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Mercury dental amalgam and multiple sclerosis
S162
Abstracts / Toxicology Letters 238S (2015) S56–S383
P05-068 NSE: Marker of the clinical toxicity of mercury
P05-069 Mercury dental amalgam and multiple sclerosis
G. Guzzi 1 , A. Ronchi 2 , I. Bolengo 1,∗ , M. Pontillo 3 , L. Soldini 3 , A. Soldarini 4 , P.D. Pigatto 5
G. Guzzi 1 , A. Ronchi 2 , R. Valentina 1 , F. Spadari 3 , G.P. Bombeccari 3 , I. Bolengo 1,∗ , L. Brambilla 4 , S. Ferrucci 4 , P. Pigatto 5
1
1
Italian Association for Metals and Biocompatibility Research – A.I.R.M.E.B., Dental Toxicology, Milan, Italy 2 IRCCS Maugeri Foundation and University of Pavia, Italy, Pavia Poison Control Center and National Toxicology Information Centre, Toxicology Unit, Pavia, Italy 3 “San Raffaele” Hospital Scientific Institute, Laboratory Medicine, Milan, Italy 4 “San Raffaele” Hospital Scientific Institute, Toxicology Unit, Laboratory Medicine, Milan, Italy 5 IRCCS Galeazzi Hospital, University of Milan, Department of Biomedical, Surgical and Dental Sciences, Unit of Oral Pathology and Medicine, Milan, Italy
Italian Association for Metals and Biocompatibility Research – A.I.R.M.E.B., Dental Toxicology, Milan, Italy 2 IRCCS Maugeri Foundation and University of Pavia, Pavia Poison Control Center and National Toxicology Information Centre, Toxicology Unit, Pavia, Italy 3 Ospedale Maggiore Policlinico Fondazione Ca’ Granda IRCCS, University of Milan, Department of Biomedical, Surgical and Dental Sciences, Unit of Oral Pathology and Medicine, Milan, Italy 4 Fondazione IRCCS Ca’ Granda – Ospedale Maggiore Policlinico, Operative Unit of Dermatology, Milan, Italy 5 IRCCS Galeazzi Hospital, University of Milan, Milan, Italy, Department of Biomedical, Surgical and Dental Sciences, Unit of Oral Pathology and Medicine, Milan, Italy
Question: CNS is sensitive to mercury. Neurotoxicity associated with mercury amalgam exposure may be underestimated because current toxicological testing does not assess early clinical conditions. Methods: 4 patients who had long-term exposure to mercury amalgams and neurologic signs and symptoms related to mercury released from amalgams. We performed biochemical measurements before and after dental amalgam-replacement: whole-blood levels of mercury and serum marker of mercury exposure (NSE). One patient was evaluated for endogenous release of mercury. We sought correlations between NSE and mercury amalgam. SerumNSE limit is <12.5 g/l. Results: 2013 – A 47-year-old man whit amyotrophic lateral sclerosis and 10 mercury fillings. Value pre-removal of blood mercury concentrations was 5.0 g/l (limit, <2) and serum NSE was 25.7 g/l. 15 days after the complete mercury amalgam removal the serum concentrations of NSE had fallen to 19.4 g/l. Levels of blood mercury post-amalgam replacement were 2.4 g/l. 2014 – A 37-year-old woman with duodenal ulcer, Hashimoto’s thyroiditis, metallic taste. Pre-removal mercury concentrations in whole-blood was 0.5 g/l. She had 3 mercury amalgams. Serum NSE was 25.7 g/l. Level of mercury in saliva was 81.8 g/l (normal range, <2.7). After amalgams removal, serum NSE returned to normal range: 11.2 g/l. 2014 – A 40-year-old man with ischemic stroke with mercury amalgams. He had elevated levels of blood mercury: 9.5 g/l (<2) as well as elevated levels of serum NSE (16.5 g/l). After mercury amalgams removal, serum NSE decreased to 14.9 g/l as well as blood mercury (2.7 g/l). 2010 – A 54-year-old woman with lichenoid stomatitis. She was exposed to mercury fillings. Levels of mercury in whole-blood was 4.46 g/l (limit < 2). A decrease in the level of mercury blood was achieved after the removal of 10 titanium dental implants, reducing to 2.9 g/l. To monitor the clinical course of patients with known adverse events to mercury, we recommend using serum NSE. Conclusions: Serological NSE represents a biomarker for toxic outcomes of mercury overexposure.
