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Biological Dentistry

Is Tooth (Tartar) Cleaning Harmful?

“They say it is harmful to have dental tartar removed” is probably one of the most frequently heard words by dentists. It is not right to process the teeth while standing still, yes. However, once the deposits on the teeth are petrified with minerals in the saliva, it is not possible to remove them with a brush. Sometimes patients say that it breaks spontaneously, but in this case, of course, there is no clean surface left behind.

What’s inside these stones? Minerals, protein-polysaccharide complexes, epithelial cells, leukocytes and microorganisms… Pay attention to the content… Of course, an inflammatory response develops in the gingiva directly adjacent to this structure. Tissue damage occurs due to both the direct activity of microorganisms and the destructive enzymes that result from the inflammatory response (1). It is possible to see this damage directly with the eyes. Below is the image of the gingiva that comes out just below when the tartar is removed. This is the picture seen only when the stone is removed without touching the gums.


Gingivitis can have serious consequences, including tooth loss, but the problem may not be limited to the mouth. It is thought that gingivitis may be associated with heart diseases, diabetes, low birth weights, rheumatoid arthritis and many other systemic problems. There are different theories about this. According to someone, the patient has a predisposition to these problems and they occur independently of each other. According to another theory, signals caused by this inflammation in the gums (cytokines, etc.) spread throughout the body through circulation. A third theory says that bacteria themselves enter the circulation and cause problems, and there are studies showing that these bacteria are found in clots from heart attack survivors. In a fourth theory, antibodies produced against bacteria attack the body itself due to “molecular similarity” (2). Did all this remind you of another painting? This situation always reminds me of “leaky gut” and the events that occur as a result. Then we can talk about a kind of “leaky gum,” right?

Going back to the initial question… There may be some chance of scratching your teeth while cleaning your tartar (this is also a bit related to how the cleaning is done). However, the damage caused by not cleaning it is many times more than this. If the stone is formed, it can be brushed with paste, baking soda, etc. we cannot completely clean it with methods. As I said, even if some of the stones are gone, the problem will not be solved completely because the remaining surface will not be smooth. That’s why teeth need to be cleaned completely with special tools. You should also know that this cleaning will not guarantee that you will be stone-free for 6 months. Bacteria plaque can become petrified even in as little as 24 hours. This time can vary from person to person, depending on the structure of saliva and some factors related to the microbiome. But as a result, it is your duty to protect the cleaning.

So how can we protect it? Short method: using a toothbrush and dental floss. When you brush and floss properly, you can control the formation of tartar because you prevent the accumulation of plaque on the surface of the teeth. However, there is another method that looks at the situation more holistically and will benefit not only oral and dental health but also the whole body: Eating healthy!

According to the “Ecological Plaque Hypothesis”, which tries to explain the reason for the occurrence of caries and gum diseases, a change in environmental conditions may bring about the disease by causing disruption in the balance of dental plaque microflora (3). The usual suspect in creating this change is excessive consumption of processed carbohydrates. In a diet far from processed foods, the acid formed by natural complex carbohydrates taken is at a level that saliva can tolerate. However, if simple carbohydrates that are processed frequently are started to be consumed, the acidic environment that forms will turn into an environment where rotting bacteria can live comfortably and our protective bacteria cannot resist. The situation is similar for gum health… Both the sticky nature of processed carbohydrates and changing the profile of the gingival fluid increase plaque accumulation. The metabolic changes created by the increasing accumulation reduce the redox potential (electron uptake potential), the pH rises and a suitable environment is created for the reproduction of the disease-causing bacteria that were previously few in number. If the deficiency in the defense system of the person is added to these, consuming sugary foods will indirectly affect this place, then it will be easier for pathogenic microorganisms to gain weight. Continuous high blood sugar levels also increase oxidative stress and trigger inflammation in the gums as well as in other regions (4).

The following studies, which I have taken from an article examining the relationship between diet and oral health and systemic diseases, are a few examples to see the relationship between gum diseases and today’s diseases that develop due to excessive consumption of processed carbohydrates:

“There is a relationship between diabetes that develops as a result of abnormal blood glucose metabolism and periodontal disease indicators in both children and adults (Tsai et al., 2002; Lalla et al., 2006). reduced the risk of disease development (Merchant et al., 2003). Obesity, which is an indicator of excessive consumption of fermentable carbohydrates, has been found to be directly proportional to the increased risk of periodontal disease (Perlstein and Bissada, 1977; Saito et al., 1998, 2005; Alabdulkarim et al. ., 2005; Dalla Vecchia et al., 2005; Reeves et al., 2006). (5) “

In the same article, it is emphasized that tooth and gum problems may actually be an alarm bell for future systemic diseases. A drink containing 50 grams of sucrose per day increases the gingival pocket depth in just 4 days (Cheraskin et al., 1965), the removal of processed carbohydrates from the diet reduces gingival bleeding within a few weeks, on the other hand, the development of systemic chronic diseases takes years, in this respect it is It is said that meat problems should be seen as a harbinger of systemic chronic diseases.

