According to Miriam Webster's OnLine Dictionary Amalgam: is an alloy of mercury with another metal that is solid or liquid at room temperature according to the proportion of mercury present and is used especially in making tooth cements. Mercury, according to Webster's, is "a heavy silver-white poisonous metallic element that is liquid at ordinary temperatures and is used especially in scientific instruments -- also called quicksilver". The word Amalgam comes from the Arabic al-malgam, meaning softening ointment (presumably because, when it is first mixed, it is soft and putty-like). Amalgam is the word for the liquid or solid alloys of mercury with other metallic elements or alloys.

In some countries dental amalgam is classified as a medicine. If that were the case in the United States it would be subject to many more regulations than it is now. As far as the U.S. Code of Federal Regulations is concerned amalgam is a prosthetic device and not a drug:

Amalgam Alloy, (a) Identification. An amalgam alloy is a device that consists of a metallic substance intended to be mixed with mercury to form filling material for treatment of dental caries. (b) Classification. Class II (21 CFR 872.3050 (2001)).

What is an alloy? According to Webster's an alloy is a "substance composed of two or more metals or of a metal and a nonmetal intimately united usually by being fused together and dissolving in each other when molten." Therefore, strictly speaking, given this definition, "amalgam is not a true alloy. It is made up of 50% mercury, which is not locked into a set filling but escapes continuously during the entire life of the filling in the form of vapor, ions and abraded particles" according to the Australasian Society Of Medicine And Toxicology (ASOMAT)'s fact sheet, which contains an extensive bibliography,

To this day there are still dentists who believe mercury amalgam is stable despite hundreds of observations and studies proving the opposite. As early as 1883 amalgam was proven to give off mercury vapor sufficient to shorten the life of the hardy cockroach (Talbot E. S., "Injurious Effects of Mercury as Used in Dentistry", MISSOURI DENT J, 15:124-30, March, 1883).

For more information about mercury and a link to the Periodic Table of Chemical Elements consult this Mercury web site.

Mercury is poisonous. But how poisonous is it really? In its metallic form it is relatively harmless. Many people talk about how they played with mercury as children after the fever thermometer broke. They usually can't remember that it made them sick. Supposedly the mercury vapors were poisonous. They probably didn't inhale enough to make them sick. There are stories of children eating mercury bubbles. They did not die from it. A New England Journal of Medicine (June 15, 2000, Elemental Mercury Embolism To the Lung) article reported that a suicidal dental assistant injected mercury into herself. She apparently recovered although her chest x-ray shows what the mercury did to her lungs.

So, is mercury really that poisonous? The question can only be answered when it is specified in what form the mercury presents itself. Also, the degree of toxicity is a matter which seems to not have been fully explored, especially when it comes as a function of time. What time frame is necessary for this substance to be causing or exacerbating autism or amyotrophic lateral sclerosis--if indeed it is? Does it take a day, a week, months or years to cause symptoms? Both diseases have been mentioned in connection with mercury. There seems to be a paucity of data on the longterm effects of lowgrade exposure. What is known is that there are varying degrees of toxicity.

The relatively less poisonous metal and vapor forms of elemental mercury are not the only forms in which mercury occurs. There are many chemical combinations, inorganic and organic ones. All of them are poisonous. The most poisonous ones are organic. To illustrate how poisonous mercury can be, one only has to mention dimethyl mercury. Dimethyl mercury is an odorless, colorless liquid with the appearance of and weighing about three times as much as water. The extreme toxicity of dimethyl mercury is brought home in the WETTERHAHN LABORATORY POISONING CASE: FINAL MEDICAL REPORT, "Dimethyl Mercury Poisoning" (New England J. Med. 4 Jun 98 338:1672)(Science-Week 26 Jun 98), which describes the death of a scientist from mercury poisoning. Karen Wetterhahn spilled only a few drops of the liquid on her latex-gloved hands. Methylated mercury is relevant in the discussion of amalgam because under certain circumstances the mercury from amalgam may be methylated (Heintze, U., Edwardsson, S., Derand, T. and Birkhed, D.: "Methylation of Mercury From Dental Amalgam and Mercuric Chloride by Oral Streptococci in Vitro." Scand. J. Dental Research 91(2) 150-152, 1983; Yamada, Tonomura: "Formation of Methyl Mercury Compounds from Inorganic Mercury by Chlostridium cochlearium," J Ferment Technol 1972 50:159-166, and Field study on the mercury content of saliva, by P.Krauß and M. Deyhle*, K.H. Maier, E. Roller, H.D. Weiß, Ph. Clédon).

The Canadian Edmonton Journal, March 27, 2001, states in its headline: "Mercury Fillings Toxic -- Report U of C Researchers Say 'Visual Evidence' Brain Cells Affected," by Robert Walker. The article further states:

New research vividly demonstrating the damage mercury has on brain cells -- in concentrations seen in people with amalgam fillings -- was published by University of Calgary medical school researchers Monday...Drs. Fritz Lorscheider and Naweed Syed's research, published in the British journal, NeuroReport, is supported by a time-lapse video showing how brain cells die within 10 minutes when they are exposed to mercury in minute concentrations...

Owen Hamill summarizes Lorscheider/Syed in an article "Mercury induced growth cone collapse: another reason for flossing" (NeuroReport 2001;12:A23) saying

...evidence indicates that mercury vapor is continuously released from tooth fillings where it is breathed in by the lungs and converted into mercuric ions. Although there is no debate on the toxic effects of high concentrations of mercury (i.e. associated with urinary concentrations > 50 µg/l), a challenge exists to demonstrate more subtle, preclinical effects associated with chronic low level mercury exposure in the general population with fillings. At least consistent with this notion is the study published in this issue [5] showing that exposure to mercury concentrations of < 0.1 M results in rapid (i.e. within 10 min) retraction of growth cones in snail neurons and is correlated with disruption of microtubules. Interestingly, the authors point out that similar disruption of microtubules is associated with Alzheimer's disease. These recent findings give added impetus for the development and implementation of alternative materials for fillings and may provide parents with added ammunition in teaching their children to floss.

