by devil » Wed Jul 13, 2005 9:56 am
I have more than a passing knowledge of both toxicology and epidemiology, having been involved in industrial health and safety, so I can speak with a certain amount of authority.
First of all, mercury is NOT toxic. You could swallow several grams of it and it would pass through the body unaltered and with no toxic effects. What IS toxic are some compounds of mercury, notably some organic compounds, known as organometallics. These are a cumulative CNS toxin. Some mercuric halides are also equally toxic, especially HgCl2.
Mercury amalgams used for dental obturations are usually trinary alloys (sometimes ternary) and the mercury forms an intermetallic compound with the silver. The important point is that there is no free mercury in the alloy: it is all bound up with the silver in a distinctive eutectic phase which is formed in the first hours after mixing the components. This intermetallic compound has been shown to be virtually non-toxic under normal conditions found in the mouth, because the phase is non-reversible until it reaches liquidus (the temperature at which the phase reaches melting point, over 200°C). As neither silver nor mercury is amphoteric (ie, reacts with both acids and bases), the chances of any chemical decomposition in the pH range of saliva are very remote, indeed, unless you drink large quantities of, say, hydrochloric acid, in which case any oxidation of the amalgam surface could conceivably minute quantities of mercurous chloride or calomel, which is less toxic than mercuric chloride.
Toxicology is not an exact science, because different animals and even individuals react differently to toxins. Toxicologists therefore always err on the safe side, usually by decreeing a safe dose as a factor of one-tenth of the lowest dose known to have any toxic effect (sometimes one-third, in the case of substances with a long known history of the toxicology and epidemiology).
It is also important to distinguish between acute, sub-chronic and chronic toxicity. Acute toxicity is the effect of a single exposure and is usually defined as LD50 (the lethal dose which will kill 50% of the subjects within 24 or 48 hours). This is obviously irrelevant to this discussion, as it implies very large doses. Chronic toxicity is the effect of extremely small doses over long periods of time, with cumulative toxins. The classic example is typified in the phrase, mad as a hatter. Hatters dressed beaver skins for top hats with mercury. As it has a vapour pressure at room temperature, they inhaled minute quantities of mercury vapour into the lungs for many years. Some of this reacted with the alveolar mucus and entered the blood stream and caused cumulative degeneration of parts of the brain. (To allay any arguments the mercury-silver intermetallic has zero vapour pressure at body temperature). Substances which cause cumulative degeneration of any tissue have a safe dosage based on (usually) the ponderal parts-per-million (ppm) or mg/m3 or µg/l, depending on the method of entry into the body.
To get to the point: there is quasi-zero risk of mercury poisoning from having amalgam fillings. There would be a risk of acute poisoning at the time of obturing the cavity, before the intermetallic phase is formed, but the quantities are too small for this risk to be serious and the metabolic disintegration of most of any ingested mercury would eliminate it in 24 hours through the faeces. Equally, there may be a minute acute risk if an existing filling is ground away, due to the high temperatures locally generated (for this reason, it is probably a mistake to remove existing fillings, certainly a plurality of them).
Modern fillings, based on UV-activated polymers are probably less toxic than mercury amalgams and are therefore preferable, but these have been developed only in the past couple of decades. There is therefore little reason for dentists to use mercury amalgams now, except in a few specific cases, where the synthetic fillings cannot hold mechanically.
The reason that mercury amalgam fillings are being actively discouraged or even banned now has nothing to do with patient safety. It is because the mixing process does release small amounts of mercury vapour which is cumulatively inhaled by the dentist and his staff: THEY are the ones at risk.
Like in many cases, a little learning is a dangerous thing and there are a minority of cranks who believe that the very word mercury means toxics, without any scientific knowledge whatsoever. These guys, often ecopoliticians, cause much economic harm by their rants, concerning many more substances than just mercury. Ignore them.
Devil dixit
PS Dentists have an enormous armoury of other toxic substances used in the practice of their art.