Amalgam fillings may be making you sick, but many dentists don't care. And once you're sick, it's hard to find a doctor to make you better
The Portland Phoenix
By Jennifer Lunden
February 27 - March 4, 2004
February is Dental Health Month, and Rosie Cronin wants you to know that not all dentistry is healthful. Cronin, 51, is the New Hampshire Coordinator for DAMS (Dental Amalgam Mercury Syndrome), a national group dedicated to spreading the word about the dangers of dental amalgams. She comes by the position honestly. After years of ill health — chronic fatigue, fibromyalgia, food allergies, headaches, vertigo, tremors, irregular heartbeat, and early menopause — and consulting with doctor after doctor to no avail, a chiropractor finally told her to open her mouth. He counted eight mercury amalgams in her teeth and said, "There’s your problem."
Skeptical, Cronin went to an MD associated with Tufts Medical Center and had her urine tested for mercury. Twice. The level of mercury in her urine was, she says, "off the charts."
Cronin was never a big fish eater; she and her doctor deduced that the mercury in her body was leaking from the fillings in her teeth. So Cronin, desperate to recover her health, did something drastic: She had all of the amalgams in her mouth removed and replaced them with composite (white) fillings. That was in 1998. And when she walked out of the dentist’s office after having the last of her amalgams removed, Cronin couldn’t believe the difference. The tremors and vertigo were gone. Her head felt clear for the first time in years. And then, gradually, her chronic fatigue, gastrointestinal problems, and other symptoms started to go away.
Organizations like DAMS, along with some alternative health-care practitioners and insurgent dentists, have been reviving a controversy that has raged since mercury was first used to fill cavities. Mercury amalgams were introduced to the US in 1833. At that time, dentistry was performed by two different types of dentists. "Medical dentists" were doctors trained to practice both medicine and dentistry; "craftsmen dentists" had no formal education in medicine, and often doubled as barbers or blacksmiths. Medical dentists used gold to fill teeth. But mercury amalgams — made up of 50-percent mercury, along with silver, copper, tin, and zinc — were a boon to craftsmen dentists due to affordability and ease of use.
Medical dentists were leery from the start of putting such a toxic metal into people’s mouths, and the leading dental organization of the time, the American Society of Dental Surgeons (ASDS), passed a resolution declaring that using amalgams constituted malpractice. The ensuing controversy led to the collapse of the ASDS. Dentists using amalgams formed the American Dental Association (ADA), a dominant force in dentistry to this day.
The ADA continues to maintain that mercury amalgams are safe. Its "Statement on Dental Amalgam" asserts that, when combined with the other metals, mercury is chemically bound into a "hard, stable, and safe substance."
And A growing number of people question the veracity of the ADA’s claim. I am one of them.
Sick since 1989 with a host of inscrutable symptoms, ranging from chronic fatigue and depression to severe food allergies and chemical sensitivities, a few years ago I was urged by an alternative health-care practitioner to ask my doctor to test me for mercury toxicity. My doctor, Dr. Joseph Py, a DO (Doctor of Osteopathy, trained in standard medical practice and additional techniques based on a philosophy of the body’s innate capacity to heal) specializing in environmental medicine, ordered a "post provocative challenge": He prescribed a chelating agent to help push the mercury into my urine, and sent me home with a cup and a bucket, with orders to collect my urine for 24 hours. I sent a sample off to the lab. When the results came in, Dr. Py told me the mercury in my system was identified by the lab as "very elevated": five times higher, in fact, than the range considered safe.
I began a protocol of chelation to try to rid my body of the toxic metal. When I did another test almost a year later and the mercury was still elevated, I began to suspect that my mouthful of mercury amalgams might be responsible. After doing some research, I, like Cronin, decided to have them removed.
I found that some experts argue that dental amalgams are not "stable" or "safe." In fact, in recent years even the ADA has acknowledged that vapors are released from dental amalgams. PhD corrosion scientist Jaro Pleva, of Sweden, analyzed a five-year-old filling and found that almost half of the mercury had leached out. Pleva also cites a study from the Journal of Dental Research, indicating that mercury vapor in exhaled air after chewing is proportional to the number of fillings in the mouth, sometimes reaching more than the maximum allowable industrial level for mercury exposure in an eight-hour, five-day-a-week job.
