The use of mercury-silver fillings should be discontinued until such time
as primary pathological evidence of amalgam safety is produced.
International Academy of Oral Medicine and Toxicology
A SCIENTIFIC RESPONSE to the
American Dental Association's
Special Report and Statement of Confidence
in Dental Amalgam
This response was prepared by the International Academy of Oral
Medicine and Toxicology, a Canadian non-profit charitable organization dedicated to
research and education. The IAOMT's corporate center is in Canada, but send all mail to
its Executive Director, Michael Ziff, D.D.S, at P.O. Box 608531, Orlando, FL, 32860-8531.
PRESENTATION: ADA claims and our
CONCLUSION: The ADA misinforms the
REFERENCES: Forty-four books and
In 1985 the International Academy of Oral Medicine and Toxicology (IAOMT)
reviewed the transcript of the National Institute of Dental Research (NIDR) Workshop on
the Biocompatibility of Metals in Dentistry1 and the then available scientific
literature and concluded that there was reasonable doubt about the safety of dental
amalgam. We recommended that:
IAOMT Says: Discontinue Amalgams
The use of mercury/silver fillings should be discontinued until such time as
primary pathological evidence of amalgam safety is produced.
ADA Claims: Amalgam Safe
Since that time, there have been a series of published statements/articles from
the American Dental Association (ADA) and Canadian Dental Association (CDA), all claiming
that dental amalgam was safe for use as a filling material. None of these pronouncements
referenced or provided any basic scientific research showing the safety of amalgam. Since
the majority of dentists in North America rely on the guidelines of the leadership of the
ADA, the CDA and the NIDR, it is imperative that these organizations be scientifically
accurate when they make statements to the profession which can affect the public health.
To address this issue of accuracy the following scientific response was prepared by the
Board of Directors of IAOMT on behalf of our members. Claims of alleged safety are
compared with the documented scientific literature.
IAOMT Recommends Moratorium on Amalgams
Since our 1985 recommended moratorium on future placement of mercury/silver
fillings, scientific research has furthered reinforced the basis for our concern. The
IAOMT acknowledges that primary pathological data linking mercury from dental amalgam with
any specific disease is not available. This would in fact be impossible because primary
studies have never been undertaken. However, we understand that such investigations are
currently underway, partially funded by this academy.
In the interest of public safety, we reaffirm our 1985 position that the use of
this material should cease.
In April of 1990 the ADA published a Special Report, entitled When Your
Patients Ask About Mercury In Amalgam.2
The ADA Special Report Is Misleading
This American Dental Association Special Report is of concern because it omits
information and contains misinformation which misleads patients and dentists regarding
amalgam safety. This misinformation could have a serious impact, preventing patients from
making an accurate informed consent.
The IAOMT has reviewed a few of the pertinent statements and compared them to
the published and documented scientific facts.
Eleven American Dental Association Claims 2
1. IS MERCURY POISONOUS?
The Patient Asks,
"But isn't mercury poisonous?"
The ADA Answers:
when used in dental amalgam. Alone, in the form scientists call elemental mercury and the
public sometimes calls quicksilver, mercury is toxic at high concentrations. However, when
mercury is combined with other metals, such as the silver, tin, and copper, it reacts with
them to form a biologically inactive substance.
The ADA answer
is false and misleading.
The ADA answer fails to mention that set dental amalgam continuously releases
"It is a fallacy that mercury is neutralized when it is combined with
other components of silver dental amalgam. The laws of physical chemistry are followed.
Mercury is diluted by the other components of amalgam in what may be considered a solid
solution. Although the vapor pressure of mercury is reduced, mercury vapor is still
released. An identical situation arises when alcohol is diluted by water." 3
Research has shown that mercury even in extremely small amounts has toxic
effects, for example, low dose mercury exposure has been shown to produce neurological
pathology, cytotoxicity to nerve tissue.4 5 6 7 8 9 10 11 12 13 14 15
We find it particularly disturbing that the ADA has made
such a blanket statement without any scientific support.
2. IS MERCURY RELEASED FROM FILLINGS?
The Patient Asks,
"Does the mercury come out of my fillings
when I eat or chew gum?"