In another article, let’s talk about systemic factors that facilitate the formation of tartar. For now, let’s finish this article with a brief summary: Once the tartar is formed, it is not harmful to clean gingivitis, but it is necessary. Afterwards, it is the responsibility of the person to protect the cleaned teeth. The quick method for this is an effective brushing and flossing habit. On the other hand, considering gingivitis as an indicator of chronic systemic problems that may occur in the future, immediately reviewing the diet and reducing the amount of processed, simple carbohydrates and the frequency of eating is the most important step to be taken.

Another article I liked about how important nutrition can be in oral and dental health was “Brushless, Paste Free, Mouth Healthy in the Stone Age”. You can read it here …


  5. Hujoel, P. (2009). Dietary Carbohydrates and Dental-Systemic Diseases. Journal of Dental Research, 88(6), 490–502. doi:10.1177/0022034509337700 

Question – Answer: Should Amalgam Fillings Be Removed?

I announced a few weeks ago that I would answer the questions I received on my Instagram account. I decided to share the answers on my website, too, so that they may also be reached by a web search.

The first question I answered, as I thought it could serve as a basis for this subject, was:

“The dentist that I wanted to have amalgam filling removed said that this was not necessary, the amalgams could expose you to high amounts of mercury only during placing and removal, that the current filling would not cause a health problem, and that there was no scientific study on this subject. Are these true?”

And my answer is:

When amalgam filling is first made and removed, the highest amount of mercury is released, it’s true (That’s why we don’t fill in anyway and we take precautions while removing the made ones). But the mercury in the filling can cause chewing, brushing, teeth grinding, mouth temperature, corrosion, etc. with it, it constantly mixes with the body. The photo shows the daily mercury intake from amalgam fillings, according to 17 different studies. The red lines are reference limits set by the California Environmental Protection Agency and the American Environmental Protection Agency. You can see that the daily mercury intake from fillings is much higher than these limits. According to the World Health Organization, there is no minimum safe dose that can be accepted for mercury.

Yani ağzınızda amalgam dolgular olduğu müddetçe sürekli civaya maruz kalıyorsunuz. Dolgulardan alınan civa buharının %80’inin akciğerler yoluyla vücuda dağıldığı tahmin ediliyor ve bu civa özellikle de beyin, böbrek, karaciğer, akciğer ve gastrointestinal sistemde birikiyor.

So as long as you have amalgam fillings in your mouth, you are constantly exposed to mercury. It is estimated that 80% of the mercury vapor taken from the fillings is distributed throughout the body through the lungs, and this mercury accumulates particularly in the brain, kidney, liver, lung and gastrointestinal tract.

There are established associations between mercury and the following diseases: Allergies, Alzheimer’s, ALS, antibiotic resistance, heart diseases, chronic fatigue syndrome, kidney ailments, multiple sclerosis, mouth lesions, Parkinson’s, gum diseases, depression and anxiety, suicidal tendency, reproductive disorders, Autism autoimmune diseases (1). And it is thought to be associated with more than 250 symptoms such as hearing difficulties, forgetfulness, headache, metallic taste, insomnia, coordination disorder, twitching / tremors, excessive shyness, social phobia, and irritability (2). There are many studies showing improvement in ALS, chronic fatigue syndrome, dermatitis, fibromyalgia, MS, mouth lesions and other health problems after removal of amalgam fillings. I should also mention that in some studies on amalgam dismantling, dismantling was done without taking any precautions. Even in such cases, the problems experienced first increased, but then decreased or disappeared completely.

And these are just part of the work based on studies …


Amalgam Removal for Pregnant Women, Breastfeeders and Those Who Want to Have a Baby

“Can amalgam be removed in pregnant and breastfeeding women?”, “I want to have a baby, how long after amalgam removal should I get pregnant?” These are questions I get frequently… I tried to answer them in this article. While doing this, I also gave examples of some studies on the removal of mercury. I think these examples contain interesting information not only for pregnant women, breastfeeders and those who want to get pregnant, but for anyone who has questions about amalgam fillings. Therefore, I think it is a paper that both patients and physicians can benefit from.

IAOMT (International Academy of Oral Health and Toxicology) has created the SMART protocol, which consists of very detailed precautions for the removal of amalgam fillings without harming the patient, physician and auxiliary staff (I have explained the details and points to be considered in this article). If you examine this protocol, you can see that all the ways the patient may be exposed to mercury are calculated and very meticulous measures are recommended against it.

