PubMed · 6584151
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1984-04-07. An ethical problem.. https://doi.org/10.1038/sj.bdj.4805323
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Mercury is released from amalgam fillings in several forms, i.e. as elemental vapour, ions and in fine particles. Despite many investigations there is still considerable uncertainty concerning the uptake of such mercury. Most available estimates have calculated the pulmonary uptake of mercury vapour based on measurements of concentrations intra-orally or in expired breath. Presented estimates vary by an order of magnitude from approximately 1 to 20 micrograms/day. The possibility of estimating this uptake based on levels of mercury in a biological index medium has received comparatively little attention. The purpose of the present work is to estimate the uptake of mercury from amalgam fillings based on urinary concentrations of mercury. It is estimated that the average uptake of mercury from amalgam fillings in Swedish subjects is within the interval 4-19 micrograms/day. This interval was arrived at after a detailed evaluation of the uncertainties in the data used and in the different assumptions. Notwithstanding the considerable range of this estimate it indicates a higher uptake than several other estimates, some of which have had a large impact on the scientific debate concerning this issue.
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174 patients referred to the Department of Oral and Maxillofacial Surgery, Central Hospital, Karlstad, Sweden during 1987 to 1989 for lichenoid lesions and evaluation of a possible connection with amalgam restorations were invited to a clinical re-examination. 159 of the patients were re-examined with the purpose of evaluating the long-term effect upon performed substitution therapy. Partial or total removal of amalgam had been recommended according to a set of given criteria. The re-examination showed that 62 patients had performed partial and 69 patients total removal of amalgam fillings. 28 patients had not performed any substitution therapy. There was a difference between recommended and performed therapy. The results demonstrated that 92% of patients with lichenoid lesions only in contact with amalgam fillings healed or improved clinically following removal of amalgam. No statistical difference was found in healing between patients who only removed fillings in contact and those who had removed all amalgam restorations. More than 60% of buccal lichenoid lesions without contact with amalgam at time of referral disappeared following amalgam substitution. Gingival lichenoid lesions did not respond to substitution of amalgam to another material. 3 out of 17 patch-tested patients demonstrated a hypersensitivity reaction to mercury. All lichenoid lesions in these patients healed following total substitution. Partial or total removal of amalgam fillings was also performed on 10 patients with completely negative patch-tests. 6 out of these patients demonstrated complete healing of their lichenoid reactions at re-examination.(ABSTRACT TRUNCATED AT 250 WORDS)