Long term changes in health complaints after removal of amalgam restorations

Björkman, Lars; Sjursen, Therese Thornton; Dalen, Knut; Lygre, Gunvor Bentung; Berge, Trine Lise Lundekvam; Svahn, Johanna; Lundekvam, Birgitte Fos

doi:10.1080/00016357.2016.1278262

Cited by 8 publications

(6 citation statements)

References 67 publications

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“…34 Additionally, general health complaints have been reported to decrease with the removal of amalgam fillings compared with the decrease in the previous urine mercury level. 26 No difference was found in the mean neurobehavioral evaluation or nerve conduction velocity in children treated with amalgam filling compared with those treated with composite resin. 41 MiRNAs have an important role in basic biological processes, such as apoptosis, proliferation, differentiation, improvement, and inflammation.…”

Section: Discussionmentioning

confidence: 87%

The Relationship Between Plasma MicroRNAs and Serum Mercury Levels in Patients with Amalgam Filling and Dentists

TUNCDEMIR

YERLİKAYA

2021

Selcuk Dental Journal

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Bu çalışmanın amacı, amalgam dolgusu olan hastalarda ve diş hekimlerinde serum civa ve nörolojik hastalıklarla ilişkili bazı plazma mikroRNA (miRNA) seviyeleri arasındaki ilişkiyi araştırmaktır.Gereç ve Yöntemler: Bu çalışmaya 30 amalgam dolgulu hasta, 30 amalgam dolgusu olmayan diş hekimi ve 30 sağlıklı kontrol grubu dahil edildi. Dolaşımdaki plazma miRNA'lar (124-3p, 125-5p ve 127-3p), gerçek zamanlı kantitatif polimeraz zincir reaksiyonu analizi kullanılarak değerlendirildi. Serum civa seviyeleri, endüktif olarak eşleşmiş plazma-kütle spektrometresi kullanılarak ölçüldü. İstatistiksel analizler için ANOVA ve Tukey'in çoklu karşılaştırma testleri kullanıldı (α = .05).Bulgular: Gruplar arasında serum civa ve plazma miRNA seviyelerinde anlamlı bir fark bulundu. Hasta grubunda serum civa ile plazma miRNA 125-5p ve 127-3p seviyeleri arasında anlamlı pozitif korelasyonlar tespit edildi (sırasıyla r: 0.56 ve r: 0.39). Serum civa ve plazma miRNA-125-5p seviyeleri, diş hekimi grubunda pozitif bir korelasyon gösterdi (r: 0.37).Sonuç: Amalgam dolguya sahip olmak serum civa ve bazı plazma miRNA düzeylerinde önemli bir artışa neden olmuştur. Pozitif bir korelasyonun varlığı, civa maruziyeti nedeniyle nörolojik hastalıklara duyarlılığın artabileceğini göstermektedir. Amalgam dolgu için alternatif restoratif materyaller tercih edilmeli ve amalgam dolgular, gerekli önlemler alınarak diğer restoratif materyaller ile değiştirilmelidir.

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Section: Discussionmentioning

confidence: 87%

The Relationship Between Plasma MicroRNAs and Serum Mercury Levels in Patients with Amalgam Filling and Dentists

TUNCDEMIR

YERLİKAYA

2021

Selcuk Dental Journal

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“…However, the improvement of health after amalgam removal is reported to last for many years, [26][27][28] which may reduce the probabil- has been reported to be associated with the reduction of concentration of inorganic mercury in serum 29 as well as the concentration of mercury in urine at baseline before treatment. 27,29 Such associations between symptoms and laboratory parameters cannot be observed by the patients, which makes observation bias an unlikely explanation for the improvements. Regression to the mean and natural recovery can also contribute to symptom reduction; however, the MUPS cohort with similar symptoms at baseline had no improvement.…”

Section: Key Resultsmentioning

confidence: 99%

“…Another possibility is observation bias, since the symptom and quality of life outcomes are documented by self‐report, and patients offered the desired treatment free of charge could possibly exaggerate their improvement. However, symptom reduction after amalgam removal has been reported to be associated with the reduction of concentration of inorganic mercury in serum 29 as well as the concentration of mercury in urine at baseline before treatment 27,29 . Such associations between symptoms and laboratory parameters cannot be observed by the patients, which makes observation bias an unlikely explanation for the improvements.…”

Section: Discussionmentioning

confidence: 99%

“…Thus, expectations about the treatment effects could influence the results. However, the improvement of health after amalgam removal is reported to last for many years, 26‐28 which may reduce the probability of placebo as the only cause of the improvement. The possibility of a discontinuation of a hypothetical nocebo effect from amalgam fillings has been suggested as one potential explanation for a reduction of health complaints following amalgam removal 22 .…”