Despite all these measures, IAOMT says we cannot claim that mercury will never be exposed even if the SMART protocol is followed. Some sources in Turkey taking measures much less than they claim Although you might be exposed to no mercury and vice versa. I think that IAOMT’s suggestion that pregnant and breastfeeding women should not be removed is due to this risk. The question may arise: Is it more mercury that a person with a lot of amalgam in his mouth gets more mercury from fillings every day or is it mercury that can be exposed during the process even if it is removed with precautions? It is difficult to answer this question. This will most likely depend on some minor details during the process (whether the rubber-dam was sealed, did the fillings come out in large pieces, was an oxygen mask that covers the nose completely, etc.) and the number and size of the filler to be removed. Nevertheless, despite the possibility of any malfunction during the procedure, it may be considered safer not to remove any amalgam in pregnant and breastfeeding women.

According to researcher Andy Cutler, who has also been damaged by amalgam fillings and so he has researched how mercury can be removed from the body and proposed various methods, this is not the only reason why pregnant and breastfeeding women are not removed. Andy Cutler suggested that a few months after all the amalgams in the mouth have been removed, you will be going through a period in which the mercury in the tissues will be removed more intensively because the mercury you are exposed to every day is no longer there, and therefore, disassembly should not be done. He says that the mercury circulating in the body during this excretion period can pass into the placenta and milk. For this reason, he says that not only during pregnancy and breastfeeding, but also before getting pregnant, a certain amount of time must pass after all the fillings are removed. In this way, it is aimed not to damage the baby not only from the mercury that comes from the fillings on a daily basis, but also from the mercury that has accumulated in the tissues over the years and is thought to be released into the blood after removal.

Unfortunately, I do not have any sources to verify this discontinuation theory other than the experience of those who followed the Andy Cutler protocol. There is a possibility that the symptoms that are thought to be experienced by these people during this period may also occur for other reasons. However, the following study showing long-term blood and urine values ​​after dismantling may help us evaluate this idea (1).

Here, the following graphics were obtained by taking blood and urine samples at various times within 1 year after dismantling of people who used rubber dam in the mouth during amalgam removal. The graph showing the blood values ​​shows a very small increase in the following months, so Andy Cutler may have a point. However, even this increase is below the initial values. So even if there was such a period, it did not affect the blood levels of the people in this study much, and did not even approach the initial level. I don’t know if it would have been a different image over longer periods of time. (By the way, although the initial blood mercury values ​​of the patients without rubber dam were lower than the values ​​of the other group, how did they increase during the procedure!)

Blood mercury values measured before and after amalgam harvesting. Straight line indicates those in use of rubber covers and dashed lines indicate those that are not.

The curve in urine values is a little different … (In those using rubber covers, although the level is higher after dismantling, the increase rate is better than those without cover). . I think that the reason for this may be that the mercury level, which rises suddenly in the blood after the removal of the rubber cover, changes the distribution of mercury to the tissues and the functioning of the mechanisms required for its removal.

Blood mercury values measured before and after amalgam harvesting. Straight line indicates those in use of rubber covers and dashed lines indicate those that are not.

So, what should be the time to wait before getting pregnant after amalgam removal?

Again, according to Andy Cutler, after all amalgams are removed, at least 18 months should be waited. Andy Cutler made this suggestion, assuming that 12 months of this period passed with the chelation method he created and that it was only expected in the next 6 months, and even added that this period could be longer in patients with poor conditions. In general, he thinks that when you wait for a while after dismantling, you will first go through a period of feeling good, then you will go through the throwing period I mentioned above and you may experience some symptoms during this time and then the symptoms will resolve. That’s why she suggested that you get pregnant only when you go through these periods and feel better. Although his general recommendations are like this, it is worth remembering that Andy Cutler generally works with people who have suffered serious damage from amalgam. So this may not be the case for everyone. How a person’s detox systems work, their genetic makeup, diet and lifestyle, and perhaps the supplements they may take may result in a prolongation or shortening of this period.

We know from cadaver studies that once exposure to mercury is present, it can still be found in tissues even after 17 years (2). Although blood levels are reduced with chelation agents… Therefore, the purpose before pregnancy is not to reset the mercury accumulated in the tissues, but to stabilize the mercury circulating in the body.

In the graphs above, it is seen that blood and urine mercury levels drop below their initial levels within 100-150 days after the procedure and follow a more straight line at the end of the first year.

Another example of how quickly blood mercury levels dropped comes from the findings of the 1970s accident in Iraq. In the incident in Iraq, farmers began to eat wheat and barley, which were distributed to them to plant and contain methyl mercury (!!!) as a preservative. A few months later, hospitals started to be filled with patients coming with serious health problems.

In a study conducted during this accident, the time required to halve the blood level of mercury was found between 40 and 105 days (3)

According to the study that Chris Shade cited (4) (but I could not find the original), this period was up to 120 days for vulnerable groups. (I would like to underline that these times are not for the blood level to fully recover, but to halve the initially measured amount.)

The graph on the right shows that some of the poisoned people have a blood half-life of up to 120 days.

Of course, mercury levels increase so much in this type of poisoning that even when half of the mercury is removed from the body, the remaining amount is still very high. Still, they are important examples in helping us understand the duration of mercury clearance.