In the Journal of Orthomolecular Medicine, researcher Robert Siblerud concludes from his study that immune systems were enhanced after amalgam removal, with subjects reporting significantly fewer colds, sore throats, sinus problems, and allergies. Another paper, published in the American Journal of Psychotherapy, makes a connection between mercury amalgams and mental-health problems. Subjects with amalgams reported more irritability, depression, fatigue, suicidal thoughts, anxiety, sudden anger, nervousness, and memory loss than those without.
But Dr. Mark Zajkowski, an oral surgeon working in South Portland, says studies like these are "bad science." Dr. Zajkowski pulled an infected tooth for me once. When I expressed concerns that my chemical sensitivity might make me reactive to Novocain, he noted that my physician was Dr. Py — who’s viewed as a maverick by traditional practitioners — and winced unapologetically. He observed from my records that I had recently replaced some fillings and asked if I had done that on the recommendation of Dr. Py. When I replied that I had made the decision to remove my amalgams after doing my own research, Zajkowski said, "You can’t believe everything you read on the Internet."
A year later, I called him up and interviewed him for this story. He said he remembered me.
Zajkowski likens mercury amalgams to salt, which is made by combining sodium and chloride. "Sodium itself is incredibly flammable. Chlorine gas would kill you if you inhaled it. Combined together, it’s table salt. Harmless. Same thing with dental amalgams."
Zajkowski says that the ADA’s position is supported by "every reputable scientific community," including the World Health Organization (WHO), the Food and Drug Administration (FDA), the National Institutes of Health (NIH), and the US Public Health Service (USPHS).
But at a May 2003 congressional hearing on the health consequences of amalgam, Professor Maths Berlin, former chair of the WHO committee of toxicologists, explained that it was only the WHO dental division — which is heavily stacked with ADA dentists — that declared mercury amalgams safe. In fact, the WHO’s committee of mercury toxicologists concluded that dental amalgams are the largest source of mercury in adults not occupationally exposed, according to a report of the hearing in Dental Truth, the DAMS newsletter.
Sandra Duffy, an attorney from Portland, Oregon, also testified at the hearing. She reported that the National Institute of Dental and Craniofacial Research, the dental research arm of the NIH, has spent hundreds of millions of dollars on 500 studies pertaining to mercury amalgams. Only one of these studies has been published, suggesting, according to Duffy, a cover-up.
And the FDA’s track record for protecting the consumer from mercury is not stellar. (See "You’re Being Poisoned," Feb. 13.)
In fact, a number of countries are now in the process of restricting or prohibiting mercury amalgams. In Sweden, a "Dental Material Commission" — comprising representatives from the Swedish Dental Association, dental schools, the Swedish National Board of Health and Welfare, and the Swedish Association of Dental Mercury Patients — recently delivered a report recommending a total ban on mercury amalgams. Norway has significantly restricted use of amalgam. Denmark and Germany have also proposed restrictions.
Here at home, Representative Diane Watson (D) of California has introduced a bill that would ban interstate commerce of mercury intended for use in dental fillings, effectively prohibiting mercury amalgams in the US. Maine’s Second District representative, Mike Michaud (D), is a cosponsor.
Other Maine citizens, like Pam Anderson, are working on the local level to outlaw mercury amalgams. Anderson describes her dentist husband, Dr. Tom Anderson, as an anti-amalgam pioneer. Pam is the office manager for his dental practice in Houlton, and she was motivated to agitate for changes in legislation after reading an article about a HoltraChem mercury leak in the Bangor Daily News. "I thought to myself, ‘My goodness, if a tablespoon’s released into the river and they’re making a big to-do of this, then what about how many tablespoons . . . Maine dentists [are] putting in the heads of people in the state of Maine every day?’ "
Anderson hopes that her efforts will end in a ban on mercury amalgams, at least in the state of Maine. She has drafted legislation to this effect, and intends to introduce it in the next legislative session.
Anderson’s first attempt to have mercury amalgams banned for use in children and women of childbearing age was defeated. But in 2001, then-governor Angus King signed a compromise bill, called "An Act to Address the Health Effects of Mercury Filling," which requires dentists to "provide each patient" with a brochure outlining the "potential advantages and disadvantages to oral health, overall human health, and the environment of using . . . mercury amalgam in dental procedures." Dentists must also display a poster "in the public waiting area" informing patients of the availability of the brochure. This was groundbreaking legislation, which is being used now as a model for other states seeking to address concerns about the risks of mercury amalgams.
But are Maine dentists following the law? One day, while I was in the midst of writing this story, my friend Patrick, an intelligent, health-conscious man, called me up to tell me he’d just had an amalgam placed in his tooth.
