Dental Amalgam Research Articles

Human biomonitoring of essential and toxic trace elements (heavy metals and metalloids) in urine of children, teenagers, and young adults from a Central European Cohort in the Czech Republic.

Exposure to toxic trace elements, which include metals and metalloids, can induce adverse health effects, including life-threatening diseases. Conversely, essential trace elements are vital for bodily functions, yet their excessive (or inadequate) intake may pose health risks. Therefore, identifying levels and determinants of exposure to trace elements is crucial for safeguarding human health. The present study analyzed urinary concentrations of 14 trace elements (arsenic, cadmium, cobalt, chromium, copper, mercury, manganese, molybdenum, nickel, lead, antimony, selenium, thallium, and zinc) and their exposure determinants in 711 individuals, spanningfrom children to young adults from a Central European population from the Czech Republic. Multivariate linear regression and non-parametric Kruskal-Wallis ANOVA were used to investigate exposure determinants. Estimates of 95th percentile concentrations and confidence intervals were carried out to establish reference values(RV95). The study also assessed the percentage of population exceeding health-based guidance values (GVs) to gauge health risks. Young adults showed elevated toxic element concentrations, whereas children exhibited higher concentrations of essential elements. Mercury concentrations were associated with both dental amalgam filling count and seafood intake; arsenic concentrations were associated with seafood, rice, and mushroom consumption. Mushroom consumption also influenced lead concentrations. Sex differences were found for cadmium, zinc, nickel, and cobalt. Between 17.9% and 25% of the participants exceeded recommended GV for arsenic, while 2.4% to 2.8% exceeded GV for cadmium. Only one participant exceeded the GV for mercury, and none exceeded GVs for chromium and thallium. Essential trace elements' GVs were surpassed by 38% to 68.5% participants for zinc, 1.3% to 1.8% for molybdenum, and 0.2% to 0.3% for selenium. The present study examines trace element exposure in a Central European population from the Czech Republic, unveiling elevated exposure levels of toxic elements in young adults and essential elements in children. It elucidates key determinants of trace element exposure, including dietary and lifestyle indicators as well as dental amalgam fillings. Additionally, the study establishes novel reference values and acomparison with established health-based human biomonitoring guidance values, which are crucial for public health decision-making. This comprehensive biomonitoring study provides essential data to inform public health policies and interventions.

Assessment of patient awareness and attitudes towards dental amalgam

Assessment of patient awareness and attitudes towards dental amalgam

P07-01 Monitoring of mercury release in dental amalgam wearers by measuring salivary and urinary mercury

P07-01 Monitoring of mercury release in dental amalgam wearers by measuring salivary and urinary mercury

The accuracy of Eclipse AXB and AAA dose algorithms with dental amalgam.

High-density materials used for dental restorations are poorly defined in CT imaging due to scanner limitations. Studies have established that Eclipse offers poor agreement with delivered dose in situations involving high-density material. Defining the accuracy of dose algorithms in situations involving high-density overrides would improve clinical outcomes both for target coverage and OAR sparing. Dental amalgam was placed within a solid water phantom and measurements were taken at 1cm increments beneath the amalgam down to a depth of 6cm. Exposed film was compared with Eclipse Treatment Planning system (TPS) calculations on a CT of the experimental setup. The amalgam was overridden with a range of HU values and material selections for dose calculation. AXB performs poorly at describing depth dose downstream of Amalgam, regardless of the override material selected. Query ID="Q2" Text="Please confirm the section headings are correctly identified." Applying the known mass density with the Anisotropic Analytical Algorithm (AAA) predicts an average of 1.8% and 2.8% for 6 MV and 10 MV beams. The closest agreement achieved using the Acuros XB (AXB) was overriding with stainless steel, which predicted approximately 1.1% and 1.8% above measured dose for 6 MV and 10 MV respectively. Without overriding the density of amalgam, AAA and AXB return depth dose predictions of 7.3% and 5.8% above film measurement for a 6 MV and 7.6% and 6.5% for 10 MV static beams. Applying override options to a clinical case using an anthropomorphic phantom showed using AXB with Stainless Steel as amalgam override returns the same results as AAA with mass density applied for amalgam. Both of these were in close agreement to the TPS.

