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Silver amalgam and mercury allergy
Silver amalgam and mercury allergy David 8. Shovelton,
Blk.,
B.D.S.,
F.D.S.R.C.S.,
Birmingham,
A
llergic lesions of the mouth caused by hypersensitivity r8re.l The investigation and treatment of a patient exhibiting may, therefore, be of interest. CASE
England’
to mercury are such sensitivity
REPORT
The patient, a 19-year-old woman, was referred to the Birmingham Dental Hospital in 1964 by her dentist because of an intraoral and facial rash which developed the day after her last office visit. It was suggested that this rash might be due to the mercury content of fresh amalgam fillings. On investigation of the history, it appeared that no abnormal reactions of any sort had been noticed until 1963. At that time, the patient experienced a reaction when mercury got under a gold ring and remained there for 12 hours. A rash described as “water blisters” developed on the area of contact with the mercury. During the succeeding two days a red, nodular rash appeared on the neck, chest, and legs and under chrome-plated clothing fasteners. The condition had been relieved by administration of antihistamine tablets. In June, 1964, the patient had her first experience of conservative dentistry. Some amalgam fillings were placed in the upper and lower right quadrants. The next day shr experienced pain on the right side of the face and developed both an intraoral and a facial rash. The intraoral lesions were described as being “like pimples under the skin.” They were distributed over the inside of the cheek, the lips, and the floor of the mouth. The extraoral lesions were described as being “similar to a cold sore. ” The lesions improved quickly when treated with antihistamine tablets. When she was seen at the Dental Hospital, the patient had no symptoms. Patch tests were undertaken with freshly mixed amalgam; amalgam 6 hours and 24 hours old; pure oopper; zinc; silver; tin; and inlay casting gold. The skin around all amalgam discs showed raised areas 24 hours later (Fig. 1). The disc around the freshly mixed amalgam was the most severe (Fig. 2). There seemed to be no reactions to any of the other materials. Antihistamine cream was applied to the patch test lesions, and the patient was given antihistamine tablets to take after she returned home.
Traatmsnt It was decided that it would be worth while to attempt conservation making sure that no amalgam particles were allowed to fall into the surfaces of the fillings liberally with varnish. One filling was undertaken
with amalgam fillings, mouth and coating all in this way, and anti-
-*Professor
of Conservative
Dentistry,
University
of Birmingham.
29
30
O.S., O.M. January,
S’hovelton
& O.P. 1968
F ‘io.
Pig. old) ; 3, 7, silver Pig.
2. Patch tests on right forearm. 1, Inlay casting gold; pure copper ; 4, pure zinc; 5, pure silver j 6, silver amalgam (6 hours old) ; 8, pure tin. 8’. Reaction to freshly mixed silver amalgam.
9, silver amalgam
amalgam (freshly
histamine tablets were given prophylactically. No reaction at all was noted. Five were done at one sitting, using a similar routine, and no trouble was recorded. Since that time the only amalgam work undertaken in the patient’s mouth trimming of one filling. No trouble was experienced on this occasion.
(24 hours mixed) ;
more has
fillings been
the
DISCUSSION
The amount of mercury expressed from a silver amalgam filling during condensation is far greater than the amount liberated from the filling after treatment. Frykholm2 says that the mercury is very quickly “bound in phases which are so stable that not even an amount of free mercury sufficient to cause allergic manifestations can be given off.” For this reason, it is suggested that existing silver amalgam fillings should not be removed from allergic patients unless they are defective. It is generally recommended that any new fillings required be done in gold or nonmetallic materials. It is seen from this case report, however, that a satisfactory result may also be achieved by careful handling of amalgam, together with prophylactic administration of antihistamines. SUMMARY
The case of a patient who was sensitive to mercury has been described, and a dental treatment procedure for such patients has been suggested. References
1. FernstrSm, Dermatitis 2. Frykholm, p.
69,
1957.
