Analysis of dental amalgam fillings on primary Sjögren's syndrome: A population-based case-control study in Taiwan.

ABSTRACT: Primary Sjören's syndrome (pSS) is an autoimmune disease characterized by the inflammatory infiltrate and progressive dysfunction of salivary glands. Dental amalgam with mercury has been raised the public concerns regarding its purported mercury toxicity from dental amalgam to possible systemic inflammatory and immune reactions.In this study, a nationwide population-based database was employed to investigate the association of amalgam filling (AMF) and the risk of pSS. A retrospective case-control study was sourced from the Taiwanese National Health Insurance Research Database (NHIRD) from 2000 to 2013. Case and control groups were matched by sex, age, urbanization level, monthly income, and comorbidities using the propensity score method with a 1:1 ratio. In this study, 5848 cases and 5848 controls were included.The results demonstrated no statistically significant differences between AMF and pSS (odds ratio [OR]: 0.974, 95% confidence interval [CI] = 0.904-1.049). In addition, pSS was also not associated with AMF for women (OR: 0.743, 95% CI = 0.552-1.000) and men (OR: 1.006, 95% CI = 0.670-1.509), respectively.Taken together, evidence demonstrated that the association of AMF and pSS was inconsistent from this robust register databank.

Validity and responsiveness of EQ-5D-5L and SF-6D in patients with health complaints attributed to their amalgam fillings: a prospective cohort study of patients undergoing amalgam removal.

BACKGROUND: Evidence of health utility changes in patients who suffer from longstanding health complaints attributed to dental amalgam fillings are limited. The change in health utility outcomes enables calculating quality-adjusted life-year (QALY) and facilitates the comparison with other health conditions. The purpose of this study was to estimate the validity and responsiveness of the EQ-5D-5L and SF-6D utilities following removal of dental amalgam fillings in patients with health complaints attributed to their amalgam fillings, and examine the ability of these instruments to detect minimally important changes over time. METHODS: Patients with medically unexplained physical symptoms, which they attributed to dental amalgam restorations, were recruited to a prospective cohort study in Norway. Two health state utility instruments, EQ-5D-5L and SF-6D, as well as self-reported general health complaints (GHC-index) and visual analogue scale (EQ-VAS) were administered to all patients (n = 32) at baseline and at follow-up. The last two were used as criteria measures. Concurrent and predictive validities were examined using correlation coefficients. Responsiveness was assessed by the effect size (ES), standardized response mean (SRM), and relative efficiency. Minimally important change (MIC) was examined by distribution and anchor-based approaches. RESULTS: Concurrent validity of the EQ-5D-5L was similar to that of SF-6D utility. EQ-5D-5L was more responsive than SF-6D: the ES were 0.73 and 0.58 for EQ-5D-5L and SF-6D, respectively; SRM were 0.76 and 0.67, respectively. EQ-5D-5L was more efficient than SF-6D in detecting changes, but both were less efficient compared to criteria-based measures. The estimated MIC of EQ-5D-5L value set was 0.108 and 0.118 based on distribution and anchor-based approaches, respectively. The corresponding values for SF-6D were 0.048 and 0.064, respectively. CONCLUSIONS: In patients with health complaints attributed to dental amalgam undergoing amalgam removal, both EQ-5D-5L and SF-6D showed reasonable concurrent and predictive validity and acceptable responsiveness. The EQ-5D-5L utility appears to be more responsive compared to SF-6D. Trial registration The research was registered at ClinicalTrials.gov., NCT01682278. Registered 10 September 2012, https://clinicaltrials.gov/ct2/show/NCT01682278 .

The cytotoxic and oxidative effects of restorative materials in cultured human gingival fibroblasts.