Mercury air, urine monitoring and health effects on occupationally exposed dental healthcare workers in Delhi, India.

Mercury (Hg) is a toxic heavy metal with multiple uses in various medical devices. Hg is used in dentistry as a restorative material. Such use creates significant exposure to dental practitioners. Hence, it is important to assess the risk created by Hg use in healthcare. To quantify airborne Hg vapour exposure and Hg levels in dental healthcare workers, and determine the association of various symptoms and diseases to Hg exposure. Air monitoring of Hg vapours were conducted in dental clinics and amalgam rooms. Urine samples were collected from occupationally exposed dental healthcare workers and urine Hg levels were measured. A cross-sectional health survey was conducted in 23 healthcare units of Delhi to determine an association between Hg exposure and various health effects. Hg vapour concentration ranged from 0.96μg/m3 to 15μg/m3, the highest concentration was recorded in the amalgam room (15μg/m3). Urine Hg levels in healthcare workers (0.51±0.17μg/L) were higher than the control (0.29±0.05μg/L). A cross-sectional health survey revealed a significant prevalence of confusion, forgetfulness, muscle spasm, and tremors by the respondents. Hg concentration in dental clinics may hover above the prescribed safe levels posing a definitive health risk to healthcare workers. Urinary Hg measurements did not reveal an excess of body burden except in one case. Since Hg bio accumulates, it is probable as these workers grow older, they may end up with a higher body burden of Hg that may lead to a variety of adverse health outcomes.

Knowledge, Attitude and Practice of Dental Students, Interns and Practitioners Towards the Phase-Down of Dental Amalgam in A Dental Institution of Libya

Knowledge, Attitude and Practice of Dental Students, Interns and Practitioners Towards the Phase-Down of Dental Amalgam in A Dental Institution of Libya

Community social responsibility of continued and appropriate use of silver amalgam as dental restorative material in southern India: A cross-sectional study

Background For more than 150 years, dental amalgam (DA) has been popular as a dental restorative material. Many organizations oppose its use due to perceived toxicity and environmental concerns. Hence, this study aimed to explore the continued use of DA from a South Indian dental practitioners’ perspective. Methods This cross-sectional study was conducted among fifty-two private and public dental practitioners of Udupi district in Southern India. A self‑administered questionnaire was distributed, that involved assessment of their preferences, continuation of use and concerns of using DA as a restorative material. The percentage contribution of each variable was calculated. Preferences for continuation of use of silver amalgam based upon the age, experience and mercury toxicity as a risk factor were analyzed using Students-t test and Fisher’s Exact Test test. Results Most dentists were satisfied (87%) with the results of the DA, found minimal failures (96%) and found DA more economical (89%). More than half (54%) of the participants reported that they would not continue the use of DA owing to mercury toxicity and environmental concerns. Dentists with higher age and longer clinical experience preferred continuation of DA. Conclusions Despite satisfaction with DA for its minimal failure, longevity and affordability, the authors found that most practitioners did not prefer its continued usage. This highlights their concerns over mercury toxicity and soft tissue lesions and accentuates their community social responsibility. There is also an urgent need to educate dentists on mercury hygiene, mercury waste management and disposal.

Survival Rates of Amalgam and Composite Resin Restorations from Big Data Real-Life Databases in the Era of Restricted Dental Mercury Use.