In my opinion, despite all this information, we still cannot talk about a clear time that can be recommended to everyone. This time can vary with the amount of mercury exposed, how well the person’s detox systems are working, supportive diet and lifestyle interventions. Therefore, it may be more accurate to determine this period individually. The mercury levels in their circulation will not be the same for someone who has a single filling, who has it removed very meticulously, who does not have obvious health problems, someone who is haphazardly removed 8 grain fillings, and who is already struggling with health problems.

If a tooth with amalgam needs urgent intervention in a pregnant or breastfeeding person?

Of course, if a problem develops in the tooth that cannot be postponed (such as the risk of breaking part of the amalgam filling and swallowing the remaining part), the pregnancy and breastfeeding periods cannot be expected to end. In this case, in addition to the meticulous implementation of the SMART protocol I mentioned above, it is recommended that the mother expresses and expels the mother’s milk for 3-4 days from the procedure, and that enough milk should be milked and stored before the procedure (The time to be milked is said to reflect the opinion of Chris Shade. I read it as 3 days in a source and 4 days in the Andy Cutler group). It is also worth remembering that the mercury released during dismantling can be minimized by wrapping around the amalgam filling without touching it and trying to remove it in large pieces.

  1. Ref. Berglund, A., & Molin, M. (1997). Mercury levels in plasma and urine after removal of all amalgam restorations: The effect of using rubber dams. Dental Materials, 13(5-6), 297–304. doi:10.1016/s0109-5641(97)80099-1
  3. Bakir, F., Damluji, S. F., Amin-Zaki, L., Murtadha, M., Khalidi, A., Al-Rawi, N. Y., … Doherty, R. A. (1973). Methylmercury Poisoning in Iraq. Science, 181(4096), 230–241. doi:10.1126/science.181.4096.230

Why and How to Do Mercury Detox?

Mercury is one of the most toxic chemicals that can underlie the chronic problems we have, and sometimes even start them. Mercury, entering the body in various ways, accumulates in our tissues and organs, causing biochemical events to be disrupted. According to the World Health Organization, “Mercury has a toxic effect on the nervous, digestive and immune systems, lungs, kidneys, skin and eyes.” It should not be forgotten that the last organizations that utter such statements are the World Health Organization and similar organizations. That’s why it is worth noting that this warning is a bit mild to many researchers, and the problems caused by mercury can be much more serious. (You can find my article on amalgam fillings and hence mercury damage here.)

According to some researchers, everyone is exposed to mercury without exception due to environmental pollution, so everyone should detox regularly. However, some people are exposed to much higher amounts of mercury, which may be due to:

  • The presence of amalgam (gray) fillings in the mouth or the removal of these fillings without taking any precautions (During disassembly, high amounts of mercury are released and this mercury can accumulate in the organs. You can read this article for the correct removal technique.)
  • Frequently consuming large fish (More mercury accumulates in fish such as tuna and swordfish, which are at the top of the food chain.)
  • Vaccines (Some vaccines contain mercury as a preservative.)
  • Being in an environment where some items that contain mercury, such as thermometers, light bulbs, are broken
  • Occupational exposure (Being a dentist, dentist or mining profession)


In the video below, the mercury vapor that the patient and the physician were exposed to during amalgam filling removal is visualized. The measured concentration of mercury in its release is quite high!

Let us remind you that mercury has different forms. We are most exposed to elemental mercury and methyl mercury. Elemental mercury is found in amalgam fillings. Since it evaporates very easily, it is mostly taken from our lungs. Mouth temperature, chewing, brushing, teeth grinding, etc. When the factors are added, the amount of mercury taken increases. Some of the mercury in the fillings turns into methylmercury and is swallowed. Since elemental mercury dissolves very easily in fat, it can pass through the blood-brain barrier and reach the central nervous system and the unborn baby by passing through the placenta. Mercury crossing the blood-brain barrier is trapped there ionized and begins to have neurotoxic effects. It can stay in the brain for so long that it can be detected here even years after exposure (1).

Another source of exposure to the methyl mercury form is fish. The mercury found in seas – due to pollution – is converted into methyl mercury by plankton. Mercury is stored in the bodies of fish that eat plankton, and the total amount of mercury accumulated increases as the bigger fish eats the smaller fish. We, who are at the last step of the chain, get all that savings when we consume big fish. Methyl mercury is mainly absorbed from the gastrointestinal system. When it enters the circulation, more than 90% of it binds to hemoglobin by entering the erythrocytes. 10% of the methyl mercury load in the body is again in the brain and it gradually turns into an inorganic form. It causes the death of nerve cells in the brain, damage to glial cells, and damages the cerebral and cerebellar cortex. Methyl mercury can also pass through the placenta to the fetus and accumulate in the baby’s brain, causing the damage I mentioned. (one) Although some sources say that the half-life of mercury in the body (the time required for half of it to be excreted from the body) is 20-90 days, autopsy studies have shown that this is not true and mercury can be detected even 17 years after exposure to mercury (2).

