Amalgam Fillings Research Articles

Failure Rate of Pediatric Dental Treatment under General Anesthesia.

Aim: To assess the failure rates of various pediatric dental treatments performed under general anesthesia (GA) after six months to five years of follow-up. Design: This multicenter retrospective cohort study was performed on patients treated by five pedodontists in two private hospitals located in northern Iran during 2010–2013 and comprised 155 patients. The patients were recalled and clinically examined. During the clinical examination of the primary teeth, oral hygiene, dmft index, and failure of previous treatments was evaluated. The data were analyzed using the Chi square and regression analyses with a significance level of 0.05. Results: 114 patients (74 males and 40 females, mean age: 37.17 ± 10.75 months) with 1155 primary teeth treated under GA participated in the follow-up. The overall failure rate was 6.59%. The failure rates of pulpectomy, pulopotomy, fissure sealant, stainless steel crown (SSC), amalgam, and composite fillings were 2.90%, 3.03%, 4.83%, 5.26%, 5.33%, and 9.63%, respectively. Among the confounding factors, only gender had a significant effect on the anterior composite failure rate (p = 0.029) and age had a significant effect on the failure rate of fissure sealant therapy (p = 0.015) and SSC (p = 0.018). Conclusion: The overall rate of treatment failure in pediatric patients, treated under GA, was 6.59%.

Microbial Diversity of Mer Operon Genes and Their Potential Rules in Mercury Bioremediation and Resistance

Background:Mercury is a toxic metal that is present in small amounts in the environment, but its level is rising steadily, due to different human activities, such as industrialization. It can reach humans through the food chain, amalgam fillings, and other sources, causing different neurological disorders, memory loss, vision impairment, and may even lead to death; making its detoxification an urgent task.Methods:Various physical and chemical mercury remediation techniques are available, which generally aim at: (i) reducing its mobility or solubility; (ii) causing its vaporization or condensation; (iii) its separation from contaminated soils. Biological remediation techniques, commonly known as bioremediation, are also another possible alternative, which is considered as cheaper than the conventional means and can be accomplished using either (i) organisms harboring themeroperon genes (merB,merA,merR,merP,merT,merD,merF,merC,merE,merHandmerG), or (ii) plants expressing metal-binding proteins. Recently, differentmerdeterminants have been genetically engineered into several organisms, including bacteria and plants, to aid in detoxification of both ionic and organic forms of mercury.Results:Bacteria that are resistant to mercury compounds have at least a mercuric reductase enzyme (MerA) that reduces Hg+2to volatile Hg0, a membrane-bound protein (MerT) for Hg+2uptake and an additional enzyme, MerB, that degrades organomercurials by protonolysis. Presence of bothmerA andmerB genes confer broad-spectrum mercury resistance. However,merA alone confers narrow spectrum inorganic mercury resistance.Conclusion:To conclude, this review discusses the importance of mercury-resistance genes in mercury bioremediation. Functional analysis ofmeroperon genes and the recent advances in genetic engineering techniques could provide the most environmental friendly, safe, effective and fantastic solution to overcome mercuric toxicity.

Biomarkers of selenium status and antioxidant effect in workers occupationally exposed to mercury