Significantly

...the other metals [also present in amalgam] – aluminum, lead, cadmium and manganese – did not produce this type of degeneration.

A news item in the Calgary Gazette provides further information about the study in which the researchers added mercury ions to snail neuron cell cultures, which were subsequently observed to degenerate rapidly. Fritz Lorscheider (physiology and biophysics) elaborates: "Our study illustrates how mercury ions alter the cell membrane structure of developing neurons. This discovery provides visual evidence of our previous findings that mercury produces a molecular lesion in the brain." (University of Calgary Gazette on the Web, April 2, 2001, "Researchers present evidence of mercury’s effect on brain neurons," April 2, 2001, Lorscheider, Syed, Leong).

The first reported cases of methyl mercury poisoning occurred in 1863:

A 30 year-old male who had been exposed to dimethyl mercury for three months "complained of numbness of the hands, deafness, poor vision and sore gums...[He was] unable to stand without support," although no motor palsy was detected. His condition rapidly worsened; he became restless and comatose within a week and died 2 weeks after the onset of symptoms. Another victim was a 23-year-old laboratory technician who had been working in the laboratory for 12 months, although he had handled dimethyl mercury for only 2 weeks.

He complained of sore gums, salivation, numbness of the feet, hands and tongue, deafness and dimness of vision. He answered questions only very slowly and with indistinct speech... Three weeks later he had difficulty in swallowing and was unable to speak... [He] was often restless and violent. He remained in a confused state and died of pneumonia 12 month after the onset of symptoms (from Environmental Health Perspectives, Vol. 104, Supplement 2, April 1996).

These two men had obviously been affected very severely. Milder cases outside of a mercury-laden environment would not have gotten much attention at a time when death from an infectious disease was so common and would probably be the suspected reason for a person's demise. The toxicity of mercury could be seen much more easily in context with a known mercury environment. In addition metallic toxins were ubiquitous. People still ate from pewter plates. Houses were painted with lead paint. People boiled tea water in copper kettles. All those metals are now known to be poisonous. The comparative symptoms of poisoning from the various heavy metals are remarkably similar and mercury was just one of them. There were no blood or urine tests, yet, sensitive enough to positively mark one or the other metal as the greater culprit for the symptoms at hand.

It is not known at which point mercury is not toxic any more. Mercury works at the molecuar level. At which point can it be said that no damage occurs? 150 years ago it was common for people to complain about symptoms of all sorts and it was even more common to label someone a hypochondriac.

All that said, already over a hundred years ago there existed reports and studies concerning the dangers of mercury from amalgam. The ADA cannot claim that amalgam has always, and by everyone, been considered to be harmless. The dentist E. S. Talbot writes in 1883:

The subject of mercurial poisoning from the use of amalgam fillings in decayed teeth, has given rise to numberless articles, and has been a source of discussion in dental societies since its introduction into this country. Symptoms of mercurial poisoning have manifested themselves in cases where these amalgams have been employed, causing the scientific members of the profession to investigate these fillings, to determine if these symptoms are due to the mercury contained in its composition. Nor is this investigation confined to men of science; the ordinary practitioner is constantly meeting these symptoms, and by careful observation will be able to diagnose these cases when met with. I will mention two cases which have come under my notice. ("Injurious Effects of Mercury as Used in Dentistry", MISSOURI DENT J, 15:124-30, March, 1883)

In those days the question of recognizing amalgam toxicity would have had to depend on an observant dentist who was aware of the dangers of mercury or on the rare truly fulminant cases that forced the dying patient to see a doctor. But even doctors were not always aware that their patients' symptoms were the symptoms of mercury poisoning since the medicines doctors commonly prescribed for baby's teething pains, kidney problems, syphilis, and constipation contained mercury (Calomel, mercuric chloride, teething powder, mercuro-chrome, Blue Mass). What was perscribed as a cure resulted in side effects, which were sometimes worse than the cure. Depression--then called melancholia--and all the other numerous symptoms that were lumped together and called "hypochondriasis" were considered less problematic because the chance of dying from an untreated illness was much greater in those days. President Lincoln, who was thought to be such a complainer, regularly took "Blue Mass." This medicine contained mercury according to an article in Perspectives in Biology and Medicine 44.3 (2001) 315-33: "Abraham Lincoln's Blue Pills, Did our 16th President Suffer from Mercury Poisoning?" by Norbert Hirschhorn, Robert G. Feldman, and Ian A. Greaves, also summarized in National Geographic Magazine - National Geographic News: "Did Mercury in 'Little Blue Pills' Make Abraham Lincoln Erratic?" by Hillary Mayell for National Geographic News, July 17, 2001.

All that said, it was very unlikely that those people who had only had a whiff of mercury would have known, that those vapors had affected them enough to make them sick. By the time the mercury started to show symptoms, they would have forgotten about the exposure to it and assumed that they had fallen ill because of some infectious agent. Mercury is insidious because one symptom of mercury poisoning is short term memory loss. So, how were they going to tell the doctor--in the rare event that he might have asked--about what they had taken when they couldn't even remember? Karen Wetterhahn, who knew what she was working with and did remember, did not feel that she was poisoned until months after her deadly exposure. She knew that she was working with a very dangerous substance. The New England Journal of Medicine reported that it took at least 90 days before any symptoms arose. It took nearly five months (154 days) for the 48 year-old scientist to complain about neurological symptoms which brought her to the hospital.