For these reasons, it is not enough to simply remove the source of mercury and wait for the body to expel the mercury in time to repair the damage caused by mercury in the body. Especially for those whose detox systems do not work well and who have a lot of mercury accumulation, it is necessary to support the body in various ways and use chelating agents and binders in order to remove mercury from the places where it is stored, especially from the brain. I must say that doing mercury detox is not as easy as mentioned in some social media accounts and blogs. Especially for those who are already battling many chronic conditions, starting a random detox product can do more harm than good. There are patients who experience adverse side effects and worsening even with the lightest protocols. That’s why I recommend you to think and research very well before seeing and using any product in Instagram stories. Mercury detox means activating mercury from the organs it has settled in and making it circulate in the body. As a result of this action, mercury can worsen the situation by being transported from an organ where it will do less harm to an organ where it will do more damage (for example, it can come out of adipose tissue and settle in the brain). So it’s not a job to be taken lightly! Therefore, I will not suggest you a specific protocol in my articles on mercury detox. Instead, I will outline the prominent protocols on this subject and address the criticisms made. Some of these protocols are:

  • Andy Cutler protocol
  • Dietrich Klinghardt protocol
  • Chris Shade / Quicksilver method
  • TRS and similar nano clitilolites
  • Boyd Haley – Emeramide (OSR)
  • HMD
  • IV chelation methods (Almost no one recommends it anymore, but I’ll talk about why it’s dangerous.)

When I write the protocols you will see that there are some common points in all of them. One of them is that you cannot remove mercury from the body in a short time, it is not right to do so. You need to be patient to get rid of the mercury that has accumulated in your body for years. Otherwise, the body may not be able to deal with the large amount of mercury released from the organs. Another common point is that most of the protocols suggest measures to support detox systems and organs in addition to the chelation method used. Before going into the details of the protocols, I am thinking of talking about our detox systems. Because no matter which method you choose, I think that if you make some systems work better in your body, as much as the toxic load allows, the possibility of experiencing the mentioned side effects will decrease. I am waiting for your comments about the points you want me to write and your contributions… See you in the next article …

Safe (SMART) Mercury Amalgam Removal

It is known that mercury gas released during the removal of amalgam fillings and mercury particles scattered around pose a danger to the patient, physician and the environment (1). I have written a detailed article before about the damages that mercury can cause.

Due to these damages, it has been suggested to take some precautions to prevent the penetration of mercury into the body of the patient and the physician and at the same time to minimize the damage to the environment. IAOMT (International Academy of Oral Medicine and Toxicology), the organization that brought these measures together within the framework of the researches carried out to date and their own experiments, called this application “Smart Protocol”.

Let’s look at these measures recommended to be taken during amalgam removal in terms of patient, physician and environmental safety (1,2):

In terms of the patient:

  • Amalgam removal is not recommended for pregnant women and breastfeeding women.
  • Before the procedure, the patient should rinse his mouth and gargle with activated carbon, chlorella, bentonite, zeolite or similar agents that are said to hold mercury. Although this sentence reflects the general protocol proposed by IAOMT, I use only activated carbon, based on my own research. According to some opinions, chlorella can do more harm than good because it is poorly attached to mercury. According to another experiment, zeolite, which is famous for heavy metal retention, is extremely unsuccessful in this regard (6). There are opinions arguing that bentonite is similar to zeolite. Apart from these, there are also physicians who recommend that a cotton impregnated with the selected agent be placed on the floor of the mouth during the procedure (3). According to some protocols, this chelation agent is given to the patient before the procedure. In my practice, the patient first takes the activated charcoal capsule or tablet and then rinse the mouth with its liquid form.
  • The contact of the amalgam particles with the mouth should be prevented by applying a rubber dam to the mouth of the patient. In addition to this rubber cover, I think that a gingival barrier, which is in gel form and cured with the lights we fill, will provide better sealing, and I do my application in this way.
  • Positive pressure air or oxygen should be given to the patient in order not to breathe the ambient air.
  • There should be a vacuum device that filters the mercury, as in the photo below, in the immediate vicinity of the mouth.
  • Güvenli amalgam sökümü nasıl olmalı?

    Mercury filter vacuum device that I use in my own clinic.

  • The patient’s hair, face and body should be covered. It was observed that the fragments removed during amalgam removal could jump up to the patient’s chest and knee. Covering the patient will prevent amalgam particles from being carried to the patient’s home through their clothes.
  • During the procedure, a strong aspiration should be provided above and below the rubber cover.
  • Disassembly should be done under plenty of water irrigation, and the filling should be prevented from getting hot and emitting more mercury vapor.
  • It should be aimed to produce amalgam in as large pieces as possible.
  • If possible, the room should be ventilated during the procedure and the windows should be opened.
  • At the end of the procedure, the patient should rinse his mouth again with plenty of water and the binding agents mentioned above and gargle.

