Gerald

DENTAL FILLINGS / Mercury

Poisoning / UCSF School Of
Medicine-Winter 1989

Mercury is a Global Neurotoxin

That Decreases Think, Command
and Control
• Think- Higher Cognitive (Mental) Functions

9/25/2010
 Steps in finding
Poison?
• Gradual Onset of fine tremor
(intention) led me to suspect
poison.
• This led to the approach of two
UCSF medical professors, Michael
Dae M.D. and Dorthlee Perloff M.D.

9/25/2010
 Medical Evaluation
• Student Health Service/Toxicology-SFGH Charles
Becker M.D.
• Objective Findings:
• Fine tremor
• Low Blood Pressure
• Normal White Blood Cell Count
• Normal Red Cell Sedimentation Rate
• Urine Hg: High Normal range [normal=<10 ug Hg/L]
• Blood Hg: High Normal range [normal= (2-20ug) Hg/L]
• (See The Heavy Metal Paradigm: No Safe Lower
Limit even at levels found in the U.S. Population.)
Urine= 3.1 ug Hg/L avg. ;range (0-34 ug Hg/L);
Kingman (1994)

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 Medical Evaluation
• Subjective Complaints
• Headaches
• Stags and Sways (Balance/Ataxia)
• Hazy Vision (slight)
• Decreased Higher Mental Functions or
Decreased Cognition.
• Speech
• Insomnia

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 Medical Evaluation
• Diagnosis/Treatment

• Winter 1989 Neuropsychiatric

Evaluation – Michael Shore PhD

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 Medical Evaluation
• Diagnosis/Treatment

• Cecil’s Textbook Of Internal Medicine

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 Medical Evaluation
• . Revealed Decreased Global Cognitive
Function-I.Q. drop of 22 pts. (1.5
Standard Deviations) From Age 9 yrs./4th
grade- Jackson Mental Health Clinic
• 1) Anxiety Neurosis -( Pt. Believed
Falsely to the point of Mental Illness that
He was being poisoned by Hg from
dental fillings)

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 Medical Evaluation
• 2)Depression- Medications

• Antitremor- Inderal (Beta-Blocker)/

(Marc Gropper M.D.) -SHS
• Antidepressants- Prozac, Trazedone,
Elavil
• Antianxiety- Valium (Mindy Fullilove
M.D.); Xanax (Tim Summers M.D.);
Insomnia-Restoril; Dalmane.

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 Apples vs. Oranges

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 Apples vs. Oranges

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 Apples vs. Oranges

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 Apples vs. Oranges

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 Apples vs. Oranges
UT-Tyler Toxicology Jeneat Burist HIV Positive Quick Draw Jackie Carter Ultra
Apple to Orange McGraw marathon Length

Peak to
Occupational Trough Peak to Trough Dose 30
Exposure -8 hrs. Dose 15 min @ 3-4 times/day min @ 3-4 times/day

9/25/2010 8 1 2 1 2
 Hg Vapor
Apples vs. Oranges
Occupational Exp.
(Known Toxic Doses)
HIV Positive Quick Jackie Carter Ultra
Draw Mc Graw – Marathon Length
Jeneat Burist Dose Dose

Duration/Area
Under The Curve
8 hrs Blue Line 1 hr 2hrs

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 Medical Evaluation
Dental Amalgam:
A Scientific Review and Recommended Public Health Service Strategy for Research, Education and Regulation
Final Report of the Subcommittee on Risk Management of
the Committee to Coordinate Environmental Health and Related Programs
Public Health Service
January 1993

Department of Health and Human Services

Public Health Service
Table of Contents
• III: Evaluation of Risks Associated With Mercury Vapor from Dental
Amalgam
• FDA Position Statement on Dental Amalgams (Mainstream Position)

