A patient with a history of trauma to the maxillary left anterior region presented with chronic pain of unknown etiology. Root canal therapy and periradicular surgery failed to resolve the persistent pain. A second surgical procedure revealed a bone cavity superior and distopalatally to the apex of the maxillary left lateral incisor. The suspected etiology was necrotic bone removed from the bone cavity.
This in vitro study evaluated the amount of fluoride released from glass ionomer-lined amalgam restorations over a period of 1 year. Class V cavities (2 x 2 x 7 mm) were prepared on the facial and lingual surfaces of 50 extracted human molars randomly distributed into 5 groups: Group 1: No restorations; Group 2: Dispersalloy amalgam alone; Group 3: same as Group 2 except 1 mm of Ketac-Silver was placed on the axial wall before amalgam insertion; Group 4: GC Lining/amalgam; and Group 5: Miracle Mix/amalgam. After restoration, each tooth was thermocycled (100x) at 5 degrees C and 55 degrees C with a dwell time of 30 seconds for baseline fluoride release levels. The teeth were placed in a polyethylene vial containing 4 ml of deionized water. At weekly intervals, each tooth was transferred to a fresh vial. Fluoride release was measured with a fluoride ion specific electrode for 10 consecutive weeks and then again at the end of 1 year. Calibration curves for low level measurements were prepared so the readings could be expressed in micrograms/ml F. At 1 year, fluoride released in micrograms/ml was: Group 1: less than 0.08; Group 2: less than 0.08; Group 3: 0.28; Group 4: 0.68; Group 5: 1.12. An ANOVA was used to evaluate the statistical difference between the groups. At the end of 1 year, measurable amounts of fluoride were recorded for all glass ionomer-lined groups with Miracle Mix and GC Lining releasing significantly more fluoride than Ketac-Silver (P less than 0.002).
A 32-yr-old white North American male resident of Norway presented with an asymptomatic radiolucency first identified 3 yr after the removal of an impacted mandibular right third molar in Southern California 16 yr previously. Surgical exploration revealed an intraosseous cavity filled with a black, homogeneous, gelatinous substance thought to be foreign material, but which was diagnosed histologically as containing black yeasts. Cultivation of a microbiologic sample for 6 wk grew black yeast-like colonies. The yeast isolate was identified as an Aureobasidium species different from the typical A. pullulans. A blood sample was negative with regard to antibodies both with double diffusion technique and ELISA. Also, examination with respect to dermatologic manifestations gave negative results. Flucytocin 10 g/d was administered systemically for 30 d. Six months postoperatively bone regeneration was satisfactory radiologically.
Epicutaneous patch testing of a battery of 35 dental test substances was carried out in 24 patients with visible lichenoid oral mucosal lesions and in 24 patients with burning mouth syndrome (BMS) without any visible lesions. Reactions to mercury ammonium chloride were found in 33% (8/24) of the patients with visible lesions compared to 0% (0/24) of the patients with BMS. The difference was statistically significant. In 7 of the 8 patients who reacted to mercury, total or partial regression of the lesions was observed after removal of dental amalgam. Reactions to nickel sulfate were found in 21% (5/24) of the patients with BMS compared to 3% (1/24) of the patients with lichenoid lesions. This difference was also statistically significant. Nickel is a rare component in dental restorations, but the oral mucosa is daily exposed to nickel through food and water intake. Removal of nickel from the environment of the patient can therefore be hard to accomplish.
This paper presents the events surrounding the dissemination of the results of a major preventive dentistry demonstration program designed and conducted to provide evidence of the effectiveness and actual costs of a combination of commonly used preventive procedures. It then reviews the controversy provoked when the results of that program were counter to the conventional wisdom of the day, prevailing national policy, and public health practice. An analysis of possible reasons for this reaction follows. The paper concludes with some observations about how such a situation might be approached to minimize similar controversy in the future.
The findings presented here suggest that mercury from dental amalgam may play a role in the etiology of oral cavity health. Comparisons between subjects with and without amalgam showed significant differences of diseases of the mouth. Subjects who had amalgams removed reported that symptoms of diminished oral health were improved or eliminated after removal. The data suggest that inorganic mercury from dental amalgam does affect the oral cavity.
The findings presented here suggest that mercury poisoning from dental amalgam may play a role in the etiology of many health disorders. A comparison of 125 health symptoms was made between a group of subjects with amalgams and a control group without amalgams. The 47 amalgam subjects reported a total of 45% (P = .0001) more health symptoms per subject compared to an age and sex matched control group of 48 nonamalgam subjects. Symptoms that were exhibited significantly more by the amalgam group were less happiness, less peace of mind, poorer reading ability, foul breath, tremors, colds and respiratory infections, heart or chest pains, heartburn, menstrual difficulties, sudden anger, depression, irritability, tiring easily, tiring in the morning, hay fever, trouble with night vision, and a metallic taste in mouth. Most of these symptoms can be explained by mercury toxicity. The data suggest that inorganic mercury poisoning from dental amalgam does affect health.
There has been much publicity about the harmful effects of mercury from dental amalgam which has resulted in a number of individuals having their amalgams removed. This paper reports on the research done on some of these people as well as presenting hypotheses on how amalgam mercury may be affecting health.
The influence of various factors that may affect the outcome of root canal therapy was evaluated in 356 patients 8 to 10 yr after the treatment. The results of treatment were directly dependent on the preoperative status of the pulp and periapical tissues. The rate of success for cases with vital or nonvital pulps but having no periapical radiolucency exceeded 96%, whereas only 86% of the cases with pulp necrosis and periapical radiolucency showed apical healing. The possibility of instrumenting the root canal to its full length and the level of root filling significantly affected the outcome of treatment. Of all of the periapical lesions present on previously root-filled teeth, only 62% healed after retreatment. The predictability from clinical and radiographic signs of the treatment-outcome in individual cases with preoperative periapical lesions cases was found to be low. Thus, factors which were not measured or identified may be critical to the outcome of endodontic treatment.
The cumulative survival rate (retention of both cusps) and the fracture pattern of 1639 endodontically treated posterior teeth were assessed in a retrospective study. All teeth had an MO/DO or an MOD cavity restored with amalgam without cuspal overlays. The 20-year survival rate of teeth with an MO/DO cavity was markedly higher than that of teeth with an MOD cavity. The lowest survival rate was found for the upper premolars with an MOD cavity: 28% of these teeth fractured within 3 years after endodontic therapy, 57% were lost after 10 years, and 73% after 20 years. Generally, the cusp most prone to fracture was the lingual one, and lingual fractures caused significantly more damage to the periodontal tissues than did facial or total crown fractures. The severity of periodontal damage increased with posterior location of the tooth. By far the most serious failures, irrespective of the cavity type, were found for the upper second molar, as 10 of 29 fractures led to extraction. It is concluded that amalgam, especially in MOD cavities, is an unacceptable material for restoration of endodontically treated posterior teeth if used without cuspal overlays.