The ADA Answers:
advances in both equipment and measurement techniques have allowed researchers to detect
extremely low levels of mercury vapor in patients' breath after they have chewed
vigorously. Very small quantities of this mercury vapor are absorbed by the body instead
of being exhaled. But no evidence exists that associate this minute amount of mercury
vapor with any toxic effects."
ADA answer is false.
Published experimental evidence as early as 1926 has demonstrated that mercury
is not locked in, but is released from fillings.16 More recent research has
shown that both chewing and tooth brushing release mercury vapor into the human oral
cavity.17 18 19
Recent advances in both equipment and measurement technique have allowed
researchers to find intra-oral mercury levels thirty to one hundred times higher that the
United States Environmental Protection Agency's (USEPA) maximum allowable concentration
for air quality. (0.3 part per million)20 21 22 23 24 25 26 Toxicology
authorities maintain that there is no threshold level of mercury exposure which can be
considered totally harmless.27 28
Dental fillings release mercury. The mercury release dramatically increases
with pressure or heat stimulation to the fillings and does not return to baseline for more
than 90 minutes.29 30 This continual release of mercury will inevitably result
in measurable exposure from the 17,000 breaths that a person inhales daily. Once this
mercury is inhaled 74% to 100% of the mercury is absorbed from the lung into the blood
stream and distributed throughout the body.31 Personal habits such as chewing
gum, grinding teeth and mouth breathing will greatly increase an individuals daily dose
exposure to dental amalgam mercury. The 1/2 life for mercury in humans is approximately 70
days. Thus, small multiple daily doses of mercury will result in a significant
accumulation over time. The critical issues are the potential for exposure to the
developing fetus and mercury accumulation in children because of their low body weight.
To study these possibilities Vimy et al. (1990) designed an elegant animal
experiment utilizing sheep and radioactively tagged mercury203. Twelve occlusal amalgams
were placed in the molars of pregnant sheep. The mothers femoral vein, the placental sack
and the femoral vein of the fetus were cannulated.32 33 Radioactivity
measurements determined the presence and quantity of mercury from the dental amalgam
fillings in the various body tissues of both the mother and fetuses. The experiment is
specific for mercury from fillings, since radioactive mercury is not a naturally occuring
substance in the environment. The design of this experiment eliminates the issue of
1) Within 3 days after amalgam placement mercury was found in the maternal
blood, amniotic fluid, fetal blood, and maternal urine and feces.
2) By 16 days after amalgam placement the maternal mercury levels were highest
in the kidney, liver, G.I. tract, and thyroid. The mercury levels in the fetus were
highest in the pituitary, liver, kidney, and placental cotyledon.
3) At 33 days after amalgam placement (birthtime), most fetal tissues had
higher levels of mercury than the maternal tissues. Specifically, the fetal liver,
epiphysial bone, bile, bone marrow, blood, and brain.
4) During lactation there was 8 times more mercury in the milk than maternal
blood serum. This resulted in an increase in mercury exposure to the neonate.
5) Seventy-three days after amalgam placement, mercury levels in the maternal
kidneys, liver, parotid glands, pancreas, pituitary glands, urine, bile, brain, and
thyroid were still rising slowly.
The researchers concluded that mercury vapor released from dental amalgam
fillings is readily absorbed in lung, gastrointestinal tract and jaw bone and
progressively accumulates in maternal and fetal tissues with exposure duration. Neonatal
mercury exposure from this dental material occurs via milk. They stated in their
conclusions that, "our laboratory findings in this investigation are at variance with
the anecdotal opinion of the dental profession, which claims that amalgam tooth fillings
3. LARGEST SOURCE OF INORGANIC MERCURY EXPOSURE
The Patient Asks,
"Are there other sources of mercury?"
The ADA Answers:
a major source of mercury exposure is from fish in the diet. . . . Research shows that you
may be exposed to more mercury from fish than from dental amalgams."
The ADA answer
is scientifically inaccurate and misleading.