9/25/2010
 Standard Of Care
• Early detection of subclinical inorganic and organic mercury
intoxication This is the USPHS own (Peer reviewed) Position
Statement on Dental Fillings!
• Evaluation of Risks Associated With Mercury Vapor from
Dental Amalgam
• Mercury is a toxic substance. For high exposures, observed
mostly in occupational settings, the severity of response
correlates with the duration and intensity of the exposure.
The relationship between the severity of response and the
duration of exposure has, however, not been quantified at
levels of exposure associated with dental amalgam
restorations. In addition, subtle signs and symptoms of
chronic mercury intoxication may not be found through
routine physical examinations. The subtle changes
previously described require special tests not commonly
used in routine examinations—that is, nerve conduction
studies, measurement of alterations in EEG, and
measures of psychomotor functioning
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 Standard Of Care
• The official recommendation by their
own (UT-Tyler Public Health Library)
Medical Toxicology Textbook- The
Clinical Basis of Medical Toxicology.
P. 1328.
• "In addition to mercury assays,
neuropsychiatric testing, nerve
conduction studies and urine assays for
N-acetyl B-D-glucosaminidase and beta-
2-microglobulin are advocated for early
detection of subclinical inorganic and
organic mercury intoxication. (20, 28,
9/25/2010 50)"
 Dose response
curve
• Does Hg vapor have a dose
response curve in biological
systems (i.e. Humans) ?

• Find the Answers below

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 Dose response
curve
• 1) Just what part of the dose response curve is a
person on with dental fillings (40 Dental fillings) ?
• 2) What part of the dose response curve causes a
blue line on gums/gingivitis?
• 3) What is the standard of care for an
occupational environment/ setting where Hg vapor
is a hazard? (For example, a Fluorescent lamp
factory, Chloralkali factory, Thermometer factory,
Dental office/workers)
• 4) What is the standard of care for a person with
dental fillings?
• 5) How was the standard of care/response curves
established ?

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 Dose response
curve
 The toxicity of mercury and its compounds,
recognized since antiquity and widely
acknowledged in industry, has recently been
reviewed (7-12).
 Clinically significant effects (erethism,
intention tremor, gingivitis) have not been
reported below air concentrations of 100 µg
Hg/m3. [The OSHA limit = 50 ug Hg/m3 x
8hr/day: not to exceed 50 hrs/wk] . Most
effects observed in persons exposed to
mercury in air concentrations below 100 ug
Hg/m3 are preclinical e.g., slowed nerve
conduction, short term memory loss, special
instrumental tests for tremor

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 Dose response
curve
• However The prideful and Pathetically
Incompetent BIG GOOFS AND FUCK-UPS AND
RUDY POOTS AND COUNTRY BUMPKINS AND
MEDICALLY IRRESPONSIBLE LOOSE
CANNONS ON DECK and refuse to Back Down
UT-Tyler Toxicology Attendings try to go around
this with the statement "The vast majority of
descriptions in our limited understanding of the
detailed literature of mercury poisoning contain a
BLUE LINE. Therefore we think that you should
have one as well".

• What is wrong with the statement above?

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 The Heavy Metal
Paradigm
• The Heavy Metal Paradigm

• (There is no safe lower limit for Lead and Mercury

at the doses found either in the occupational
environment or from Dental Amalgams)
• Normal Values Urine= <10 ug Hg/L; Blood= (0.2-
2 ug) Hg/100 ml [2-20 ug Hg/L]
• There is considerable overlap among
concentrations of mercury found in the normal
population, asymptomatic exposed
individuals, and patients with clinical evidence
of poisoning. There is no definitive correlation
between blood and urine mercury levels with
mercury toxicity. 9,23

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 The Heavy Metal
Paradigm
• U.S. Population Hg Levels (Kingman
1994)
• Urine= 3.1 ug Hg/L avg. ;(0-34 ug Hg/L)

• These levels are mainly due to either

dental amalgams or methyl mercury
from seafood/fish consumption. These
overlap with the doses in several
studies (see above; Aphoshian-1998)
which have produced Hg toxicity.