From the Perspective of Physicians:

  • The physician should wear a special protective gas mask that can filter mercury vapor, goggles,  bonnet  in addition to the measures such as gowns and gloves that he routinely uses. In my opinion,  fabric masks that are said to filter mercury “smoke” are not enough. We need masks that filter gas, not smoke.

In the Name of Avoiding Environmental Pollution:

  • In order to prevent the disassembled amalgam from harming the environment through the waste water pipe, it is recommended to place a device that can separate the amalgam in the waste water system (4).
  • If amalgam can be removed in one piece, it should be stored in x-ray solution or in a lidded container in water, it should be collected and eliminated by authorized units (5).

The Period Before and After Amalgam Filling Removal

Even if the amalgam fillings are removed properly, some additional protocols may be required to remove mercury from the patient’s body before and after the procedure. Since these protocols will need to be tailored to the patient, ideally, the dentist evaluates the patient with a physician who can administer mercury detox.

In order to remove the mercury that has accumulated in the tissues over the years, both the detox systems must work well and the mercury must be extracted and removed from the tissues with chelation agents that can bind mercury.

Unfortunately, it is not possible to talk about a consensus among doctors about the agents to be used for chelation. Some “natural” products such as chlorella and coriander are widely used for heavy metal detox. recommended chelation agents in basic training I have attended so far in Turkey was always them. But personally, I find it quite remarkable to point out that these are not strongly bound to mercury, and therefore it moves mercury from one place to another. It is difficult to ignore the numerous stories of patients whose health has deteriorated even more with such agents. Apart from these, it is worth mentioning that fast chelation methods using high doses of agents such as DMPS and DMSA are also mentioned. That is why I want to emphasize again and again that one should be careful about chelation and not be taken lightly.

Are Amalgam Fillings Safe ? Facts About Amalgam Fillings

Amalgam fillings have been used for 150 years. Although there is an undeniable literature on its harms, organizations such as FDA and TDB in our country continue to recognize amalgam as a safe and harmless application (1,2). In some serious websites (3), the mentioned damages of amalgam are shown as fraudulent and it is claimed that the real “sensitivity” of dentists on this issue is to make a new profit for themselves by replacing old amalgams.

On the other hand, organizations such as IAOMT (International Academy of Oral Medicine and Toxicology) and IABDM (International Academy of Biological Dentistry and Medicine) and many functional medicine experts say that amalgam fillings should not be applied under any circumstances and that comprehensive safety measures should be taken during removal.

First, let’s look at what exactly amalgam filling is. Some physicians may also name amalgam filling as silver filling. Since both names do not express the mercury content of the filling, it is possible that patients will be incomplete. The definition given on the website of the Turkish Dental Association (TDB) is as follows: “Amalgam fillings are also defined as silver fillings. Amalgam; It is obtained by mixing silver, tin and copper alloy with mercury. Mercury, which constitutes 45-50% of the mixture, creates a durable filling material by binding the metals together ”(4). The American Food and Drug Administration (FDA) also defines amalgam similarly (1). The important part of these definitions is that mercury constitutes 50% of the amalgam. Therefore, it is beneficial for patients to be aware that when it comes to silver filling or amalgam filling, a mercury-containing filling is made almost half.

The claim we hear the most is that the mercury released from the fillings is less than the mercury we get from fish and does not exceed the threshold value considered toxic in the body. I still remember how even one of my professors, who was a professor at the university, avoided this subject by saying “You get that much mercury from fish, my dear.” However, according to the 2005 WHO report, there is no specific lower value required for the toxic effects of mercury to begin to appear, so we cannot speak of a safe threshold of “that much mercury”. According to the same report, mercury can damage the nervous system, digestive system, respiratory system and immune system, and cause kidney and lung damage (5). In addition, the form of mercury taken from fish and the mercury in amalgam fillings are different from each other, and there are numerous studies about the damages of mercury from fish. In other words, it does not matter whether it is made of fish or amalgam filling, mercury can cause harm in the body in any way.

Another misconception is that the mercury in amalgam is stable and not released into the body thanks to its connections with other metals. On the contrary, amalgam fillings especially brushing, cleaning, clenching and grinding, chewing, etc. It is known that mercury vapor is released during the laying, renewal and removal of fillings. (6)

According to IAOMT’s review of scientific studies, there is an increase in mercury concentration in the specified tissues in the following cases (6 You can find many references for each of the substances in this report):

  • Chewing, brushing and / or bruxism (teeth grinding)
  • In the breath of those with amalgam filling and in the air in their mouths
  • In the saliva of those with amalgam filling
  • In the blood of those with amalgam filling
  • Various organs including kidneys, liver, pituitary gland, thyroid and brain of those with amalgam filling
  • In the stools of those with amalgam filling
  • Depending on the amount of amalgam in the mother, amniotic fluid, umbilical cord, placenta, various organs of the fetus such as liver, kidney and brain
  • In colostrum and breast milk, depending on the amount of amalgam in the mother

As it can be understood from these, the mercury in amalgam does not stay in its place, it finds new settlements by walking around the body.