The aim of this study was to evaluate the cytotoxic and oxidative effects of the most commonly used dental restorative materials on human gingival fibroblast cells (HGFCs). HGFCs were obtained from healthy individuals. The tested restorative materials were a microhybrid resin based composite, a compomer resin, a glass ionomer cement, and an amalgam alloy. One hundred eight cylindirical samples, 10 mm in diameter and 2 mm in height, were prepared according to ISO 10993-12:2002 specifications (n = 9 in the tested subgroups). Freshly prepared and aged samples in artificial saliva at 37 °C (7 and 21 d) were placed into well plates and incubated. Wells without dental materials were constituted as the control group. After 72 h incubation period, cytotoxicity was determined using the neutral red (NR) assay. Oxidative alterations were assessed using total antioxidant capacity (TAC) and total oxidant status (TOS) assay kits. Data were analyzed using the ANOVA and LSD post hoc tests. All tested materials led to significant decreases in the cell viability rates (33-73%) compared to the control group. Glass ionomer and resin composite were found to be more cytotoxic than amalgam alloy and compomer. The highest TAC level was observed in glass ionomer after seven-day aging and these changes prevented an increase in TOS levels. Increases in TAC levels after seven-day aging in all groups exhibited significant differences with freshly prepared samples (p < 0.05). In all material groups, TOS levels of freshly prepared samples differed statistically and significantly from samples aged for 7 and 21 d (p < 0.05). The data obtained suggested that all the tested materials exhibited cytotoxic and pro-oxidant features. Freshly prepared samples caused higher TOS levels. However, oxidant status induced by materials decreased over time.

Dental Amalgam Fillings and Multiple Sclerosis: A Nationwide Population-Based Case-Control Study in Taiwan.

Multiple sclerosis (MS) is an inflammatory neurological disease characterized by autoimmune-mediated demyelination of the central nervous system. Genetic and environmental factors may contribute to the development of MS. This has not been confirmed yet. Dental amalgam has long been controversial in MS due to its mercury content but the toxicological implications of mercury-containing amalgam fillings (AMF) for MS remain to be elucidated. We conducted a case-control study to investigate the association between AMF and the risk of MS from the Taiwanese National Health Insurance Research Database (NHIRD). Case (n = 612) and control (n = 612) groups were matched by sex, age, urbanization level, monthly income, and Charlson comorbidity index by propensity score matched with a 1:1 ratio from 2000 to 2013. Differences between cases and controls was not statistically significant (OR: 0.82, 95% CI = 0.65-1.05). In subjects stratified by gender, MS was also not associated with AMF for women (OR: 0.743, 95% CI = 0.552-1.000) and men (OR: 1.006, 95% CI = 0.670-1.509), respectively. In summary, this Taiwanese nationwide population-based case-control study did not find an association between MS and AMF.

Association between Dental Amalgam Filling and Essential Tremor: A Nationwide Population-Based Case Control Study in Taiwan.

Essential tremor (ET) is a common neurological disorder and the most common movement disorder. Low-level occupational exposure to mercury vapor is known to be a crucial factor that increases the risk of tremor. Dental amalgam is one of the main sources of mercury in those who possess amalgam restorations. However, the relationship between ET and amalgam filling (AMF) is not quite clear. The purpose of this study was to investigate the association between AMF and the risk of ET using a population-based administrative databank. The data for this study were sourced from the Taiwanese National Health Insurance Research Database (NHIRD). A retrospective case-control study was conducted using this databank from 2000 to 2013. Case and control groups were matched by sex, age, urbanization level, monthly income, and Charlson comorbidity index using the propensity score method with a 1:1 ratio. In this study, 3008 cases and 3008 controls were included. The results from this nationwide population-based case-control study did not indicate any association between ET and AMF in Taiwan. Although the results were not significantly statistical, the findings may be worthy to be valued.

Mercury in dental amalgam: a risk analysis.