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 The Heavy Metal
Paradigm FDA n=550
Reports
• Adverse effects information—collected from
FDA's Medical Device Reporting (MDR) and
Problem Reporting Programs (PRP) n=550
Reports concerning Dental Amalgams

• Not Measured (expected to be in normal range)

• A plethora of reports (n=550) have been filed

(FDA) with chief complaints that were claimed to
be resolved with the removal of amalgam/mercury
restorations A Blue Line nor Gingivitis was not
reported, even during the process of removal.
(See Below-Bjorkman:1997)

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 Dose response
curve
• Study/Conc. Hg ug/m3 (air)
Effects (gingivitis) Yang (1994)-
Taiwanese Lamp socket Factory
worker
• 945 ug Hg/m3; (Urine= 610ug
Hg/L); (Blood=237ug Hg/L)
• Prominent gingivitis, ataxia, blurred
vision, dysarthria, tremors (usually
postural and intentional), unsteady
gait, and slow mental response
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 PEL (Maximum
Permissible Exposure
Limit) OSHA, WHO,
ACGIH
• 100 ug Hg/m3 and above

• See Below; Only brief

exposures are advised w/o
respiratory protection

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 Dose response
curve
• Scientific Literature100 ug Hg/m3 and
below Clinically significant effects
(erethism, intention tremor, gingivitis)
have not been reported below air
concentrations of 100 µg Hg/m3. [The
OSHA limit = 50 ug Hg/m3 x 8hr/day: not
to exceed 50 hrs/wk] . Most effects
observed in persons exposed to mercury
in air concentrations below 100 ug
Hg/m3 are preclinical e.g., slowed nerve
conduction, short term memory loss,
special instrumental tests for tremor
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 Dose response
curve
• Ehrenberg et al. (1991):
Thermometer plant workers
• 76 ug Hg/m3
• Difficulty with heel-to-toe gait was
observed in thermometer plant
workers.

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 OSHA Limit
• OSHA Limit
• 50 ug Hg/m3 x 8hr/day: not to
exceed 50 hrs/wk
• See Above (mostly preclinical)

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 Dose response
curve
• Fawer,. et al. (1983): Mercury-exposed workers
in 3 industries (n=26)
• 26 ug Hg/m3
• Hand tremor induced by industrial exposure to
metallic mercury. a study of workers exposed to a
time weighted average of 26 ug/m3 for an
average of 15.3 years with an increase in
intentional tremor compared to the control group
These results clearly indicate that metallic
mercury, even at concentrations below the
current OSHA TLV-TWA of 50 ug Hg/m3, can
lead to neurological disorders.

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 WHO Limit
• WHO Limit
• 25 ug Hg/m3 x 8hr/day: not to exceed
50 hrs/wk
• The World Health Organization (WHO)
adopted a health-based recommended
limit for occupational exposure of 25
ug/m3 . The WHO Study Group selected
this value to ensure a reasonable degree
of protection not only against tremor but
against mercury-induced nonspecific
symptoms (17). Effects induced by
exposures that exceed these levels have
9/25/2010 been well documented (7,9,10,16)
 ACGIH Limit
• ACGIH Limit ACGIH - American
Congress of Governmental Industrial
Hygienists
• 25 ug Hg/m3 x 8hr/day: not to exceed
50 hrs/wk
• The American Congress of
Governmental Industrial Hygienists
(ACGIH) adopted a health-based
recommended limit for occupational
exposure of 25 ug/m3 See WHO study.

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 Dose response
curve
• Piikivi, L., Tolonen, U. (1989):
Chloralkali workers (n=41)
• 15-25 ug Hg/m3

• Comparison of computer-supported
evaluation of EEGs obtained from
mercury exposed and control workers
showed those from the exposed group
were significantly slower and more
attenuated. This difference was most
prominent in the occipital region,
became milder parietally, and was
9/25/2010 almost absent frontally
 Dose response
curve
• Ngim (1992) Dentists (n=98) 14 ug Hg/m3
• Dentists (n=98, mean age 32, range 24–49) with
an average of 5.5 years of exposure to low levels
of mercury showed impaired performance on
several neurobehavioral tests. The dentists
showed significantly poorer performance on finger
tapping (measures motor speed), trail making
(measures visual scanning), digit symbol
(measures visuomotor coordination and
concentration), digit span, logical memory delayed
recall (measures visual memory), and Bender-
Gestalt time (measures visuomotor coordination).
The dentists had a higher aggression score than
the controls..

