SUMMARY The aim of the present study was to investigate whether removal of all amalgam fillings was associated with long-term changes in health complaints in a group of patients who attributed subjective health complaints to amalgam fillings. Patients previously examined at the Norwegian Dental Biomaterials Adverse Reaction Unit were included in the study and assigned to a treatment group (n = 20) and a reference group (n = 20). Participants in the treatment group had all amalgam fillings replaced with other restorative materials. Follow-ups took place 3 months, 1 and 3 years after removal of all amalgam fillings. There was no intervention in the reference group. Subjective health complaints were measured by numeric rating scales in both groups. Analysis of covariance was used to compare changes in health complaints over time in the two groups. In the treatment group, there were significant reductions in intra-oral and general health complaints from inclusion into study to the 3-year follow-up. In the reference group, changes in the same period were not significant. Comparisons between the groups showed that reductions in intra-oral and general health complaints in the treatment group were significantly different from the changes in the reference group. The mechanisms behind this remain to be identified. Reduced exposure to dental amalgam, patientcentred treatment and follow-ups, and elimination of worry are factors that may have influenced the results.

The inter-individual variation of intensities of health complaints was considerable and the reduction of health complaints varied for the different complaints. Several factors may be of importance for the observed reduction of complaint intensity.

Psychol.). Björkman and Bentung Lygre (Dental Biomaterials Adverse Reaction Unit) both have backgrounds in dentistry, whereas Dalen (currently working at the private practice nevropsykolog.no) and Binder (Department of Clinical Psychology, Faculty of Psychology) are both specialists in clinical psychology. My own background is also in psychology (Cand. Psychol./certified psychologist). The Faculty of Medicine and Dentistry granted me a three-year, full-time scholarship and one year of duty work. During these years, I was employed at the Department of Clinical Dentistry. As a Ph.D. candidate, I was enrolled in the doctoral programs at the Department of Clinical Dentistry, and at the Graduate School of Clinical and Developmental Psychology, Faculty of Psychology. The Biomaterials research group, Faculty of Medicine and Dentistry, and the (now dissolved) Group for Qualitative Research on Mental Health, Faculty of Psychology, have also been important for the conceptualization and realization of the present work. The Dental Biomaterials Adverse Reaction Unit covered the costs of the research project, with the exception of the qualitative part of the study that was partly funded by a research grant from the Meltzer Research Fund. The Dental Biomaterials Adverse Reaction Unit also covered the cost of a small part-time position for me in the period 2013 to 2014. The Dental Biomaterials Adverse Reaction Unit is funded by the Norwegian Ministry of Health and Care Services. First and foremost I would like to thank the patients and the dentists who participated in this study. Without you there would not have been a study. We are grateful and amazed that all twenty participants in the treatment group stayed with us through the five years follow-up. Thank you! Without my team of supervisors, I would not have been able to carry out and complete the present work. Even though the road we have travelled together has been bumpy at times, it has included life lessons, wonderful conversations and inspiring conference experiences that I will always treasure. Lars Björkman, thank you for the inspiring conversations we have had where we have tried to connect all the dots and made drafts of models explaining "everything". Gunvor Bentung Lygre, thank you for your patience and support and for always helping me simplify things. Knut Dalen, thank you for always being in a good mood and for your willingness to share your thoughts and expertise regarding ethical considerations in clinic and in research. Per-Einar Binder, thank you for your gentle supervision, mindful presence and wonderful insights. In addition to my supervisors, there have also been a number of other wonderful people in the environments where I have been working on my thesis. Every one of you deserves a personal thank you, and I hope you know who you are. Some people do however warrant a special mention: Vigdis Helland, you are a wonderful person, and I believe that I am a better person for having met you. Nils Roar Gjerdet, also a wonderful person I am happy to have met. Tha...

Removal of amalgam restorations was followed by a long term reduction of general health complaints, which was associated with mercury concentration in urine before amalgam removal. Additional studies are needed to confirm the potential mechanisms for the observed reduction.

In this article, we explore how patients with health complaints attributed to dental amalgam experienced and gave meaning to changes in health complaints before, during, and after removal of all amalgam fillings. We conducted semistructured qualitative interviews with 12 participants from the treatment group in a Norwegian amalgam removal trial. Interviews took place within a couple months of the final follow-up 5 years after amalgam removal. Using the NVivo9 software, we conducted an explorative and reflective thematic analysis and identified the following themes: Something is not working: betrayed by the body, You are out there on your own, Not being sure of the importance of amalgam removal, The relief experienced after amalgam removal, and To accept, to give up, or to continue the search. We discuss the findings in the context of patients’ assigning meaning to illness experiences.

Hovedbudskap Brekningsrefleksen kan være et hinder for god oral helse og evnen til å gjennomføre oral undersøkelse og tannbehandling Refleksen hindrer aspirasjon av fremmedlegeme til halsen, men kan forsterkes av psykiske og sosiale faktorer i pasientens liv Ekstreme brekninger kan behandles, men krever spesifikk kunnskap om opprettholdende faktorer og behandling

Hovudbodskap Studien kan tyda på at både tannhelsetenesta og brukarane har mykje å vinna på auka fokus på brukarmedverknad i tannhelsetenesta. For å førebyggja tannbehandlingsangst meinte deltakarane at god kommunikasjon og forklaring i forkant og undervegs i behandlingsprosessen er viktig. Deltakarane ynskte å oppleva kontroll, og å bli sett og høyrt i behandlingssituasjonen. Deltakarane opplevde det vanskeleg å sei ifrå til behandlaren når dei opplevde noko ugreitt i tannbehandlingssituasjonen. Fleire av deltakarane meinte at dersom det hadde blitt lagt betre til rette for brukarmedverknad tidlegare, kunne det hindra eller redusert behovet deira for hjelp frå TOO.