Question: Exposure to mercury-containing dental amalgam tooth fillings is believed to be a risk factor for multiple sclerosis (MS) in humans according to case series studies, systematic review, and meta-analysis. We report 3 cases of multiple sclerosis related to mercury-containing dental amalgam restorations. Methods: Patients were evaluated for toxicological, immunological, and allergological assessment. Results: Patient 1. In 2015, a 55-year-old woman, multiple sclerosis developed after the removal of mercury dental amalgam on her upper left first molar. The patient’s whole-blood mercury level was 3.2 g/l (normal range, <2 g/l). Urinary levels of mercury was <0.5 g/l (normal range, <1.4 g/l). Serum NSE was slightly elevated 13.4 (<12.5). She had high titer for IgM anticardiolipin antibodies (26.2 MPL). Patient 2. In 1999, a 18-year-old woman soon after a new mercury-containing dental amalgam filling (48 h), she developed signs and symptoms of demyelinating disorder (i.e., visual loss, ocular pain, and tongue paresthesia). In 2012, wholeblood mercury concentrations were 9 g/l (limit, <2); whereas urinary mercury levels was 0.5 (limit, <1.4). Total mercury in her head scalp hair was 1.6 g/g (limit, <2). Dental procedure may have triggered the development of retrobulbar optic neuritis and subsequently multiple sclerosis. Patient 3. In 2010, a 44-year-old woman received titanium implants very close to mercury amalgam dental tooth fillings. Multiple sclerosis in response to titanium implants placed near to mercury amalgam developed after dental surgery (within 28 days), possibly due to oral galvanism associated with labyrinthitis, vertigo, and roaring tinnitus (left ear). She had allergic sensitization to nickel, cobalt, palladium, zinc diagnosed by patch testing (score ++), which are constituents of mercury dental amalgam. Lymphocyte transformation test confirmed severe allergy to nickel (SI 61.6, <2). Conclusions: Three patients received a diagnosis of multiple sclerosis within a month after they had recently begun dental treatment, specifically after mercury amalgam-removal treatment was made.
http://dx.doi.org/10.1016/j.toxlet.2015.08.500
http://dx.doi.org/10.1016/j.toxlet.2015.08.501
Abstracts / Toxicology Letters 238S (2015) S56–S383
P05-068 NSE: Marker of the clinical toxicity of mercury
P05-069 Mercury dental amalgam and multiple sclerosis
G. Guzzi 1 , A. Ronchi 2 , I. Bolengo 1,∗ , M. Pontillo 3 , L. Soldini 3 , A. Soldarini 4 , P.D. Pigatto 5
G. Guzzi 1 , A. Ronchi 2 , R. Valentina 1 , F. Spadari 3 , G.P. Bombeccari 3 , I. Bolengo 1,∗ , L. Brambilla 4 , S. Ferrucci 4 , P. Pigatto 5
1
1
Italian Association for Metals and Biocompatibility Research – A.I.R.M.E.B., Dental Toxicology, Milan, Italy 2 IRCCS Maugeri Foundation and University of Pavia, Italy, Pavia Poison Control Center and National Toxicology Information Centre, Toxicology Unit, Pavia, Italy 3 “San Raffaele” Hospital Scientific Institute, Laboratory Medicine, Milan, Italy 4 “San Raffaele” Hospital Scientific Institute, Toxicology Unit, Laboratory Medicine, Milan, Italy 5 IRCCS Galeazzi Hospital, University of Milan, Department of Biomedical, Surgical and Dental Sciences, Unit of Oral Pathology and Medicine, Milan, Italy
Italian Association for Metals and Biocompatibility Research – A.I.R.M.E.B., Dental Toxicology, Milan, Italy 2 IRCCS Maugeri Foundation and University of Pavia, Pavia Poison Control Center and National Toxicology Information Centre, Toxicology Unit, Pavia, Italy 3 Ospedale Maggiore Policlinico Fondazione Ca’ Granda IRCCS, University of Milan, Department of Biomedical, Surgical and Dental Sciences, Unit of Oral Pathology and Medicine, Milan, Italy 4 Fondazione IRCCS Ca’ Granda – Ospedale Maggiore Policlinico, Operative Unit of Dermatology, Milan, Italy 5 IRCCS Galeazzi Hospital, University of Milan, Milan, Italy, Department of Biomedical, Surgical and Dental Sciences, Unit of Oral Pathology and Medicine, Milan, Italy