Section: Discussionmentioning

confidence: 99%

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Removal of dental amalgam restorations in patients with health complaints attributed to amalgam: A prospective cohort study

Björkman

Alræk

Werner

et al. 2020

J of Oral Rehabilitation

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Summary Background The Norwegian Ministry of Health and Care Services initiated a project including experimental treatment for patients with health complaints attributed to amalgam restorations. Objective The aim was to evaluate changes of general health complaints in patients who participated in the project and had all amalgam restorations removed. Methods The project was designed as a prospective cohort study and organised by the Dental Biomaterials Adverse Reaction Unit in Bergen, Norway. The dental treatment was provided by the patient's local dentist. The main target group consisted of patients with medically unexplained physical symptoms, attributed to dental amalgam restorations (Amalgam cohort). The primary comparison group consisted of patients with medically unexplained physical symptoms without attribution to dental amalgam restorations (MUPS cohort). Primary outcome was self‐reported general health complaints (GHC index) at follow‐up 12‐months after completed amalgam removal. Results In the Amalgam cohort, a significant reduction of GHC index from 43.3 (SD 17.8) at baseline to 30.5 (SD 14.4) at follow‐up (mean reduction 12.8, SD 15.9; n = 32; P < .001) was observed. The change scores for GHC index indicated that the reduction of complaints was significantly higher (P = .004) in the Amalgam cohort compared with the MUPS cohort (mean reduction 1.2, SD 12.3, n = 28). After adjustment for age, gender, education and baseline GHC index, the mean adjusted difference was −8.0 (95% confidence interval from −15.4 to −0.5; P = .036). Conclusion In a group of patients with medically unexplained physical symptoms, which they attributed to dental amalgam restorations, removal of amalgam restorations was followed by a significant reduction of health complaints.

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“…With advancement in technology and materials, there is an increasing tendency to use mercury-free and environmental-friendly materials and avoid the use of dental amalgam [11]. Although there is no strong evidence that amalgam restorations can cause general health symptoms, there are several studies showing that general health complaints are significantly reduced after amalgam removal [12][13][14][15][16]. Using similar data, a recent study showed a considerable reduction of general health complaints after amalgam removal in patients with attribution to their health complaints to amalgam restorations [17].…”

Section: Introductionmentioning

confidence: 99%

Is amalgam removal in patients with medically unexplained physical symptoms cost-effective? A prospective cohort and decision modelling study in Norway

et al. 2022

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There are many patients in general practice with health complaints that cannot be medically explained. Some of these patients attribute their health complaints to dental amalgam restorations. This study examined the cost-effectiveness of the removal of amalgam restorations in patients with medically unexplained physical symptoms (MUPS) attributed to amalgam fillings compared to usual care, based on a prospective cohort study in Norway. Costs were determined using a micro-costing approach at the individual level. Health outcomes were documented at baseline and approximately two years later for both the intervention and the usual care using EQ-5D-5L. Quality adjusted life year (QALY) was used as a main outcome measure. A decision analytical model was developed to estimate the incremental cost-effectiveness of the intervention. Both probabilistic and one-way sensitivity analyses were conducted to assess the impact of uncertainty in costs and effectiveness. In patients who attribute health complaints to dental amalgam restorations and fulfil the inclusion and exclusion criteria, amalgam removal is associated with modest increase in costs at societal level as well as improved health outcomes. In the base-case analysis, the mean incremental cost per patient in the amalgam group was NOK 19 416 compared to the MUPS group, while mean incremental QALY was 0.119 with a time horizon of two years. Thus, the incremental costs per QALY of the intervention was NOK 162 680, which is usually considered cost effective in Norway. The estimated incremental cost per QALY decreased with increasing time horizon, and amalgam removal was found to be cost saving over both 5 and 10 years. This study provides insight into the costs and health outcomes associated with the removal of amalgam restorations in patients who attribute health complaints to dental amalgam fillings, which are appropriate instruments to inform health care priorities.

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Long term changes in health complaints after removal of amalgam restorations

Abstract: Removal of amalgam restorations was followed by a long term reduction of general health complaints, which was associated with mercury concentration in urine before amalgam removal. Additional studies are needed to confirm the potential mechanisms for the observed reduction.

Cited by 8 publications

References 67 publications

The Relationship Between Plasma MicroRNAs and Serum Mercury Levels in Patients with Amalgam Filling and Dentists

The Relationship Between Plasma MicroRNAs and Serum Mercury Levels in Patients with Amalgam Filling and Dentists

Removal of dental amalgam restorations in patients with health complaints attributed to amalgam: A prospective cohort study

Is amalgam removal in patients with medically unexplained physical symptoms cost-effective? A prospective cohort and decision modelling study in Norway

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