"Why’d you go and do a thing like that?" I said.
Patrick’s response? "I didn’t know I had a choice."
He was treated at Community Dental, in Portland, a clinic for low-income patients, and he said he didn’t see a poster or any brochures outlining his options.
So I went down to Community Dental and had a look around. Nothing.
I asked Nicky Yattaw, Operations Manager, for help, but she was also unable to locate the brochure. She enlisted the help of a fellow worker, and after a brief scramble they came out from behind the locked door, brochure in hand.
They told me they keep the brochures in each operatory. When I asked if I could see the location, the staffers denied me entry, explaining that they were in the midst of a meeting.
Later, I spoke with Yattaw on the phone. She told me they hand a form to every patient which includes information about the brochure. As for the poster, "I need to look and see where [it] is."
In the meantime, people like Patrick, who may not read the fine print, are having mercury amalgams put in their mouths without knowing they have a choice, and without knowing the risks.
Last year, Governor John Baldacci signed another bill targeting amalgams, requiring Maine dentists to install amalgam separator systems in their offices. This device prevents dental amalgam from entering the waste stream. The Maine Dental Association (MDA) supported this legislation, although its executive director, Frances Miliano, is quick to qualify that support, asserting that "the Dental Association does not feel that dentists are a significant contributor to mercury in the waste stream."
But the Zero Mercury Campaign, an organization created to pressure New England state governments to fulfill their commitment to eliminate mercury emissions, maintains that 50 percent of mercury in water comes from dental amalgams. Some of that flows out of dentists’ offices; the rest is excreted in human waste. And the Bar Harbor Times reports that an average of one to two pounds of mercury flows every year from each of the 600 Maine dental offices. That adds up to 600 to 1200 pounds of mercury entering Maine’s wastewater.
One gram of mercury is all it takes to contaminate a lake the size of a football field, making fish unsafe for human consumption.
When I asked Dr. Zajkowski to explain how it is that mercury amalgams are considered to be a pollutant in the water but not in the mouth, he replied, "Just because I’m calling it a pollutant doesn’t mean that it’s a toxic substance." He likened it to dropping a titanium plate from a broken jaw, or a gold crown, into a lake. Litter. "Because we know the state is very environmentally conscious we supported that [amalgam separator legislation]. Even though it probably won’t make a difference in the environment at all."
While Dr. Zajkowski and the ADA assert that mercury amalgam is not a toxic substance, directions for use provided by Dispersalloy, an amalgam manufacturer, direct dentists to store amalgam scrap "in well sealed containers." And "Dental Mercury Hygiene Recommendations" provided by the ADA Council on Scientific Affairs, printed in the Journal of the American Dental Association (JADA), state that "amalgam scrap should not be stored in water."
Cronin, of DAMS, puts it bluntly: "In essence our mouths are mini–toxic dump sites . . . If it’s bad for the environment, it’s bad for us."
And few stop to wonder what happens to amalgams after people die. If the deceased is cremated, the mercury is incinerated into the air. The EPA has set no limits for mercury emissions from crematoria. A study of crematoria workers showed they had higher concentrations of mercury in their hair than a control group.
And what about the dentists who use mercury amalgams to fill their patients’ teeth? Are they at risk for higher levels of toxicity? Some say that just as milliners in the 19th century were made "mad as a hatter" by the mercury used to make felt hats, the high levels of depression and suicide in dentists may be related to their exposure to mercury. A study of 180 dentists in Scotland showed that dentists had up to four times the normal level of mercury in their urine and nails, and that dentists with higher levels of mercury in their bodies had more memory lapses and kidney problems than the general population.
As we reported in Part One of this series, 10 percent of US women — and 20 percent of Maine women — of childbearing age have enough mercury in their bodies to put a fetus at risk for permanent neurological damage. To date, these numbers are largely blamed on environmental pollution and fish consumption. But it’s possible that the amalgams in women’s teeth are a prime culprit. Mercury amalgams in pregnant women do impact the fetus, according to the US Agency for Toxic Substances and Disease Registry (ATSDR). Representative Dan Burton (R-IN) says that in 1999 the ATSDR published a report stating that mercury vapors are constantly emitted from amalgam, that they go first to the brain, and that children, because their brains are still developing, are most at risk of long-term damage. The report adds that mercury crosses the placenta to the developing fetus, and that it contaminates breast milk.
