Mercury Amalgam Position Paper by

Australian Integrative Medicine Association (AIMA)

Who is AIMA:

It’s Mission Statement is:” To act as the peak medical body promoting the practice of evidence-based integrative medicine, research and education as the gold standard for optimizing wellbeing, prevention and management of disease in Australasian health care systems”.

The Australasian Integrative Medicine Association (AIMA) is an independent not for profit organization of individual medical practitioners seeking to provide whole person medical care by integrating evidence-based complementary medicine into mainstream practice. AIMA is supported by its membership and governed by a Board of voluntary doctors and academic leaders in the field of integrative medicine.

Paper Summary:

From current available scientific evidence, it is clear that adverse health effects from mercury cannot be ruled out in a small and more susceptible part of the exposed population.

AIMA supports international moves to phase out and ban the use mercury in the health care sector to reduce risks to human health and in the environment from the release of mercury and its compounds.

International warnings include:

The United Nations Environment Programme’s (UNEP) Governing Council which concluded that there is sufficient evidence of significant global adverse impacts from mercury to warrant further international action.

The World Health Organisation (WHO) issued a policy paper in 2005 calling for a phase-out of mercury in the health sector with short, medium, and long-term measures), and subsequently passed a resolution in 2008 calling for the substitution of mercury-based medical devices with safer alternatives Health Care Without Harm, an international coalition of health professionals, health care institutions and networks has worked to substitute such devices in the health sector in Asia, Africa, Latin America, Europe and North America for the past decade.

The European Parliament has asked the Commission to draft legislation limiting the use of mercury in dental amalgam.

The Food Drug Administration (FDA) has issued a warning on its website: “Dental amalgams contain mercury, which may have neurotoxic effects on the nervous systems of developing children and foetus…Pregnant women and persons who may have a health condition that makes them more sensitive to mercury exposure, including individuals with existing high levels of mercury bioburden, should not avoid seeking dental care, but should discuss options with their health practitioner.”  Norway, Denmark and Sweden totally banned the use of mercury products including mercury dental amalgams in their country since 2008. Aligned with international moves and in view of the growing body of scientific evidence demonstrating health concerns associated with mercury exposure, the AIMA urgently calls upon the Australian Government to reconsider and support the request by the United Nations that dental amalgam be included as part of the global phase-out of mercury products. 

Australasian Integrative Medicine Association Position Paper on Mercury Amalgam Introduction

As clearly stated in the WHO Report in 2005, mercury is now recognized as a chemical of global concern due to its long-range transport in the atmosphere and waterways, its persistence in the environment, its ability to bioaccumulate in ecosystems and its significant negative effect on human health and the environment. (1)

Mercury is released into the global environment from a broad array of activities, including chlor alkali production, artisanal gold mining and the burning of coal in power plants.(2) Unfortunately now, health care facilities are one of the main sources of mercury release into the atmosphere because of emissions from the incineration of medical waste.(3) According to a report submitted to the OSPAR Commission (Convention for the Protection of the Marine Environment of the North-East Atlantic), 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.(4)

In 1991, the WHO confirmed that mercury contained in dental amalgam is the greatest source of mercury vapour in nonindustrialized settings, exposing the concerned population to mercury levels significantly exceeding those set for food and air.(5)

When inorganic mercury is released into the environment, it is organified into methylmercury through the process of methylation by phytoplankton in marine environments and by sulfate-reducing bacteria in freshwater sediments. (6). Once organified, methylmercury is readily absorbed by marine life, and bioaccumulates and biomagnifies as it ascends the aquatic food chain.

Dental Amalgams and Mercury Body Burden

Mercury can produce a range of adverse human health effects. Concern has existed that exposure to mercury vapour from dental amalgams may produce neurotoxicity in children. It has been demonstrated that small amounts of mercury vapour which are liberated by chewing are subsequently inhaled, resulting in measurable levels of mercury in the body.(7)

It is important to note that exposure to mercury from dental amalgams has generally been considered to occur via either erosion or evaporation directly from the surface of fillings, followed by ingestion.(8) X-ray absorption near-edge spectroscopy (XANES) has now shown that mercury (Hg) and Zinc (Zn) are detected in the teeth several millimetres from the location of the amalgams. The detection of Hg in areas of the tooth that once contained an active bloodstream and in calculus indicates that direct migration of mercury through the tooth is in fact another exposure pathway.(9)

New research, however, even suggests that MRI and microwave radiation emitted from mobile phones significantly release mercury from dental amalgam restoration. Further research is, of course, needed to clarify whether other common sources of electromagnetic field exposure may cause alterations in dental amalgam and accelerate the release of mercury.(10)

Maternal and Foetal Mercury Exposure.