Supposing twenty years ago a child broke a fever thermometer. She picked up a bubble of mercury from the floor and ate it. The girl's younger brother watched and inhaled some of the vapor. Or, supposing a dentist's two-year old grandson sneaked into the office where amalgam had just been mixed and inserted into a patient's mouth. The child inhaled the still lingering vapor. And, supposing a young woman, somewhat compromised in her calcium intake because she didn't drink milk, needed fillings in her teeth. She also needed a root canal because she had been eating sweets almost all her life without brushing her teeth.

The little girl had no known ill effects from ingesting the beads of mercury, and it may seem far fetched to blame such a small amount of mercury mercury vapor for the Attention Deficit and Hyperactivity Disorder her brother later experienced. The reason why the little girl was not affected as much can be explained with the fact that metallic mercury goes through the system and is absorbed only minimally. On the other hand, our knowledge of what a small amount of tobacco smoke does should alert us to not be casual about what a small amount of mercury vapor might do. A puff of smoke here and there (passive smoke) from another person's cigarette is also only a very small amount of smoke. And yet, the cumulative puffs have been known to cause lung cancer. Note! There is one important difference between tobacco smoke and mercury. It is visible and easily detectable by its smell and mercury vapor is not.

Nothing happened to the boys at the time when they inhaled the vapors. However, years later when they were young adults, they came down with Multiple Sclerosis. About the young woman who had a root canal done, which was filled with amalgam, she did not know that she had been given mercury. The dentist who had performed the then (1965) new procedure did not know that a root canal should never be filled with mercury amalgam and thus set into action a process that would cause the woman to suffer pain and several surgeries nearly thirty years later.

Root canals should not be filled with amalgam! Here is why: A root canal may eventually turn into a bone cyst, also called cavitation. Bacteria, trapped at the tip of the root, remain--despite all precautions --after the root canal is filled. The anaerobic bacteria multiply. The only place they can go is into the jaw bone. There they may cause the bone to erode. It becomes necrotic. The bacteria, which cannot be eradicated easily with antibiotics because the blood does not circulate very well through bone, could then convert the accessible mercury from amalgam into methylated mercury. This can continually be dispersed into the blood stream, possibly through osmosis. It seems methyl mercury seeps through tissues fairly easily. (It entered Karen Wetterhahn's system through Latex gloves and the skin). Furthermore mercury helps the bacteria to survive better because it compromises the immune system. Thus the mercury indirectly causes the cavitation to get bigger and bigger. What makes the situation worse is that cavitations are not visible in x-rays, and they may remain painless for many years because the nerves do not reach into the bone and tell the person that something is wrong. (Scand. J. Dental Research 91(2) 150-152, 1983). The patient only notices the problem when the cyst finally gets large enough and breaks through to the outside or comes in contact with nerves.

Another explanation for the erosion of bone is given in a web site about osteonecrosis/osteomyelitis, which when it happens to the mandible and maxilla is also called Phossy Jaw or Maxillofacial Osteonecrosis. This condition used to be very common in the 19th cntury. It is a condition where the bone dies due to "intramedullary ischemia and infarction." The ischemia is thought to have resulted from "environmental pollutants, such as lead and the phosphorus used in safety matches, as well as from popular medications containing mercury, arsenic or bismuth."

Maxillofacial Osteonecrosis of the maxillofacial region is not new to dentistry. During the pre-antibiotic era "phossy jaw" and other forms of "chemical osteomyelitis" resulted from environmental pollutants, such as lead and the phosphorus used in safety matches, as well as from popular medications containing mercury, arsenic or bismuth.[23-29] This disease was well established by 1867, did not often occur in individuals with good gingival health, and appeared to "attack" the mandible first.[25] It was associated with localized or generalized deep ache or pain, often of multiple jawbone sites. The teeth often appeared sound and suppuration was not present. Even so, the dentist often began extracting one tooth after another in the region of pain, often with temporary relief but usually to no real effect.[24] Occasionally, large fragments of necrotic bone would come out with the tooth, sometimes involving much of an entire quadrant, as depicted in the figure at the top of this page. Apparently, Lorinser of Vienna in 1845 was the first to call attention to the problem.[25]

( http://www.maxillofacialcenter.com/NICOhistory.html#History, and http://www.maxillofacialcenter.com/NICO1v55.html#Why)

According to the above web sites the chemical osteomyelitis described in Phossy Jaw can be seen in other parts of the body, i.e. for necrosis in the head of the femur it is called Legg-Calvé-Perthes disease. "G. V. Black,[29] the father of modern dentistry, described in 1915 an osteomyelitis look-alike disease which he called 'chronic osteitis.'" Other conditions are Osgood-Schlatter Disease, Panner's Disease and many others. (Appendix B)

The baby boy born nine months later would seem to be normal and happy. Of course, he received his DPT shots on time and was, to be more efficient, inoculated on the same day, for whatever else there might be to guard against illnesses. By age three this same child also had received thirty amalgam fillings. The perfect looking teeth had many tiny pin-hole cavities, which, according to the dentist, needed to be taken care of. He is still working as a pediatric dentist and professor. Not filling those teeth would cause them to fall out prematurely, he said, and that would later affect the bite in the growing child.

This is what happened to the baby when he grew up. As already said, he seemed to be normal. Still, it was disconcerting that he did not learn to talk until age three and a half, much later than his peers. At least he did not wait to talk until age five as Einstein did. Talking late would be of no concern if the boy turned out to be another Einstein. But this boy also had a difficult time falling asleep and his mother would wear herself out trying to wake him up in the morning to get him ready for school. Was that like Einstein? Later when he was tested at school, the boy had an Intelligence Quotient of 137--quite a bit above average. So nobody worried. Maybe he would be like Einstein after all. But then, as a teenager, he withdrew from social interaction. He was very shy and after a while he suffered from depression. His mood swings caused disruptions for his family. Indeed his mother and father were afraid to criticize him for fear that he would react with outbursts of anger at any given moment. He is now thirty-five years old, and he is still depressed.

