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Dental Fillings and Mercury Levels

Many of us grew up having silver colored dental fillings (called dental amalgam) in our teeth. Dental amalgam has been used for over 150 years for the treatment of dental cavities (caries) because it is durable, easy to use, and affordable. But it is composed of about 50% elemental mercury (Hg) and so it may release a certain amount of mercury both during the time the cavity is filled and afterward with normal wear. Mercury can cause adverse health effects, such as effects on the central nervous system, kidneys, and immune system. Human mercury exposure also occurs through the consumption of mercury (MeHg) contaminated seafood.

Recently many dentists switched to the use of the composite resins, which are mercury-free alternative materials. However, these can release can release small quantities of bisphenol A (BPA) when applied and as they degrade in the mouth. BPA is an endocrine disruptor, has been found to cause various adverse health effects, including reproductive effects, and can be measured in urine. Which raised the question, do persons with composite resin fillings have elevated BPA in their bodies?

This study examined 14,703 subjects who were divided into three groups based on the number of dental surface restorations (DSR): 0, 1–8, or greater than 8. Dental surface restorations applies to fillings, and not crowns. Note that a tooth's surface can have 5 surfaces (in molars and pre-molars), so 8 filled surfaces can be fewer than 8 teeth with fillings. (It's not the number of fillings, but the surface area they occupy - so the Science Daily article title is misleading.)

They found that the more dental surface restorations a person has, the higher the levels of mercury in the blood. But they found no association between dental surface restorations and urinary BPA. These results are reassuring for those with fillings made of composite resins, but not for people with fillings of dental amalgam. Note: DSR are Dental Surface Restorations, THg is blood total mercury, IHG is inorganic mercury, and MeHg is methyl mercury (typically from seafood). From Science Daily:

Have more than eight dental fillings? It could increase the mercury levels in your blood

Dental surface restorations composed of dental amalgam, a mixture of mercury, silver, tin and other metals, significantly contribute to prolonged mercury levels in the body, according to new research from the University of Georgia's department of environmental health science in the College of Public Health.This research, which analyzed data from nearly 15,000 individuals, is the first to demonstrate a relationship between dental fillings and mercury exposure in a nationally representative population. 

The researchers further analyzed exposure by specific types of mercury and found a significant increase in methyl mercury, the most toxic form of mercury, related to dental fillings. Yu said this result suggests the human gut microbiota, a collection of microorganisms living in the intestines, may transform different types of mercury.

Dental amalgam has been the go-to dental filling material for more than 150 years, because it's affordable and durable. However, about half of the compound contains mercury, a heavy metal known to be toxic at high levels, causing brain, heart, kidney, lung and immune system damage. New research suggests that methyl mercury may cause damage even at low levels.

"As toxicologists, we know that mercury is poison, but it all depends on the dose. So, if you have one dental filling, maybe it's OK. But if you have more than eight dental filings, the potential risk for adverse effect is higher," Yu said....The results show that individuals with more than eight fillings had about 150 percent more mercury in their blood than those with none. The average American has three dental fillings, while 25 percent of the population has 11 or more fillings.

The study also looked at dental composite resins, a mercury-free alternative for dental fillings that can release small amounts of bisphenol A, or BPA, which may cause developmental or reproductive damage. The results found no association between dental fillings and urinary BPA, but further research is needed to understand BPA exposure from resin-based materials.

From the original study in :  Associations of blood mercury, inorganic mercury, methyl mercury and bisphenol A with dental surface restorations in the U.S. population, NHANES 2003–2004 and 2010–2012

Elevated mercury in urine usually indicates exposure to an elemental or inorganic source of mercury, while elevated mercury in blood usually indicates exposure to organic mercury or recent exposure to a high level of elemental mercury vapor. However, our current study found that THg, MeHg, and IHg significantly increased with the number of the DSRs after the adjustment of covariates. It is well established that inorganic mercury is released into circulation from amalgam restorations (Lorscheider et al., 1995); it is also widely believed that the only source of the organic form, methyl mercury, is from fish in the diet. However, accumulating evidence demonstrates that human oral or gut commensal bacteria can methylate mercury....Leistevuo et al. found a correlation between the total amalgam surfaces and organic mercury in saliva, suggesting both methylating and nonmethylating bacteria can enhance the formation of toxic methylmercury (Leistevuo et al., 2001).

Conclusions: We have found that dental surface restorations significantly contributed to the blood concentrations of THg and IHg in both periods of study, as well as MeHg in 2011–2012, after adjusting covariates such as age, education, race/ethnicity, gender, smoking, and fish consumption history. However, no association between the dental fillings and urinary BPA was found. This is the first study to demonstrate the relationship between dental fillings and body level of Hg and /or BPA in a nationally representative population. Our findings did not address the potential adverse health effects at low thresholds of mercury exposure; however, a significant correlation between the blood level of mercury and dental restoration raises major concerns about potential mercury exposure. 

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