Tooth decay, also known as caries, is a significant medical problem that harms teeth. Treatment is based on the removal of the carious material and then filling the cavity left in the tooth, most commonly with amalgam or composite resin. The consequences of filling failure include repeating the filling or performing another treatment such as a root canal or extraction. Dental amalgam contains mercury, and there is a global effort to reduce its use. However, no consensus has been reached regarding whether amalgam or composite resin materials are more durable, and which is the best restorative material, when using randomized clinical trials. To determine which material is superior, we performed a retrospective cohort study using a large database where the members of 58 dental clinics with 440 dental units were treated. The number of failures of the amalgam compared to composite resin restorations between 2014 and 2021 were compared. Our data included information from over 650,000 patients. Between 2014-2021, 260,905 patients were treated. In total, 19,692 out of the first 113,281 amalgam restorations failed (17.49%), whereas significantly fewer composite restorations failed (11.98%) with 65,943 out of 555,671. This study indicates that composite is superior to amalgam and therefore it is reasonable to cease using mercury-containing amalgam.

Evaluating the accuracy of Chat Generative Pre-trained Transformer version 4 (ChatGPT-4) responses to United States Food and Drug Administration (FDA) frequently asked questions about dental amalgam

BackgroundThe use of artificial intelligence in the field of health sciences is becoming widespread. It is known that patients benefit from artificial intelligence applications on various health issues, especially after the pandemic period. One of the most important issues in this regard is the accuracy of the information provided by artificial intelligence applications.ObjectiveThe purpose of this study was to the frequently asked questions about dental amalgam, as determined by the United States Food and Drug Administration (FDA), which is one of these information resources, to Chat Generative Pre-trained Transformer version 4 (ChatGPT-4) and to compare the content of the answers given by the application with the answers of the FDA.MethodsThe questions were directed to ChatGPT-4 on May 8th and May 16th, 2023, and the responses were recorded and compared at the word and meaning levels using ChatGPT. The answers from the FDA webpage were also recorded. The responses were compared for content similarity in “Main Idea”, “Quality Analysis”, “Common Ideas”, and “Inconsistent Ideas” between ChatGPT-4’s responses and FDA’s responses.ResultsChatGPT-4 provided similar responses at one-week intervals. In comparison with FDA guidance, it provided answers with similar information content to frequently asked questions. However, although there were some similarities in the general aspects of the recommendation regarding amalgam removal in the question, the two texts are not the same, and they offered different perspectives on the replacement of fillings.ConclusionsThe findings of this study indicate that ChatGPT-4, an artificial intelligence based application, encompasses current and accurate information regarding dental amalgam and its removal, providing it to individuals seeking access to such information. Nevertheless, we believe that numerous studies are required to assess the validity and reliability of ChatGPT-4 across diverse subjects.

Quantum Chemical and Electrochemical Studies of Water and Ethanol Extracts of Salvadora Persica (Miswak) as a New Green Inhibitor for Dental Amalgam in Artificial Saliva

Abstract The corrosion-inhibitive properties of Salvadora Persica water and ethanol extracts as a novel green inhibitor for dental amalgam in artificial saliva were studied by using potentiodynamic polarization measurements and electrochemical impedance spectroscopy measurements (EIS). The electrochemical results revealed that the Salvadora Persica extracts demonstrated strong inhibitory effects at 0.66 g/L and implied that the water extract was more effective than the ethanol extract. The inhibition efficiency (IE%) increases with increasing concentrations of both Salvadora Persica extracts and decreases with increasing temperature. The results of this work indicated that Salvadora Persica extracts act as mixed-type inhibitors, inhibiting the corrosion of dental amalgam by the adsorption process, which followed the Langmuir adsorption isotherm model. The thermodynamic results revealed that the adsorption process is endothermic with electrostatic interaction (physisorption). Various DFT parameters, like HOMO and LUMO energy, gab energy (∆E), electronegativity (χ), softness (

Impact of bisphenol A and analogues eluted from resin-based dental materials on cellular and molecular processes: An insight on underlying toxicity mechanisms.