In contrast to the ADA position, it has been scientifically concluded that
mercury/silver fillings constitutes the largest source of inorganic mercury exposure to
the general population and this exposure exceeds organic mercury exposure from fish.34
Autopsies of people with fillings confirm that dietary mercury exposure is apparently much
less than from dental amalgam mercury.35 36 Authorities in the field of metal
toxicology have concluded that this chronic exposure from dental fillings makes the
predominant contribution of human exposure to mercury.37
4. OTHER MATERIALS SAFE?
The Patient Asks,
"Are these other materials safe?"
The ADA Answers:
ADA has approved a number of them as 'safe and effective,' and I have confidence in that
seal of approval. The profession has been using amalgam for more than 150 years, and some
of these newer materials have been around for only a decade or less, so we don't have the
long-standing history of safety with them that we have with amalgam."
The ADA answer
There is no ADA certification for the mixed amalgam as, "safe and
effective." The ADA has maintained that mixed dental amalgam is a reaction product
manufactured by the individual dentist and therefore cannot be certified and it is the
responsibility of the individual dentist to determine the efficacy of the materials and
their appropriateness for each patient.38 One reading this paragraph is given
the distinct impression that dental amalgam has the ADA seal of approval as, "safe
and effective" and has been certified. What has been certified is the purity of the
mercury and the composition of the silver alloy.
5. 150 YEARS OF SUCCESSFUL (?) USE
Dental Association's: Special Report:
In the statement of confidence in amalgam, the ADA no longer maintains that the
safety of this dental implant has been scientifically proven but relies on the anecdotal
opinion of 150 years of "successful" use.
The ADA States:
strongest and most convincing support we have for the safety of dental amalgam is the fact
that each year more than 100 million amalgam fillings are placed in the United
This is a
It should be cause for concern that approximately seventy-two tons of mercury
are used annually in dentistry, much of it being implanted in the teeth of North Americans
without any proof of safety. "The absence of evidence is not evidence of
absence" (Carl Sagan).
Historically numerous common products were thought to be safe; for example
asbestos, lead, and DDT. In each case the scientific concerns were immediately discounted
by the industry responsible for the production or use of the material and often the
assertions of safety were initially supported by the responsible government agencies.
After a period of time as the evidence became overwhelming and legal liability impossible
to ignore, they were regulated or withdrawn from the market. Each of these products
demonstrated pathology after a latency period of chronic low dose exposure as does
Moreover, the resulting pathology from mercury tends to be of a medical nature
and would not be apparent to most dentists. Thus, in the case of amalgam mercury exposure,
if a health problem should exist, most dentists are not trained to diagnose such a
condition and most physicians would not be aware of the possibility that mercury from
fillings might have induced the pathology.
6. BLATANTLY FALSE STATEMENT
The ADA Statement Of Confidence
In Amalgam claims:
"The Food and Drug Administration in
1987 classified mercury amalgam as a Class I dental device."
The ADA statement is
In fact, the FDA in 1987 classified the alloy and the mercury components of
mercury amalgam separately. They refused to classify the set amalgam reaction product.
7. REMOVE CURRENT AMALGAMS?
The Patient Asks,
"If there is any question at all, wouldn't it be wise for concerned patients to
simply have their amalgam fillings removed and replaced with other materials?"
The ADA Answers:
"Unless the patient suffers an immediate adverse (allergic) reaction to an amalgam, a
reaction that does not resolve in a short time, it is not advisable to have amalgam
Since 1984 the ADA has claimed that the incidence of hypersensitivity to
mercury is less than 1%.39
The ADA answer
is both false and misleading.
The ADA position is in stark contrast to the published scientific literature
both before and after 1984.
It has been reported that cutaneous (skin) allergy to mercury occurs in
approximately 5% of the general population.
Studies of those with amalgam fillings finds that between 2% - 35% test
hypersensitive to mercury.40 41 42 None of the experimental subjects without
dental amalgam tested positive for allergy to mercury.
The development of this adverse reaction may not be immediate but, research
shows that the incidence of allergy gradually increases with time and onset may be delayed
five or more years.43
8. MISLEADING BIBLIOGRAPHY
Association's: Special Report
does includes a short bibliography.
The ADA 's Sources:
ADA supports their argument with five references.