In several studies, maternal environmental Hg exposure has been demonstrated to be related to the number of fish meals per week as well as the number of occlusal amalgam fillings, hence the current recommendations to reduce average fish consumption.(11-25) In one recent Iranian study, the estimated weekly intake of Hg of a breast-fed infant was higher than the provisional tolerance weekly intake recommended by the WHO.(26)

The Foods Standards Australia New Zealand (FSANZ) advises pregnant women, women planning pregnancy and young children should limit their intake of shark (flake), broadbill, marlin and swordfish to no more than one serve per fortnight with no other fish to be consumed during that fortnight due to risks of mercury toxicity. Those at highest risk of mercury toxicity are children, the unborn infant of pregnant women and newborns who are breastfeeding (exposure via the breast milk) from mothers who frequently (more than once a week) eat large predator species of fish.

Studies have shown that, in a fish-eating population, intake of Methyl-mercury (Me-Hg) via the diet has a marked impact on the Me-Hg concentration in the brain, while exposure to dental amalgam restorations increases the inorganic mercury 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.(27)

MeHg is a well-documented neurotoxicant even at low levels of exposure. The developing brain, in particular, is vulnerable to this. Through bioaccumulating to differing degrees in various fish species, MeHg can have serious adverse effects on the development and functioning of the human central nervous system, especially during prenatal exposure.(28)

The human placenta acts as a poor barrier to the transport of mercury and foetal exposure occurs as a result of maternal exposure to Hg, with possible subsequent neurodevelopmental disabilities in infants. In one study, a strong positive correlation between maternal and cord blood Hg levels was found (rho=0.79; P<0.001) and levels of Hg in the cord blood were significantly associated with the number of maternal amalgam fillings (rho=0.46, P<0.001) and with the number of years since the last filling (rho=-0.37, P<0.001).(28) Mercury levels in amniotic fluid and breast milk also correlate significantly with the number of maternal dental amalgams.(29)

Recent publications have built upon previous evidence which demonstrates that mild detrimental neurocognitive effects can occur from prenatal methylmercury exposure from maternal fish consumption during pregnancy.(7)(21-4) It has therefore been concluded that dental amalgam fillings in girls and women of reproductive age should be used with caution, to avoid increased prenatal Hg exposure. (7)(28)(29)(30)

The number of dental amalgams in a mother is correlated with mercury levels in cord blood, and thus presumably with foetal brain exposure. (31) It is important to note, however that there are conflicting studies suggesting that maternal dental care during pregnancy, including amalgam fillings, is not associated with birth outcomes such as preterm delivery and low birth weight, or with child development at age 15 months.(32),(33)

Mercury is a Known Neurotoxin

The neurotoxic effects of exposure to high-dose mercury are well documented (34). Although mercury can affect the central nervous system at any developmental stage, unfortunate episodes of community-wide poisoning in Japan and Iraq has revealed the particular sensitivity of the foetus to the toxic effects from mercury exposure. (35)(36) In these communities, exposed pregnant women who themselves had no or minimal symptoms gave birth to babies with devastating neurological handicaps, including delayed attainment of developmental milestones, blindness, deafness and cerebral palsy. Whereas adult mercury exposure causes localized damage to discrete areas of the brain, exposure in foetal life causes diffuse and widespread neurological damage. (37)

Studies have shown effects, such as tremors, impaired cognitive skills, and sleep disturbance in workers with chronic exposure to mercury vapour even at low concentrations. (38) Another study has shown that acute exposure to calculated elemental mercury levels of 1.1-44 mg/m 3 results in chest pain, dyspnoea, cough, haemoptysis, impairment of pulmonary function and evidence of interstitial pneumonitis. (39)

