by Mark K. Anderson
Mercury is one of the most toxic substances on the planet. Ingesting a drop of it will send you straight to the emergency room. A thimbleful will kill. A half gram of mercury in a 10-acre lake is enough to warrant a fish advisory. In 1994, Minnesota banned running shoes with lights in their heels because the shoes contained a half gram of mercury and were deemed too hazardous to consumers.
The average "silver" dental filling also contains a half gram of mercury. Too hazardous for footwear or a 10-acre lake yet safe enough to be implanted in your mouth? It's quite a paradox, one that has researchers around the world at loggerheads with dental organizations such as the American Dental Association. These organizations claim researchers are needlessly scaring patients with unfounded speculation; the researchers insist that silver amalgam fillings may be responsible for millions of cases of long-term low-level mercury poisoning which have been misdiagnosed as everything from chronic fatigue syndrome to Alzheimer's disease to colitis to senility. To listen to some dentists, it's an issue best ignored. "These people are making fraudulent claims based on a scientific fiction," says San Francisco dentist and lawyer Edwin Zinman. "There has never been a causal link established between silver amalgam fillings and systemic disease." To others the connection is obvious. "The scientific literature is replete with studies that show the potential danger of amalgams," says Los Gatos dentist Jim Adams, who has maintained a mercury-free practice for 15 years. "These papers are peer-reviewed and undeniable."
The average "silver" dental filling also contains a half gram of mercury. Too hazardous for footwear or a 10-acre lake yet safe enough to be implanted in your mouth? It's quite a paradox, one that has researchers around the world at loggerheads with dental organizations such as the American Dental Association.
These organizations claim researchers are needlessly scaring patients with unfounded speculation; the researchers insist that silver amalgam fillings may be responsible for millions of cases of long-term low-level mercury poisoning which have been misdiagnosed as everything from chronic fatigue syndrome to Alzheimer's disease to colitis to senility.
To listen to some dentists, it's an issue best ignored. "These people are making fraudulent claims based on a scientific fiction," says San Francisco dentist and lawyer Edwin Zinman. "There has never been a causal link established between silver amalgam fillings and systemic disease." To others the connection is obvious. "The scientific literature is replete with studies that show the potential danger of amalgams," says Los Gatos dentist Jim Adams, who has maintained a mercury-free practice for 15 years. "These papers are peer-reviewed and undeniable."
Silver amalgam fillings were invented in the early 19th century. To make the first amalgam, in 1812, a British chemist mixed coin shavings with mercury (added so the filling would harden without shrinking) for a "silver paste" that he used in tooth restoration. It was a revolutionary innovation -- gold was previously the only metal both durable and safe enough for fillings. And gold was -- and is today -- prohibitively expensive, beyond the budgets of most cavity-getters. Silver and mercury, on the other hand, were cheap. And that meant modern mouths could be fitted with affordable metal implants whenever decay claimed another tooth.
Almost from the beginning, though, some dentists advocated a ban on amalgams, for fear of inadvertently poisoning their patients. Mercury has been known as a deadly substance for millennia. In the 19th century the symptoms of mercury poisoning were widely evident. Many hat makers used mercury on hat felt to make the material more pliable. In the process they inhaled toxic levels of mercury vapor and developed extreme cases of mercury-induced dementia. Lewis Carroll's Mad Hatter in Alice's Adventures in Wonderland is a satirical glimpse of these quicksilver victims.
But the presence of a known poison in the new tooth-restoring material did not deter dentists from using amalgams. By the mid-19th century most mercury-free dentists had either left the business or opted for the increased number of customers that amalgams brought in. In the ensuing century and a half, the mercury has continued to flow, to the point where some three-quarters of the people living in the industrialized world now have at least one silver-mercury filling in their mouths.
Mercury is manna to the ADA. Says a 1990 issue of the Journal of the American Dental Association, "The 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 States. And since amalgam has been used for more than 150 years, literally billions of amalgam fillings have been successfully used to restore decayed teeth."
This "lack-of-proof" public-relations posture was for years a favorite of tobacco manufacturers. But it's as irresponsible for dentists as it is for cigarette makers, says Florida dentist Michael Ziff, executive director of the Canada-based International Academy of Oral Medicine and Toxicology. "The ADA's position is not scientific, it's not analytical, it's not even ethical."