Mercury is a highly potent cell toxin with effects on human and animal nervous systems. Mercury vapour released from dental amalgam is the predominant source of mercury in the human adult and foetal central nervous system in populations of developed countries. Only in small populations with high consumption of methyl mercury containing fish can the contribution from fish consumption reach or surpass that of amalgam fillings. The most severe health risk is that of interference with foetal and child brain development. This effect of mercury vapour exposure has been demonstrated in animal experiments on monkeys and rats and in nerve cell cultures at nanomolar concentrations. The effect is also supported by epidemiological studies on women occupationally exposed to mercury vapour during pregnancy. However, there is no data permitting an assessment of dose-response relations for this effect in humans. In epidemiological studies on populations with occupational exposure to mercury vapour, subclinical effects on kidneys, the immune system, thyroid function, and CNS function have been observed at an exposure level equal to the upper range of the exposure range seen in amalgam bearers and measured as urine excretion rate of inorganic mercury. The cell toxic effect of mercury is likely to be based on the ability of mercury to modify protein tertiary and quaternary structure. As protein structure is genetically determined, there is ample scope for genetic polymorphism to manifest itself in varying sensitivity and reaction to mercury exposure. It is also likely that mercury exposure from dental amalgam exerts side effects like most potent pharmaceuticals. The clinical support for this assumption is reviewed. An incidence of side effects exceeding 10% is unlikely considering available epidemiological evidence. However, an incidence of 1% or below is highly probable. It is recommended that use of amalgam for dental restorations is abandoned and substituted with available less toxic material and that amalgam restorations in children and women of childbearing age should be avoided due to the potential risk of interference by mercury with brain development.

Amalgama y mercurio. Visión y evolución en la odontología restauradora actual / Amalgam and mercury. Vision and evolution in current restorative dentistry

La amalgama dental ha sido un material restaurador muy confiable, de gran utilidad en la odontología y que, aún con su gran aceptación y amplio uso en la profesión dental, ha presentado siempre muy limitado reconocimiento profesional, por su poca o nula capacidad estética o de color de diente y por las «guerras¼ que ha tenido que librar a través de sus muchos años de vida. El mercurio es un componente importante en la mezcla de la amalgama dental, y su presencia ha sido uno de los factores preponderantes que han causado el detrimento injusto del uso de este material restaurador, que ha demostrado un comportamiento clínico excelente en sus casi 200 años de vida (AU)

Dental amalgam has been a very trustable restorative material, highly utilized in dentistry and although with high acceptance and ample use in the dental profession, it has always had to deal with limited professional acknowledgement due to little or poor esthetic and lack of tooth color and because of the many «wars¼ it has to fight in the many years of life. Mercury is a very important component of the mix in the dental amalgam and its presence has been one of the key factors that has caused the unjustified detriment of the use of this restorative material that has shown an excellent clinical behavior in the almost 200 years of life (AU)

La amalgama dental en el futuro / Dental amalgam in the future

Las convenciones internacionales relacionadas con las posibles consecuencias ambientales del empleo del mercurio a las que ha adherido la República Argentina llevan a la paulatina desaparición de la posibilidad del empleo de este elemento. Consecuentemente, se genera la necesidad de reducir y, en última instancia, eliminar el uso de productos médicos que lo contengan, como es el caso de la amalgama dental. Se requiere de la decisión conjunta de las comunidades académica y asistencial para definir estrategias a aplicar en la reducción gradual del uso de la amalgama dental. La forma de hacerlo y la tecnología para su reemplazo aún son inciertas (AU)

International conventions related to the possible environmental consequences of the use of mercury that the Argentine Republic has subscribed lead to the gradual disappearance of the possibility of using this element. Consequently, there is a need to reduce and ultimately eliminate the use of medical products that contain it, as is the case with dental amalgam. The joint decision of academic and healthcare communities is required to define strategies to be applied in the gradual reduction of the use of dental amalgam. The way to do it and the technology for its replacement still remain uncertain (AU)

Evaluation of amalgam-related retinal neurotoxicity with optical coherence tomography findings.

PURPOSE: To evaluate the neurotoxic effect of amalgam dental fillings on plasma mercury (Hg) levels and retino-choroidal layers measured by spectral domain optical coherence tomography (SD-OCT). MATERIALS/METHODS: Study participants included 56 cases with amalgam dental fillings and 44 healthy controls. All participants were examined in terms of detailed ophthalmic examination, oral examination, and body mass index (BMI). The measurement of retinal layers and choroid was performed using SD-OCT. Venous blood samples were collected and blood Hg levels were measured using cold vapor atomic absorption spectrometric analysis. Correlations between SD-OCT measurement results and blood Hg levels were analyzed. RESULTS: There were no differences between groups in terms of age, sex, or BMI. The mean blood Hg level was 2.76 ± 1.21 µg/L in the amalgam group and 2.06 ± 1.15 µg/L in the control group ( p = 0.04). The Hg/BMI ratio was 0.12 ± 0.06 kg/m2 in the amalgam group and 0.09 ± 0.05 kg/m2 in the control group ( p = 0.01). Reduced volumes of ganglion cell layer and inner plexiform layer were observed in the amalgam group when compared with the control group ( p < 0.05). CONCLUSION: Amalgam dental fillings can cause retinal neurotoxicity. SD-OCT can be useful for evaluating amalgam-related retinal neurotoxicity.