The next child, two years later, was a healthy boy. He has had only one cavity so far. No problems with him. But then there was the third child. Four years after her first son was born, and after more dental work--done during pregnancy--the same mother gave birth to a third son. This boy had a number of birth defects, which the doctors lumped together as midline defects. The boy's profound psycho/motor retardation became obvious after the craniosynostosis, the partially missing corpus callosum, the inguinal hernia and problems having to do with his teeth and ears were diagnosed. These defects may be explained by what Dr. Hal Huggins, DDS, refers to in his essay about mercury and Birth Defects:

How can dental mercury produce birth defects? What are the mechanisms? During normal cell division, our cells undergo a process called mitosis in which all the internal substance of a cell duplicates itself, then the contents divide evenly, and migrate to opposite ends of the cell until the cell looks something like an exercise dumbbell. Finally it squeezes itself in the middle until it separates into two identical cells. Mercury can stop this duplication process at any of its multiphasic steps resulting in an abnormal cell. If this new cell is capable of reproduction, then the abnormality may show up as a birth defect. If it is deep within a tissue, it may alter the function of a tissue or organ without being readily observed.

This retarded boy never talked. He is the size of a small nine-year old and looks like a child. He learned to walk at age 4. He was toilet trained already before that. At age 32 he is confined to a wheelchair due to the unfortunate after-effects of Legg-Calvé-Perthes disease. Doctors examined him long ago, thinking that he might be autistic. This child certainly would not have been able to diagnose himself.

As for the other above-mentioned three boys, they would never be able to connect the earlier events with their later illnesses, either, and, even though the four examples are not hypothetical, they are not meant to be proof that amalgam actually caused the neurological, psychological and behavioral difficulties just mentioned. There are too many confusing factors. They do, however, point out that the connections between cause and effect are not always visible within a short time span. Here it is worth mentioning that it takes years for the nicotine in tobacco to cause cancer, for the AIDS virus to do its damage, and the prion to cause Bovine Spongiform Encephalopathy (BSE). The children who were exposed to mercury would not remember that they had inhaled the vapors while watching brother or grandfather. The parents of the third boy could not relate the delay in speech acquisition, his shyness and, later, his depression to the fact he had been exposed to mercury via his dental fillings or his mother's amalgam-filled root canal while he was still in the womb. They did not know that "silver fillings", that's what amalgams are called, contained mercury.

On the subject of delay in toxicity of methyl mercury D. C. Rice writes in Neurotoxicology, 1996 Fall/Winter, 17 3-4, p.583-96:

Delayed toxicity as a result of developmental methyl mercury exposure was identified in mice two decades ago by Spyker, who observed kyphosis, neuromuscular deficits, and other severe abnormalities as the mice aged. Delayed neurotoxicity was also observed in monkeys...
http://www.web-light.nl/AMALGAM/EN/SCIENCE/medl_neuro.html

There are so many reasons why things can go wrong in a person's life. A mother looks for all the known factors of what might have influenced her child. Was he traumatized somehow? Maybe his mother got impatient and yelled at him because he was so difficult to handle. What other psychological scars might there be? Depression and anger are supposed to originate from early childhood experiences. What about childhood illnesses that might have left neurological scars? The guessing game does not stop when a child has difficulties. Were those many vaccines to blame? They sometimes cause a fever and mimic the illness the vaccine is meant inoculate against. The doctor tells the frightened mother that those symptoms are a natural reaction. But, after all the guessing, one thing that is never mentioned, and that situation resembles that of amalgam--is that the vaccines contained a preservative called Thimerosal (it, too, contains mercury). Neither the parents nor, of course, the children had knowledge or control over receiving mercury (Children must be vaccinated. It's the law).

No doctor made the parents aware of the mercury even though Thimerosal which contains ethyl mercury (chemical cousin to methyl mercury) and salicylic acid has been used in vaccines since the 1930s. What might come as a surprise in this context--in addition to the fact that vaccines contain mercury--is that Eli-Lilly, the inventor of the preservative Thimerosal, first tested the vaccine on 22 patients dying of meningitis. I guess Eli-Lilly did not want to test mercury injections on healthy subjects. That the meningitis patients did not die within 6 weeks of exposure to Thimerosal supposedly made it safe for the rest of the population? (WFAA.com, June 21, 2002, Dallas Fort Worth: Mercury in Childhood Vaccines: What did the Government Know? (Part II))

Disclosing that mercury might be an ingredient in a vaccine is the law in California. That law is constantly being sidestepped today. Nobody suspects mercury in a vaccine. What's more vaccines don't need Thimerosal to work. As a matter of fact, there are several studies where it is shown that Thimerosal does not kill bacteria at all and causes a diminished immune response. Dr. John Whitman writes in his website:

The presence of mercury in dental amalgam fillings has been shown conclusively to adversely affect the body's immune response. It has been shown that after amalgam removal the red and white blood cell levels tend to seek normal range with a corresponding increase in the body's immune response as evidenced by Tlymphocyte count increase (Bio-Probe References: Immunologic Adverse Effects)

That gets me to wondering whether an AIDS patient getting a flu-shot might inadvertently be risking his life by receiving Thimerosal with the vaccine.

