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Altern Med Rev 1998 Aug;3(4):295-300 Cerebrospinal fluid protein changes in multiple sclerosis after dental amalgam removal. Huggins HA, Levy TE. Center for Progressive Medicine, Puerto Vallarta, Mexico. A relationship between multiple sclerosis (MS) and dental silver-mercury fillings has been suggested by some investigators, but never proven. This study documents objective biochemical changes following the removal of these fillings along with other dental materials, utilizing a new health care model of multidisciplinary planning and treatment. The dramatic changes in photolabeling of cerebrospinal fluid (CSF) proteins following these dental interventions suggest CSF photolabeling may serve as an objective biomarker for monitoring MS. The clear-cut character of these changes should also encourage more research to better define this possible association between dental mercury and MS.PMID: 9727079 J Prosthet Dent 1987 Dec;58(6):704-7Correlation of dental amalgam with mercury in brain tissue. Eggleston DW, Nylander M. Department of Restorative Dentistry, University of Southern California, School of Dentistry, Los Angeles. Data from this project demonstrate a positive correlation between the number of occlusal surfaces of dental amalgam and mercury levels in the brain (p less than .0025 in white matter). This is indirect evidence suggesting that mercury from dental amalgam fillings may contribute to the body burden of mercury in the brain. The toxic levels of mercury in human tissues have not been sufficiently investigated and the amount of mercury in human brain tissue from dental amalgam may or may not be clinically significant. Nevertheless, dental amalgam exposure should be considered in monitoring sources of mercury accumulation in human brain tissue. PMID: 3480359 Swed Dent J 1987;11(5):179-87Mercury concentrations in the human brain and kidneys in relation to exposure from dental amalgam fillings. Nylander M, Friberg L, Lind B. Department of Environmental Hygiene, Karolinska Institute, Sweden. Samples from the central nervous system (occipital lobe cortex, cerebellar cortex and ganglia semilunare) and kidney cortex were collected from autopsies and analysed for total mercury content using neutron activation analyses. Results from 34 individuals showed a statistically significant regression between the number of tooth surfaces containing amalgam and concentration of mercury in the occipital lobe cortex (mean 10.9, range 2.4-28.7 ng Hg/g wet weight). The regression equation y = 7.2 + 0.24x has a 95% confidence interval for the regression coefficient of 0.11-0.37. In 9 cases with suspected alcohol abuse mercury levels in the occipital lobe were, in most cases, somewhat lower than expected based on the regression line. The observations may be explained by an inhibition of oxidation of mercury vapour. The regression between amalgams and mercury levels remained after exclusion of these cases. The kidney cortex from 7 amalgam carriers (mean 433, range 48-810 ng Hg/g wet weight) showed on average a significantly higher mercury level than those of 5 amalgam-free individuals (mean 49, range 21-105 ng Hg/g wet weight). In 6 cases analysis of both inorganic and total mercury was carried out. A high proportion (mean 77% SD 17%) of inorganic mercury was found. It is concluded that the cause of the association between amalgam load and accumulation of mercury in tissues is the release of mercury vapour from amalgam fillings.PMID: 3481133 Sci Total Environ 1987 Oct;66:263-8 The distribution of mercury in various tissues of guinea-pigs after application of dental amalgam fillings (a pilot study). Fredin B. Department of Physiological Chemistry IV, University of Lund, Sweden. Mercury accumulation in brain, kidney, liver and heart following insertion of amalgam in the teeth of guinea-pigs has been studied. During the accelerated wear of the amalgam in these gnawing animals, a significant mercury accumulation in the above tissues was demonstrated. Finely diffused and abraded amalgam must not be ignored as a source of absorbable mercury. PMID: 3685953 Swed Dent J 1989;13(6):235-43 Mercury accumulation in tissues from dental staff and controls in relation to exposure. Nylander M, Friberg L, Eggleston D, Bjorkman L. Department of Environmental Hygiene, Karolinska Institute, Stockholm, Sweden. Samples, mainly from occipital cortex and pituitary gland, but also from rental cortex, olfactory bulbs, thyroid gland and liver were collected from autopsies of 8 dental staff cases and 27 controls. These samples were analysed for total mercury content using radiochemical neutron activation analyses. The results revealed high mercury concentrations (median 815, range 135-4,040 micrograms Hg/kg wet weight) in pituitaries from the dental staff cases compared to controls (N = 23, median 23 range 6-1, 170 micrograms Hg/kg). In occipital cortex, the cases had a median of 17, range of 4-300 micrograms Hg/kg and the controls (N = 20) had a median of 10, range 2-29 micrograms Hg/kg. A few samples from olfactory bulbs show low mercury concentrations for both cases and controls. Renal cortex was analysed from three cases and contained clearly higher concentrations (945, 1,545, 2,110 micrograms Hg/kg) compared to controls (N = 12, median 180, range 21-810 micrograms Hg/kg). There is no control material for the other analysed samples, but one thyroid sample had an extremely high concentration of 28,000 micrograms Hg/kg. PMID: 2603127 Community Dent Oral Epidemiol 1988 Jun;16(3):153-8 Exposure of dentists and assistants to mercury: mercury levels in urine and hair related to conditions of practice. Herber RF, de Gee AJ, Wibowo AA. Coronel Laboratory for Occupational and Environmental Health, Medical Faculty, University of Amsterdam, The Netherlands. A study of 162 dentists' and their assistants' mercury levels in hair and urine, and of questionnaire items regarding mercury consumption, revealed some striking relations. The mercury concentrations in both hair (Hg-H) and urine (Hg-U) were somewhat higher in the dentists than the assistants. There was no relation between concentrations in hair and urine. The method of condensation of amalgam was positively related to Hg-U; the vibration method was negatively related. Hg-U was also positively related to number of fillings and hours in own practice. The relation of Hg-U to ventilation in the surgery applied only to the dentists. PMID: 3163962 Exp Mol Pathol 1990 Jun;52(3):291-9Traces of mercury in organs from primates with amalgam fillings. Danscher G, Horsted-Bindslev P, Rungby J. Department of Neurobiology, University of Aarhus, Denmark. In order to trace possible accumulations of mercury, three vervet monkeys received occlusal amalgam fillings, three others maxillary bone implants of amalgam, and three untreated monkeys served as controls. One year later all animals were sacrificed by transcardial perfusion with glutaraldehyde. Tissue sections from different organs were subjected to silver amplification by autometallography and analyzed at light and electron microscopical levels. It was found that amalgam fillings (total, 0.7-1.2 g) caused deposition of mercury in the following tissues: spinal ganglia, anterior pituitary, adrenal, medulla, liver, kidneys, lungs, and intestinal lymph glands. In monkeys with maxillary silver amalgam implants (total, 0.1-0.3 g), mercury was found in the same organs except for liver, lungs, and intestinal lymph glands. Organs from the three control animals were devoid of precipitate. To evaluate whether silver released from the corroding amalgam fillings added to the staining pattern, tissue sections were exposed to potassium cyanide prior to being autometallographically developed. This treatment removes all traces of silver, leaving mercury sulfide accumulation untouched. By comparing sections that had been exposed to cyanide with untreated parallels no difference was seen in the pattern confirming that mercury was the only catalyst present in the tissue. These results strongly support what has been suggested previously that dental fillings in primates cause absorption of mercury released from amalgam fillings through lungs and intestinal tract, and that depending on exposure mercury is distributed to most organs and will eventually be found in the central nervous system. The present data also show that silver released from the corroding filling is not absorbed. PMID: 2115006Br J Ind Med 1991 Nov;48(11):729-34Mercury and selenium concentrations and their interrelations in organs from dental staff and the general population. Nylander M, Weiner J. Department of Environmental Hygiene, Karolinska Institute, Stockholm, Sweden. Mercury (Hg) and selenium (Se) concentrations were determined by radiochemical neutron activation analysis in samples from the pituitary glands, occipital cortices, renal cortices, abdominal muscles, and thyroid glands of cadavers. Samples were retrieved from dental staff occupationally exposed to Hg and from the general population. Increased concentrations of both Hg and Se in samples from dental staff showed that Se accumulated together with Hg. Regression analysis of data from the pituitary glands and occipital cortices of dental staff indicated the accumulation of Se at a rough stoichiometric ratio of 1:1 with Hg. The same stoichiometric ratio between the elements was seen in the renal cortices from the general population. The regression analysis showed that a substantial fraction of Se was not associated with Hg; it is assumed that this corresponds to biologically available Se. Concentrations of biologically available Se decreased with advancing age in the pituitary gland, but not in other organs, and varied appreciably between organs. PMID: 1835404Neuroendocrinol Lett 1999;20(3-4):221-228Mercury and nickel allergy: risk factors in fatigue and autoimmunity. Sterzl I, Prochazkova J, Hrda P, Bartova J, Matucha P, Stejskal VD. Institute of Endocrinology, Prague, Czech