The central nervous system is the critical organ for mercury vapour exposure. Subacute exposure has given rise to psychotic reactions characterized by delirium, hallucinations and suicidal tendency. Occupational exposure has resulted in broad-ranging functional disturbance, including erethism, irritability, excitability, excessive shyness, and insomnia. With continuing exposure, a fine tremor develops and may escalate to violent muscular spasms. Tremor initially involves the hands and later spreads to the eyelids, lips, and tongue. Long-term, low-level exposure has been associated with more subtle symptoms of erethism, including fatigue, irritability, loss of memory, vivid dreams and depression. (40)

Furthermore, children exposed to mercury vapours through gold-mining in developing countries show typical symptoms of mercury intoxication, such as ataxia. (41)

Longitudinal prospective studies in island populations were established in the 1970s and 1980s to evaluate the effects of moderate methylmercury exposure from frequent fish consumption during pregnancy. Results from cohorts in New Zealand and in the Faroe Islands, but not in the Seychelle Islands, suggest that higher prenatal methylmercury exposure from seafood consumption is indeed associated with decrements in attention, language verbal memory, motor speed and visuospatial function. (42-45)

In an integrative analysis of all 3 Island studies, it was estimated that each microgram per gram increase in maternal hair mercury was associated with a decrement of 0.18 child intelligence quotient (IQ) points.(46)

In another quantitative analysis using the same data, it was estimated that prenatal methylmercury exposure sufficient to increase the concentration of mercury in maternal hair by 1 ?g/g decreases child IQ by 0.7 points. (47)

Indeed, mercury exposure combined with nutritional deficiencies has recently been shown to disrupt metabolic processes and alter neuroplasticity which may be factors in the development of neurodevelopmental and behavioural disorders as well as learning difficulties. It is important to note that, although the consumption of seafood is the greatest risk for methylmercury exposure, high fructose corn syrup has also been shown to contain trace amounts of mercury. Furthermore, the consumption of certain artificial food colourings and high-fructose corn syrup have both been shown to lead to the loss of zinc, which is in turn required for mercury elimination. (48)

Several analyses have been conducted on neurotypical children aged 6-10 and 8-10 years with no prior exposure to amalgams to assess whether future dental amalgams had adverse neuropsychological or renal effects. These trials suggested that dental amalgam is safe and without adverse neurocognitive effects in children, although it is possible that exposure at younger ages, or follow-up for longer duration, might reveal some evidence for harm.  These studies have sparked further professional debate as children with neurodevelopmental disorders, considered by many to be a population particularly at risk, were excluded from participating in these clinical trials. This is even more significant as the conclusion from these trials, that dental amalgam is safe, was extended to all children, whether they were neurotypical or not. (49-57)

Renal Effects of Mercury Exposure

The kidneys are an important target organ of mercury vapour from dental amalgums and it is known that mercury is toxic to the kidney. (58-60) It has also been demonstrated that mercury deposition in the kidney increases proportionally with the dose. (61) Indeed, urinary mercury concentrations are highly correlated with both number of amalgam fillings and time since placement in children. (62)(63)

Daily gum chewing in the presence of amalgam has also been associated with high urinary mercury excretion. (64)

Most current knowledge on kidney concentrations of nephrotoxic metals like mercury comes from autopsy studies. It is interesting to note that such post-mortem studies have shown that mercury levels originating from dental amalgam surfaces and retained in tissues are actually higher in the brain and thyroid than those measured in the renal cortex. (65)
Recent studies on living kidney donors have demonstrated that kidney Hg increases by 6% for every additional amalgam surface, but is not associated with fish consumption. Thus, dental amalgam has been found to be the main determinant of kidney Hg. (66)

Although the New England Children’s Amalgum Trial involving 6-10 year olds did not support earlier findings in an observational study of an effect of low-level mercury on tubular biomarkers in children, there was, however, a significantly increased prevalence of microalbuminuria, an early sign of kidney damage, among children in the amalgam group 3-5 years after exposure. (67)

This confirmed findings of an earlier study that microalbuminuria was associated with dental amalgums and, from a nephrotoxic point of view, dental amalgums are an unsuitable filling material as it may give rise to mercury toxicity. (68)