Thimerosal is useful only to the manufacturer. Thimerosal allows the manufacturer to be a little sloppier in his laboratory. What's more Thimerosal is known to lower the immune response to certain organisms. What Thimerosal does is mask the expression of contamination during the manufacturing process, and diverts attention from a potential defect in the vaccine. It serves the manufacturer well, but not the patient. The patient is not likely to connect the dots because they are hidden from view. Ask your doctor next time if the flu shot he is giving you contains mercury. His answer will most likely be: "Of course not." Then ask for the insert that comes with the shot. The insert will, most likely, tell you that it contains mercury. The next thing you'll hear is: "You got me there. But its only a trace amount." Most doctors don't know that those trace amounts can make your baby sick. For more information on the subject of organic mercury poisonings read Chiho Watanabe and Hiroshi Satoh who wrote about the "Evolution of Our Understanding of Methylmercury as a Health Threat."

Returning to amalgam I am assuming that mercury from tooth fillings does similar damage as mercury from Thimerosal depending on the oral environment. Thus it is entirely conceivable that mercury from amalgam that interacts with aspirin, taken for a headache, becomes something very similar to Thimerosal.

The main ingredient in dental amalgam is mercury. Amalgam has been used for centuries. The Chinese used it 1400 years ago to fill cavities. In the western world it became popular less than 200 years ago. It is a malleable material, similar to putty, and much easier to work with than gold when the dentist lays it into the cavity. That and the fact that it was much cheaper than gold, eventually made it the material of choice in all dentists' offices despite the fact that American dentists in the first half of the 19th century were amalgam-free.

Before the 1850s, there were strong efforts to ban the substance because it was thought to be poisonous. For economic reasons and convenience the proponents of amalgam prevailed. At that time the evidence that mercury compounds are poisonous was not found sufficiently compelling to discontinue it considering all its "beneficial" properties. By and large amalgam was thought to be stable. It was thought to be a special material that absolutely did not dissolve, at all. Since then chemists have learned that there is no substance, including amalgam, that does not dissolve in water over time.

Mercury's poisonous effects were well known in the days when mercury was used indiscriminately in certain industries. For instance, madness was an occupational hazard for workers in the felt industry. That was an accepted fact. That is why the saying "Mad as a Hatter" was coined. The "Mad Hatter" syndrome was a symptom complex thought to be due to mercuric nitrate used in the processing of animal fur for felt hats. The mercury made you "mad" but it was thought that it didn't kill you (In Danbury, Connecticut, where the expression "Danbury Shakes"--shaking is a symptom of mercury poisoning--was coined, mercury was used by felt makers until 1941). For more on the interesting history of felt making please see: Was the Mad Hatter Really Mad? by Sharon West, March 20, 2001. Still, it was known that mercury could kill; that is why prisoners were, and maybe still are in some places, used for mercury mining. It was not widely known, though, that you could die from mercury poisoning the way Karen Wetterhahn did.

It should be added that the expression "mad scientist" was worn almost as a badge of honor. Chemical labs had always been thought to be places where an abundance of poisons made their way into the world. Among all those poisons amalgam was indeed a very safe substance. Yes, you could get poisoned. Laboratories were not the safest places to be. But the alchemist's goal was to make gold, and create wealth. The prospect of winning praise from the king for making porcelain and gun powder or ultimately gold was worth the risk. A good description of the Norwegian scientist Kristian Birkeland who, it appears, was affected by mercury and other noxious vapors in his laboratory can be found in Lucy Jago's "Bright Lights, Big Trouble - How The Aurora Drove A Genius Mad - The Bright Stuff" (The Independent On Sunday: The Sunday Review, 29 April, 2001, p.11). Arnold Orville Beckmann, founder of Beckmann Instruments, a medical insturmentation company, was so severely affected by mercury that he had to

...switch over from organic chemistry to physical chemistry, away from mercury and toward a whole new realm of fascinating chemical questions and puzzles.

Because it is commonly thought to be a stable substance, in other words non-toxic, amalgam has not been subjected to the strict regimen the Food and Drug Administration prescribes for all new medicines, applied internally as well as externally. Amalgam was approved (grandfathered in) without actually ever having been tested for toxicity. Environmentalists, on the other hand, have made sure that mercury amalgam outside the human body was included in the list of hazardous substances. It is poisonous before the dentist puts it into the mouth and after he takes it out. The only place dental amalgam is still considered to be safe is in the mouth. It is considered hazardous in any other place.

The recent lawsuits (See also below under Additional Websites: Stanford Law School - Dental Amalgam Litigation) filed in the United States dealing with the environmental hazard of dental amalgam (Tibau v. American Dental Association, BC252124, and Kids Against Pollution v. American Dental Association, BC 252125; San Francisco Daily Journal, Wed. June 13, 2001, p.2) have brought renewed interest in whether dental amalgam is really as safe as dentists have us believe. In spite of all the recent studies, ADA President Dr. Robert M. Anderton (ADA.org: Today's News - Association Responds to Amalgam Litigation, June 15, 2001) responds to these suits stating:

There is no sound scientific evidence supporting a link between amalgam fillings and systemic diseases or chronic illness. This is a position shared by the ADA and all major U.S. public health agencies and is a matter of public record.

Dr. Murray J. Vimy, DMD, Clinical Associate Professor, Faculty of Medicine, University of Calgary, Canada, counters Dr. Anderton's letter by pointing to 9 critical facts why amalgams are harmful. After referencing carefully those facts he concludes that

... statements by ADA spokespersons suggest that the ADA and its advisors may be knowingly disinforming the public through the media or they lack an understanding of the scientific research about mercury release from amalgam published in their own journals

control (by dental regulators) of dental licenses to punish, or threaten punishment of dentists who criticize mercury amalgam.

...legislative demands for creation and distribution of a warning sheet on the potential side effects of mercury cavity fillings.