Republic. This study examined the presence of hypersensitivity to dental and environmental metals in patients with clinical disorders complicated with chronic fatigue syndrome. Three groups of patients were examined through medical history, dental examination, and by using a modified test of blast transformation for metals-MELISA(R). The three groups consisted of the following: 22 patients with autoimmune thyroiditis with or without polyglandular autoimmune activation; 28 fatigued patients free from endocrinopathy; and 22 fatigued professionals without evidence of autoimmunity. As controls, a population sample or 13 healthy subjects without any evidence of metal sensitivity was included. Healthy controls did not complain of marked fatigue and their laboratory tests did not show signs of autoimmunity and endocrinopathy. We have found that fatigue, regardless of the underlying disease, is primarily associated with hypersensitivity to inorganic mercury and nickel. The lymphocyte stimulation by other metals was similar in fatigued and control groups. To evaluate clinical relevance of positive in vitro findings, the replacement of amalgam with metal-free restorations was performed in some of the patients. At a six-month follow-up, patients reported considerably alleviated fatigue and disappearance of many symptoms previously encountered; in parallel, lymphocyte responses to metals decreased as well. We suggest that metal-driven inflammation may affect the hypothalamic-pituitary-adrenal axis (HPA axis) and indirectly trigger psychosomatic multisymptoms characterizing chronic fatigue syndrome, fibromyalgia, and other diseases of unknown etiology.PMID: 11462117Neuroendocrinol Lett 1999;20(5):289-298 Books Metal-specific lymphocytes: biomarkers of sensitivity in man. Stejskal VD, Danersund A, Lindvall A, Hudecek R, Nordman V, Yaqob A, Mayer W, Bieger W, Lindh U. Dept Clinical Chemistry, Danderyd Hospital and Karolinska Institute, Stockholm, Sweden. Many patients attribute their health problems to amalgam and other dental metals. In genetically susceptible indviduals, mercury and gold may function as haptens and elicit allergic and autoimmune reactions. The frequency of metal-induced lymphocyte responses was examined in 3,162 patients in three European laboratories using MELISA(R), an optimized lymphocyte proliferation test. The patients suffered from local and systemic symptoms attributed to dental restorations. The effect of dental metal removal was studied in 111 patients with metal hypersensitivity and symptoms resembling Chronic Fatigue Syndrome (CFS). After consultation with a dentist the patients decided to replace their metal restorations with non-metallic materials. The changes in health and in vitro lymphocyte reactivity were studied by inquiries and follow-up MELISA(R). Lymphocyte reactivity was also analyzed in 116 healthy subjects with no complaints of metal allergy. A significant number of patients had metal-specific lymphocytes in the blood. Nickel was the most common sensitizer, followed by inorganic mercury, gold, phenylmercury, cadmium and palladium. As compared to lymphocyte responses in healthy subjects, the CFS group had significantly increased responses to several metals, especially to inorganic mercury, phenylmercury and gold. Following dental metal removal, 83 patients (76%) reported long-term health improvement. Twenty-four patients (22%) reported unchanged health and two (2%) reported worsening of symptoms. Following dental metal replacement, the lymphocyte reactivity to metals decreased as well. We propose that an inflammatory process induced by metals may modulate the hypothalamic-pituitary-adrenal axis (HPA axis) and trigger multiple non-specific symptoms characterizing CFS and other chronic conditions like myalgic encephalitis (ME) and multiple chemical sensitivity (MCS). PMID: 11460087 Br Dent J 2001 May 26;190(10):558-60 Mercury vapour release from a dental aspirator. Stonehouse CA, Newman AP. Coventry University, School of Natural and Environmental Sciences, UK. OBJECTIVE: To investigate the release of mercury vapour from a dental aspirator which vented its waste air through its base directly into the surgery environment. METHODOLOGY: Mercury vapour in air concentrations were measured at the breathing zone of the dentist during continuous operation of the aspirator. Further series of mercury vapour measurements taken at the aspirator exhaust vent were carried out to determine the sources of mercury vapour from this particular device. RESULTS: At the dentist's [and patients' LJF] breathing zone, mercury vapour concentrations of ten times the current occupational exposure limit of 25 micrograms/m3 were recorded after 20 minutes of continuous aspirator operation. A build up of amalgam contamination within the internal corrugated tubing of the aspirator was found to be the main source of mercury vapour emissions followed by particulate amalgam trapped within the vacuum motor. As the vacuum motor heated up