Thinking outside the (pill) box: Does toxic metal exposure thwart antibiotic stewardship best practices?

Multi-antibiotic resistant (MAR) bacteria cost billions in medical care and tens of thousands of lives annually but perennial calls to limit agricultural and other misuse of antibiotics and to fund antibiotic discovery have not slowed this MAR deluge. Since mobile genetic elements (MGEs) stitch single antibiotic resistance genes into clinically significant MAR arrays, it is high time to focus on how MGEs generate MAR and how disabling them could ameliorate the MAR problem. However, to consider only antibiotics as the drivers of MAR is to miss the significant impact of exposure to non-antibiotic toxic chemicals, specifically metals, on the persistence and spread of MAR. Toxic metals were among the earliest discovered targets of plasmid-encoded resistance genes. Recent genomic epidemiology clearly demonstrated the co-prevalence of metal resistances and antibiotic multi-resistance, uniquely in humans and domestic animals. Metal resistances exploit the same, ancient "transportation infrastructure" of plasmids, transposons, and integrons that spread the antibiotic resistance genes and will continue to do so even if all antibiotic misuse were stopped today and new antibiotics were flowing from the pipeline monthly. In a key experiment with primates, continuous oral exposure to mercury (Hg) released from widely used dental amalgam fillings co-selected for MAR bacteria in the oral and fecal commensal microbiomes and, most importantly, when amalgams were replaced with non-metal fillings, MAR bacteria declined dramatically. Could that also be happening on the larger public health scale as use of amalgam restorations is curtailed or banned in many countries? This commentary covers salient past and recent findings of key metal-antibiotic resistance associations and proposes that the shift from phenotyping to genotyping in surveillance of resistance loci will allow a test of whether declining exposure to this leading source of Hg is accompanied by a decline in MAR compared to countries where amalgam is still used. If this hypothesis is correct, the limited success of antibiotic stewardship practices may be because MAR is also being driven by continuous, daily exposure to Hg, a non-antibiotic toxicant widely used in humans.

Increased mercury emissions from modern dental amalgams.

All types of dental amalgams contain mercury, which partly is emitted as mercury vapor. All types of dental amalgams corrode after being placed in the oral cavity. Modern high copper amalgams exhibit two new traits of increased instability. Firstly, when subjected to wear/polishing, droplets rich in mercury are formed on the surface, showing that mercury is not being strongly bonded to the base or alloy metals. Secondly, high copper amalgams emit substantially larger amounts of mercury vapor than the low copper amalgams used before the 1970s. High copper amalgams has been developed with focus on mechanical strength and corrosion resistance, but has been sub-optimized in other aspects, resulting in increased instability and higher emission of mercury vapor. This has not been presented to policy makers and scientists. Both low and high copper amalgams undergo a transformation process for several years after placement, resulting in a substantial reduction in mercury content, but there exist no limit for maximum allowed emission of mercury from dental amalgams. These modern high copper amalgams are nowadays totally dominating the European, US and other markets, resulting in significant emissions of mercury, not considered when judging their suitability for dental restoration.

Systematic review on highly viscous glass-ionomer cement/resin coating restorations (Part II): Do they merge Minamata Convention and minimum intervention dentistry?