...Lawyers for Attorney General Bill Lockyer, who weighed in on the case on the side of the plaintiffs, called the decision an important reaffirmation of one of the basic foundations of the 1986 voter-approved law...

The Chicago Tribune entered the discussion with the headline: "Health Risks of Mercury Debated" (Chicago Tribune, August 22, Wednesday, 2001, p.N1). The article states among other things that:

The fillings slowly release tiny amounts of odorless, colorless mercury vapor. Their effect on health has been the subject of scores of conflicting studies, and no federal agency has moved to prohibit the fillings.

"You can't say mercury fillings are bad for you," said Dr. Myron Bromberg, a dentist in Reseda, Calif., and spokesman for the Academy of General Dentistry, an industry group. "You can't say it because it's inaccurate. ...I have silver fillings in my mouth. I have silver fillings in my kid's mouth. If there were any problem with them, I wouldn't use them."

"It should be reassuring to parents that we found no convincing evidence linking Thimerosal to any neurological disorder," said Dr. Marie McCormick of the Harvard School of Public Health...

This statement is being made even though ethyl mercury (mercurochrome, merthiolate), a chemical cousin to methyl mercury, has been banned for external use. Apparently, as long as mercury is applied internally it magically loses its toxicity. Furthermore, as long as there is any evidence at all, convincing or not, the medical community ought to be erring on the side of caution when it comes to toxic substances like mercury.

In spite of the above assurance, law suits keep coming. law.com published an article "Drug Companies Sued Over Vaccines Containing Traces of Mercury" by William McCall (October 3, 2001) where it states:

A coalition of law firms went to court across the nation Tuesday, trying to force the pharmaceutical industry to study whether vaccines containing a trace of mercury cause autism and other brain damage in young children.

Getting back to mercury in teeth, the California Lawyer joins into the debate by featuring Shawn Khorrami in an article about his multiple amalgam lawsuits filed in Los Angeles as well as San Francisco (Getting Drilled - The Controversy Over Mercury Fillings Turns Litigious, October 2001, p.18):

Shawn Khorrami calls it "the m-word," and the Van Nuys attorney wants dentists to open wide and say it. The m-word is mercury, a component in countless dental fillings that speckle the mouths of millions of Americans.

Further down on the same page it becomes evident that law makers keep busy, too. The same article comments about the California Dental Board saying

Senator Liz Figueroa (D-Fremont) has a bill pending (SB 26) that would shut the current board down altogether, with the intention of forming a new board. "I've never seen any government agency that is more alligned with a trade association than this board," says Julianne D'Angelo Fellmeth of the Center for Public Interest Law at the University of San Diego.

On October 11, 2001 the Feat Daily Newsletter (www.feat.org) reported that Governor Gray Davis had "signed SB 134 (Figueroa), the Dental Board sunset reform bill. One of the reforms in the bill requires a dentist to provide a fact sheet on possible health risks related to mercury to a patient prior to performing a dental restoration that could involve the use of dental amalgam. The bill also requires new patients to receive and acknowledge receipt of the mercury risk fact sheet."

In February 2002 under the Section: FDA Forum, Pharmaceutical & Medical Devices the Web Postings report among other news that

the FDA's Center for Devices and Radiological Health has created a web page, http://www.fda.gov/cdrh/consumer/amalgams.html (updated Feb. 11) with the latest safety information on the amalgam materials used in dental fillings. The FDA and other organizations of the U.S. Public Health Service continue to investigate the safety of amalgams used in dental restorations (fillings). However, no valid scientific evidence has ever shown that amalgams cause harm to patients with dental restorations. The FDA is aware that some manufacturers have advised in their labeling against using amalgam in very young children and pregnant and nursing women.

The FDA Plans to uniformly regulate dental mercury, amalgam alloy, and pre-encapsulated dental amalgam. To reduce allergic reactions from restorative materials, FDA will propose in labeling guidance that the products's labeling list the ingredients in descending order of weight by percentage and include lot numbers, appropriate warnings and precautions, handling instructions and expiration dating.

The Daily Journal (March, 21, 2002, Mercury In Dental Fillings Caused Autism, Family Claims, by Erin Carroll) covers what it claims is the "first case to link [autism] to mercury in dental fillings:"

LOS ANGELES - A Burbank family has sued the American Dental Association and 29 other dental corporations, claiming that they concealed the dangers of mercury in dental fillings, a toxin the family believes contributed to their child's autism.

In the suit, lawyers for Kathy Galeano allege that her nine amalgam fillings released enough mercury into her system during her pregnancy to help cause her son Daniel, now 5, to develop severe autism. While lawsuits have been filed alleging a link between mercury in pediatric vaccines and autism, plaintiffs' lawyer Shawn Khorrami of Van Nuys believes this is the first case to link the disease to mercury in dental fillings. Galeano v. American Dental Association, BC270306 (L.A. Super. Ct., filed March 20, 2002).

The FDA defends itself in the Daily article by making the same statement it had already made in its Web Postings (Vide supra): "...no valid scientific evidence has ever shown that amalgams cause harm to patients with dental restorations. The FDA is aware that some manufacturers have advised in their labeling against using amalgam in very young children and pregnant and nursing women."

Shawn Khorrami, however, states that the "metal's link to autism has been documented and that, despite mercury's known dangers, the dental profession continues to use it in fillings."

The Seattle Post-Intelligencer (Wednesday, March 20, 2002, Suit: Fillings Caused Child's Autism by Erica Werner, also Charleston Gazette, March 21, 2002, also San Jose Mercury News, Mar. 21, 2002, p.11A, DENTAL GROUPS SUED OVER CHILD'S AUTISM) reports about the same suit, and quotes ADA chief counsel Peter Sfikas as saying that

mercury in fillings is chemically bound with metals including silver, copper and tin into a "hard, stable and safe substance"

whereas Boyd Haley, chairman of the chemistry department at the University of Kentucky, states in the Seattle Post-Intelligencer: "I don't know that it's [the connection between amalgams and autism] proven, but it's very credible. Mercury is one of the most neurotoxic compounds known to man."