The present observation based research was designed to evaluate the influence of occupational human exposure to metallic mercury (Hg°) vapor on the biomarkers of selenium status involved in the antioxidant defense system. For this purpose we determined Hg and selenium (Se) concentrations in body fluids, the markers of antioxidant effect measured as an activity of Se-dependent enzymes (red blood cell and plasma glutathione peroxidase: GPx1-RBC and GPx3-P), concentration of selenoprotein P in the plasma (SeP-P) and total antioxidant activity in the plasma (TAA-P) in 131 male workers from a chloralkali plant exposed to Hg° and 67 non-exposed males (control group). The mRNA expression levels of glutathione peroxidases (GPX1, GPX3), selenoprotein P (SEPP1), thioredoxin reductase 1 (TRXR1), thioredoxin 1 (TRX1), peroxiredoxins (PRDX1, PRDX2) were also examined in the leukocytes of peripheral blood. Hg concentration in the blood (Hg-B) and urine (Hg-U) samples was determined using the thermal decomposition amalgamation/atomic absorption spectrometry (TDA-AAS) method and Se concentrations in plasma (Se-P) and urine (Se-U) using the inductively coupled plasma mass spectrometry (ICP-MS) method. Activities of GPx1-RBC, GPx3-P and TAA-P were determined using the kinetic and spectrophotometric method, respectively. Gene expression analysis was performed using the quantitative Real-Time PCR.The results showed significant higher Hg levels among the Hg°–exposed workers in comparison to control group (12-times higher median for Hg-B and almost 74-times higher median for Hg-U concentration in chloralkali workers). Se-P was also significantly higher (Me (median): 82.85 μg/L (IQR (interquartile range) 72.03–90.28 μg/L) for chloralkali workers vs. Me: 72.74 μg/L (IQR 66.25-80.14 μg/L) for control group; p = 0.0001) but interestingly correlated inversely with Hg-U in chloralkali workers suggesting depletion of the Se protection among the workers with the highest Hg-U concentration. The mRNA level for GPX1, PRXD1 were markedly but significantly higher in the workers compared to the control group. Moreover, concentrations of Hg-B and Hg-U among the workers were significantly positively correlated with the levels of selenoprotein P at both the mRNA and selenoprotein levels. In the multivariate model, after adjusting to cofounders (dental amalgam fillings, age, BMI, job seniority time, smoking), we confirmed that Hg-U concentration was inversely correlated with genes expression of TRXR1.This is the first comprehensive assessment of the impact of occupational exposure of workers to Hg° at both the mRNA and selenoprotein levels, with investigation of fish intake obtained by means of a questionnaire. These findings suggest that exposure to Hg° alters gene expression of the antioxidant enzymes and the level of Se-containing selenoproteins.

Accuracy and consistency of electronic root canal length determination with electrically isolating rubber stoppers.

The aim of this study was to investigate the influence of an isolating silicone stopper on the measuring accuracy and display consistency of three electrometric apex locators. The length of the canal to the major foramen was determined electrometrically using an ISO size 10 file in 20 extracted teeth each with natural crowns (Group I), amalgam fillings (Group II) or base-metal crowns (Group III), The measurements were performed with isolating or conventional silicone stoppers using three different apex locators with a four-level scale consistency rating. The use of isolating stoppers resulted in a more consistent display than with conventional stoppers, independent of the presence or type of coronal restoration (P = 0.017). Across all coronal restorations, the position of the major foramen could be determined to within ± 0.5 mm without significant differences (P = 0.79) using conventional and isolating stoppers. The use of modified isolating stoppers provides a significant increase in display consistency.

"Triple M" Effect: A Proposed Mechanism to Explain Increased Dental Amalgam Microleakage after Exposure to Radiofrequency Electromagnetic Radiation.

A large body of evidence now indicates that the amount of mercury released from dental amalgam fillings can be significantly accelerated by exposure to radiofrequency electromagnetic fields (RF-EMFs) such as common mobile phones and magnetic resonance imaging (MRI). Studies performed on the increased microleakage of dental amalgam restorations after exposure to RF-EMFs have further supported these findings. Although the accelerated microleakage induced by RF-EMFs is clinically significant, the entire mechanisms of this phenomenon are not clearly understood. In this paper, we introduce "Triple M" effect, a new evidence-based theory which can explain the accelerated microleakage of dental amalgam fillings after exposure to different sources of electromagnetic radiation. Based on this theory, there are saliva-filled tiny spaces between amalgam and the tooth. Exposure of the oral cavity to RF-EMFs increases the energy of these small amounts of saliva. Due to the small mass of saliva in these tiny spaces, a small amount of energy will be required for heating. Moreover, reflection of the radiofrequency radiation on the inner walls of the tiny spaces causes interference which in turn produces some "hot spots" in these spaces. Finally, formation of gas bubbles in response to increased temperature and very rapid expansion of these bubbles will accelerate the microleakage of amalgam. Experiments that confirm the validity of this theory are discussed.