Question: CNS is sensitive to mercury. Neurotoxicity associated with mercury amalgam exposure may be underestimated because current toxicological testing does not assess early clinical conditions. Methods: 4 patients who had long-term exposure to mercury amalgams and neurologic signs and symptoms related to mercury released from amalgams. We performed biochemical measurements before and after dental amalgam-replacement: whole-blood levels of mercury and serum marker of mercury exposure (NSE). One patient was evaluated for endogenous release of mercury. We sought correlations between NSE and mercury amalgam. SerumNSE limit is <12.5 g/l. Results: 2013 – A 47-year-old man whit amyotrophic lateral sclerosis and 10 mercury fillings. Value pre-removal of blood mercury concentrations was 5.0 g/l (limit, <2) and serum NSE was 25.7 g/l. 15 days after the complete mercury amalgam removal the serum concentrations of NSE had fallen to 19.4 g/l. Levels of blood mercury post-amalgam replacement were 2.4 g/l. 2014 – A 37-year-old woman with duodenal ulcer, Hashimoto’s thyroiditis, metallic taste. Pre-removal mercury concentrations in whole-blood was 0.5 g/l. She had 3 mercury amalgams. Serum NSE was 25.7 g/l. Level of mercury in saliva was 81.8 g/l (normal range, <2.7). After amalgams removal, serum NSE returned to normal range: 11.2 g/l. 2014 – A 40-year-old man with ischemic stroke with mercury amalgams. He had elevated levels of blood mercury: 9.5 g/l (<2) as well as elevated levels of serum NSE (16.5 g/l). After mercury amalgams removal, serum NSE decreased to 14.9 g/l as well as blood mercury (2.7 g/l). 2010 – A 54-year-old woman with lichenoid stomatitis. She was exposed to mercury fillings. Levels of mercury in whole-blood was 4.46 g/l (limit < 2). A decrease in the level of mercury blood was achieved after the removal of 10 titanium dental implants, reducing to 2.9 g/l. To monitor the clinical course of patients with known adverse events to mercury, we recommend using serum NSE. Conclusions: Serological NSE represents a biomarker for toxic outcomes of mercury overexposure.
Question: Exposure to mercury-containing dental amalgam tooth fillings is believed to be a risk factor for multiple sclerosis (MS) in humans according to case series studies, systematic review, and meta-analysis. We report 3 cases of multiple sclerosis related to mercury-containing dental amalgam restorations. Methods: Patients were evaluated for toxicological, immunological, and allergological assessment. Results: Patient 1. In 2015, a 55-year-old woman, multiple sclerosis developed after the removal of mercury dental amalgam on her upper left first molar. The patient’s whole-blood mercury level was 3.2 g/l (normal range, <2 g/l). Urinary levels of mercury was <0.5 g/l (normal range, <1.4 g/l). Serum NSE was slightly elevated 13.4 (<12.5). She had high titer for IgM anticardiolipin antibodies (26.2 MPL). Patient 2. In 1999, a 18-year-old woman soon after a new mercury-containing dental amalgam filling (48 h), she developed signs and symptoms of demyelinating disorder (i.e., visual loss, ocular pain, and tongue paresthesia). In 2012, wholeblood mercury concentrations were 9 g/l (limit, <2); whereas urinary mercury levels was 0.5 (limit, <1.4). Total mercury in her head scalp hair was 1.6 g/g (limit, <2). Dental procedure may have triggered the development of retrobulbar optic neuritis and subsequently multiple sclerosis. Patient 3. In 2010, a 44-year-old woman received titanium implants very close to mercury amalgam dental tooth fillings. Multiple sclerosis in response to titanium implants placed near to mercury amalgam developed after dental surgery (within 28 days), possibly due to oral galvanism associated with labyrinthitis, vertigo, and roaring tinnitus (left ear). She had allergic sensitization to nickel, cobalt, palladium, zinc diagnosed by patch testing (score ++), which are constituents of mercury dental amalgam. Lymphocyte transformation test confirmed severe allergy to nickel (SI 61.6, <2). Conclusions: Three patients received a diagnosis of multiple sclerosis within a month after they had recently begun dental treatment, specifically after mercury amalgam-removal treatment was made.
http://dx.doi.org/10.1016/j.toxlet.2015.08.500
http://dx.doi.org/10.1016/j.toxlet.2015.08.501