Consequently, the directions for use of the amalgam Dispersalloy contraindicate use in expectant mothers and children six and under. These considerations are not mentioned in the ADA’s official "Statement on Dental Amalgam." Nor is there legislation in place prohibiting such use. "That’s what we’re trying to do," says Anderson.
Dentists aren’t trained to recognize the signs of mercury toxicity, and their Code of Ethics prohibits them from recommending removal of amalgams. And there aren’t many doctors in Maine who are experienced in recognizing and treating mercury toxicity. Dr. Py was one. But last November, Dr. Py’s Portland patients were surprised to open a form letter explaining that he would be closing his Portland practice. The letter sent shock waves through a community of environmentally ill people who had come to rely on Py for his creative and effective solutions to their very challenging health problems, problems many doctors before him had failed to address effectively. Patients scrambled to find supportive replacements. Some resolved to make the hour-and-20-minute drive to his Amesbury, Massachusetts office.
One patient, who sees Py twice a month and is too ill to drive, called a number of nonprofit and state social service agencies before a Catholic Charities case worker helped her secure a volunteer driver, a Shriner, to chauffeur her to her appointments.
When I asked Dr. Py why he decided to close his Portland practice, he told me a story I could hardly believe. Later, when I interviewed him for this article, I asked him to give my number to Debora Tyler, his patient and a key player in his story. Tyler and I met over lunch at Wild Oats.
Tyler believes, now, that she was poisoned by mercury starting in 1991, when an unethical Massachusetts dentist replaced all her composite fillings with mercury amalgams. Tyler, a former army medic, microbiologist, and lab technician, got sick gradually within a year of having the amalgams put in her teeth. She recites a long litany of symptoms: thyroid problems, ovarian cysts, excruciating pain, sleep disorder, cognitive difficulties, tinnitus, food allergies, nausea, diarrhea, numbness in her feet, bleeding gums, spots before her eyes, and hair loss. She also gained 40 pounds. At her sickest, she couldn’t work at all.
Tyler consulted with three Maine doctors. They focused on fibromyalgia and hypothyroidism and dismissed Tyler’s requests for heavy metal testing. Meanwhile, Tyler got sicker and sicker.
In 1999, Tyler found Dr. Py, who eventually diagnosed her with mercury toxicity after lab results indicated she had "very elevated" levels of mercury in her body. So Tyler had her amalgams removed and began a process of chelation. Over a period of four to five months, Tyler reduced her mercury 14-fold, down to what is considered nontoxic levels. The cysts disappeared, and within two to three months her pain had substantially diminished.
By the time I met with her, Tyler had lost almost all the weight she had gained when she was so sick. She said she rarely suffers from pain. The spots in front of her eyes are gone, so that she can now read and drive again. Playing in an online Spades league is helping her restore her cognitive function. And she is able to work part- time.
But Tyler is frustrated that she was sick for so long with a treatable condition, and she is concerned that the medical system is ignoring a significant public health issue.
So she submitted a complaint to the Board of Licensure in Medicine, naming the doctors who missed the diagnosis and charging them with providing inadequate medical care, ignoring her complaints, failing to do proper testing, and misdiagnosing her.
The board voted unanimously to dismiss the complaints against all three doctors. It did not acknowledge her mercury toxicity. In fact, the board voted to forward Tyler’s complaint to the Board of Osteopathic Licensure for review. And the DO board decided to investigate Dr. Py, who practices complementary and alternative medicine(CAM), for using chelation therapy — standard medical protocol for treating heavy-metal toxicity — to clear the mercury out of Tyler’s body.
The board is charged both with protecting the public safety and upholding the standard of care. In the case of Debora Tyler, there was no patient complaint and no patient injury. It appears, then, that the board’s motive in this case is strictly to preserve the standard of care. The question is: Whose standard of care does the board preserve?
The Federation of State Medical Boards’ proposed guidelines for evaluating CAM physicians recommend including a CAM doctor on the board, or at least consulting with one, in order to perform a fair evaluation. Py says the DO board does not follow these guidelines. "Nor are its members informed about these practices. Yet they’re expected to render decisions in the appropriateness of the treatments given by CAM physicians."
I was unable to obtain comment from the DO board.
Py has never had a patient complaint. But he was investigated by the board once before for his practice of complementary and alternative medicine. And he says he’s not the only CAM physician who has been targeted. After seeing a number of colleagues pursued by the DO board, Py questions whether the board is biased against CAM practices.