Quantitative estimation of mercury intake by toxicokinetic modelling based on total mercury levels in humans

Mercury is a toxic metal that can be disseminated into the environment from both natural and anthropogenic sources. Human exposure to the metal stems mainly from food, and more particularly from the consumption of fish and other seafoods. Examining dietary exposure and measuring mercury levels in body tissues are two ways of estimating exposure to mercury. In this study, we utilized a modelling system consisting of three linear toxicokinetic models for describing the fate of methyl mercury, inorganic mercury, and metallic mercury in the body, in order to estimate daily intake of mercury as measured through total mercury concentrations in the blood. We then compared the results stemming from our modelling system to those of the detailed semi-quantitative food frequency questionnaire (FFQ) of the Norwegian Fish and Game (NFG) Study, a project that focused on dietary mercury exposure.The results indicate that toxicokinetic modelling based on blood levels gave higher daily intake values of mercury compared to those of the FFQ. Furthermore, the former had a wider range of estimates than the latter. The properties of the toxicokinetic model or limitations in the dietary exposure assessment could be posited as reasons for the differences between the respective methods. Moreover, the results may have been influenced by sources of mercury exposure that cannot be described as dietary, such as amalgam fillings.

Toxic heavy metals in human blood in relation to certain food and environmental samples in Kerala, South India.

Toxic heavy metals such as arsenic (As), lead (Pb), and mercury (Hg) are systemic toxicants that are hazardous to human health. However, as these elements are increasing in the environment due to fast urbanization, industrialization, and chemicalized agricultural activities, accumulation of the same in human body anywhere in the world is quite interesting to global assessment of environment quality. In this connection, random examination of blood samples of human population in Kerala, South India, was carried out to assess the threat of heavy metal contamination to humans in this part of the globe, especially in relation to the amount of such metals in food and other environmental samples. Except pure vegetarians, people of Kerala consume rice as the staple food with a lot of fish. Therefore, the amount of these three heavy metals in drinking water, fish, rice, and paddy soils was done. Heavy metals in the blood were examined in relation to age, gender, and dietary habits such as frequency of fish eating or vegetarianism. Influence of dental amalgam fillings on blood mercury levels was also analyzed. Quantitative assessment of metals in samples was done by inductively coupled plasma-mass spectrometry (ICP-MS). The levels of arsenic, lead, and mercury were found well below the reference values, though diet seemed to pull them up as the amount of metals in blood showed significant differences between vegetarians and non-vegetarians. Evidence to the influence of dental amalgam fillings on blood mercury levels could not be established with the present samples.

Clinical and Radiographic Evaluation of Marginal Bone Loss and Periodontal Parameters after Various Dental Reconstruction Procedures

Background: Periodontal disease is a bacterial infection that causes bone resorption of bone supporting teeth and leads to change in the normal architecture of the alveolar process. There are instances where the technique sensitive nature of restorative procedures or the faulty restorative margins may inadvertently lead to conditions which could bring about periodontal disease/ destruction. Therefore, this study was designed to determine the impact of dental restorations type on marginal bone among some patients being treated for chronic periodontitis. Material and Methods: Three hundred patients from the periodontics clinics in college of dentistry, King Khalid university were participated in our study. A total of 292 patients completed the study, 152 males and 140 female. They were divided according to dental reconstructions into three groups: Group I was without dental reconstructions (control group), group II patients received amalgam class II fillings and group III received fixed bridge denture. Plaque index (PLI) gingival index (GI), clinical attachment loss (CAL) and marginal bone loss (MBL) were recorded. All data were collected and were analyzed by ANOVA test. Results: In the present study, the restored teeth revealed significantly higher mean values for PLI, GI, CAL and MBL than the non-restored teeth (p-value < 0.05). Conclusion: Although the limitations of the present study, the patients in group II had the highest clinical attachment loss and value of marginal bone loss which can explain the more extension of amalgam fillings into subgingival direction, leading to increased plaque accumulation and increased periodontal destruction.

