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Treatment of Health Complaints Attributed to Amalgam
Howard E. Strassler, DMD
Melchart D, Vogt S, Köhler W, et al. J Dent Res. 2008;87(4):349-353.
The aim of the present study was to compare the reduction of subjective complaints by three treatment strategies in 90 “amalgam patients” whose complaints could not be explained by a medical or psychological disorder. The individuals were randomly assigned either to removal of dental amalgam only (removal group), or removal in combination with “biological detoxification” therapy with high doses of vitamins and trace elements (removal-plus group), or participation in a health promotion program without removal of dental amalgam (no-removal group). Between baseline and month 12, the sum score of main complaints decreased by 3.5 (SD = 2.2) points on average in the removal group, as well as in the removal-plus group, and by 2.5 (SD = 2.4) points in the no-removal group (P = .152). Both removal groups showed a significant decrease in steady-state levels of inorganic mercury compared with the no-removal group. Thus, all three interventions were associated with clinically relevant improvements.
Frequently, safety concerns relating to the mercury content of dental amalgam has been questioned and investigated. Dental amalgam remains widely used as a restorative material for the treatment of dental caries and the replacement of defective restorations. Methylmercury is a known toxic agent to the developing brain. Two randomized longitudinal studies on the neuropsychological effects of amalgam in children concluded that during the time period of these studies (5 to 7 years) the children did not have statistically significant differences in neurobehavioral assessments or in nerve conduction velocity when compared with children who received resin composite materials without amalgam. These findings, combined with the trend of higher treatment need later among those receiving composite, suggest that amalgam should remain a viable dental restorative option for children. In either instance, both studies state that a follow-up might be needed to appreciate any other subtle toxic effects that might be associated with dental amalgam.
With this in mind, some patients with amalgam restorations who have vague chronic, subjective symptoms with nonspecific health problems suspect their clinical complaints are caused by mercury released from their amalgam restorations. These individuals have been described as “amalgam patients.” In some cases, these patients’ symptoms correspond with the major toxic effects on the nervous and immune systems that are considered associated with chronic subtoxic exposure to mercury. This controlled trial investigated the effectiveness of three treatment strategies for “amalgam patients” in reducing subjective health complaints that could not be explained by other medical or psychological disorders. Patients with other restorations, endodontic treatment, or previous history of mental disorders were excluded from the study. The protocol for this study was well designed to distinguish any differences in the three groups: (1) removal of dental amalgam only (removal group); (2) removal in combination with “biological detoxification” therapy with high doses of vitamins and trace elements (removal-plus group); (3) participation in a health promotion program without removal of dental amalgam (no-removal group). Of interest, 43 (12/14/17 by group) of the 90 participants in the study reported 73 “new” complaints. All three groups had a marked reduction in subjective complaints and mental stress that persisted throughout the 18-month follow-up. From this study it can be concluded that reasons for amalgam-related complaints remain unclear and that amalgam removal is not the only treatment option because all three treatments were associated with clinically relevant improvements.
About the Author
Howard E. Strassler, DMD
Professor and Director of Operative Dentistry
Department of Endodontics, Prosthodontics and Operative Dentistry
University of Maryland Dental School