Bibliography: 1) Reinhardt, J.W. Risk assessment of mercury exposure from
dental amalgams. J. Public Health Dent 48:172-7, 1988
2) Langan, D.C., Fan, P.L., Hoos, A.A. The use of mercury in dentistry: a critical review
of the recent literature. JADA 115:867-880, 1987
3) Fan, P.L. Safety of Amalgam. CDA J 15:34-6 1987
4) The Mercury Scare. Consumer Reports, March 1986
5) Council on Dental Materials, Instruments, and Equipment and Council on Dental
Therapeutics. Safety of amalgam-an update. JADA 119:204-5 1989
bibliography cited is misleading.
The total lack of valid science to support the continued use of amalgam is
apparent in the ADA Special Reports bibliography.
They cite only review articles and lay media reports and no primary research
into either animal or human physiological or immunological reaction to dental amalgam
The review articles and lay reports rely almost exclusively on measurements of
mercury from blood, and urine to support their conclusions. On page 396 of the Special
Report the author partially quotes the conclusion of the 1984 NIDR Workshop on the
Biocompatibility of Metals in Dentistry, "and there appears to be little correlation
between (mercury) levels in urine, blood, or hair, and toxic effects." They thereby
negate the validity of their own bibliographical references.
The scientific literature clearly does not support such an approach.
Quoting directly from the research, "Urinary mercury levels may give some
indication of the degree of exposure. They are of limited value in the diagnosis of
poisoning, since high levels can be found in human subjects who are symptom-free, and low
levels in those exhibiting marked evidence of mercurialism. It has been suggested that, in
some cases, failure to excrete mercury is a factor in the development of poisoning. Those
investigators that have studied the subject are in almost unanimous agreement that there
is poor correlation between the urinary excretion of mercury and the occurrence of
demonstrable evidence of poisoning." 44
Moreover, none of the articles referenced in the ADA bibliography contain hard
research. They merely cited other primary research papers to support their divergent
conclusions. Many of the primary research scientists referenced in the review articles did
not conclude that amalgam was safe. This bibliography would therefore be very misleading
to anyone not familiar with the current research.
9. ADA BROCHURE MISINFORMS
Health Care Needs"
A Brochure from the ADA
The ADA Promotes:
ADA utilized this Special Report to promote the sale of their patient education brochure
on the safety of dental amalgam titled, Filling Dental Health Care Needs (W186).
makes many of the same false claims and factual errors found in the ADA's Special Report.
It is the conclusion of this academy, the International Academy of Oral
Medicine and Toxicology, that the use of the ADA's brochure alone would misinform dental
patients regarding the potential risks they might undergo from having this material
implanted and leave the dentist at risk of legal liability and guilty of negligent
10. ADA PROMOTES VIOLATION OF DENTAL ETHICS
The ADA Principals
found in the ADA's: Special Report
The ADA States:
ADA Principals of Ethics and Code of Professional Conduct Sect E under Research and
Development states, "The dentist has the obligation to make known to all the results
of his investigations if they have an effect on public health."
full informed consent is subverted.
Scientific documentation has clearly proven chronic exposure, biological
accumulation, and delayed adverse immune response to mercury from amalgam fillings. The
ADA, by promoting the use of this document and pamphlet W186, is apparently suggesting
that dentists deliberately violate their own code of ethics and withhold vital information
from their patients and the public. Such action cannot help but intentionally violate the
patients right to full informed consent.
11. ADA VIOLATED PATIENTS' RIGHTS
Changes to the
American Dental Association's: Special Report
The ADA Alters:
ADA and CDA Principals of Ethics and Code of Professional Conduct was recently changed to
say, "the removal of amalgam restorations from the non-allergic patient for the
alleged purpose of removing toxic substances from the body, when such treatment is
performed solely at the recommendation or suggestion of the dentist, is improper and
violated patients' rights.
We conclude that the alteration of the ADA and CDA code of ethics to indict
those dentists who recommend the removal of amalgam because of suspected toxicity violated
the rights of the patient to informed consent and freedom of choice between the doctor and
Although the Associations state that "dentists should choose the best
possible restorative material for each patient on an individual basis," this is
clearly not their intent. The changes to the Principals of Ethics and Code of Professional
Conduct restrict the dentists freedom of speech and deprive the patient of the legal right
to informed consent and freedom of choice.