"The ADA is on thin ice," agrees Dr. Fritz Lorscheider of the University of Calgary Medical School. "They're trying to counter medical research evidence with dental opinion." And what is the medical research evidence? It has been well established scientifically for more than a decade that mercury does not remain inert or "locked in" to a filling, as the ADA and amalgam proponents claimed for more than a century. (The ADA has since backed off that claim. It now says that amalgams release a measurable but inconsequential amount of mercury.)
The average individual with amalgam fillings is presently estimated to be breathing in anywhere from 1 to 29 micrograms of mercury each day. If you have a lot of fillings, or if you chew gum, grind your teeth when you sleep, chew your food a certain way or eat high-acid foods, then you could be breathing in a lot more mercury -- as much as 100 micrograms a day. In 1994 the U.S. Public Health Service deemed 0.28 micrograms of mercury vapor per day the "minimal risk level," the amount above which one risks harm from the vapor.
Autopsy studies in Sweden, Germany and the U.S. have established that people with amalgams have significantly more mercury in their brains and kidneys than those without, and the mercury concentration increases with the number of amalgams. The World Health Organization has stated that amalgam fillings constitute the principal source of mercury exposure for people with amalgams -- more than every other mercury source combined. This finding has been independently verified by the Canadian national insurance program Health Canada and the National Institutes of Dental Research.
Still the ADA remains steadfast -- a flabbergasting idea to some researchers. "What's puzzling is their adamant stance in going to the wall even when the medical evidence is so overwhelming," says Lorscheider. "Mercury has been demonstrated as one possible cause of Alzheimer's disease and the World Health Organization says that people with amalgams get more mercury from their fillings than from all other sources combined," Ziff says. "Two plus two equals what? According to the ADA it equals zero."
However slow their progress in the U.S., anti-amalgamists have had success in Canada and Western Europe. Germany has banned low-copper, "conventional" amalgams entirely and restricted the use of high-copper amalgams in children, women of childbearing age and patients with kidney problems. The German company Degussa, one of the world's leading manufacturers of dental fillings, has dropped its amalgam line entirely. Sweden has severely restricted the use of amalgams-only a small percentage of fillings now placed in that country have any mercury at all. The Austrian government plans to ban all amalgams by the year 2000. Canada is considering similar measures. The Canadian Broadcasting Corporation program "Dcouverte" revealed earlier this year that Health Canada has sponsored four independent investigations into amalgams since 1976. All four have recommended stopping or severely restricting the use of amalgams.
But Health Canada, to date, has not followed the recommendations. "Dcouverte" uncovered Health Canada memoranda urging instead the protection of amalgam manufacturers. A Parliamentary investigation and class-action suit against Health Canada is now pending.
In the U.S. the issue has gotten scant attention, given the number of people potentially at risk. Newsweek ran an article warning of the risks of amalgam fillings in October 1990 and "60 Minutes" followed the magazine's lead that December. Recent stories, though, have been setbacks for the anti-amalgam side. In May "Dateline NBC" produced a highly negative piece on Colorado dentist Hal Huggins, the nation's most vocal anti-amalgam crusader. Los Gatos dentist Jim Adams says he was disappointed with the tone of the "Dateline" report, which was entitled "Drilling for Dollars." "I thought it was a very confrontational show and that the agenda was set long before the interviews started. They made it sound like dentists removing amalgam fillings are all quacks."
Worse, some dentists complain, the dental industry has embarked upon a campaign of intimidation against those dentists who inform their patients of the potential risks of putting mercury in the mouth. Several dentists contacted in the course of this story refused to speak on the record.
Michael Ziff accuses the dental industry in California of "going after" the licenses of those dentists who have stopped using mercury amalgam fillings. He says the California Dental Association, with help from amalgam manufacturers, is working to overturn Proposition 65, the state law that mandates California businesses warn the public of exposure to substances "known to the state to cause cancer, birth defects or reproductive harm." "Don't take lightly the current attack by the CDA on Prop. 65," he warns. "They've got unlimited funds."
The Environmental Law Foundation in Oakland is pursuing a lawsuit against the Kerr Corporation, an amalgam manufacturer. The ELF contends that dentists should be provided with materials to caution patients, especially women of childbearing age, about the possible dangers of mercury and amalgams, in accordance with Proposition 65. "We don't take a position on the health effects of amalgams," says ELF attorney Alice Kaufman. "But we do argue that according to California law anyone who uses amalgams should warn the patient."