Haley said some studies show people with amalgam fillings have four to five times as much mercury in their blood and urine as people without such fillings.

Not surprisingly the ADA counters with a newsletter (ADA.org, Todays News, April 5, 2002) saying that

Eleven lawsuits claiming that mercury in dental amalgam caused autism in the plaintiffs' children were filed thisweek in Fulton County (Georgia) State Court.

Named as defendants were the American Dental Associationand Georgia Dental Association; pharmaceutical firms American Home Products (now Wyeth), GlaxoSmithKline, Armour Pharmaceutical and Johnson & Johnson; and utility Georgia Power Co.

...these complaints are an "egregious abuse of the legal system," the ADA immediately responded. "Actions like these mislead vulnerable people, using information with no scientific basis to give false hope to those with chronic, often incurable illnesses."

Dr. Dean Edell, whose syndicated "Health Talk" radio program is broadcast nationwide, characterized the autism suits as prime examples of "junk science" in the courtroom.

"Autism is not caused by vaccines or [amalgam fillings] in your mouth," Dr. Edell told his audience April 4. "A jury doesn't understand the science in this.... We all pay for this."

Natural Health (March 1, 2002, p.26) asks its readership to comment on the controversy by asking: "Should Amalgam Fillings Be Banned? Evidence On The Risks Of Mercury Fillings Is Mixed. Should They Be Outlawed Anyway? Backtalk." The article refers to a bill recently introduced to Congress by Diane Watson, D-Calif., that would prevent dentists from using amalgam fillings nationwide by 2006. It also mentions that results from two trials currently underway at the National Institute of Health are expected in 2005.

The ADA, instead of expressing interest in the bill and merely being cautiously skeptical rather than concerned about all dental patient's wellbeing, finds Diane Watson's proposed bill threatening enough to respond with an ADA.org Newsletter (April 16, 2002):

"In plain terms, Rep. Watson is attempting to legislate based on junk science," ADA Executive Director James B. Bramson said in an April 12 statement posted online. "We have requested meetings with her numerous times and thus far have been shut out. But we will continue to attempt a dialogue with her."

Further down in the same newsletter it states:

"Concern about amalgam, because of its mercury content, is intuitive but unfounded," the ADA executive director said. "The process by which amalgam is made renders the bound mercury component stable and therefore safe for use in accepted dental applications."

Rep. Watson's proposed Mercury in Dental Filling Disclosure and Prohibition Act would prohibit after 2006 introduction into interstate commerce of mercury intended for use in a dental filling. The bill would require new labeling, with consumer warnings about mercury content, for dental amalgam materials regulated by the U.S. Food and Drug Administration.

The CDA states:

Studies show that no filling material has been proven superior to amalgam in safety, durability, and cost effectiveness. Amalgam has been researched worldwide and no study has ever caused a professional dental organization or agency to recommend a ban of amalgam (Fact Sheets: Dental Health by the California Dental Association)

If it were as easily proven that amalgams are not as dangerous as dental associations make them out to be why does it take no time at all to find the following study that confirms the dangers of mercury. B. Fredin comes to the following conclusion in Studies on the Mercury Release from Dental Amalgam Fillings:

...It is concluded that dental amalgam should be considered an unstable alloy constituting a long term Hg exposure and toxicologically unsuitable as a dental filling material. (Swed J Biol Med no 3, 1988 pp 8-15)

This study may be from a foreign country and it may be small. But it gives a clue about the validity of the tenet that amalgam causes symptoms. Amalgam may have been researched worldwide; but the ADA has never acknowledged the importance of studies in other countries. Dental associations have not recommended a ban on amalgam because this very recommendation would mean--in the absence of long-overdue ADA initiated studies--admitting that amalgam has always been a toxic substance.

Apparently there is no need to acknowledge the facts of basic science that there is no such thing as absolut stability in science, and that chemists have known for a long time that mercury is not stable even in amalgam form (See Alfred Stock).

It is much easier to stick with conventional wisdom. That attitude does not convert conventional wisdom into modern science. It merely leaves us in the dark. The media have forgotten how to expose powerful forces such as the ADA and various amalgam manufacturers. Thus, unfortunately, even the usually outspoken Washington Post is not convinced of the dangers of amalgam. Jennifer Huget discusses amalgam in two articles (March 26, 2002, Tuesday, p.F01 and p.F04). The headline in the first one reads: "Filling In For Mercury; There's No Proof Dental Amalgam Is Unsafe" (p.F01). The second one gives a synopsis of the two opposing views titled "Mercury Fillings: The Cases For And Against; Mercury Amalgam's 150-Year History As A Dental Restorative Has Been Marked By Occasional Eruptions Of Controversy Over Its Safety. Following Is A Synopsis Of The Opposing Arguments" (p.F04). While her discussion gives voice to both sides of the argument, the main points of the anti-amalgam argument--that it is poisonous to many systems in the human organism--are only discussed in the most general terms.

But lawyers are not fooled that easily. A law.com headline on April 29, 2002, reads "National Lawyer Network Gears up for Mercury Litigation; Two Miami Lawyers Launch Attacks on Vaccine Makers, Saying Mercury Component Leads to Autism," by Julie Kay. She points out, among other things that

Robles is one of hundreds of plaintiffs' lawyers around the country who are filing or about to file negligence lawsuits against companies that manufactured or distributed vaccines containing thimerosal, a mercury-containing preservative that until the past few years was used in many pediatric vaccines. It is still used in some adult vaccines

and

While Robles has advertised on daytime television, in the National Enquirer and on his Internet site for clients in other types of cases, he says he isn't scouting for mercury clients. "I don't have to," says the attorney, who heads the Robles Law Center. "There are thousands of them. This is definitely the next big thing."