BACKGROUND: With the Minamata Convention the use of mercury will be phased down, and this undoubtedly will have an effect on dental treatment regimens and economic resources. Composite resin restorations are considered viable alternatives to amalgam fillings; however, these will not be covered completely by health insurance systems in many countries. Recently, a high-viscosity glass-ionomer cement (hvGIC) processed with a resinous coating (RC) has been introduced, and has been marketed as a restorative material in load-bearing Class I cavities (and in Class II cavities with limited size), thus serving as a possible alternative to amalgam fillings. OBJECTIVE: To discuss the outcome based on the evaluation presented in Part I of this paper, and to critically appraise the methodologies of the various studies. RESULTS: Two of the included studies were industry-funded, and status of the other clinical trials remained unclear. Quality of study reporting was considered perfectible. The use of a light-cured nanofilled resin coating material would seem advantageous, at least when regarding short- and medium term outcomes. CONCLUSION: Within the respective indications and cavity geometries, the hvGIC/RC approach would seem promising, could merge the phase-down of mercury and the objectives of minimally invasive treatment to some extent, and might be a restorative alternative for patients suffering from allergies or not willing to afford other sophisticated or expensive techniques. These recommendations are based on studies evaluating EQUIA Fil (GC), but are not transferable to clinical perspectives of the glass hybrid successor product (EQUIA Forte; GC).

Toxicidade do amálgama dentário na saúde do paciente: uma revisão sistemática / Toxicity of dental amalgam in patient health: a systematic review

O amálgama dentário (AD) é um material restaurador utilizado há mais de 190 anos na Odontologia, com indicação clínica, longevidade e custo-efetividade reconhecidos. No entanto, a presença do mercúrio, como um de seus componentes, ainda gera polêmica em função de seu efeito tóxico potencial aos pacientes, profissionais e ao meio ambiente, sendo este a motivação para inúmeras tentativas de banimento do seu uso. No entanto, não há consenso. Esta revisão sistemática objetivou responder à pergunta: A presença do mercúrio no amálgama dentário causa efeitos danosos à saúde do paciente? Para isto, sob orientação de uma bibliotecária experiente, a partir da elaboração de um mapa conceitual que usou as palavras-chaves "amálgama", "mercúrio" e "testes de toxicidade" para definir uma estratégia personalizada, buscou-se na literatura, de forma sistemática, tanto nas bases eletrônicas MEDLINE via PubMeb, Scopus, Web of Science, LILACS, BBO e Cochrane Library, quanto nos registros de ensaios inéditos e em curso, dissertações e teses no Portal de Periódicos da CAPES. Foram selecionados ensaios clínicos randomizados controlados, publicados até outubro de 2016 e sem restrição de idioma, que compararam pacientes com restauração de AD em relação a pacientes sem restaurações ou com restaurações de compósito. Os desfechos primários eram presença de doença sistêmica ou morte ou sinais de intoxicação por AD. Foram identificados 623 estudos nas bases de pesquisa e 246 na busca manual. Removidas as duplicatas, foram identificados 452 artigos, destes, 27 permaneceram para a síntese qualitativa que foi realizada pela ferramenta da colaboração Cochrane, Rev Man 5.0 para análise de risco de viés. Os resultados mostraram que 09 estudos foram classificados como "baixo" risco, 05 "moderado" e 13 "alto" risco. No entanto, apenas 02 estudos de "baixo" risco dada a comparabilidade e recorrência de seus resultados, foram analisados. A meta-análise mostrou que não há diferença entre o AD e o compósito em relação à toxicidade medida pelo teor de mercúrio na urina das crianças. Portanto, segundo a evidência científica disponível, ainda não é possível comprovar efeito danoso do AD na saúde dos pacientes. (AU)

Dental amalgam (AD) is a restorative material used for more than 190 years in Dentistry, with recognized clinical indication, longevity and cost-effectiveness. However, the presence of mercury, as one of its components, still provokes controversy due to its potential toxic effect to patients, professionals and the environment, being the motivation for numerous attempts to ban its use. However, there is no consensus. This systematic review aimed to answer the question: Does the presence of mercury in dental amalgam cause harmful effects to the patient's health? For this, under the guidance of an experienced librarian, a concept map using the keywords "amalgam", "mercury" and "toxicity tests" to define a personalized strategy was systematically, both in the electronic databases MEDLINE via PubMeb, Scopus, Web of Science, LILACS, BBO and Cochrane Library, as well as in the records of unpublished and ongoing essays, dissertations and theses in the Portal of Periodicals of CAPES. We selected randomized controlled trials, published up to October 2016 and without language restriction, that compared patients with AD restoration in relation to patients without restorations or with composite restorations. Primary outcomes were presence of systemic disease or death or signs of AD poisoning. A total of 623 studies were identified in the search databases and 246 in the manual search. Once the duplicates were removed, 452 articles were identified. Of these, 27 remained for the qualitative synthesis that was performed by the Cochrane collaboration tool Rev Man 5.0 for bias risk analysis. The results showed that 9 studies were classified as "low" risk, 5 "moderate" and 13 "high" risk. However, only 02 "low" risk studies given the comparability and recurrence of their results were analyzed. The meta-analysis showed that there is no difference between the AD and the composite in relation to the toxicity measured by the mercury content in the children's urine. Therefore, according to available scientific evidence, it is still not possible to prove the damaging effect of AD on patients' health. (AU)

