Psychological, Allergic, and Toxicological Aspects of Patients with Amalgam-Related Complaints

Abstract

Background: To deepen the understanding of the numerous unspecific complaints which are related to the dental material amalgam both in patients and physicians, an interdisciplinary case-control study regarding toxicological, allergic, psychological and psychiatric aspects was conducted. Forty patients with amalgam-associated complaints were compared to a well-matched group of 40 amalgam bearers without complaints. Methods: Patients and controls underwent a dental examination, which included recording of the quantity, surface area and quality of amalgam fillings, a determination of the mercury load in blood and urine, an allergy examination including patch testing with amalgam and a psychometric assessment with questionnaires noting coping strategies (ABI-UMW-P), interpersonal problems (Inventory of Interpersonal Problems) and self-consciousness (SAM), the NEO Five-Factor Inventory, Symptom Checklist-90-R, Beck Depression Inventory and a screening instrument for somatoform disorders. Results: Patients and controls did not differ with respect to mercury concentrations in body fluids. Only 1 patient was found to have a positive amalgam patch test; various other allergies could be determined in 28% of patients (n = 11). Patients had higher levels of psychic distress, a higher incidence of depression and somatization disorders as well as different styles of coping with anxiety compared to controls. Conclusions: No indication for mercury intoxication or amalgam allergy as a cause of the patients’ complaints could be found. The theory of amalgam-related complaints as an expression of underlying psychic problems is supported. Treatment should focus on somatization and changing coping and attribution styles.

Patients' choice of dental treatment following examination at a specialty unit for adverse reactions to dental materials

“…On the other hand, several other factors may influence patients' experience of health. It is well established that the differences could be associated with psychological factors (23)(24)(25)(26), One study indicated that a majority of patients with health complaints related to dental amalgam frequently had mental disorders, including anxiety, depression, and somatization (27), However, this does not explain the fact that the majority ofthe patients in the present study reported that they felt better after having their amalgam restorations replaced. Interestingly, it has been reported that health improvement after removal of amalgam restorations was related to mercury excretion in urine prior to removal (13), It has also been suggested that the improvement may be due to a normal fluctuation over time among patients with severe symptoms (22), Most of the patients recommended to have dental materials replaced actually did so.…”

Predictors of treatment outcomes after removal of amalgam fillings: associations between subjective symptoms, psychometric variables and mercury levels

“…Thus, our data definitely support the necessity to be aware of and offer help for the psychological dimension of amalgam intolerance. We found statistically significant correlations between symptom scores and three different objective measures of mercury level in the range from r = 0.25 to 0.39 with regard to baseline values. Corresponding correlation coefficients in the literature are usually lower or not statistically significant compared with the zero correlation (10, 24). The number of amalgam fillings (often used in the literature to estimate mercury burden) is probably a less precise measure and also usually fails to be associated with symptom scores (11, 20, 22, 31) – this was also the case in the study presented here ( r = 0.13).…”

“…A number of studies involved personality inventories to analyze relations between personality factors and subjective amalgam intolerancewith inconsistent findings. While some found indications of specific personality traits in amalgam patients (18)(19)(20)(21) others failed to show any relationship or differences compared with controls (22)(23)(24).…”

Stressful negative life events and amalgam-related complaints

“…Gottwald et al (20) found that persons with amalgam complaints use a more vigilant coping style when faced with environmental threats by actively seeking out threatening information to reduce the uncertainty. This coping style has been suggested to lead to a rather ruminative focus on the potential negative health effects of amalgam (20). The specific cognitive style has been considered similar to that of psychosomatic patients (10,22,31,32).…”