title: Psychological, allergic, and toxicological aspects of patients with amalgam-related complaints.
abstract: BACKGROUND
  To deepen the understanding of the numerous unspecific complaints which are related to the dental material amalgam both in patients and physicians, an interdisciplinary case-control study regarding toxicological, allergic, psychological and psychiatric aspects was conducted. Forty patients with amalgam-associated complaints were compared to a well-matched group of 40 amalgam bearers without complaints.
  
  
  METHODS
  Patients and controls underwent a dental examination, which included recording of the quantity, surface area and quality of amalgam fillings, a determination of the mercury load in blood and urine, an allergy examination including patch testing with amalgam and a psychometric assessment with questionnaires noting coping strategies (ABI-UMW-P), interpersonal problems (Inventory of Interpersonal Problems) and self-consciousness (SAM), the NEO Five-Factor Inventory, Symptom Checklist-90-R, Beck Depression Inventory and a screening instrument for somatoform disorders.
  
  
  RESULTS
  Patients and controls did not differ with respect to mercury concentrations in body fluids. Only 1 patient was found to have a positive amalgam patch test; various other allergies could be determined in 28% of patients (n = 11). Patients had higher levels of psychic distress, a higher incidence of depression and somatization disorders as well as different styles of coping with anxiety compared to controls.
  
  
  CONCLUSIONS
  No indication for mercury intoxication or amalgam allergy as a cause of the patients' complaints could be found. The theory of amalgam-related complaints as an expression of underlying psychic problems is supported. Treatment should focus on somatization and changing coping and attribution styles.
authors.affiliation: Department of Medical Psychology, University of Giessen, Germany.
authors.forename: Birgit
authors.initials: B
authors.lastname: Gottwald
authors.forename: Jörg
authors.initials: J
authors.lastname: Kupfer
authors.forename: Isabel
authors.initials: I
authors.lastname: Traenckner
authors.forename: Carolina
authors.initials: C
authors.lastname: Ganss
authors.forename: Uwe
authors.initials: U
authors.lastname: Gieler
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D003723:Dental Amalgam / Q000009:adverse effects*; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D006801:Humans; D006967:Hypersensitivity / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D008297:Male; D013001:Somatoform Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D011795:Surveys and Questionnaires
chemical_list: D003723:Dental Amalgam