Further studies are needed to elucidate this further.(67)

Mercury and Hearing Loss

A significant positive linear correlation between amalgam filling data and auditory thresholds at 8, 11.2, 12.5, 14, and 16 kHz has also been found. The strongest association was at 14 kHz, where each additional amalgam filling was associated with a 2.4 dB decline in hearing threshold. The results suggest an association between more amalgam fillings and poorer thresholds at higher frequencies, which could contribute to presbyacusis in developed countries. This provides further argument for the use of amalgams to be phased out where suitable alternatives exist. (69)

Mercury and Kawasaki’s Disease

Medical literature, epidemiological findings, and some case reports have suggested that mercury may play a pathogenic role in Kawasaki’s Disease. Most symptoms and diagnostic criteria which are seen in children with acrodynia, known to be caused by mercury, are similar to those seen in Kawasaki’s Disease. Genetic depletion of glutathione S-transferase, a susceptibility marker for Kawasaki’s Disease, is also known to be a risk factor for acrodynia and may also increase susceptibility to mercury. (70)

Mercury and Oral Health

It is now known that neurogenic inflammation plays a relevant part in the pathogenesis of many cutaneous diseases. In several instances, peri-oral dermatitis has been associated with the mercury contained in dental fillings and/or its organic compounds formed by oral/gut bacteria, providing new information on the possible cross-talk between neuroimmunodermatology and potential triggers of per-oral dermatitis. (71) There is also some evidence that amalgam-associated Hg exposure might be related with other symptoms of oral health, such as aphthous ulcers, white patches, and burning-mouth sensations. (72) It has been demonstrated that mercury from dental amalgam can induce mercury resistant bacteria. (73-75)

This leads to a general antibiotic resistance in oral bacteria and in other body sites. (75)

Mercury Exposure, Inflammation and Immunotoxicity

A correlation has been found between atopic eczema, IgE-levels and the body burden of mercury. ([76)].

Amalgam fillings can induce lichenoid reactions (77-81) which disappear in most cases after amalgam removal. (82)

Mercury has also been shown to induce inflammatory mediator release (VEGF, IL-6) from human mast cells which can disrupt the blood brain barrier and permit brain inflammation.(83)

Although epidemiological studies indicate that external factors play an important role in triggering or aggravating autoimmune processes in genetically predisposed individuals, most autoimmune disease-promoting environmental agents are unknown because their relationships to immune function are not understood. Although not entirely understood, recent studies have started to elucidate the mechanisms by which heavy metal exposure leads to immune activation and loss of self-tolerance.(84)

Constant low-dose mercury exposure, as can happen with dental amalgams, has been considered a possible factor in the development of certain autoimmune diseases, e.g. multiple sclerosis, rheumatoid arthritis or systemic lupus erythematosus (SLE). (77),(86-95). These effects occur with exposure below current mercury safety limits. (96)

Individuals with oral lesions, autoimmune disorders and multiple sclerosis have been demonstrated to have relatively and significantly higher mercury levels, but within the threshold values. When tested by multiple logistic regression adjusted for age and gender, mercury levels in blood or urine, numbers of amalgams were not significant for multiple sclerosis or previously diagnosed autoimmune disease. (97)

Recent research, however, has shown that mercury and ethylmercury have the ability to inhibit the first step in the innate and acquired immune response of humans at very low levels. (98)

There has also been a case report highlighting the possible link between mercury vapour exposure from cracked dental amalgam and early activation of the immune system leading to pyrexia of unknown origin.(99)

Indeed, mercury-induced immunotoxicity arises far earlier than overt toxicity in the renal and central nervous systems.(100)

Recently, studies have reported that inorganic mercury induces immunosuppression by decreasing the production of thymus gland hormone (thymulin). Interference with nitric oxide synthetase by mercury is another possible mechanism for it’s immunotoxicity.(101)

Mercury, Genotoxicity and Oxidative

Stress Dental amalgam fillings have been found to cause DNA damage in human tissue cells and lymphocytes.(102)(103). Chromosomal aberrations have also been provoked by amalgam in cell cultures. (104) Individuals with amalgam fillings show significantly increased oxidative stress in both their saliva (105)(106) and blood (107)(108), the amount of which correlates with the numbers of amalgam fillings.

