There is no topic in modern dentistry as controversial as the use of silver mercury amalgam dental fillings. Since the 1840s, the potential hazards of this common dental device have been a source of contention. Despite scientific evidence supporting the health and environmental hazards of mercury fillings, the American Dental Association (ADA) continues to endorse its safety, and the Food & Drug Administration (FDA) continues to side with the industry supporting its use.

While the debate continues, New York City’s Times Square is currently the site of a jumbotron projecting: “MERCURY DENTAL FILLINGS RELEASE TOXIC MERCURY.” The billboard is part of a massive effort to educate the public about the toxic properties of silver amalgam dental fillings. Highlighted is the “Safe Mercury Amalgam Removal Technique” (SMART) developed by its sponsor, the International Academy of Oral Medicine and Toxicology (IAOMT), a mercury-free dental organization that certifies dentists in an amalgam removal protocol to reduce the potential negative health outcomes of mercury exposure to patients, dental professionals, students, staff and others.

Today’s dental amalgam fillings are comprised of mercury, silver, copper, tin and sometimes zinc. At one time ADA professed that mercury was bound within the amalgam and was not released once properly mixed and implanted into the tooth. However, after years of debate, the ADA now admits “small amounts of mercury are released from these fillings,” and the FDA concurs that dental amalgam “releases low levels of mercury in the form of a vapor that can be inhaled and absorbed by the lungs” and that “high levels of mercury vapor exposure are associated with adverse effects in the brain and the kidneys.”

Despite ADA and FDA’s long overdue acknowledgement that mercury, a known neurotoxin, is released from these fillings, traditional dentists rarely advise patients of the potential exposure to mercury while sitting in the dental chair. One local dentist claims mercury is still “inert” once mixed in an amalgam.

So when does mercury veer from safe to toxic? A 2005 World Health Organization policy paper stated “mercury may have no threshold below which some adverse effects do not occur.” Although no official conclusion has been reached among U.S. public health organizations, a landmark provisional agreement was approved in January 2017 by the three governing institutions of the European Union (E.U.) to ban amalgam dental fillings for children as well as pregnant and nursing women. The legislation takes effect July 1, 2018, and will affect 500 million people. It still must be approved by E.U. governing bodies but is overwhelmingly supported by citizens and lawmakers.

As efforts progress to ban the use of mercury amalgams worldwide, the U.S. remains unrestricted with the exception of FDA’s caution for use in pregnant women and children under 6, despite their acknowledgment that “some individuals [may] have an allergy or sensitivity to mercury.” This stance of sober reluctance also seems to be the prevailing position of most traditional dentists, although, up to half of American dentists no longer use mercury amalgam fillings. Their use fell steadily from an estimated 157 million mercury fillings placed in the U.S. in 1979 to fewer than 20 million in 2015.

Although some medical professionals believe that it is “stretching biological plausibility to associate the vast number of health disorders associated with mercury fillings,” scientific studies support the link between mercury fillings and symptoms related to Parkinson’s, lupus, Alzheimer’s, multiple sclerosis (MS), Lou Gehrig’s disease (ALS), schizophrenia, ADHD, insomnia, memory loss, neuromuscular effects, kidney failure, headaches, cognitive and motor dysfunction, autoimmune disease, depression, anxiety and autism spectrum disorder.

Patients that believe their health was severely compromised by mercury fillings (many of whom experienced improved health following safe removal of their fillings) agree with IAOMT’s position that dental amalgams pose a public health threat and should be banned.

The official line of ADA, FDA, the Environmental Protection Agency and other public health organizations is that while there may be a dearth of “credible” science linking amalgam fillings to “adverse health effects”, pregnant women and children under 6 are cautioned against use. And while the FDA grants that “some individuals [may] have an allergy or sensitivity to mercury,” not enough “credible” studies exist to calculate which populations are at risk. Thus amalgams remain on the market, innocent until proven guilty. Those that report mercury poisoning are dismissed as “allergy” anomalies or as medical cases that lack apparent cause.

Meanwhile, the issue has moved from hearings to federal court. In 2008, a federal class action suit was filed by the IAOMT against the FDA to reclassify dental amalgams from a Class I to a Class II medical device, indicating their potential to be harmful. The broad coalition of plaintiffs in the case included consumer advocacy groups, professional associations and individuals.

In early 2012, the IAOMT brought a federal court suit seeking a ban or limitation of use of amalgam fillings. In response, the FDA docket indicated a new amendment to its standing amalgam policy would require “… a sea change in the government’s regulation of the controversial filling material.” It promised prohibition of “the use of mercury-based dental fillings...in pregnant women, nursing mothers, children aged less than 6 years, and other groups considered sensitive to the metal’s neurotoxic vapors.” Furthermore, according to the 2012 FDA safety commission draft, “alternative materials would best be offered as the first line of restorative care, minimizing the use of dental amalgam.” Before passage, the FDA guidance was struck down on its path to the Department of Health and Human Services.

Robert Reeves, a Kentucky litigator and self-described “mercury survivor”, has been bringing cases of mercury poisoning before the courts for over 30 years. He says, “on the part of the FDA and ADA, this is widespread ignorance at best and fraudulence at worst.”

Reeves explains that the burden of proof falls on the victims to produce evidence linking their health-related symptoms to mercury exposure from amalgams. Two such cases were fought and won by Pennsylvanians, one filed in PA and the other in New York State.

When Karen Palmer, a former Lehigh Valley dental assistant of 27 years, won her 2005 settlement, she became the first and only dental assistant in the U.S. to win an occupational mercury exposure case claiming illness and injury through workers’ compensation in Pennsylvania. In 2006, she was awarded a full decision in her social security disability case for mercury poisoning that manifested as chronic fatigue, paresthesia, central nervous system damage, toxic neuropathy and M.S. (Palmer was one of the plaintiffs in the 2008 and 2012 federal class actions, as well).

Another longtime warrior in the fight for mercury-free dentistry is Montgomery County resident Freya Koss. In 2014, after a 14-year legal battle, her landmark case was settled outside of court with the dentist who improperly removed a mercury amalgam and replaced it with a new one. Within days of the dental work, Koss experienced a host of symptoms including double vision, light sensitivity, muscle weakness and loss of equilibrium. Neurologists diagnosed her with three life-threatening autoimmune diseases including lupus, MS and myasthenia gravis, warning that there were no known causes or cures. After discovering her symptoms were the result of having been acutely mercury poisoned, her fillings were safely removed by an IAOMT dentist, and she was treated by an alternative medical doctor who supported her slow recovery.

Today, she is an impassioned health advocate and founder and director of the Pennsylvania Coalition for Mercury-Free Dentistry, the organization that spearheaded the 2009 passage of Philadelphia Councilwoman Blondell Reynolds Brown’s “Use of Amalgam in Dentistry” ordinance. Philadelphia is the first city in the nation to require distribution of an informed consent brochure advising patients of the dangers of mercury in silver amalgam fillings and FDA’s warnings for pregnant women and children.

The battle is far from over; consumer advocacy groups, NGOs, lawyers, mercury-free dentist coalitions and individuals from all walks life comprise the patchwork of populations working to make mercury amalgams a part of dentistry’s past.

Rebecca Antsis is a Pennsylvania-based writer, multimedia performer and editorial associate for Natural Awakenings BuxMont. Connect at [email protected].

Karen G. Meshkov is the Publisher and Director of Advertising Partnerships of Natural Awakenings BuxMont. Connect at [email protected].

March 2017