Dental resin systems, used for artificial replacement of teeth and their surrounding structures, have gained popularity due to the Food and Drug Administration's (FDA) recommendation to reduce dental amalgam use in high-risk populations and medical circumstances. Bisphenol A (BPA), an endocrine-disrupting chemical, is an essential monomer within dental resin in the form of various analogues and derivatives. Leaching of monomers from resins results in toxicity, affecting hormone metabolism and causing long-term health risks. Understanding cellular-level toxicity profiles of bisphenol derivatives is crucial for conducting toxicity studies in in vivo models. This review provides insights into the unique expression patterns of BPA and its analogues among different cell types and their underlying toxicity mechanisms. Lack of a consistent cell line for toxic effects necessitates exploring various cell lines. Among the individual monomers, BisGMA was found to be the most toxic; however, BisDMA and BADGE generates BPA endogenously and found to elicit severe adverse reactions. In correlating in vitro data with in vivo findings, further research is necessary to classify the elutes as human carcinogens or xenoestrogens. Though the basic mechanisms underlying toxicity were believed to be the production of intracellular reactive oxygen species and a corresponding decline in glutathione levels, several underlying mechanisms were identified to stimulate cellular responses at low concentrations. The review calls for further research to assess the synergistic interactions of co-monomers and other components in dental resins. The review emphasizes the clinical relevance of these findings, highlighting the necessity for safer dental materials and underscoring the potential health risks associated with current dental resin systems.

Health complaints before and at one and five years after removal of dental amalgam restorations - data from a prospective cohort study in Norway.

Health complaints attributed to dental amalgam fillings comprise both intraoral and general health complaints. There are data suggesting that patients with medically unexplained physical symptoms (MUPS) attributed to amalgam fillings show improvement in symptoms after removal of all amalgam fillings. However, data indicating changes of specific health complaints are limited. This study evaluated the changes of health complaints after removal of amalgam restorations in patients with health complaints attributed to dental amalgam fillings. Patients with MUPS attributed to dental amalgam (Amalgam cohort) had all their amalgam fillings removed. The participants indicated an intensity of 11 local and 12 general health complaints on numeric rating scales before the treatment and at follow-up after 1 and 5 years. The comparison groups comprising a group of healthy individuals and a group of patients with MUPS without symptom attribution to dental amalgam did not have their amalgam restorations removed. In the Amalgam cohort, mean symptom intensity was lower for all 23 health complaints at follow-up at 1 year compared to baseline. Statistically significant changes were observed for specific health complaints with effect sizes between 0.36 and 0.68. At the 5-year follow-up, the intensity of symptoms remained consistently lower compared to before the amalgam removal. In the comparison groups, no significant changes of intensity of symptoms of health complaints were observed. After removal of all amalgam restorations, both local and general health complaints were reduced. Since blinding of the treatment was not possible, specific and non-specific treatment effects cannot be separated.

Effect of Polishing and Universal Bonding Application on Mercury Release from Aged Amalgam after Exposure to Bleaching Agents.

Objectives: Teeth bleaching is an accepted and modern treatment in cosmetic dentistry. Bleaching agents may affect amalgam restorations and increase mercury release; therefore, patients are at increased risk of mercury exposure in the body. The aim of this study was to investigate the effect of polishing and universal bonding application on mercury release from aged amalgams exposed to bleaching. Materials and Methods: In this in-vitro experimental study, 64 dental amalgam specimens with dimensions of 3×5×10 were prepared and divided into two experimental and control groups. Each group was further divided into 4 subgroups and received one of the following treatments: no intervention, surface bonding, polishing, or polishing and surface bonding. Subsequently, the samples were immersed in bleaching agent containing 7% hydrogen peroxide and the amount of mercury released after 96h was measured. The results were analyzed by two-way ANOVA and Tukey post hoc tests (α≤0.05). Results: The results showed that the type of solution (P<0.05) and surface treatment (P<0.001) significantly affected the level of mercury release. However, there was no significant interaction between surface treatment methods in the bleaching group and those in the phosphate buffer group (P=0.621). Conclusion: Bleaching agents were found to enhance mercury release from dental amalgam. The application of polishing and universal bonding on amalgam surfaces exhibited significant effects on the reduction of the mercury release.

