motor functions, cognitive functions, and behavior. (Ref. 69, Ref. 70). With progressively higher exposures, these effects become more pronounced and include prominent tremor, ataxia (incoordination), memory loss, psychological distress, irritability, excitability, depression, and gingivitis (inflammation of the gums) (Refs. 69, 70).

At these ventilation rates, chronic exposure at the level of the MRL would result in an estimated dose of mercury vapor of 3.2 μg/day in the average adult,
Chronic exposure at the level of the RfC would result in an estimated dose of mercury vapor of 4.9 μg/day in the average adult,
Chronic exposure at the level of the RfC would result in an estimated dose of elemental mercury vapor of 6 μg/day in the average adult.
The highest estimate that WHO reports was a dose of 12 μg/day, for middle-aged individuals with approximately 30 amalgam surfaces (Ref. 22).
Studies of adults with dental amalgam restorations have found a positive correlation between the number of dental amalgam restorations in the mouth and urinary mercury concentration.
The urinary mercury concentrations generally observed in adults and children age six and older with dental amalgam restorations is approximately one order of magnitude less than the threshold levels associated with preclinical neurological and renal health effects in persons occupationally exposed to mercury vapor.
FDA has concluded that exposures to mercury vapor from dental amalgam do not put individuals age six and older at risk for mercury-associated adverse health effects.

Studies have shown a lack of association between amalgam exposure and neuropsychological and neurobehavioral deficits. In a retrospective study of 550 adults, no significant associations between neuropsychological function and indices of cumulative amalgam exposure over many years were found (Ref. 33). In a report evaluating 1,127 men (Ref. 37), no effects on tremor, coordination, gait, strength, sensation, muscle stretch, or peripheral neuropathy were associated with amalgam exposure.

FDA concludes that the existing data support a finding that exposures to mercury vapor at levels associated with dental amalgams do not result in neurological deficits, tremors, peripheral neuropathies, or Alzheimer’s Disease in the population age six and older.


Dental amalgam is the least expensive type of filling material. Potential Risks:

Dental amalgam contains elemental mercury. It releases low levels of mercury vapor that can be inhaled. High levels of mercury vapor exposure are associated with adverse effects in the brain and the kidneys.

FDA has reviewed the best available scientific evidence to determine whether the low levels of mercury vapor associated with dental amalgam fillings are a cause for concern. Based on this evidence, FDA considers dental amalgam fillings safe for adults and children ages 6 and above. The amount of mercury measured in the bodies of people with dental amalgam fillings is well below levels associated with adverse health effects. Even in adults and children ages 6 and above who have fifteen or more amalgam surfaces, mercury exposure due to dental amalgam fillings has been found to be far below the lowest levels associated with harm.

If I am concerned about the mercury in dental amalgam, should I have my fillings removed?

If your fillings are in good condition and there is no decay beneath the filling, FDA does not recommend that you have your amalgam fillings removed or replaced. Removing sound amalgam fillings results in unnecessary loss of healthy tooth structure, and exposes you to additional mercury vapor released during the removal process.

FDA recommends the inclusion of an “information for use” statement in dental amalgam labeling as a special control: Dental amalgam also releases low levels of mercury vapor, a chemical that at high exposure levels is well-documented to   cause neurological and renal adverse health effects.17 18

FDA recognizes that dental amalgam releases low levels of mercury, and that there are scientific data showing mercury vapor, at high enough exposures, to be a neurotoxicant and nephrotoxicant.

FDA is aware that, in autopsy studies, mercury has been found to accumulate in the brain. However, it is difficult to draw conclusions from autopsy studies regarding a potential association between exposure to dental amalgam and adverse health outcomes without information concerning the individual’s lifetime history of exposure to mercury from fish and other environmental sources.


fda statement : FDA Issues Final Regulation on Dental Amalgam

The U.S. Food and Drug Administration today issued a final regulation classifying dental amalgam and its component parts –  elemental mercury and a powder alloy—used in dental fillings.

While elemental mercury has been associated with adverse health effects at high exposures, the levels released by dental amalgam fillings are not high enough to cause harm in patients. This final rule reclassifies mercury from the lower risk class I to the higher risk class II and classifies dental amalgam as class II.

49) The Safety of Dental Amalgam- Health Canada

Images used

English: At sea aboard USS Kitty Hawk (CV 63) Nov. 10, 2002 — Lt. Raul Barrientos from New York, N.Y., and Dental Technician Seaman Scott Lanney from South Hadley, Mass., drill on a Sailor’s tooth to remove all signs of decay from a cavity and fill it with amalgam. Amalgam is a mixture containing silver that is soft when placed into a cavity and is shaped by the dentist. It will then hardens and prevent further deterioration of the tooth. Kitty Hawk is the U. S. Navy’s only forward-deployed aircraft carrier and operates out of Yokosuka, Japan. U.S. Navy photo by Photographer’s Mate 2nd Class Justin Proulx. (RELEASED)
Date     10 November 2002
English: amalgam leafletDate    24 September 2009 Carretta
CAMP LEMONNIER, Djibouti (Sept. 28, 2009) Lt. Cmdr. Rodney Scott, a dentist at the Emergency Medical Facility at Camp Lemonnier, Djibouti, prepares a amalgam filling as his assistant, Hospital Corpsman 3rd Class Shaunta Johnson, watches over a patient. (U.S. Navy photo by Mass Communication Specialist 2nd Class Marc Rockwell-Pate/Released)
hazardous waste

Jeffrey Dach MD
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