In 1995, William Tolhurst took a dentist, two amalgam manufacturers and an amalgam distributor to court. A Los Gatos chiropractor, Tolhurst based his suit on the fact that he developed the rare degenerative neurological disorder Guillian-Barr syndrome just weeks after he allegedly was exposed to "copious quantities of mercury" during the removal of eight amalgam fillings without protective measures. Because a high-speed dental drill vaporizes most of the mercury in a filling, amalgam extraction without at least a nose mask and a rubber dam in the mouth can cause a patient to inhale dangerous amounts of the toxin.
Although Tolhurst and his lawyer, Jim Love, introduced more than 40 peer-reviewed case studies showing a link between mercury exposure and Guillian-Barre syndrome, the evidence was not considered sufficient. Last September, Tolhurst lost the suit. "You're never going to reach the threshold of proof for some people," Love says. "Remember, we still haven't convinced R.J. Reynolds that cigarettes are dangerous to your health."
Others have stayed out of the courts but have equally harrowing tales to tell. In 1991, Los Angeles-area movie and television producer John Woods began losing his memory and motor skills. Because he'd seen the same symptoms in two family members who were eventually diagnosed with multiple sclerosis, Woods decided not to wait for his own diagnosis before taking action. In the process, he discovered Huggins, the mercury-free Colorado dentist who has gained national recognition for the seemingly miraculous results he's achieved by removing patients' amalgam fillings. Woods had his 16 amalgams safely replaced in 1993. Since following up with a mercury detoxification program, he says his symptoms have disappeared.
"I went out to Huggins' office with a video camera. I saw something like 19 people going in in wheelchairs, with seizures, with Epstein-Barr syndrome. And people were getting their amalgams out and having their symptoms no more."
Dr. Lydia Bronte -- a New York-based author and expert on aging -- had severe allergies and chronic pain from age 5, when she first had amalgam fillings put in, until several years ago, when she had them taken out. While working on her book The Longevity Factor, her health deteriorated to the point where she was sleeping 20 hours a day and in increasing pain. She consulted more doctors than she can now remember. "The only potential cause I hadn't eliminated was mercury poisoning," she says. "The reason I hadn't tested for that previously-even though my cousin, who was a nurse, had told me about it-was I thought it was nonsense. I even told her she should see a shrink. I had to call her later and apologize."
Bront looked into the possibility further and realized that not only was there mercury in her mouth, there was enough for her to be considered a walking toxic waste site. "If I had taken my 17 fillings and set them down on my living room floor," she says, "there would have been enough mercury in my living room that the EPA could have quarantined my apartment. Yet they were still considered safe enough to be in my mouth."
She had her 17 amalgams replaced. The first two were the roughest. "I had my first two large silver fillings removed without really knowing that there were safety precautions that should be taken," she says. "And neither my doctor nor my dentist knew it. The next morning I woke up with a sound like a jackhammer coming out of my chest every time I breathed. I had inhaled so much mercury from the drilling that I had lung damage." She is now back to what she calls "98 percent of where I should be but 98 percent is something I can live with."
Adams says he worries that "most dentists out there doing amalgam removal are not doing it safely and don't feel they need to be equipped with extra safety procedures because the ADA is telling them that everything is fine." He says there should be an "exhaust and aspiration source" to rid the area of the mercury particles disturbed by the fillings' removal, "copious amounts of cold water" to cool the fillings and "rubber dental dams and gloves must be changed repeatedly throughout the course of the procedure."
In 1988 Kip Sullivan, a 41-year-old Minnesota research director for a statewide progressive political organization, began suffering from intestinal cramping and chronic diarrhea. He endured the symptoms for a few years but then his situation deteriorated. He began feeling fatigued, had night sweats, nausea, stiffness, dry skin, pressure behind the eyes and memory loss. He was eventually diagnosed with colitis, an intestinal problem. "I was bleeding my guts away," he says. Sullivan saw the "60 Minutes" amalgam segment, which included interviews with a half-dozen people who had experienced chronic, degenerative conditions that were eliminated by the removal of their mercury fillings. He researched the evidence on his own and reached the conclusion that amalgams might be the cause of his troubles.
"I had my 14 fillings out between April and May of 1991," he recalls. "By July my symptoms were gone. I personally know 50 people who have had their amalgams out and their recovery was modest to miraculous."