Community social responsibility of continued and appropriate use of silver amalgam as dental restorative material in southern India: A cross-sectional study

Background For more than 150 years, dental amalgam (DA) has been popular as a dental restorative material. Many organizations oppose its use due to perceived toxicity and environmental concerns. Hence, this study aimed to explore the continued use of DA from a South Indian dental practitioners’ perspective. Methods This cross-sectional study was conducted among fifty-two private and public dental practitioners of Udupi district in Southern India. A self‑administered questionnaire was distributed, that involved assessment of their preferences, continuation of use and concerns of using DA as a restorative material. The percentage contribution of each variable was calculated. Preferences for continuation of use of silver amalgam based upon the age, experience and mercury toxicity as a risk factor were analyzed using Students-t test and Chi-square test. Results Most dentists were satisfied (87%) with the results of the DA, found minimal failures (96%) and found DA more economical (89%). More than half (54%) of the participants reported that they would not continue the use of DA owing to mercury toxicity and environmental concerns. Dentists with higher age and longer clinical experience preferred continuation of DA. Conclusions Despite satisfaction with DA for its minimal failure, longevity and affordability, the authors found that most practitioners did not prefer its continued usage. This highlights their concerns over mercury toxicity and soft tissue lesions and accentuates their community social responsibility. There is also an urgent need to educate dentists on mercury hygiene, mercury waste management and disposal.

Dental Metal Matrix Composites: The Effects of the Addition of Titanium Nanoparticle Particles on Dental Amalgam.

Dental amalgams have been used by dentists for the restoration of posterior human teeth. However, there have been concerns about the release of mercury from amalgams into the oral cavity. The objective of the present research is to study the effect of titanium (Ti) nanoparticles on the microstructural mechanism of the release of mercury vapor in two commonly used brands of dental amalgam (the Dispersalloy: 11.8% Cu; the Sybralloy: 33% Cu). Ti powder was added to both the Dispersalloy and the Sybralloy in increments of 10 mg up to 80 mg. The addition of Ti powder to both brands of dental amalgam has been found to result in a considerable decrease in Hg vapor release. The decrease in the Hg vapor release due to Ti addition has been explained by the formation of strong Hg-Ti covalent bonds, which reduce the availability of Hg atoms for evaporation. The Ti atoms in excess of the solubility limit of Ti in Hg reside in the grain boundaries, which also reduces the evaporation of Hg from the amalgam. The binding of Hg with Ti via a strong covalent bond also results in a significant improvement in mechanical properties such as Vickers hardness.

Evaluation of Cytotoxic Effects of Purified Mercury in Human Gingival Fibroblasts-In vitro Study.

Since the introduction of amalgam for tooth fillings, there have been concerns that mercury toxicity could pose unacceptable health risks. Rasa shastra is an ancient medical discipline that focuses on the utilization of metals and minerals for the treatment of diseases. Nevertheless, these minerals cannot be directly administered to the human body in their natural state due to their potential adverse effects. Hence, for medicinal purposes, these metals and minerals need to undergo purification (Shodhana) to eliminate impurities and modify their physical, chemical, and biological characteristics. Human gingival fibroblasts (HGF) were exposed to commercially available mercury (CA-Hg) and ayurvedically purified mercury (AP-Hg) at concentrations of 6.25 μM, 12.5 μM, 25 μM and 50 μM. The unexposed HGF cultured in basal media was considered a control. All the samples were cultured for 24 hours and 48 hours, and the cytotoxicity was analyzed by MTT assay. Cell viability between the control and experimental groups varied at 24 hours, however, the results were not statistically significant (p>0.05). At 48 hours, cell viability was higher in the AP-Hg group as compared to the CA-Hg group at the concentration of 6.25 μM, and the difference was statistically significant (p<0.05). The cell proliferation assay results demonstrated a statistically significant difference in the mean optical density values (p<0.05) between CA-Hg and AP-Hg at 12.50 μM, 25 μM, and 50, μM concentrations observed at 24 hours. At 48 hours, a statistically significant difference in the mean OD values (p<0.05) between CA-Hg and AP-Hg at all four concentrations was observed. Conclusion: AP-Hg at a concentration of 6.25 μM demonstrated higher cell viability at 48 hours. Further, the cell proliferation rate was also higher for AP-Hg at all concentrations at 24 and 48 hours. These results indicated a less cytotoxic effect of AP-Hg than CA-Hg in HGF and hence could be employed for dental amalgam preparations.

