J Oral Rehabil 2002 Aug;29(8):705-713 Multidisciplinary
examination of patients with illness attributed to
dental fillings.
Langworth S, Bjorkman L, Elinder CG, Jarup L, Savlin P.
Department of Public Health Sciences, Division of
Occupational Medicine, Karolinska Hospital and Karolinska
Institutet, Stockholm, Sweden, Department of Odontology,
Karolinska Institutet, Stockholm, Sweden, and National
Registry of Adverse Reactions to Dental Materials, Bergen,
Norway, Department of Renal Medicine, Huddinge University
Hospital and Karolinska Institutet, Huddinge, Sweden,
Department of Epidemiology and Public Health, Imperial
College School of Medicine, London, UK, and Institute of
Environmental Medicine, Karolinska Institutet, Stockholm,
Sweden, and Department of Environmental Health, Stockholm
County Council, Norrbacka, Stockholm, Sweden.
Objective and methods. In 1993, a special Amalgam Clinic
was established at Huddinge University Hospital.
Residents in the Stockholm County area with morbidity
attributed to dental fillings ('amalgam disease'😉, were
referred to this clinic. Patients were examined by a
dentist (n 428), a physician (n 379), and a psychologist
(n 360). Sixty-nine per cent were women and 31% men; the
mean patient age was 46 years.
Results. Oral symptoms included tender or aching teeth
(60%), metallic taste (54%), sore mouth (43%) and dry mouth
(43%). Signs of moderate or severe temporomandibular joint
dysfunction were found in 81 cases, glossitis in 30 and oral
lichen in 26 cases. Common general symptoms included diffuse
pain (78%), general weakness (75%), extreme fatigue (68%)
and dizziness (68%). Seven per cent of the patients suffered
from previously undiagnosed medical conditions (thyroid
dysfunction, anaemia, cardiopathy, renal disease, cancer).
In 26 subjects, skin patch testing revealed allergy to
mercury, gold or palladium. The median concentration of
mercury was 10 nmol L-1 in whole blood, 3 nmol L-1 in plasma
and 10 nmol L-1 in urine, i.e. normal levels. Earlier mental
trauma was common, and in the psychological questionnaire
SCL-90, clear tendencies to somatization were found. Only a
few cases of severe psychiatric illness were observed. No
positive correlation was found between the amount of amalgam
and somatic symptoms or psychological effect parameters.
Conclusions. The results do not support the hypothesis that
release of mercury from amalgam fillings is the cause of
amalgam disease', but suggest that there may be various
explanations for the patient's complaints.