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 Dose response curve
The Double-Double
Effect
• Echeverria, Aposhian (1998) Dentists (n=49)
• (Urine pre= 0.94 ug Hg/L avg.; 9.1post ug Hg/L)

• By using an approach (pre and post chelation Urine Hg levels)

that distinguishes recent Hg exposure from Hg body burden,
subtle associations were observed between Hg and symptoms,
mood, motor function, and nonspecific cognitive alterations in
task performance in an occupationally exposed group (dentists)
with Hg Urine levels comparable to the general U.S. population.
(0-4 ug Hg/L). Some of the subclinical findings were due only to
the Hg source derived from their own dental amalgams. This
study is evidence that Hg toxicity (CNS is Target) can occur
from the low-levels emitted by dental fillings, By using the
pre/post chelation technique of course some had toxicity due to
both sources, occupational (DENTAL OFFICES AVG. 20-40 ug
Hg/m3 8 hrs/day x 40hrs/wk) and dental amalgams, YET NONE
HAD A BLUE LINE ON GUMS. Application of this approach may
be particularly useful in defining thresholds of Hg toxicity and
for establishing safe limits of exposure to mercury from dental
amalgam material, the restoration itself, diet, and other sources.

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 Dose response
curve
• Dental Amalgams (Björkman et
al. 1997; Lorscheider et al. 1995).
• 1-100ug Hg/day (weight) depends
on no. and (highest to lowest peak
levels during) drilling, installation,
chewing, acidic, tooth brushing, hot
liquids etc…Gingivitis or Blue Line
on gums has not been reported per
FDA’S own review of literature.
(175 STUDIES) & 550 case reports
9/25/2010
 Dose response
curve
• What this means is that the mercury released
from dental amalgams has a definite dose
response curve in the human body just like
food or a drug like Bayer Aspirin. The highest
Hg vapor/plasma/urine peaks ever measured
are during removal (requires drilling one by
one), the next highest, during installation, the next
during heavy chewing esp. w/ acidic foods, tooth
brushing w/abrasive grit toothpaste, then hot
liquids but yet a Blue Line on Gums was never
seen/observed or reported.
• Removal of dental amalgams in people who have
no indication of adverse effects is not
recommended and can put the person at greater
risk, if performed improperly. (ATSDR -1999)
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 MRL (Minimum Risk
Level)
• 0.2 ug Hg/m3 = MRL continuous
• (26 ug Hg/m3) x (8/24 hrs/day) x (5/7 days/wk) /
10 variability /3 minimal effect
• Dose and end point used for MRL derivation:
0.026 mg/m3; increased frequency of tremors.
• Since the duration of exposure does influence the
level of mercury in the body, the exposure level
reported in the Fawer et al. (1983)
occupational study was extrapolated from an
8-hour/day, 40-hour/workweek exposure to a level
equivalent to a continuous 24 hour/day, 7
days/week exposure as might be encountered
near a hazardous waste site containing
metallic mercury.

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 MRL (Minimum Risk
Level)
• During the development of toxicological profiles, Minimal Risk Levels (MRLs) are derived
when reliable and sufficient data exist to identify the target organ(s) of effect or the most
sensitive health effect(s) for a specific duration for a given route of exposure. For Hg
(inorganic/ organic) the target organ is the CNS.
• An MRL is an estimate of the daily human exposure to a hazardous substance that is likely to
be without appreciable risk of adverse noncancer health effects over a specified duration of
exposure.
• MRLs are based on noncancer health effects only and are not based on a consideration of
cancer effects. These substance-specific estimates, which are intended to serve as
screening levels, are used by ATSDR health assessors to identify contaminants and potential
health effects that may be of concern at hazardous waste sites.
• Additional studies or pertinent information which lend support to this MRL: The ability of
long-term, low level exposure to metallic mercury to produce a degradation in neurological
performance was also demonstrated in other studies.