Curcumin Mitigates Mercury-induced Memory Impairment and Neurotoxicity: Insights from the Drosophila melanogaster Model

Mercury-containing products, such as dental amalgam used for dental filling in dentistry, have been heavily criticised due to their associated toxicity. Nevertheless, it is still in use in low-income countries due to it being relatively affordable. Therefore, in this study, we evaluate the neurotoxic effects of mercury (Hg) and the possible ameliorative effects of polyphenol-curcumin using the fruit fly (Drosophila melanogaster) model. Male and female D. melanogaster, aged 3 to 5 days, were categorized into six groups, each consisting of 40 flies. To evaluate the impact of Hg exposure and the potential protective effects of curcumin, we conducted measurements on multiple parameters. These included assessing the survival rate, determining the memory index using an aversive phototaxis suppression assay, evaluating locomotor performance through negative geotaxis, and analysing various biochemical parameters associated with antioxidant status and neuronal function-related enzymes. Our findings indicate that dietary exposure to Hg resulted in a decreased survival rate and impaired locomotor performance in D. melanogaster. However, we observed a notable improvement in the antioxidant system among D. melanogaster exposed to Hg toxicity when they were fed a diet supplemented with curcumin. This improvement was evident through enhanced catalase activity, improved memory index, and modulation of acetylcholinesterase and monoamine oxidase activities. These effects were observed in comparison to D. melanogaster solely exposed to HgCl2 without curcumin supplementation. Collectively, these data showed that curcumin could mitigate the neurotoxicity associated with Hg and thus could serve as a substitute for Hg-containing products like dental amalgam.

Posterior tooth anatomy: wax carving. Part 2

This second article in the two-part series on wax carving provides a step-by-step guide focusing on the coronal anatomy of whole posterior teeth. The exercises are primarily designed to help clinicians simulate and master the carving and shaping of extensive dental amalgam and posterior resin composite restorations, as well as for use in designing fixed and removable prosthodontic restorations. CPD/Clinical Relevance: Knowledge and understanding of the anatomy of posterior teeth is a key skill in dentistry.

Adverse reactions to dental biomaterials: Experiences from a specialty clinic

ObjectivesThe Dental Biomaterials Adverse Reaction Unit was initiated by the Norwegian health authorities in 1992 as a response to the public concern regarding the safety of dental amalgam and other dental materials. In this paper, experiences from the Unit are briefly summarized. MethodsThe Norwegian health authorities’ strategy included four main topics: (i) development of a manufacturer-independent system for monitoring adverse reactions related to dental materials, (ii) funding of a specialty unit for clinical examinations of referred patients, (iii) development of official guidelines for examination and treatment of patients with health complaints attributed to dental materials, and (iv) funding of an experimental treatment project for patients with health complaints attributed to dental amalgam. ResultsFrom the start, more than 2700 adverse reaction reports were received. In the initial years, amalgam was the most frequent material mentioned in the reports. Reports about polymer-based composite materials have not increased after the prohibition of amalgam in Norway. Clinical examination of referred patients is complex and time consuming, and it is important to consider differential diagnoses. There are methodological challenges associated with the design of experimental treatments used on patients with adverse reactions attributed to dental materials. However, the results from the treatment project indicate lower symptom load after replacement of amalgam with other dental restorative materials. SignificanceProducer independent adverse reaction reporting can provide valuable information about the safety of these materials and could serve as a complement to the mandatory reporting system described in the European medical device regulations (MDR).

End of the Road for Dental Amalgam?

End of the Road for Dental Amalgam?