Given the inconsistencies between the scientific facts and this American Dental
Association Special Report, the International Academy of Oral Medicine and Toxicology has
serious concerns regarding the ADA's lack of scientific rigor and the tendency to
misinform the dental profession and, thereby, the public at large regarding the
established scientific facts about amalgam safety.
We hereby call to task the ADA for failure to adequately support their position
on dental amalgam with hard scientific data. This failure has resulted in inadequate
protection to the public and inadequately protects the membership of the ADA from personal
harm due to amalgam usage.
1 National Institute of Dental Research (NIDR). Workshop on the
biocompatibility of metals in dentistry JADA (169-171) Vol 109, 1984
2 JADA, Special Report: When your patients ask about mercury in amalgam. Vol
120, p 395-398 April 1990
3 Dun, A. Harmful Vapors in the Office: A report of the findings of the 1985
ODA/RCDS survey of mercury vapor in dental offices in Ontario Ontario Dentist p 37-38
4 Sharma, R.P., Obersteiner, E.J. Metals and Neurotoxic Effects: Cytotoxicity
of Selected Metallic Compounds on Chick Ganglia Cultures. Journal of Comp. Pathology Vol.
5 Leirskar, J. On the mechanism of cytotoxicity of silver and copper amalgams
in a cell culture system. Scand J Dent Res 82:74-81, 1974
6 Wedeen, R.P. Lead, Mercury and cadmium nephropathy Neurotoxicology (Park
Forrest Ill, 4(3): 134-146, 1983
7 Weening, J.J. et al. Autoimmune reactions and glomerulonephritis caused by
heavy metals and other toxins. Dev Toxicol Environ Sci, 11: 211-216, 1983
8 Weening, J.J. et al. Mercury induced immune complex glomerulopathy: an
experimental study. Chapter 4: pp 36-66. VanDendergen, 1980
9 Koller, L.D. Immunotoxicology of heavy metals. Int J Immunopharmacol ,
10 Koller, L.D. Immunosuppression produced by lead, cadmium, mercury. Am J Vet
11 Koller, L.D. et al. Immuno response in rats supplemented with selenium. Clin
Exp Immunol. 63 (3) :570-576, 1986
12 Fiskesjo, G. The effect of two organic mercury compounds on human leukocytes
in vitro. Hereditas. 64:142-146, 1970
13 Gerstner, H.B., Huff JE. Clinical Toxicology of Mercury. Journal of
Toxicology and Environmental Health. Vol 2, Issue 3 (491-526), 1977
14 Verschaeve, L. et al. Genetic Damage induced by Occupational Low Mercury
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15 Nordberg, G.F., ed. Effects and Dose Response Relationships of the Toxic
Metals. New York: Scientific Publishing Co 1976
16 Stock, A. Die Gefahrlichkeit des quecksilberdampfes. Z Angew Chem. 1926, 39:
17 Svare, C.W., Peterson, L.C., Reinhardt, J.W., Boyer, D.B., Frank, C.W., Gay,
D.D., Cox, R.D. The effect of Dental Amalgams on mercury levels in expired air. J Dent
Res. 60:1668-71, 1981
18 Vimy, M.J., Lorscheider, F.L. Intra-oral air mercury released from dental
amalgam. J Den Res. 64:1069-71, 1985
19 Patterson, J.E.; Weisberg, B.G.; Dennison, J.P. Mercury in Human breath from
dental amalgam. Bull Environ. Conatam. Toxicol. 34: 459-468, 1985
20 U.S.E.P.A. Mercury Health Effects Update. Final Report
(1984)EPA-600/8-84-019F United States Environmental Protection Agency, Office of Health
and Environment Assessment. Washington, D.C. 20460
21 Gay, D.D., Cox, R.D., Reinhardt, J.W. Chewing releases mercury from
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22 Svare, C.W. et al. The effect of dental amalgams on mercury levels in
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23 Reinhardt, J.W., et al. Exhaled mercury following removal and insertion of
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24 Till, T. and Maly, K., Mercury in tooth roots and in Jaw bones. ZRW. 87 (6)
: 288-2909 1978
25 Moller, B. Reaction of the human dental pulp to silver amalgam restorations.
Swed Dent J. 1978 : 2 : 93-7
26 Freden, H. et al. Mercury content in gingival tissues adjacent to amalgam
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27 National Institute for Occupational Safety and Health (NIOSH). A recommended
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28 Vostal, J.J., Clarkson, T.W. Mercury as an environmental hazard. J Occupat
Med. 15:649-56, 1973
29 Vimy, M.J., Lorscheider, F.L. Serial measurements of intra-oral air mercury;
Estimation of daily dose from dental amalgam. J Dent Res. 64(8):1072-5, 1985.