Nevertheless, some people probably have no problem by removing mercury from their body easily because they have a well-functioning detox system, while some vulnerable groups are exposed to the severe destructive effects of mercury. The fact that mercury is still considered safe by some quarters is perhaps because these vulnerable groups are getting lost in the statistics. Of course, there are many people who have no problem with amalgam filling. However, there are other groups whose health is severely impaired by mercury, and unfortunately it is often not predictable who will belong to which group. Personally, as a dentist, I don’t want to gamble on anyone!

Below I have mentioned these vulnerable groups, largely referring to IAOMT’s compilation on the subject. I quoted some of the scientific studies included in the report of IAOMT as in the report, and tried to summarize some of the more interesting ones by reading it myself. I have included some other studies not included in the report.

Some genetic variations increase the effects of mercury on the body

Gene polymorphisms, the deviations seen in genes, cause some people to be more sensitive to mercury. This is, in my opinion, the most important part of the research I have read. I conclude that these genetic variations always play a role in the links between mercury and various diseases. On the other hand, since these occur only in a fraction of the population, a direct causal relationship cannot be established between mercury and these diseases, and mercury is still considered safe.

The most common form of polymorphisms are SNPs (read as snips), that is, single nucleotide polymorphisms (single nucleotide polymorphisms). There are about 10 million SNPs in the human genome, and most of them are thought to have no health impact. However, it has been proven that some SNPs can be used to predict information such as how an individual will respond to various environmental factors, drugs, toxins, and which diseases they may be prone to (7).

The following preliminary information in the introduction of the article (8), which was made on the members of the American Dental Association in 2015 and investigated whether there is a relationship between SNPs in physicians and body mercury load, is actually a summary of the situation:

“One of the major difficulties when assessing mercury risk is that although they are exposed to similar amounts of mercury […] there is a huge difference between individuals of communities in terms of mercury levels measured in hair (Canuel et al., 2005). Differences in mercury’s absorption, distribution, and excretion processes (in other words, toxicokinetics) may also play an important role in the occurrence of this distinction, although the difference in mercury content between individuals may explain to some extent the source and dose of mercury exposed. Mercury toxicokinetics may be affected by changes in, for example, functional enzymes and proteins that transport, oxidize or reduce mercury (Gundacker et al., 2010).

The study itself is as follows:

By taking hair, urine and blood samples from 380 dentists, mercury amounts and genetic sequences are obtained. The relationship between the presence of 88 SNPs, which are thought to have a role in mercury toxicokinetics, and the amount of mercury is questioned. A link between mercury levels and 38 SNPs is detected. The genes with these SNPs are genes that play a role in the control of detox systems in the body. According to the researchers, these results are a contribution to the growing literature on genetic factors that affect the accumulation and toxicity of mercury in the body.

According to the study of dentists by Echeverria et al in 2006 (9), a polymorphism in the genes encoding BDNF (brain derived neurotrophic factor) combined with the effect of mercury causes worse results in neurobehavioral tests. This polymorphism does not cause an increasing toxic response to mercury, but it does lead to a lower level of neurobehavioral abilities, and thus an increased exposure of mercury.

A similar effect was found in those with CPOX4 (coproporphorpyrinogen oxidase) polymorphism. Although mercury does not have a direct effect, it contributes to the neurobehavioral response that worsens in those with this polymorphism. (10) (11)

There were also different interpretations of the studies on 507 students aged 8-10 at the Casa Pia School in Lisbon, known as Casa Pia children. In this study, amalgam was applied to 253 children and composite fillings were applied to 254 children (the number of filling surfaces was almost the same). The mercury rate in the urine of children treated with amalgam increased by 1-1.5 micrograms / gram compared to the baseline. However, De Rouen could not detect a difference in memory, attention, visiomotor function and nerve conduction velocity in children, and even suggested that amalgam would be a more preferred option because 50% of composite fillings require renewal (12).

On the other hand, Woods, taking the children in this experiment again, concluded that mercury leads to a decrease in the success of neurobehavioral tests in children who have some gene variations. Moreover, these gene variations are not very rare variations in the general population (13).

As you can see, when the harms of mercury are mentioned, there is a group of people not reflected in the statistics. Although statistics provide us with valuable information, the fact that regulations are based on these statistics causes individual differences to be ignored. While a dentist will not harm his 5 patients who can easily expel mercury from his body and who do not have gene variations that will cause negative consequences when encountering mercury in his genetic sequence, he will not harm his 5 patients with the amalgam fillings he has made or removed without precaution, while another patient who has difficulty in removing mercury from his body and whose genetic sequence is sensitive may inadvertently trigger negative results. .