Association between History of Dental Amalgam Fillings and Risk of Parkinson's Disease: A Population-Based Retrospective Cohort Study in Taiwan.

The impact of dental amalgam on the development of Parkinson's disease (PD) is still uncertain, although a positive association between dental amalgam and PD has been found in a few case-control studies. The patients with amalgam fillings restored between 2000 and 2008 were identified by using the National Health Insurance Research Database (NHIRD) in Taiwan. The same number of patients who had no new amalgam filling restored was matched by sex, age, and treatment date. Both cohorts were followed up from the treatment date until the date of diagnosis of PD, death, or the end of the year 2008. The individuals who received amalgam fillings had a significantly higher risk of PD afterward (adjusted hazard ratio [HR]=1.583, 95% confidence interval [CI]=1.122-2.234, p=0.0089) than those who did not. In the individuals who received amalgam fillings, being diagnosed with diabetes or hyperlipidemia demonstrated a significantly lower HR of PD occurrence than in the patients without diabetes or hyperlipidemia (HR=0.449, 95% CI=0.254-0.794, p=0.0059; HR=0.445, 95% CI=0.260-0.763, p=0.0032) after adjusting for comorbidities and Charlson-Deyo Comorbidity Index (CCI) scores. Meanwhile, hypertension increased the hazard risk of PD (HR=1.645, 95% CI=1.098-2.464, p=0.0159). The patients exposed to dental amalgam fillings were 1.583 times more likely to have PD afterward compared to their non-exposed counterparts after adjusting for comorbidities and CCI scores.

Systematic review on highly viscous glass-ionomer cement/resin coating restorations (Part I): Do they merge Minamata Convention and minimum intervention dentistry?

BACKGROUND: With the Minamata Convention the use of mercury will be phased down, and this undoubtedly will have an effect on dental treatment regimens and economic resources. Composite resin restorations are considered viable alternatives to amalgam fillings; however, these will not be covered completely by health insurance systems in many countries. Recently, a high-viscosity glass-ionomer cement (hvGIC) processed with a resinous coating (RC) has been introduced, and has been marketed as a restorative material in load-bearing Class I cavities (and in Class II cavities with limited size), thus serving as a possible alternative to amalgam fillings. OBJECTIVE: To evaluate the literature on this treatment approach, and to focus particularly on the clinical performance of the hvGIC/RC combination. SEARCH STRATEGY: The Cochrane Library as well as Ebsco, Embase, PubMed, and Scopus databases were screened. Moreover, relevant abstracts published with dental meetings were reviewed. SELECTION CRITERIA: All available randomized clinical trials focusing on the hvGIC/RC approach (published either as full-texts or abstracts until June 2016) were selected. Moreover, single-group studies using hvGIC/RC were included. DATA COLLECTION AND ANALYSIS: Screening of titles and abstracts, data extraction, and quality assessments of full-texts according to Oxford scoring were performed. RESULTS: Regarding failure rates, minor differences between hvGIC/RC and GIC or composite resins as comparators could be observed in seven clinical studies. The hvGIC/RC combination showed high survival rates (with only few catastrophic failures) of up to 6 years. CONCLUSION: Class I retention rates of hvGIC/RC seem promising, but further high-quality clinical studies are clearly warranted.

Increased mercury release from dental amalgam restorations after exposure to electromagnetic fields as a potential hazard for hypersensitive people and pregnant women.