A. I. B.., Frykholm, K. O:, and Huldt, S.: Mercury Allergy With Eczematous Due to Srlver Amalgam Fillmgs, Brit. D. J. 112: 204, 1962. K. 0.: Mercury from Dental Amalgam, Acta. Odont. scandinav. 15: Supp. 22,
d
Blk.,
B.D.S.,
F.D.S.R.C.S.,
Birmingham,
A
llergic lesions of the mouth caused by hypersensitivity r8re.l The investigation and treatment of a patient exhibiting may, therefore, be of interest. CASE
England’
to mercury are such sensitivity
REPORT
The patient, a 19-year-old woman, was referred to the Birmingham Dental Hospital in 1964 by her dentist because of an intraoral and facial rash which developed the day after her last office visit. It was suggested that this rash might be due to the mercury content of fresh amalgam fillings. On investigation of the history, it appeared that no abnormal reactions of any sort had been noticed until 1963. At that time, the patient experienced a reaction when mercury got under a gold ring and remained there for 12 hours. A rash described as “water blisters” developed on the area of contact with the mercury. During the succeeding two days a red, nodular rash appeared on the neck, chest, and legs and under chrome-plated clothing fasteners. The condition had been relieved by administration of antihistamine tablets. In June, 1964, the patient had her first experience of conservative dentistry. Some amalgam fillings were placed in the upper and lower right quadrants. The next day shr experienced pain on the right side of the face and developed both an intraoral and a facial rash. The intraoral lesions were described as being “like pimples under the skin.” They were distributed over the inside of the cheek, the lips, and the floor of the mouth. The extraoral lesions were described as being “similar to a cold sore. ” The lesions improved quickly when treated with antihistamine tablets. When she was seen at the Dental Hospital, the patient had no symptoms. Patch tests were undertaken with freshly mixed amalgam; amalgam 6 hours and 24 hours old; pure oopper; zinc; silver; tin; and inlay casting gold. The skin around all amalgam discs showed raised areas 24 hours later (Fig. 1). The disc around the freshly mixed amalgam was the most severe (Fig. 2). There seemed to be no reactions to any of the other materials. Antihistamine cream was applied to the patch test lesions, and the patient was given antihistamine tablets to take after she returned home.
Traatmsnt It was decided that it would be worth while to attempt conservation making sure that no amalgam particles were allowed to fall into the surfaces of the fillings liberally with varnish. One filling was undertaken
with amalgam fillings, mouth and coating all in this way, and anti-
-*Professor
of Conservative
Dentistry,
University
of Birmingham.
29
30
O.S., O.M. January,
S’hovelton
& O.P. 1968
F ‘io.
Pig. old) ; 3, 7, silver Pig.
2. Patch tests on right forearm. 1, Inlay casting gold; pure copper ; 4, pure zinc; 5, pure silver j 6, silver amalgam (6 hours old) ; 8, pure tin. 8’. Reaction to freshly mixed silver amalgam.
9, silver amalgam
amalgam (freshly
histamine tablets were given prophylactically. No reaction at all was noted. Five were done at one sitting, using a similar routine, and no trouble was recorded. Since that time the only amalgam work undertaken in the patient’s mouth trimming of one filling. No trouble was experienced on this occasion.
(24 hours mixed) ;
more has
fillings been
the
DISCUSSION
The amount of mercury expressed from a silver amalgam filling during condensation is far greater than the amount liberated from the filling after treatment. Frykholm2 says that the mercury is very quickly “bound in phases which are so stable that not even an amount of free mercury sufficient to cause allergic manifestations can be given off.” For this reason, it is suggested that existing silver amalgam fillings should not be removed from allergic patients unless they are defective. It is generally recommended that any new fillings required be done in gold or nonmetallic materials. It is seen from this case report, however, that a satisfactory result may also be achieved by careful handling of amalgam, together with prophylactic administration of antihistamines. SUMMARY
The case of a patient who was sensitive to mercury has been described, and a dental treatment procedure for such patients has been suggested. References
1. FernstrSm, Dermatitis 2. Frykholm, p.
69,
1957.
A. I. B.., Frykholm, K. O:, and Huldt, S.: Mercury Allergy With Eczematous Due to Srlver Amalgam Fillmgs, Brit. D. J. 112: 204, 1962. K. 0.: Mercury from Dental Amalgam, Acta. Odont. scandinav. 15: Supp. 22,
d