title: Longitudinal analysis of the association between removal of dental amalgam, urine mercury and 14 self-reported health symptoms.
abstract: BACKGROUND
  Mercury vapor poses a known health risk with no clearly established safe level of exposure. Consequently there is debate over whether the level of prolonged exposure to mercury vapor from dental amalgam fillings, combining approximately 50% mercury with other metals, is sufficiently high to represent a risk to health. The objective of our study is to determine if mercury exposure from amalgam fillings is associated with risk of adverse health effects.
  
  
  METHODS
  In a large longitudinal non-blind sample of participants from a preventative health program in Calgary, Canada we compared number of amalgam fillings, urine mercury measures and changes in 14 self-reported health symptoms, proposed to be mercury dependent sub-clinical measures of mental and physical health. The likelihood of change over one year in a sample of persons who had their fillings removed was compared to a sample of persons who had not had their fillings removed. We use non-parametric statistical tests to determine if differences in urine mercury were statistically significant between sample groups. Logistic regression models were used to estimate the likelihood of observing symptom improvement or worsening in the sample groups.
  
  
  RESULTS
  At baseline, individuals with dental amalgam fillings have double the measured urine mercury compared to a control group of persons who have never had amalgam fillings. Removal of amalgam fillings decreases measured urine mercury to levels in persons without amalgam fillings. Although urine mercury levels in our sample are considered by Health Canada to be too low to pose health risks, removal of amalgam fillings reduced the likelihood of self-reported symptom deterioration and increased the likelihood of symptom improvement in comparison to people who retained their amalgam fillings.
  
  
  CONCLUSIONS
  Our findings suggest that mercury exposure from amalgam fillings adversely impact health and therefore are a health risk. The use of safer alternative materials for dental fillings should be encouraged to avoid the increased risk of health deterioration associated with unnecessary exposure to mercury.
authors.affiliation: School of Public Policy, University of Calgary, Calgary, AB T2P 1H9, Canada. zwicker1@ucalgary.ca.
authors.forename: Jennifer D
authors.initials: JD
authors.lastname: Zwicker
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Dutton
authors.forename: John Charles Herbert
authors.initials: JC
authors.lastname: Emery
mesh_terms: D000328:Adult; D002170:Canada / Q000453:epidemiology; D003723:Dental Amalgam / Q000009:adverse effects*; D004784:Environmental Monitoring; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008628:Mercury / Q000633:toxicity* / Q000652:urine; D008875:Middle Aged; D018570:Risk Assessment; D057566:Self Report
chemical_list: D003723:Dental Amalgam; D008628:Mercury