In 1993 the dental amalgam newsletter Bio-Probe compiled case studies of 1,569 patients from the U.S., Sweden, Denmark and Canada whose mercury amalgams had been removed. More than four out of five patients reported moderate to complete recovery from their chronic ailments after the removal of their amalgams. While Bio-Probe does not claim to be a peer-reviewed scientific journal, its results do offer clinical evidence to support the case against amalgams. Preliminary results from an ongoing study of more than 2,000 amalgam removals in Marburg, Germany, have corroborated the newsletter's findings.
Still the ADA does not budge. The Journal of the American Dental Association -- which is also not peer reviewed -- states that "no evidence exists that associates this minute amount of mercury vapor [given off by amalgams] to any toxic effects." The ADA's position paper on amalgams (available on the Internet at http://www.ada.org) claims dental amalgam has an "indisputable safety record and has been extensively reviewed," citing reports from the FDA, the National Institutes of Health Technology Assessment Conference and the National Institutes of Dental Research. Furthermore, the ADA notes, a 1991 issue of Consumer Reports investigated pro- and anti-amalgam claims and concluded that "given their solid track record, amalgam fillings are still your best bet."
Ward Eccles, a Livermore dentist who has been mercury free for 17 years, says in his opinion your best bet is fillings made of "composite," a plastic material that's been around for 25 years. "Composite wears equal to or better than mercury amalgam, it bonds better, it looks like a tooth." The rap on composite, he says, was that it wasn't strong enough to be used to fill teeth in the back of your mouth, where the pressure of chewing is greatest.
But recent formulations have solved that problem-the real issue now, he says, is money. "Putting in a composite filling takes more time, which means you have to charge more, which means you have to charge the insurance companies more, which they don't like. Amalgam is easier -- you just slop it in there and thumb it off. Dentists are like anyone else -- we're lazy, we don't want to change." Eccles charges patients 20 percent to 40 percent more to insert a composite filling.
He says more dentists don't use composite because it's "technique sensitive" and many dentists don't know how to do it. He says one dental dean told him only 10 percent of the dentists coming out of school are trained to do a posterior composite, a filling in a back tooth. "They argue that amalgam is perfectly safe in your mouth because it has a 'biofilm' on it," Eccles says. "I'd laugh at that but it's not funny. To dispose of the mercury we don't use, we have to put on gloves and a breathing apparatus and take it to a class-A toxic waste dump."
San Francisco dentist and lawyer Edwin Zinman is a leader in the effort to maintain the prevalence of amalgams. He calls anti-amalgam advocates "distortionists" and cites the U.S. Public Health Service, saying, "they've looked at the scientific literature on amalgams and did not conclude amalgams were dangerous."
But when Jim Love queried amalgam manufacturers in the Tolhurst lawsuit, he says he heard a different tune. "I deposed one Johnson & Johnson representative who admitted on the stand that he knew of no independent study that has ever been done to establish the safety of amalgam," Love recalls. "They keep saying amalgam is perfectly safe. Well, show me the evidence. Don't tell me how smart you are and why I should respect your opinions. Show me the science. We have to prove the safety of every other substance besides amalgam before it's brought to the market. We haven't done that with mercury and amalgams, and the reason is that they're making so damn much money with them."
At the University of Kentucky Medical School a team of scientists led by Dr. Boyd Haley recently completed a study exposing six laboratory rats to a typical intake of amalgam mercury vapor, diluted to account for the size difference between rats and humans. Every rat developed symptoms and brain tissue damage indistinguishable from those of Alzheimer's disease patients. The results were so remarkable that Haley and his team figured something must have gone wrong. So they repeated the experiment. They got the same results.
Bront quotes Haley's response to his group's findings in her book The Mercury in Your Mouth: The Truth About "Silver" Dental Fillings: "The results of this experiment are terrifying. I'm getting the rest of my fillings taken out right now and I've asked my wife to have hers replaced too."
A second University of Kentucky research team discovered in an autopsy study that humans who died of Alzheimer's have twice as much mercury in their brains as people who died of other causes at similar ages. Mercury toxicity from amalgams is now being investigated as a possible factor in multiple sclerosis, amyotrophic lateral sclerosis (Lou Gehrig's disease) and Parkinson's disease.