Studies on the effects of mercury on women

The reaction to mercury can also vary by gender. It has been observed that men and women differ from each other in the rate at which mercury is expelled from the body and the distribution of mercury in the body. Men generally remove mercury from their bodies faster. Also, when mercury enters the body, it tends to pass into the kidneys and urine. In women, mercury stays in the body longer, making toxic effects more likely. More of the mercury taken goes to the brain and central nervous system than in men. Studies on the rate and distribution of mercury in men and women are as follows (14):

Hongo et al. (1994) studied the rate at which mercury was cleared from the kidneys in university staff and students. They found that gender, age, and the number of amalgam fillings correlated with mercury removal rate.
Jokstad (1990), in a study of 849 members of the Norwegian Dental Association, showed that women have a mild but statistically significant urine mercury ratio compared to men (40nmol / L for women, 44nmol / L for men). Factors such as work experience and how many years of last work did not explain this difference.
Pamphlett et al. (1997) compared the uptake of inorganic mercury by motor nerve cells in the mouse brain and concentrations in the kidneys. Female mice had more mercury granules in their motor nerves than male mice, while male mice had more mercury in their kidneys than females. They concluded that the less mercury in the kidneys of the female mice led to an increase in mercury circulating in the body and increased retention by nerve cells.
Pamphlett and Coote (1998) found that mercury was seen in the motor nerves of female mice 6 hours after exposure and 12 hours after exposure in male mice.
Thomas et al. (1986) observed that mercury penetrates the brains of female mice 2.19 times more than male mice.

According to the recommendation of the American Occupational Safety and Health Act, fertile dentistry staff women should not be exposed to air containing mercury more than 10mcg / m3, and pregnant dentistry personnel should not work in a professionally mercury-containing environment. This recommendation was repeated in Koos and Lango’s study of pregnant women, fetuses and newborns, not only for dental staff but for all women (15).

In a study by Sikorski (16), it was found that there was a relationship between the amount of mercury in the hair strands of female dentists and their assistants, reproductive problems and menstrual irregularities. In other studies conducted on women working in a mercury-rich environment, it was found that up to 45% of women suffer from hypermenorrhea and hypomenorrhea (having more or less periods than normal). It has been observed that such irregularities occur in 36-45% of women, 6 months after starting work, and this rate has increased to 67% within 3 years. Moreover, in the control group, these rates are very low, such as 1%. In line with this information, the American Environmental Protection Agency (USEPA) also reported that women who are chronically exposed to mercury vapor experience more frequent menstrual irregularities and miscarriages. He also added that the mortality rate increased in the babies of women with mercury poisoning symptoms (17).

In parallel with these studies, 418 female dentist assistants who became pregnant in the last 4 years were evaluated in terms of the time required for them to become pregnant without using birth control methods. It has been determined that those working in clinics with more than 30 amalgam applications per week and poor mercury hygiene get pregnant up to 63% more difficult than the dentist assistant control group who do not apply amalgam. (Age, smoking, history of inflammatory disease in the pelvic region, frequency of sexual intercourse, race, etc. factors were also taken into account, so that it did not affect the result.) (18)

These problems that mercury can cause in women are important, but an even more important consequence of mercury to which women are exposed is that they pass it on to their babies. There are various studies showing that the mercury in the mother is transferred to the baby through amniotic fluid and breast milk.

Mercury passes through amniotic fluid and breast milk to the baby

Vimy, in his study of sheep and monkeys (19), showed that mercury passes through amalgam fillings to the fetus. Berlin stated that the amount of mercury in the blood of the fetus increased significantly at the end of pregnancy and even exceeded the amount in the mother (20).

In a study investigating the relationship between the number of amalgam fillings in the mother and the mercury burden in the fetus, baby and child (21), mercury levels in the liver, renal cortex and cerebral cortex of 108 babies and children aged 1 day to 5 years and 36 fetuses were measured. It was observed that the mercury levels in fetuses were directly proportional to the mercury content in 11-50 weeks old children and the number of amalgam fillings in mothers.

In another study from 2008 (22), the relationship between the number of amalgam fillings in the mother and the amount of mercury the fetus was exposed to was examined. That is, it was looked at whether the baby was exposed to mercury by the amalgam fillings in the mother before she was born. It has been observed that the amount of mercury in cord blood exceeds the mercury in maternal blood, confirming other studies. It has also been found that these rates are higher in newer amalgam fillings. Another interesting point in this study is that mothers consume very little fish during their pregnancy. In other words, in this study, amalgam fillings are almost the only source of mercury in the fetus. In similar studies conducted in northern countries with more fish in their diets, the researchers noted that the total mercury load in the body was even greater.

In the study of Koos et al., Which I mentioned above, examining the effects of mercury on pregnant women and the fetus, the link between mercury and spontaneous abortion and stillbirth was also revealed (15).

In one case, it was reported that during the 35 weeks of her pregnancy, a young dentist working in an amalgam environment gave birth to a baby with severe brain damage due to mercury poisoning. Although this is only about a single woman, it is actually very important in terms of showing once again how important individual differences are. I guess none of us would have wanted that woman to have a relative.

In my next article, I will talk about the effect of mercury on Alzheimer’s, MS and other nervous system diseases and the studies done on dentists and their assistants …


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