It appears that the board has changed it purview from protecting the public safety to protecting the standard of care. While this may sound like a worthy goal, complementary and alternative treatments that that have been shown to improve health are still considered suspect by mainstream medical practitioners devoted to prescribing expensive pharmaceuticals and invasive surgeries. Since the ADA insists that amalgams are safe, and mercury toxicity is effectively ignored by mainstream medicine, it appears that doctors who venture to diagnose and treat it are putting themselves in danger of being disciplined by their licensing boards.
Dr. Py had been through it once. When he was notified of the second complaint, he knew that his practice in Maine would never be safe from the board’s scrutiny. So he decided to pull up stakes and leave his Maine practice behind.
I called up the Maine Board of Licensure in Medicine to try to get some understanding of how it is that a complaint about doctors under its jurisdiction (MDs), ended up at the Board of Osteopathic Licensure, where a complaint was filed on a doctor who successfully treated a patient and with whom the patient was happy.
I spoke with Executive Director Randall Manning, who told me that, even though I could provide a signed release from Tyler (who also was unable to obtain records regarding her case), due to board statutes protecting confidentiality of patients and physicians, he could not provide me with any information specific to the case, other than board minutes.
Since media watchdogs have no meaningful access to the medical licensing board’s decision-making process, I asked Manning who is charged with its oversight. He told me board members are appointed by the governor. He pointed out that three members of the public are included on the board, ostensibly as counterweight to possible bias. The medical board does not lobby for specific nominees, according to Manning. If a complainant is dissatisfied with a decision, s/he can make an appeal to the board with additional information. Beyond that, there’s no one else to whom s/he can appeal.
In essence, nobody is watching the boards. So if bias exists, frightening physicians from diagnosing and treating mercury toxicity, there’s no way to identify and challenge it. And sick patients are left with no one to tell them what’s wrong or how to get better.
Physicians like Dr. Py are sometimes referred to as "quacks" by those who support mainstream medicine. It is ironic that the term was first applied to dentists who used mercury, or quaksilber (in English, "quicksilver"), in amalgams. Mercury toxicity has been associated, in various studies, with Alzheimer’s, multiple sclerosis, autism, chronic fatigue syndrome, multiple chemical sensitivities, fibromyalgia, and attention deficit/hyperactivity disorder (ADHD). Lisa Marie Presley told Rolling Stone that she believes mercury amalgams were responsible for her health breakdown a number of years ago. Local doctors such as Dr. John Pelletier, a DO specializing in musculoskeletal health, and Dr. Paul Balzer, a family practice MD, had their amalgams removed due to concerns about health effects. And Dr. Py has had a number of patients whose health improved after amalgam removal.
But my own random survey of Maine dentists found that seven of the eight who responded still use amalgam in their practices. They believe that it is a safe product. They cite durability, economy, and ease of use as chief factors influencing continued use. And they worry that low-income people will not have access to alternative fillings — which are more expensive — should amalgams be banned. Even insured patients do not always have access to alternatives; many insurance companies, like the one used by the Phoenix, will not reimburse any fillings but amalgams.
Though I myself fall into the category of "low income," I will never again allow a dentist to put mercury amalgams into my teeth. Removing my amalgams has helped me chelate my mercury, so far, down to a quarter of its highest level. And though, given the gradual nature of my mercury detox, it’s difficult to make a direct correlation, some of my symptoms have abated. I agree with former governor Angus King, who compared current use of mercury in dental fillings with the use of X-ray machines in shoe stores in the ’50s: "Now we realize it was a terrible thing to do, but then it seemed perfectly normal. Some day we will wonder how we could ever have put such a toxic substance into the human mouth," he told reporters when he signed the informed consent legislation into law.
If you have silver fillings in your teeth, you have mercury in your mouth. You may not have noticed any ill effects. While it is apparent that some people are more sensitive to the effects of mercury than others, it is also true that mercury toxicity from amalgams generally develops gradually, and since it expresses itself differently in different people, it is not easily identified.
But even Rosie Cronin urges caution around amalgam removal. "I caution people, before they go running and have their mercury amalgam fillings out, if they’re suspicious of having mercury poisoning, to get testing first — to make sure that they do have high levels of mercury in their bodies. And if they do, they want to go to somebody who is well-versed in the protocol." Removal of amalgams must be done properly, or worse damage can be done.
If you’re worried that your amalgams might be affecting your health, DAMS can help you find a reputable practitioner who can work with you to assess your options. The Maine contact is Marjorie Monteleon, at (207) 244-5577.