No research team has hazarded any definitive conclusions but scientists have found some telling leads. A medical researcher at the University of Colorado has published more than 20 articles showing a link between mercury toxicity and MS and ALS. Huggins, the Colorado dentist and anti-mercury advocate, says he's had success in treating Parkinson's patients with amalgam removal.
If a definitive link could be found between any of these diseases and mercury amalgams, the legal implications would be staggering. In 1985-before some of the most important papers on the subject were written-the San Francisco Bar Association indicated that the ensuing mass litigation could be unprecedented in the history of toxic tort cases. "The scientific and medical evidence available even now suggest that the mercury amalgam issue is an internal Love Canal waiting to be exposed," concluded an article in the association's newsletter.
When mercury amalgams were introduced to the U.S., in the early 19th century, the American Society of Dental Surgeons was so adamantly opposed to the use of a known toxic chemical in tooth restoration that it pushed to make mercury use an issue of malpractice.
But the American Society of Dental Surgeons did not expect that this position would alienate it from most of its potential members. By 1856 amalgams had become so popular in dentistry that the ASDS -- which maintained its anti-amalgam stance to the end-disbanded due to dwindling membership.
So along came the American Dental Association. Its basic position on amalgams has changed little since its formation. It maintains today, as it did on day one, that mercury amalgams are perfectly safe for a vast majority of patients.
The ADA goes further. Its code of ethics declares that a dentist is acting "ethically" if he installs mercury amalgams and speaks of their safety. But the dentist is guilty of "unethical" behavior if he tells a patient that the amalgam may be harmful or that the patient may be exposed to harmful amounts of mercury vapor. While it is "ethical" to remove an amalgam filling for cosmetic or aesthetic reasons, it is "unethical" if the removal is carried out to rid the body of a toxic chemical and if the recommendation for removal is made solely by the dentist.
When brought to court the ADA has claimed to be merely a "trade organization." While that stance may insulate the ADA from litigation, it puts the ADA in a questionable position to be pontificating on medical ethics. Such up-is-down pronouncements may be the reason why more than 40,000 American dentists -- including half of those under age 35 -- are not members of the ADA.
That's not to say that the ADA wields a small stick, though. It doesn't. In fact, pressure from the ADA and state dental associations exerted upon several states' dental licensing boards is part of the reason that six mercury-free dentists have had their licenses revoked within the past few years. Some dentists who refuse to use mercury are looking over their shoulder. "I have not been hounded but I've watched out very carefully," says Adams. "Are you going to bail me out of jail after this appears?" he adds with a laugh.
Colorado's Huggins lost his license last year, in what some critics called a "classic witch-hunt." Mercury-free since 1973 and perhaps the country's most prominent anti-amalgam dentist, Huggins would be a natural target for anyone looking to discredit the anti-amalgam movement. In 1991 the ADA sent letters to the Colorado licensing board asking it to investigate Huggins' mercury-free practice. It did, and Huggins eventually lost. While the state dental examiners stand behind their conclusions, Huggins asserts that "dentistry is trying to embarrass me for getting this message out."
Also last year Dr. Gary Jacobson, a mercury-free dentist practicing in Minneapolis, gave up his license after being hounded for 13 years by the state dental board in a case history riddled with what many consider suspiciously petty charges. Twin Cities Wellness reported that Jacobson-an outspoken opponent of amalgams-had been brought before the State Board of Dentistry on charges that included joking with a patient about mercury, claiming that he treated "mercury toxicity" and using "Inc." after the title of his clinic instead of "P.A."
"It's a system that is so wrong, and most dentists don't know how wrong it is," Jacobson says. "The board is like the Gestapo. They don't have to be fair or right or timely or anything. They're not accountable to anyone and they can't be sued if they screw up."
In 1994 the California Board of Dental Examiners threatened to revoke the license of mercury-free dentist Edward Arana of Carmel Valley. The case was later dropped-after Arana suffered a near-fatal stroke. "It was a ridiculous case," says Arana's attorney. "It was a complete misuse of power on the part of the dental boards, which have enormous discretionary power. Rather than use that power to fight fraud they instead go after dentists who don't toe the party line."
Michael Ziff, the Florida dentist, asserts that patient disclosure should be the foremost concern of dentists and their licensing boards alike. "If you had fillings in your mouth that were 50 percent arsenic, that had been proven to leak out into your body, don't you think you should have the right to know?"
This article first appeared in East Bay Monthly
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