• (Ngim et al. 1992); (Ehrenberg et al. 1991) See Above.

• Abnormal nerve conduction velocities have also been observed in chloralkali plant workers
at a mean urine concentration of 450 µg/L (Levine et al.1982). These workers also
experienced weakness, paresthesias, and muscle cramps.

• Tremors have also been reported in occupationally exposed workers with urinary mercury
concentrations of 50–100 µg/g creatinine, and blood levels of 10–20 µg/L (Roels et al. 1982).

• (Piikivi et al. 1984), decreases in performance on tests that measured intelligence

(similarities) and memory (digit span and visual reproduction) were observed in chloralkali
workers exposed for an average of 16.9 years (range, 10–37 years) to low levels of mercury
when compared to an age-matched control group..

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 References
• REFERENCES
• . DHHS. 1993. Dental amalgam: A scientific review and recommended public health service strategy
for research, education and regulation. Department of Health and Human Services, Public Health
Service, Washington, D.C
• Björkman L, Sandborgh-Englund G, Ekstrand J. 1997. Mercury in salvia and feces after removal of
amalgam fillings. Toxicol Appl Pharmacol 144:156-162
• Ehrenberg RL, Vogt RL, Smith AB, et al. 1991. Effects of elemental mercury exposure at a
thermometer plant. Am J Ind Med 19(4):495-507
• Fawer, R.F., DeRibaupiere, Y., Guillemin, M. et al. (1983): Measurement of hand tremor induced by
industrial exposure to metallic mercury. Br J Ind Med 40:204-208
• Levine SP, Cavender GD, Langolf GD, et al: Elemental mercury exposure: peripheral neurotoxicity.
Br J Ind Med 1982 May; 39(2): 136-9[Medline]
• Ngim CH, Foo SC, Boey KW, et al. 1992. Chronic neurobehavioural effects of elemental mercury in
dentists. Br J Ind Med 49(11):782-790
• Piikivi L, Hanninen H, Martelin T, et al. 1984. Psychological performance and long term exposure to
• mercury vapors. Scand J Work Environ Health 10:35-41.
• Piikivi L, Hanninen H. 1989. Subjective symptoms and psychological performance of chlor-alkali
workers. Scand J Work Environ Health 15(1):69-74.
• Piikivi, L., Tolonen, U. (1989): EEG findings in chlor-alkali workers subjected to low long term
exposure to mercury vapour. Br J Ind Med 46:30-35
• Roels HA, Lauwerys R, Buchet JP, et al. 1982. Comparison of renal function and psychomotor
• performance in workers exposed. Int Arch Occup Environ Health 50:77-93.
• Yang Y-J, Huang C-C, Shih T-S, et al. 1994. Chronic elemental mercury intoxication:clinical and
field studies in lampsocket manufactures. Occup Environ Med 51(4):267-270

9/25/2010
 Dose response
curve
• Translation: There are no published reports of a
blue line on gums (gingivitis) from either
occupational exposure below 100 ug Hg/m3
• or
• Dental Fillings
• This is what is wrong with it!
• There are no applications of the dose response
curve of Hg Vapor to this approach.
• Like any drug or just like food, Hg vapor has a
dose response curve just like Bayer Aspirin.
• You are pathetic failures in Pharmacology! 
• This Evidence cannot be scientifically refuted by
any trained PhD. or M.D. in Medical Toxicology

9/25/2010
 SUMMARY
Of course the UT-Tyler Attendings can try to get a
publication In the Journal of Toxicology
As to how the Blue Line on Gums can be used to
track low-term, low-dose
Effects of Exposure to HG vapor,
However no peer reviewed Toxicology Journal would
let you Publish,
Because, I almost forgot The Studies have already
been done.
Is that what they meant by “got”?
A small child can see that you don’t have (ain’t got) a
lick
Of sense.