Relevant Laws for California:

• Health & Safety Code: Section 25249.6 et seq., Business & Prof. Code 17200 et seq.
• Labor Code 6382(b)(1) and 6382(d) discussing the list of chemicals known to cause cancer and reproductive toxicity
• Chapter 3.2. California Occupational Safety and Health Regulations (CAL/OSHA) Subchapter 1. Regulations of the Director of Industrial Relations, §339. The Hazardous Substances List

While dentists are shying away from the "m-word" dental amalgam manufacturers are worried about future litigation. According to ASOMAT, a letter was sent out March 13, 1998 by the Australian Dental Association to 10,500 dentists stating, among other things, that

Contrary to the claims made by the Australian Dental Association that amalgam is safe, the manufacturers are now acknowledging the intrinsic dangers of this material. The legal implications of this latest development are far reaching. If you continue to use dental amalgam you may be playing legal roulette with your assets.

Caulk, Australian amalgam manufacturer of Dispersalloy, warns that their product is not safe contradicting the Australian Dental Association's own statement that it is. This information comes from http://www.zip.com.au/~rgammal/letdent.html. Another manufacturer of dental amalgam, Dentsply, issued the following warning: "Contraindications: The use of amalgam is contraindicated:

• In Proximal Or Occlusal Contact To Dissimilar Metal Restorations.
• In Patients With Severe Renal Deficiency.
• In Patients With Known Allergies to Mercury.
• For Retrograde or Endodontic Filling.
• As A Filling Material For Cast Crown.
• In Children 6 and Under.
• In Expectant Mothers.

Most mercury is mined in Spain and in the Near East in countries such as Uzbekistan and Tajikistan. Amalgam manufacturers are found all over the globe. Amalgam has been used in more or less identical formulation for more than 160 years. Nowadays it is supplied in two parts. Part 1. is mercury and Part 2. is a mixture of ground mercury and other metals. After the two parts are mixed, the resulting amalgam often contains more than 50% mercury. The other ingredients, by the way, are also poisonous. The percentages of the other ingredients vary from manufacturer to manufacturer depending on how strict the manufacturer country's environmental regulations are. This matters because the global marketplace does not respond to the rules of the country to which the amalgam is shipped unless the country's regulators are watchful. Individual countries' governments have to see that their own environmental laws are obeyed.

The mercury contents, depending on who supplies the amalgam, vary from as low as 50% to as high as 70% depending on the source.

According to http://www.ericdavisdental.com/facts_and_figures_mercury.htm the amount of mercury in amalgam is sometimes as high as 65%. This means that the amounts of copper, zinc, and other heavy metals vary, as well.

Usual percentages mentioned are approximately:

• Mercury: 50%
• Silver: 34-38%
• Tin: 12-14%
• Copper: 1-2%
• Zinc: 1-2%

These figures do not tell the whole story, however. There are two versions of amalgam. One, the gamma-2 amalgam, is more corrosion-prone because of the greater possibility of the following equation: AgSn + 2Hg = AgHg + HgSn. Here the HgSn part is the most poisonous. When this phase occurs, there is supposedly a greater chance for mercury vapors to develop, which are harmful to dental personnel and patients. The second, the gamma-2-free amalgam is supposedly more stable. Also, instead of the black color of corrosion, it retains the color of silver. When the two amalgams are compared, the change in the percentages of copper and silver are the following:

The gamma-2-phase amalgams contain equal parts, 50% of liquid mercury, and 50% of an alloy powder containing:

• > 65% silver (Ag) (poisonous)
• < 29% tin (Sn) (Highly poisonous)
• < 6% copper (Cu) (poisonous)
• < 2% zinc (Zn)
• < 3% mercury (Hg) (poisonous)

The gamma-2-free amalgams contain equal parts, 50% of liquid mercury, and 50% of an alloy powder containing:

• > 40% silver (Ag) (poisonous)
• < 32% tin (Sn) (Highly poisonous)
• < 30% copper (Cu) (poisonous)
• < 2% zinc (Zn)
• < 3% mercury (Hg) (poisonous)

Note: It is rather disturbing that, according to Ulf Bengtsson and others, studies have found that the desired stability of gamma-2 free amalgam was not achieved. Not only are the modern non-gamma-2 amalgams shown to release even more mercury vapors than the gamma-2 containing ones, but they have a strange propensity to form mercury droplets on the amalgam surfaces after polishing (On the Instability of Amalgams, by Ulf Bengtsson, January 1, 1997).

Another problem is posed by the interaction of dissimilar metals, which are, if not part of the amalgam, often found in gold crowns or other protheses next to the fillings. According to the Kieler Amalgam Gutachten-- reviewed by Birgit Calhoun (excerpts in English: http://www.zan.cc/AG5.htm)-- Loebich, the leader of the metallographic laboratory of Degussa AG, a former German amalgam manufacturer, published a report already in the 1950s warning that "...amalgam has 'caused complaints and Illnesses.'" Also according to Loebich (1955), it is not necessary that the metals in question need touch each other. Merely the presence in the mouth is enough to cause generalized malaise. Loebich says: "This can happen via two fundamentally differing pathways:
Either the ions (metal salts) work as poisons, which may form from the metal (chemical Influences).
Or the potential difference (voltage) effects some sort of functional disturbance in the organism (physical influence)" (Translated from the German by B. Calhoun). The author of the just mentioned web

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