TO TABLE OF CONTENTS
Dental Amalgams and CFIDS:
Harmless Fillings — or Toxic Concern?
By Michael D. Fleming,
Are dental amalgams bad for your health? The debate
continues to rage about the mixed-metal tooth fillings, which contain mercury
and other potentially toxic substances. The topic is of particular interest to
people with CFIDS, who are searching for relief from the multitude of symptoms
they face every day.
The American Dental Association (ADA)
unequivocally that amalgam fillings are safe, since the mercury is made stable
when mixed with other materials. Although other materials are now available for
fillings, the ADA says that amalgams still play a role in modern dentistry — and
should not be removed simply out of unfounded concern over the presence of
Yet not all medical professionals are convinced. Michael
Fleming, DDS, writes that amalgam removal cannot promise miracles — but should
not be completely rejected, either.
CFIDS remains one of the most clinically challenging
conditions to treat in the health care setting. Many people with CFIDS (PWCs)
have tried so many different things to get well that they have worn themselves
out emotionally, financially and physically in the process. The ongoing symptoms
have often led patients on a wild goose chase searching for a cure. Some may
have simply resigned themselves to a life managed with medications. Others
continue the quest for healing with varying degrees of success.
A controversial treatment advocated to relieve chronic fatigue
states and other disorders is the removal of mercury-based amalgam fillings and
other dental materials from the mouth. In the search for wellness, many PWCs
have replaced their fillings, believing that the materials in them may be
working their way into the body and causing symptoms. Some PWCs have shown
measurable results, and others little or no perceived benefit. Many others have
considered having their amalgam fillings removed but are not at all sure of the
relevance and effectiveness of such a treatment.
The current scientific evidence does not adequately support
the legitimacy of amalgam replacement treatment to treat disease or ill health.
However, when considered as part of a broader long-term plan to recover health,
replacement therapy can be seen as “taking a brick off the wagon” of the immune
system. Treatments should therefore not be seen as offering the final answer to
a patient’s health problems, but rather as taking one more step toward allowing
the body an opportunity to heal itself.
Dental amalgam is a mixture of at least three metals: mercury
(45–55 percent), silver and tin. Depending on the manufacturer, copper is often
added for corrosion resistance, along with zinc, palladium and other trace
metals. Amalgam has been the standard filling material for teeth since the
mid-to-late 1800s, and its use in teeth was first recorded in
as the 1780s.
Virtually every dentist practicing in the world today has been
trained to do amalgams and the majority of them continue to install them
routinely. Dental amalgam remains a deeply entrenched treatment modality even
though there has been significant decline in its use with the development of
tooth-colored alternatives and growing health concerns over the presence of
When the body is exposed to mercury, the health effects
include a variety of toxic, allergenic and local oral symptoms. The list is
long, but typical symptoms would include fatigue, a decline in mental clarity,
irritability, depression, withdrawal from family and friends, poor sleep, night
sweats, anxiety, panic, pre-mature aging and a general sense that one is losing
one’s health and mind. There may be cardiovascular, neurological,
gastrointestinal and genitourinary symptoms of all sorts.
Many of the symptoms of mercury toxicity mimic those of CFIDS,
multiple chemical sensitivity syndrome and autoimmune disorders. Furthermore, it
can take months or years for any effects of mercury to appear, making a
conclusive diagnosis of any mercury-related disease nearly impossible. It is not
uncommon for people with mercury poisoning to be functioning at a high level
until an illness or significant life stress event occurs and health begins to
decline either suddenly or more gradually.
It is worth noting that the World Health Organization has
stated that dental mercury fillings constitute the main mercury exposure risk to
humans, exceeding food, air and water sources combined.
Even though mercury in the mouth is a hot issue in dentistry
these days, PWCs must realize the oral cavity can also contain a veritable
smorgasbord of other materials as well. It is not at all uncommon in a dental
practice to see patients with a combination of root canals, crowns, bridges,
implants, amalgams, composite fillings, removable metal/plastic appliances and
all sorts of bonding and bleaching agents, solvents, fillers and cements. These
materials can contain mercury, tin, silver, copper, zinc, palladium, gold,
nickel, beryllium, chromium, iridium, gallium, indium, platinum, titanium,
barium and aluminum — as well as complex plastic polymers and adhesives. Root
canal fillings often contain a latex rubber derivative (gutta percha),
formaldehyde, eugenol (oil of cloves), heavy metals including mercury and
various cements and bulking agents.
The decision for PWCs to enter into a treatment process like
amalgam removal needs to be made after careful consultation with a trusted and
knowledgeable physician and dentist, who, in turn, will work with each other and
the patient to establish a plan of treatment. Attention needs to be given to all
the materials present in the mouth, not just the amalgams. Careful consideration
needs to be given to the patient’s current state of health when entering into
this treatment. Fortunately, PWCs generally tolerate dental treatment very well
with few complications. If a choice is made not to engage in removal therapy, in
my opinion it still would be a good idea for PWCs to avoid the installation of
any more amalgams.
Dentists are not obligated to provide removal treatment and
many do not believe the removal of amalgam has any value in treating health
problems such as CFIDS. Both dentist and patient need to mutually appreciate the
need for this treatment and the risks and potential benefits must be clearly
discussed and understood. Patients may wish to consult with a dentist and/or
physician familiar with the new materials and procedures and experienced in
managing patients with CFIDS.
Patients also must be prepared to accept the fact that no
guarantees of improvement of symptoms can be made. There can be significant
expense — sometimes thousands of dollars — to have removal treatments performed,
depending on how much material is present in the mouth. These expenses are not
always covered by dental insurance.
It is the dentist’s duty to do no harm in the process of
removal treatment and to give his or her best efforts to those who seek care for
this purpose. While amalgam removal is a treatment worthy of consideration in
the CFIDS population, it is well for all of us to remember to “be informed
before anyone performs.”
Michael D. Fleming, DDS, has been treating CFIDS patients
for more than 18 years and practices general dentistry in Durham, N.C. His wife
has had CFIDS for more than 12 years; they live in Wake Forest, N.C.