9/25/2010
 Ongoing Studies of
Long-Term Low Dose
Exposure to
HgD Vapor
• Echeverria,
• Battlle Centers, Public Health and
Evaluation, Seattle, WA
• Neurologic Effects of Metallic
Mercury Exposure In Dental
Personnel
• National Institute Of Dental
Research

9/25/2010
 Ongoing Studies of
Long-Term Low Dose
Exposure to
Hg Vapor
• Factor-Litvak, P
• Columbia University, New York,
New York
• Dental Amalgams and
Neuropsychological Function
• National Institute Of Dental
Research

9/25/2010
 Ongoing Studies of
Long-Term Low Dose
Exposure to
•
• Hg Vapor
Crawford, S. New England Research Institute
Health Effects of Dental Amalgam in Children
http://www.neri.org/html/research/clinical/cat.asp
• Children's Amalgam Trial
• - CAT Funding: National Institute of Dental and Craniofacial
Research

• Safety will be measured in two ways Cognitive function (IQ) is the

primary outcome, given the hypothesis that mercury vapor,
released from amalgam may affect neuropsychological
development in children. Dr. David Bellinger (Children's Hospital,
Harvard Medical School and Dr. David Daniel (University of Maine,
Farmington) are providing leadership in these measurements.
Kidney (renal) function, the other important system likely to be
adversely affected by mercury, is being measured in the laboratories
of Dr. Tom Clarkson (U. Rochester, NY) and Dr. Lars Barregard (U.
Goteborg, Sweden)
• Originally funded by the National Institute of Dental and Craniofacial
Research in 1996, this trial has been funded for another 5 years in
order to complete the planned 5 years of dental treatment and follow-
up measurement originally planned. A sister trial "Casa Pia", is
9/25/2010 also funded by the same Institute, to complete similar treatment
and measurement on children in Portugal
 Ongoing Studies of
Long-Term Low Dose
Exposure to
• DeRuen, T.Hg Vapor
• University of Washington

• The Casa Pia Study [ Portugal ] of Dental

Amalgam in Children (See Above)

• National Institute Of Dental Research

• The target organs of mercury exposure are

renal and neurological. Baseline and annual
repeated measures are taken on all subjects for
renal function, nerve conduction velocity and a
large battery of neurobehavioral tests. Follow-
up is planned for a period of 7 years

9/25/2010
 Conclusions
Your Gimp Asses Would Kill them
waiting on a Blue Line to show up.
UT-Tyler Attendings in Toxicology.
Orange Peels for Brains

9/25/2010
 Medical Malpractice
This fact is so obvious, GIMP UT-Tyler Attendings in
Toxicology that it is Surreal.
You Truly are the Fuck-Ups, Big Goofs and Rudy
Poots of The
Entire Country-Country Bumpkins.
Incompetent, Bumbling, Inept, UT Tyler Toxicology
Attendings, Big Goofs, Big Fuck-Ups, Rudy Poots and
Country Bumpkins whose approach to the detailed
literature of HG poisoning is Causal ,Shallow,
Lackadaisical, Lassie-Faire, Misapplied as an Apple
is to an Orange, Non- Committal ,Half-Ass, Not
Tolerated , grossly medically incompetent and gets a
grade of "F"

9/25/2010
 Medical Malpractice
• Sensory distal latency correlated significantly with more than
half of the urine mercury exposure indices used. Motor distal
latency also showed significant correlation with mercury
indices. These manifestations of toxicity were not
apparent through standard physical examinations. In
workers from a chloralkali plant (Levine et al. 1982).
• These workers also experienced weakness,
paresthesias, and muscle cramps.

1. JUST WHEN DO THE UT-TYLER ATTENDINGS

ADVOCATE
2. DIAGNOSIS/TREATMENT/REMOVAL FROM EXPOSURE?
3. BLINDNESS 2) CRIPPLED OR 3) CRAZY

• This is why
• The UT-Tyler Attendings themselves need to be sued for
medical malpractice/negligence as well.