30 Patterson, J.E.; Weisberg, B.G.; Dennison, J.P. Mercury in Human breath from
dental amalgam. Bull Environ. Conatam. Toxicol. 34: 459-468, 1985
31 Goldwater, L.J. Ladd, A.C. and Jacobs, M.B. Absorption and Excretion of
Mercury in Man; VII Significance of mercury in Blood. Arch Envir Health. 9:735-741: 1964
32 Hahn, L.J. ; Kloiber, R.; Vimy, M.J.; Takahashi, Y.; Lorscheider, F. Dental
"silver" tooth fillings: a source of mercury exposure revealed by whole-body
image scan and tissue analysis. FASEB J. 3:2641-2646; 1989
33 Vimy, M.J., Takahashi, T., Lorscheider, F.L. Maternal-fetal distribution of
Mercury 203 released from dental amalgam fillings. Journal of American Physiology. 4/90
34 Clarkson, T.W., Friberg, L., Hursh, J., and Nylander, M."Biological
Monitoring of Toxic Metals". in Clarkson, T.W., Friberg, L., Nordberg, G.F. &
Sager, P.: Eds. Plenum Press, N.Y. Feb 1988
35 Friberg, L., Kullman, L., Lind, B., Nylander, M. Kvicksilver i centrala
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Correlation of dental amalgam with mercury in brain tissue. J Pros Dent. 58:704-7, 1987
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from Dental Amalgam Computer Simulation of a Metabolic Compartment Model. J. Dent. Res.
65(12):1415-1419, December, 1986
38 ADA Letter: John W. Stanford, PhD. Secretary CDMIE. May 22,1986
39 JADA. NIDR Workshop Vol. 109 9/84
40 Djerassi, E., Berova, N. The possibilities of allergic reactions from silver
amalgam restorations. Int Dent J. 19:48l-8, 1969
41 Robinson, H.M., Bereston, E.S. Contact dermatitis due to the mercury of
amalgam dental fillings. Arch Dermatol Syphilol. 59:116-8, 1949
42 White, R.R., Brandt, R.L. Development of mercury hypersensitivity among
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43 Miller, E.G., Perry, W.L., Wagner, M.J. Prevalence of mercury
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44 Goldwater LJ. The toxicology of inorganic mercury. Annals NY Acad Sci
Copyright © 1995-1998
by Preventive Dental Health Association and Sizzle! Productions
End: A Scientific Response
Other Pages On This Site:
Dental Health Risks
"Mercury from Amalgam fillings contributes 3 to 4 times
more mercury to our bodies than all the environmental sources combined."
Dental health Forums:
Dental Care & Amalgam
Other Recommended books:
- The Mercury In Your Mouth---Quicksilver Associates, 10 East 87 Street, New
York, NY 10128. Tel: 212 423 3074 Fax - 289 3046
- The End of Cancer by Charlotte Dubois & John Lubecki, D.C.
- Root Canal Cover Up by George Meinig
- Toxic Metal Syndrome by Casdorph & Walker
- Dental Mercury Detox by Ziff
Dentists have the highest suicide and divorce rates among professional. Female
dental personnel have a higher spontaneous abortion rate, a raised incidence of premature
labour, and an elevated perinatal mortality.
Research has demonstrated that 100% of all root canals result in residual
infection due to the imperfect seal that allows bacteria to penetrate. The toxins given
off by these bacteria are more toxic than mercury. These toxins can cause systemic
diseases of the heart, kidney, uterus, and nervous and endocrine systems.
"Electrogalvanism is frequently the cause of lack of concentration and
memory, insomnia, psychological problems, tinnitus, vertigo, epilepsy. To name a
few."---Edward Arana, D.D.S.