with run time, mercury vapour emissions increased. It was found that the bacterial air exhaust filter (designed to clean the contaminated waste air entering the surgery) offered no protection to mercury vapour. In this case the filter trapped particulate amalgam which contributed to further mercury vapour contamination as high volume air was vented through it. CONCLUSION: It is not known how many dental aspirators are in use that vent their waste air directly into the surgery or if this aspirator is representative of others in existence. The safety of dental aspirating systems with regard to mercury vapour exposure requires further investigation. PMID: 11411891 Caries Res 2001 May-Jun;35(3):163-6Dental amalgam fillings and the amount of organic mercury in human saliva.Leistevuo J, Leistevuo T, Helenius H, Pyy L, Osterblad M, Huovinen P, Tenovuo J. The National Public Health Institute, Antimicrobial Research Laboratory, Turku University, Turku, Finland. We studied differences in the amounts of organic and inorganic mercury in saliva samples between amalgam and nonamalgam human study groups. The amount of organic and inorganic mercury in whole saliva was measured in 187 adult study subjects. The mercury contents were determined by cold-vapor atomic absorption spectrometry. The amount of organic and inorganic mercury in paraffin-stimulated saliva was significantly higher (p<0.001) in subjects with dental amalgam fillings (n = 88) compared to the nonamalgam study groups (n = 43 and n = 56): log(e) (organic mercury) was linearly related to log(e) (inorganic mercury, r(2) = 0.52). Spearman correlation coefficients of inorganic and organic mercury concentrations with the number of amalgam-filled tooth surfaces were 0.46 and 0.27, respectively. Our results are compatible with the hypothesis that amalgam fillings may be a continuous source of organic mercury, which is more toxic than inorganic mercury, and almost completely absorbed by the human intestine. PMID: 11385194 Aust Dent J 2000 Dec;45(4):246-9 The environmental effects of dental amalgam. Chin G, Chong J, Kluczewska A, Lau A, Gorjy S, Tennant M. School of Dentistry, University of Western Australia. Dental amalgam is one of the most commonly used materials in restorative dentistry. However, one of its major components, mercury, is of particular concern due to its potential adverse effects on humans and the environment. In this review, the environmental impact of dental amalgam will be discussed, with particular reference to the effects attributed to its mercury component. Mercury commonly occurs in nature as sulfides and in a number of minerals. Globally, between 20,000-30,000 tons of mercury are discharged into the environment each year as a result of human activities. According to a recent German report, approximately 46 per cent of the freshly triturated amalgam is inserted as new amalgam restorations and the rest is waste. Depending on the presence of an amalgam separating unit, some of the generated amalgam-contaminated sludge is discharged into the sewage system. Lost or extracted teeth with amalgam fillings and amalgam-contaminated waste, such as trituration capsules and cotton rolls are discharged with the solid waste and, in most instances, are incinerated. Use of disinfectants containing oxidizing substances in dental aspirator kits may contribute to remobilization of mercury and its subsequent release into the environment. Nevertheless, dental mercury contamination is only a small proportion of terrestrial mercury (3-4 per cent), which is quite insignificant compared with industrial pollution and combustion of fossil fuels by vehicles. The environmental impact of dental mercury is mainly due to the poor management of dental amalgam waste. Proper collection of mercury-contaminated solid waste prevents the release of mercury vapour during combustion. In addition, the use of amalgam separating devices reduces the amount of amalgam-contaminated water released from dental clinics. Publication Types: Review Review, tutorial PMID: 11225525 J Am Dent Assoc 2001 Jan;132(1):58-64 Potential health and environmental issues of mercury-contaminated amalgamators. Roberts HW, Leonard D, Osborne J. USAF Dental Investigation Service, Detachment 1, USAFSAM, 310C B St., Building 1H, Great Lakes, Ill. 60088, USA. BACKGROUND: Dental amalgamators may become contaminated internally with metallic mercury. This contamination may result from mercury leakage from capsules during trituration or from the long-term accrual from microscopic exterior contaminants that result from the industrial assembly process. The potential health risk to dental personnel from this contamination is unknown. METHODS: The authors assessed used amalgamators from the federal service inventory for the amounts of mercury vapor levels, as well as the visual presence of mercury contamination. They evaluated these amalgamators for potential mercury vapor health risk, using established National Institute for Occupational Safety and