Hg toxicity has also been shown to reduce glutathione peroxidase enzyme activity in Red Blood Cells. (109) This is highly significant as glutathione is one of the body’s most powerful anti-oxidants and it’s reduction can induce cellular damage. (110)(111). A high level of glutathione is in turn necessary for the excretion of mercury, thus individuals with gene polymorphisms resulting in impaired glutathione production are susceptible to increased body burden of mercury.(112)(113)

Mercury and Cardiovascular Disease

Results from recently published studies have shown an independent association between the mercury concentration in the human body and the risk of coronary heart disease. Mercury may promote atherosclerosis and hence it may increase the risk of acute coronary events in several ways. Mercury stimulates the production of free radicals, binds to sulfhydryl groups of enzymes and forms an insoluble complex with selenium. Thus mercury may induce lipid peroxidation and increase oxidized low-density lipoprotein concentration in blood.(114) Mercury may contribute to both hypertension and myocardial infarction (115) and significant mercury accumulation (more than 22,000 times that of controls) has been found in idiopathic dilated cardiomyopathy. (116)

Mercury and Neurological Disorders

There is some evidence that mercury may play a pathogenetic role in Alzheimer’s Disease (117-121), however there is also evidence to the contrary.(122)

Heavy metals have long been suspected to be a cause of Parkinson’s Disease (PD), with many studies demonstrating this association. (123-132). Chronic occupational metallic mercury intoxication has induced PD (127), and in one case report, the condition of PD substantially improved after treatment with penicillamine, a mercury chelator, and remained unchanged during a 5-year follow-up period. (125) Several studies have associated PD with elevated blood mercury levels (124),(128) and a further case-control study found significantly higher amalgam exposure in individuals with PD compared to healthy controls. (131)

The prevalence of Multiple Sclerosis (MS) has been shown to be correlated with both the prevalence of caries (133),(134) and the prevalence of amalgam. (135),(136) Indeed, several MS endemics have occurred after acute exposure to mercury vapour or lead. (137) Studies of the CSF (cerebrospinal fluid) of individuals with MS have demonstrated a 7.5 fold increased level of mercury compared with controls. (138)

Animal models have shown that inorganic mercury can result in a loss of Schwann cells which build myelin sheaths and stabilize the neuronal axons. (139) Autoimmune pathogenesis, including antibodies against myelin basic protein (MBP) can also be provoked by mercury and by other heavy metals. (140)

A retrospective cohort study on 20,000 healthy military individuals revealed a significantly higher risk for MS in individuals with more amalgam fillings. (141) Subsequent epidemiological assessments and a recent systematic review have confirmed these findings, suggesting a 3.9 fold risk of developing MS for those with amalgams compared with controls. (142),(143)

There have been several studies on patients with MS who have had their amalgams removed. Significantly lower levels of mercury in blood were found (144) and, furthermore, pathological oligoclonal bands in the CSF disappeared in these MS patients after amalgam removal. (145) MS patients who have had their amalgams removed also showed fewer episodes of depression, less aggression and less psychotic and compulsory behaviours when compared to a group of MS patients with amalgam fillings. (146)

It is also important to note that removal of dental amalgam has also led to a recovery in a significant proportion of patients with MS. (145)

There are many studies which suggest that mercury may play a pathogenetic role in Motor Neuron disease (MND)/Amyotrophic lateral sclerosis (ALS). (141)(148-156). Mercury vapour is absorbed by motor neurons (148) and has been found to promote motor neuron diseases such as MND. (149-153) A retrospective study has reported a statistically significant association between an increased number of amalgam fillings and the risk of MNDs. (141)

Indeed, there is a reported case of a Swedish woman with more than 34 amalgam fillings who suffered from MND who recovered after removal of these fillings.(154) Mercury also enhances glutamate toxicity in neurons, which is one factor in MND, and several case reports have shown a correlation between accidental mercury exposure and MND. (155),(156)

