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An in vitro method is described in which measurements were made of the total amount of mercury vapor released from three types of amalgam during routine dental procedures. It was found that the greatest amount of mercury was released during dry polishing of one amalgam (44 micrograms). Removal of amalgam from a Class I cavity under water spray and high volume evacuation also generated large amounts of mercury as expected (15-20 micrograms). However, under the more clinically relevant conditions of extending evacuation for one minute to remove residual amalgam and mercury after cutting, this value was reduced by approximately 90%. The total amount of mercury generated during placement (6-8 micrograms), wet polishing (2-4 micrograms) and trituration (1-2 micrograms) were also measured. The study showed that dental procedures associated with amalgam do potentially expose the patient and operator to mercury vapor. However, the total amount of mercury released during any procedure was far below the total exposure level calculated from the daily threshold limits established by regulatory agencies for occupational exposure.

The use of base metal alloys in dentistry has gained wide popularity in recent years. However, claims of their safety have not been universally accepted. An artificial oral environment capable of reproducing three-dimensional force-movement cycles of human mastication was used to determine whether nickel, chromium, and beryllium ions were leached from base metal alloy. Twelve pairs of crowns were articulated in the following combinations: metal versus metal, metal versus enamel, metal versus porcelain, and metal versus metal without chewing as a control. In a simulated 1-year period of mastication, the results showed that nickel and beryllium metals were released both by dissolution and occlusal wear. These findings suggest that if these conditions occur in the oral cavity, the stability of base-metal alloys is subject to question. Further studies are needed to determine whether the leaching reported has long-term consequences for patients receiving base metal restorations.

Mercury has several forms and produces subtle effects at chronic low-level exposures, mercury toxicity can be a difficult diagnosis to establish.

However, the effects on the central nervous system often appear after a long latency and remain long after the excretion in urine has dimished.

To study amalgam-related toxicity in a primary target cell type, human oral fibroblasts were grown in a low-serum medium containing 1.25% fetal bovine serum and exposed to Hg2+, a corrosion product of amalgam. A 1-h exposure to various concentrations of Hg2+ resulted in a dose-dependent loss of colony forming efficiency. Removal of the low-molecular-weight thiol cysteine from the medium increased the toxicity of Hg2+ almost 50-fold in comparison with complete medium or medium without fetal bovine serum. Accordingly, fetal bovine serum was not found to contain detectable levels of low-molecular-weight thiols. The levels of cellular free protein thiols were shown to be depleted Hg2+ at significantly lower concentrations of the metal ion than those required to decrease the levels of the major cellular low-molecular weight thiol glutathione. These decreases were dependent on the exposure conditions, i.e. the presence of serum and thiols, in a manner similar to the effect on colony forming efficiency. Other functions commonly related to cell viability, including the accumulation of the vital dye neutral red, the cytosolic retention of deoxyglucose and the mitochondrial reduction of tetrazolium were also inhibited by Hg2+, albeit at higher concentrations. Finally, the depletion of cellular glutathione, by pre-exposure of the cells to the glutathione synthesis inhibitor buthionine sulfoximine, somewhat increased the toxicity of Hg2+ and potentiated the depletion of protein thiols. Taken together, the toxicity of Hg2+ in human oral fibroblasts was demonstrated in several assays of which colony forming efficiency was the most sensitive, cell killing by this agent was related to its high affinity for protein thiols, whereas glutathione showed a significant, but limited, ability to protect the cells from Hg2+ toxicity.

Mercury from dental amalgams does not seem to cause dose-related intoxications. However, animal studies have shown that high-dose exposure to mercury may support various types of immunologic reactions. Ten patients claiming that their symptoms were caused and aggravated by amalgam therapy were selected for a study of the effects of removal of one amalgam restoration followed by placing of a composite filling. Clinical symptoms and the result of laboratory tests were recorded. Six patients had contact allergies to metals, three of them to mercury ammonium chloride. The comparison of pre- and post-experimental test results showed significant reductions in p-IgE and dU-albumin and significant increases in p-C3d and dU-beta 2-microglobulin. There was no laboratory evidence of a direct toxic effect by mercury on the patients. The observed response by some of the studied factors to the low acute exposure to amalgam may imply that an activation of the immune system occurred.

The kinetics of the release of elements from six dental casting alloys into cell-culture medium was assessed by means of atomic absorption spectroscopy. Alloys were evaluated in the polished and polished-cleaned conditions so that the effects of cleaning could be determined. Auger scanning microscopy was used for analysis of the surfaces of selected alloys before and after exposure to the cell-culture medium. Release patterns for each element were characterized by the shape of the dissolution vs. time curve, concentration of the element at 12 h as a percentage of the 72-hour concentration, and the relative slope of the curve from 48 to 72 h. Three patterns of release were observed for elements in these alloys. Type I patterns had logarithmic shapes with relatively large 12-hour concentrations and low 48-72-hour slopes. Type II patterns had logarithmic shapes but with moderate 12-hour concentrations and 48-72-hour slopes. Type III patterns were polynomial in shape, had relatively low 12-hour concentrations, and had large 48-72-hour slopes. Cleaning did not change the pattern of release but did generally significantly decrease the quantities of elements released (p = 0.05). The type of dissolution vs. time curve appeared to be dependent upon the element and the composition of the alloy. When cleaning reduced dissolution, surface analyses showed that the cleaning process increased the abundance of elements such as Au and Pd and reduced the abundance of Ag and Cu. Elements which were released from the alloys were more abundant on the surface than in the bulk in both polished and polished-cleaned conditions.