9/25/2010
 Medical Malpractice
• When asked these questions in a
court of law in a scientific,
medical and/or medical-legal
context there is one answer that
can be given by experts in Hg
poisoning and any medically
trained professional inc. UT-
Tyler Attendings w/o BLATANT
LYING UNDER OATH.

9/25/2010
 Medical Malpractice
The Double-Double
Effect
• Did some of these persons
Diagnosed with and/or
Experiencing Mercury Poisoning
In Occupational Environments
(The Double-Double Effect)
ALSO HAVE DENTAL
AMALGAMS/FILLINGS?

9/25/2010
 Medical Malpractice
1. What is the definition of Subclinical?
• The subclinical onset of chronic metallic mercury
poisoning as also described in the Textbook
reference at UT-Tyler Public Health Library [The
Clinical Basis of Medical Toxicology p. 1328 with
several references (20, 28, 50) from their own
Public health Library.

• "In addition to mercury assays, neuropsychiatric

testing, nerve conduction studies and urine assays
for N-acetyl B-D-glucosaminidase and beta-2-
microglobulin are advocated for early detection of
subclinical inorganic and organic mercury
intoxication. (20, 28, 50)"

9/25/2010
 Medical Malpractice
• What is the definition of Normal
Physical Examination and
manifestations of toxicity?
• These manifestations of toxicity
were not apparent through
standard physical examinations.
In workers from a chloralkali
plant (Levine et al. 1982). Metals
and Metalloids p.90 Levine (1982)

9/25/2010
 Medical Malpractice
1. Does Mercury have a dose response curve in the body or
biological systems?
• Mosby's Occupational Medicine-1994  p. 552

• "Chronic mercury poisoning is the mercurial poisoning found most commonly

in the occupational setting.(45,78) The symptoms may first occur after a very
few weeks of exposure, or they may not become apparent for several years.
The more intense the exposure has been, the more the symptoms will relate to
the mouth, the kidney, and the respiratory systems and gastrointestinal
systems. The more prolonged and the lower the level of exposure, the more
likely the symptoms and signs will be pathoneurologic in nature. Most cases
have a blending of both. " 
•  Recently, controversy has surrounded the use of mercury amalgams in
dentistry and the potential for adverse for adverse effects in both dental
personnel and patients. Studies have shown that amalgam fillings have
significantly contributed to plasma and urinary mercury levels; There is a
definite relationship between plasma mercury levels and the number and
surface area of amalgam dental fillings. (54,55) Removal of fillings resulted in
initially higher plasma mercury levels, followed by eventual significant
decreased levels compared to preremoval. (17,70) However, there is as yet no
conclusive evidence of significant adverse health effects from exposure to
dental amalgams, except in cases of allergic sensitivity.(53,74) 

9/25/2010
 Medical Malpractice
• What is the standard for care for occupational exposure
and/or dental fillings?
• The subclinical onset of chronic metallic mercury poisoning as also described in the
Textbook reference at UT-Tyler Public Health Library [The Clinical Basis of Medical
Toxicology p. 1328 with several references (20, 28, 50) from their own Public
health Library.

• "In addition to mercury assays, neuropsychiatric testing, nerve conduction

studies and urine assays for N-acetyl B-D-glucosaminidase and beta-2-
microglobulin are advocated for early detection of subclinical inorganic and
organic mercury intoxication. (20, 28, 50)“

• III: Evaluation of Risks Associated With Mercury Vapor from Dental Amalgam
o Mercury is a toxic substance. For high exposures, observed mostly in occupational
settings, the severity of response correlates with the duration and intensity of the
exposure. The relationship between the severity of response and the duration of
exposure has, however, not been quantified at levels of exposure associated
with dental amalgam restorations. In addition, subtle signs and symptoms of
chronic mercury intoxication may not be found through routine physical
examinations. The subtle changes previously described require special tests
not commonly used in routine examinations—that is, nerve conduction studies,
measurement of alterations in EEG, and measures of psychomotor functioning.

9/25/2010