Infertility

There is some evidence from older studies that exposure to mercury can result in fertility problems. Female dental assistants exposed to amalgam have shown a higher rate of infertility. (157) Women with more amalgam fillings or increased mercury levels in urine (after mobilization with the mercury chelating agent DMPS (2,3-dimercapto-1-propane-sulphonic acid) also had a higher incidence of infertility. (158-160).Exposure to mercury can also lead to decreased male fertility. (161-163) It should be noted, however, that the SCENIHR (Scientific Committee on Emerging and Newly Identified Health Risks) has stated that “There is no evidence of any association between amalgam restorations and either male or female fertility or obstetric parameters”.(57)

Adverse Health Effects in Dentists and Dental Assistants

It is well documented that dentists working with amalgam have an increased mercury
exposure. (164-166) Occupational exposure of dental staff to elemental mercury vapour released
from dental amalgam is an issue of concern because of the possible immunological and neurological
adverse outcomes, and, as such, there has been a multitude of studies regarding symptoms of
mercury exposure in this sub-population.(167)

Many of these studies indicate that occupational exposure of dentists to mercury, even at low
levels, is associated with a significant increase in the prevalence of neuropsychological, cognitive,
muscular, respiratory, cardiovascular and dermal symptoms. This corresponds with a significantly
higher urinary concentration of mercury compared with controls in most studies.(167-173) As stated
above, Lindbohm et al. (2007) found a two-fold increased risk for miscarriage through occupational
exposure to mercury. (163) Even 30 years after cessation of mercury exposure, dental nurses
showed significant adverse health effects. (174) Importantly, it has been found that 15% of
dentists/dental assistants demonstrated increased mercury-induced neurological deficits with
polymorphism of the CPOX4 gene. (175-177) Thus, it seems evident that the exposure to mercury
among dental personnel varies substantially and this must be taken into account when making
exposure assessments for this group of workers. (178)

Mercury and Neurodevelopmental Disorders

Further studies certainly need to be conducted to evaluate the critical relationship between
mercury exposure from dental amalgams during foetal and early infant periods and the subsequent
risk of developing neurodevelopmental disorders. As stated previously, there have been a number of
studies demonstrating correlations between the number of maternal amalgams and mercury present
in breast milk, amniotic fluid, cord blood as well as foetal tissue. (29,179-185)

A recent randomised clinical trial also found a significant increase in urinary mercury excretion
in children with amalgam restorations.(50) Maternal hair levels have also been used as a marker for
foetal mercury exposure and have been found to be associated with subsequent decreases in the
cognitive performance of children.(186) Both high and low levels of mercury have been found in the
hair of children with autism and several different explanations have been postulated regarding
this.(187-191)

One trial has demonstrated a significantly higher number of maternal amalgams in the
mothers of autistic children compared with controls.(191) A further study has demonstrated the
highest exposures to mercury from maternal amalgams during pregnancy were associated with an
increased risk of autism (severe clinical symptoms) in comparison to Autistic Spectrum Disorder
(ASD) (mild clinical symptoms). Importantly, the risk of increasing autism severity became significantly
manifest amongst those with 6 or more amalgams during pregnancy.(29) There are, however,
conflicting reports regarding the association of amalgams used to treat dental caries and rates of
severe autism in children.(192),(193)
It should be noted that , a recent study found no correlation between blood mercury levels
and autistic status, although this same study did find increased blood mercury levels for children with
dental amalgams who chewed gum or ground their teeth.(194) It should be noted that increase levels of mercury in red blood cells as opposed to serum have been observed in children with ASD as compared with controls. (195)

It should be noted, however, that heated professional debates regarding methodological flaws in several of the above-mentioned studies are ongoing. (196)

Current research is suggesting different genetic transcriptional programs associated with mercury in boys with autism compared to typically developing boys. (197) Furthermore, significantly increased levels of urinary porphyrins associated with mercury toxicity have been shown in several studies to be higher in children with autism than controls. It is important to note, however, that the influence of other factors, such as genetics and other metals, cannot at this stage be completely ruled out. (198-203)

The particular vulnerability of the developing nervous system for low level exposure to chemicals is well established.(204) Since mercury is an established mutagen and a known neurotoxin, further high quality trials are certainly needed to clarify this connection.(205),(206) Current scientific research does not support rejecting the link between the neurodevelopment disorder of autism and toxic exposures.(207),(208)