Wear of resin composites: Current insights into underlying mechanisms, evaluation methods and influential factors.

SummaryThe application of resin composites in dentistry has become increasingly widespread due to the increased aesthetic demands of patients, improvements in the formulation of resin composites, and the ability of these materials to bond to tooth structures, together with concerns about dental amalgam fillings. As resistance to wear is an important factor in determining the clinical success of resin composite restoratives, this review article defines what constitutes wear and describes the major underlying phenomena involved in this process. Insights are further included on both in vivo and in vitro tests used to determine the wear resistance of resin composite and the relationships between these tests. The discussion focuses on factors that contribute to the wear of resin composite. Finally, future perspectives are included on both clinical and laboratory tests and on the development of resin composite restorations.

Hair mercury and risk assessment for consumption of contaminated seafood in residents from the coast of the Persian Gulf, Iran

The health risks of mercury exposure due to the high consumption of aquatic were assessed for fishermen and non-fishermen families living on the Bandar Abbas, Bushehr, and Mahshahr cities located in the coast of Persian Gulf (Iran). The mean hair mercury concentration of people in Bandar Abbas, Bushehr, and Mahshahr cities was obtained 1.56±0.17, 1.97±0.22, and 5.12±0.3μgg-1, respectively. Hair mercury concentration in 8.8% of people exceeded the no observed adverse effects level (NOAEL) of 10μgg-1 declared by the World Health Organization (WHO). The fish and shrimps consumption, place of living, and fisher and non-fisherman family were variables that significantly effected on mercury levels in the hair. The effect of other factors (age, sex, and number of dental amalgam fillings) on hair mercury was not significant. The mean concentrations of mercury in three fish species in Mahshahr exceeded the recommended maximum standard level (0.5μgg-1) set by the Joint Food and Agriculture Organization/World Health Organization Expert Committee on Food Additives (JECFA). The estimated weekly intake (EWI) for mercury in some fish species in Bandar Abbas, Bushehr, and Mahshahr was higher than the provisional tolerable weekly intake (1.6μgkg-1 bw) set by European Food Safety Authority (EFSA) for some groups. The significant positive correlation between daily mercury intake and hair mercury concentration of people (r=0.64, P<0.001) reasserts that the hair mercury concentration could be explained by fish consumption. HQ>1 was obtained for women in child bearing age in fishermen families in Bandar Abbas and Bushehr cities, children in fishermen families in Bushehr, and for all groups of population except adult in non-fishermen families in Mahshahr. So, the limited consumption of some fish species for these groups of people is recommended. The maximum of allowable fish consumption rate was 0.70 meals/month for Pseudorhombus arsius from Mahshahr fish for women of child bearing age. Also, it is necessary to create and monitor and enforce environmental standards, preventing the entry of pollutants released into the marine aquatic environment without proper early treatment.

Dental amalgam fillings and the use of technological devices as an environmental factor: Updating the cumulative mercury exposure-based hypothesis of autism.

Dental amalgam fillings and the use of technological devices as an environmental factor: Updating the cumulative mercury exposure-based hypothesis of autism.

Choroby miejscowe i układowe wywołane obecnością ciał obcych w jamie ustnej

The oral cavity is the first part of the digestive and respiratory systems; it fulfills important vital functions. Its normal function is dependent on many factors, both internal and external. The oral mucosa is constantly exposed to the influence of external factors. In addition, various foreign bodies are more often placed in the mouth, for both therapeutic treatment and decoration. For example: oral piercing, braces, dental implants, amalgam fillings. All of these factors can adversely affect the function of the mucosa as well as the whole organism. This paper is a review of recent literature and an analysis of the impact of selected foreign bodies on the oral cavity and the whole body, with particular attention paid to the risks associated with piercing. Studies clearly show that the presence of foreign bodies in the mouth contributes to the formation of many pathological conditions and diseases. They can be just local complications, but in some cases also general. Literature reports indicate that the presence of foreign bodies in the mouth can also lead to complications that have serious consequences to overall health. The presence of foreign bodies, particularly in the oral cavity can adversely affect its functioning and health of the entire system.