Over the past decades, the use of common sources of electromagnetic fields such as Wi-Fi routers and mobile phones has been increased enormously all over the world. There is ongoing concern that exposure to electromagnetic fields can lead to adverse health effects. It has recently been shown that even low doses of mercury are capable of causing toxicity. Therefore, efforts are initiated to phase down or eliminate the use of mercury amalgam in dental restorations. Increased release of mercury from dental amalgam restorations after exposure to electromagnetic fields such as those generated by MRI and mobile phones has been reported by our team and other researchers. We have recently shown that some of the papers which reported no increased release of mercury after MRI, may have some methodological errors. Although it was previously believed that the amount of mercury released from dental amalgam cannot be hazardous, new findings indicate that mercury, even at low doses, may cause toxicity. Based on recent epidemiological findings, it can be claimed that the safety of mercury released from dental amalgam fillings is questionable. Therefore, as some individuals tend to be hypersensitive to the toxic effects of mercury, regulatory authorities should re-assess the safety of exposure to electromagnetic fields in individuals with amalgam restorations. On the other hand, we have reported that increased mercury release after exposure to electromagnetic fields may be risky for the pregnant women. It is worth mentioning that as a strong positive correlation between maternal and cord blood mercury levels has been found in some studies, our findings regarding the effect of exposure to electromagnetic fields on the release of mercury from dental amalgam fillings lead us to this conclusion that pregnant women with dental amalgam fillings should limit their exposure to electromagnetic fields to prevent toxic effects of mercury in their fetuses. Based on these findings, as infants and children are more vulnerable to mercury exposures, and as some individuals are routinely exposed to different sources of electromagnetic fields, we possibly need a paradigm shift in evaluating the health effects of amalgam fillings.

The use of amalgam in pediatric dentistry: new insights and reappraising the tradition.

The debate on amalgam led to its being phased out in some countries. Results of clinical trials report failure rates of amalgams ranging from 12 percent to over 70 percent. Treatment of caries should meet the needs of each particular patient, based on his/her caries risk. In general, for small occlusal lesions, a conservative preventive resin restoration would be more appropriate than the classic Class I amalgam preparation. For proximal lesions, amalgam would be indicated for two-surface Class II preparations that do not extend beyond the line angles of primary teeth. This recommendation might not be appropriate for high-risk patients or restoring primary first molars in children four years old and younger where stainless steel crowns have demonstrated better longevity. Currently, amalgam demonstrates the best clinical success for Class II restorations that extend beyond the proximal line angles of permanent molars. The need to reduce the use of amalgam as a mercury-containing material is inevitable when aiming to reduce environmental contamination. It is important always to praise prevention and constantly search for biologically safe materials regarding health, clinical work, and environment. The purpose of this report was to summarize several factors that affect the effectiveness, advantages, and disadvantages of using dental amalgam in primary teeth.

In vitro cytotoxicity of self-curing acrylic resins of different colors.

OBJECTIVE: The aim of this study was to assess the in vitro cytotoxicity of acrylic resins of different colors over time. METHODS: Specimens were divided into 4 groups (n = 6) according to the color of the acrylic resin (Orto Class, Clássico, Campinas, São Paulo, Brazil): Group 1, clear acrylic resin; Group 2, pink acrylic resin; Group 3, blue acrylic resin; and Group 4, green acrylic resin. All specimens were fabricated according to the mass manipulation technique and submitted to mechanical polishing protocol. The control was performed with an amalgam specimen (C+), a glass specimen (C-) and cell control (CC). Specimens were immersed in Minimum Eagle's Medium (MEM) and incubated for 24 h at 37ºC. The extracts from the experimental material were filtered and mixed with L929 fibroblast. Cytotoxicity was evaluated at four different times, 24, 48, 72 and 168 h. After contact, cells were incubated for 24 h and added to 100 µ of 0.01% neutral red dye. The cells were incubated for 3 h for pigment incorporation and fixed. Cells viability was determined by a spectroscopic (BioTek, Winooski, Vermont, USA) with a 492-nm wavelength λ=492 nm). RESULTS: There were no statistical differences between the experimental groups and the CC and C- groups. CONCLUSION: Clear, pink, blue and green self-curing acrylic resins fabricated by means of the mass manipulation technique and mechanically polished are not cytotoxic. Neither the pigment added to the self-curing acrylic resin nor the factor of time influenced the cytotoxicity of the material.