Conclusion

From the above evidence, it is clear that adverse health effects cannot be ruled out in a small and more susceptible part of the exposed population. Individual differences in toxicokinetics and the presence of polymorphisms, such as COMT and the serotonin transporter gene, may explain individual susceptibility to heavy metals such as mercury. Such findings extend evidence of genetic factors potentially affecting human susceptibility to the toxic effects of mercury and other environmental chemicals. (209-212)

Likewise, and conversely, particular environmental risk factors may also result in de novo genetic mutations that contribute to certain disorders through epigenetic mechanisms. (213) Thus, at this stage, one cannot rule out the possibility that the individual gene profile and/or gene environment interactions may play a role in modulating the response to acquired risk of neuropathological conditions by modifying individual susceptibility. (214)

The detrimental neurobehavioral and/or nephrotoxic effects of increased Hg on children should be a cause of concern, and further investigation is warranted. Changes in dental practices involving amalgam, especially for children, are highly recommended in order to avoid unnecessary exposure to Hg. (215)

Indeed, a 2008 analysis documented $76.6 billion in annual costs of environmentally mediated diseases, including prenatal methylmercury exposure, lead poisoning, childhood cancer, asthma, intellectual disability, autism and attention deficit hyperactivity disorder, in US children. This will no doubt continue to rise on a global scale unless important changes in federal policies are implemented to prevent exposures to toxic chemicals. (216)

United Nations Mercury Treaty

Mercury has been on the United Nations Environment Programme’s (UNEP) agenda since 2001. In 2003, The Governing Council of UNEP concluded that there is sufficient evidence of significant global adverse impacts from mercury to warrant further international action. UNEP subsequently formed mercury partnerships between governments and other stakeholders as one approach to reducing risks to human health and the environment from the release of mercury and its compounds to the environment.

The World Health Organisation (WHO) issued a policy paper in 2005 calling for a phase-out of mercury in the health sector with short, medium, and long-term measures (5)

The World Medical Association subsequently passed a resolution in 2008 calling for the substitution of mercury-based medical devices with safer alternatives. Health Care Without Harm, an international coalition of health professionals, health care institutions and networks has worked to substitute such devices in the health sector in Asia, Africa, Latin America, Europe and North America for the past decade. Growing numbers of hospitals in the developing countries are moving toward mercury-free health care and, indeed, many are now mercury-free.

As part of a global strategy to eliminate mercury, the European Parliament has asked the Commission to draft legislation limiting the use of mercury in dental amalgam. Furthermore, the FDA’s recent decision to classify mercury fillings is a reflection of the legislations enacted in Europe and Canada that highlight the neurotoxic effects of mercury fillings.(217) The FDA now states the following on its website: “Dental amalgams contain mercury, which may have neurotoxic effects on the nervous systems of developing children and foetus…Pregnant women and persons who may have a health condition that makes them more sensitive to mercury exposure, including individuals with existing high levels of mercury bioburden, should not avoid seeking dental care, but should discuss options with their health practitioner.”

Indeed, more and more countries are recommending that the use of amalgam should be restricted, particularly in pregnant women and children. (218) In 2008, Norway, Denmark and Sweden totally banned the use of mercury products including mercury dental amalgams in their country. (219)

In June 2010, the United Nations began a process of negotiations to produce a global legally-binding instrument on control and/or phase?out of all sources of mercury use.

As one of the five major mercury polluting products, dental amalgam was listed as a product to be phased out in the first draft of this environmental treaty.

Unfortunately, in its submission to the UNEP in January 2011, the Australian government singled itself out as the only nation in the world to request an exemption for amalgam from the phase-out list as called for in the treaty. The primary reasons given were the “public health advantages” of lower cost, ease of use, and quality over alternative materials.

The Government’s support for amalgam is confusing at best considering the 1999 review by the NHMRC, which recommended amalgam not be used in children, pregnant women and nursing mothers, and people with kidney impairments, due to mercury exposure. (220)

In July 2011, AIMA, as well as 27 other non-government organisations, including medical groups, endorsed a letter to the Australian government regarding the withdrawal of Australia’s recent request to the United Nations that dental amalgam be exempt from the global phase-out of mercury products.

AIMA Position Paper on Mercury Amalgam

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