Competence profiles in undergraduate dental education: a comparison between theory and reality

BackgroundCompetence profiles are purposed to provide a blueprint in support to develop and/or benchmark the learning outcomes of undergraduate dental curricula. This study aims to investigate whether a competence profile as proposed by academic- and clinical experts is able to represent the real clinical reality.MethodsA questionnaire was developed including questions about gender and age, perception about required competences, and educational organisation and was distributed among Flemish dentists via email and on paper during a symposium. The data was analysed using descriptive statistics, Chi-square and non-parametric Mann-Whitney U-tests.ResultsA total of 312 questionnaires were completed (=6.5% of dentist population, with similar gender and age characteristics). All competences in the European competence profile were rated between 7.2 and 9.4 on a 10-point scale. In dentists under 50 years, females rated the importance of identifying/managing anxiety and abnormal patient behaviour; and promoting/improving oral health as significantly higher than males. In dentists of 50 years and above, females rated 8 competences significantly higher than males, including obtaining/recording a complete history; identifying/managing anxiety and abnormal patient behaviour; obtaining/interpreting radiography; identifying temporomandibular and associated disorders; identifying orthodontic needs; awareness of own limitations/when to refer; managing dental urgencies; and basic-life-support/defibrillation. Clinical practice management was most frequently reported as additional competence to address in dental education. Furthermore, the respondents suggested an undergraduate dental curriculum based on 34% theoretical education, 26% preclinical skills training, and 40% clinical education and 86% agreed with a duration of 5 years. Finally, the respondents also illustrated the dynamic nature of dentistry including a reduction of amalgam fillings, a shift from individual practice to group practices, an increased administrative load, and more assertive patients.ConclusionFindings in the present study suggest the validation of the proposed competences for graduating European dentists within the clinical reality of dental professionals in daily practice. Nevertheless, the results have also demonstrated heterogeneity regarding gender and age within the dentist population and emphasised a continuously evolving dental profession and required competences. Hence, to maintain high quality of dental care, a strategy should be developed in which dental curricula are continuously benchmarked against an evolving clinical reality.

Response to Comment on Giuseppe Genchi et al. Mercury Exposure and Heart Diseases. Int. J. Environ. Res. Public Health 2017, 14, 74.

We are grateful to Paknahad and coauthors for giving us the opportunity to consider the interesting papers by Kursun et al., Mortazavi S.M.J. et al., Mortazavi G. et al., Shahidi et al., Yilmaz et al., about the effects of electromagnetic fields (EMFs) produced by magnetic resonance imaging (MRI) or those generated by other sources such as mobile phones, mobile base stations, cordless phones, Wi-Fi routers, radio and TV broadcasting, and X-rays which can increase the mercury release from amalgam fillings [1,2,3,4,5,6].[...]

Mercury exposure from amalgam fillings during pregnancy

Mercury exposure from amalgam fillings during pregnancy

Reduced Susceptibility to Antiseptics Is Conferred by Heterologous Housekeeping Genes.

Antimicrobial resistance is common in the microbial inhabitants of the human oral cavity. Antimicrobials are commonly encountered by oral microbes as they are present in our diet, both naturally and anthropogenically, and also used in oral healthcare products and amalgam fillings. We aimed to determine the presence of genes in the oral microbiome conferring reduced susceptibility to common antimicrobials. From an Escherichia coli library, 12,277 clones were screened and ten clones with reduced susceptibility to triclosan were identified. The genes responsible for this phenotype were identified as fabI, originating from a variety of different bacteria. The gene fabI encodes an enoyl-acyl carrier protein reductase (ENR), which is essential for fatty acid synthesis in bacteria. Triclosan binds to ENR, preventing fatty acid synthesis. By introducing the inserts containing fabI, ENR is likely overexpressed in E. coli, reducing the inhibitory effect of triclosan. Another clone was found to have reduced susceptibility to cetyltrimethylammonium bromide and cetylpyridinium chloride. This phenotype was conferred by a UDP-glucose 4-epimerase gene, galE, homologous to one from Veillonella parvula. The product of galE is involved in lipopolysaccharide production. Analysis of the E. coli host cell surface showed that the charge was more positive in the presence of galE, which likely reduces the binding of these positively charged antiseptics to the bacteria. This is the first time galE has been shown to confer resistance against quaternary ammonium compounds and represents a novel, epimerase-based, global cell adaptation, which confers resistance to cationic antimicrobials.

Comparison of cone beam computed tomography and digital intraoral radiography performance in the detection of artificially induced recurrent caries-like lesions

The aim of this study was to compare the performance of cone beam computed tomography (CBCT) and digital radiography in the detection of artificial recurrent caries-like lesions under amalgam and composite fillings. The study included class II cavities in 30molars that had been filled with amalgam. Fifteen of those molars had the restoration-enamel interface artificially demineralized. Phantoms were prepared, and CBCT images were acquired with 2 units in 3 voxel sizes (K9000, 0.076mm; i-CAT, 0.2mm and 0.4mm). Intraoral radiographs were obtained with 3 systems (Digora, VistaScan, and RVG-6100). Amalgam fillings were then replaced by composite, and new images were obtained. Three examiners assessed all of the images. Sensitivity, specificity, accuracy, and receiver operating characteristic curve were calculated and verified through analysis of variance and the Tukey test. There were no significant differences in sensitivity and specificity when the same restorative material was present or when the restorative materials were compared with the imaging technique as a constant. As for accuracy and receiver operating characteristic curve, there were statistically significant differences when the 2 materials were compared, and there were differences in the amalgam group when the imaging modalities were compared. CBCT performed similarly to intraoral radiography in detecting demineralization under restorations. However, the voxel size and the type of restorative material influenced its performance.

Assessment of Different Techniques to Detect Recurrent Carious Lesion Around Amalgam Filling

Assessment of Different Techniques to Detect Recurrent Carious Lesion Around Amalgam Filling

Four or More Amalgam Fillings Correlate With Higher Blood Mercury Levels in Pregnant Women but Not High Enough to be of Health Concern

Dental associations with blood mercury in pregnant women. Golding J, Steer CD, Gregory S, Lowery T, Hibbeln JR, Taylor CM. Community Dent Oral Epidemiol 2016; 44: 216-22. This study was funded by a combination of government (UK Medical Research Council), foundation/nonprofit (the Welcome Trust) and university (University of Bristol, UK) grants. Cross-sectional.

Managing Amalgam Phase Down: An Evaluation of Mercury Vapor Levels in a Dental Center in Lagos, Nigeria

Background: Occupational exposure to elemental mercury vapor in a dental setting is mainly through inhalation exposure during preparation, insertion, polishing, and removal of amalgam fillings including storage of amalgam waste before disposal. This study aims to determine the indoor air levels of elemental mercury vapor in the dental operatories and ancillary sites at the Lagos State University Teaching Hospital (LASUTH). Materials and Methods: Samples of the ambient air were taken at seven locations the Dental Center of LASUTH by a trained technician between 9:00 and 11:00 a.m. This was done at a predetermined height (41/2feet) above the floor for mercury vapor concentration using Lumex 915 light data logger mercury vapor analyzer manufactured by Ohio Lumex Company Incorporation, USA®. Results: The highest level of 1434 ng/m3 of mercury vapor in the air was found in the restorative clinic while the lowest of 23 ng Hg/m3 was found in the ambient air at the entrance of the dental Center. The Oral Surgery clinic had mercury vapor level of 318 ng/m3 which was slightly higher than Environmental Protection Agency recommended value of 0.3 μg/m3. Conclusion: An unacceptably high level of mercury vapor was detected, especially in the restorative clinic. Every dental clinic should have its ambient air evaluated for mercury vapor level for the purpose of forming a baseline data for monitoring purposes during the period of phase down of amalgam use. Best practices should also be instituted to reduce the level of exposure of patients and dental care workers to mercury vapor.