Health methods and American Conference of Governmental Industrial Hygienists standards. RESULTS: Ten of the 11 amalgamators assessed had measurable mercury vapor levels. Four amalgamators were found to have internal static mercury vapor levels above Occupational Safety and Health Administration ceiling limit thresholds. During a simulated worst-case clinical use protocol, the authors found that no amalgamators produced mercury vapor in the breathing space of dental personnel that exceeded established time-weighted federal mercury vapor limits. CONCLUSIONS: Amalgamators may be contaminated internally with metallic mercury. Although the authors detected mercury vapor from these units during aggressive, simulated clinical use, dilution factors combined with room air exchange were found to keep health risks below established federal safety thresholds. CLINICAL IMPLICATIONS: Dental personnel should be aware that amalgamators may be contaminated with mercury and produce minute amounts of mercury vapor. These contaminated amalgamators may require disposal as environmentally hazardous waste. PMID: 11194400 Acta Cient Venez 2000;51(1):32-8 [Occupational exposure and health effects of metallic mercury among dentists and dental assistants: a preliminary study. Valencia, Venezuela; 1998]. [Article in Spanish] Rojas M, Guevara H, Rincon R, Rodriguez M, Olivet C. Centro de Investigaciones Toxicologicas, Universidad de Carabobo (CITUC), Valencia, Venezuela. The aim of this investigation was to establish mercury (Hg) health effects on dentists and dental assistants, its relationship with exposure conditions and the potential renal damage Hg-related. The total population was 66 people, with a sample of 37 (56%), 22 dentists (59.5%, 19 male, 3 female) and 15 dental assistants (40.5%, all female). This was accomplished by an interview, Hg in urine (Hg-U) and N-acetyl-B-D-glucosaminidase activity in urine (NAG-U). Average values of Hg-U for dentists were 22.4 +/- 6.4 micrograms/g creatinine and 22.2 +/- 6.1 micrograms/g creatinine for dental assistants NAG-U average values were 2.9 +/- 3 U/L and 5.2 +/- 8.1 U/L respectively. There were no statistically significant differences between these averages (p > 0.05). There was no correlation between the quantity of amalgam prepared and working hours with Hg-U and NAG-U. Most frequent symptoms referred by dentists were: irritability (54.5%), cephalalgia [headache LJF] (45.4%), arthralgias [joint pain LJF] (40.9%), and the ones more referred by assistants were arthralgias (53.3%), irritability (46.7%) and cephalalgia (46.7%). It was not found a significative risk of having them among these groups. There is a need for further investigations including environmental monitoring of Hg, clinical evaluation and neurobehavioural tests to detect early effects. It is important to enforce personal safety measures to control the exposure. PMID: 10974705 Altern Ther Health Med 2000 Jul;6(4):49-55 Results of dental amalgam removal and mercury detoxification using DMPS and neural therapy. Kidd RF. Sixty consecutive patients who had undergone replacement of dental amalgam fillings and a protocol of nutritional support and heavy metal detoxification using dimercapto-propanyl-sulfate and neural therapy were surveyed. A questionnaire was mailed to the patients and 42 responded, resulting in a response rate of 70%. The reasons for undergoing treatment were many, ranging from a patient's desire to avoid potential health problems in the future to treatment of serious current disease. Although medical diagnoses were made when possible before treatment, this survey studied only the patients' estimations of their most distressing symptoms and their evaluations of response to treatment. The most common complaints were problems with memory and/or concentration; muscle and/or joint pain; anxiety and insomnia; stomach, bowel, and bladder complaints; depression; food or chemical sensitivities; numbness or tingling; and eye symptoms, in descending order of frequency. The most distressing symptoms were headache and backache, fatigue, and memory and concentration problems. Headache and backache responded best to treatment, but all symptoms showed considerable improvement on average. Of the respondents, 78% reported that they were either satisfied or very satisfied with the results of treatment, and 9.5% reported that they were disappointed. PMID: 10895513
Ιστορικό της χρήσης αμαλγάματος για το "σφράγισμα" των δοντιώνΟι γιατροί είχαν ήδη ξεκινήσει να χρησιμοποιούν το αμάλγαμα για οδοντιατρικούς λόγους (σφράγισμα δοντιού) από την εποχή της αναγέννησης. Ωστόσο, καθώς γινόταν ολοένα και περισσότερα πράγματα γνωστά για τα χαρακτηριστικά των μετάλλων που αποτελούν το αμάλγαμα οι οδοντίατροι και γενικότερα ο ιατρικός κόσμος υποψιάζονταν πως ιδιαίτερα ο υδράργυρος ο οποίος περιέχεται στο οδοντιατρικό αμάλγαμα μπορεί να προκαλέσει σοβαρά και χρόνια προβλήματα υγείας.Τα γνωστά, ιδιαίτερα στους μεγαλύτερους σε ηλικία, μαύρα σφραγίσματα, γνωστά και ως αμάλγαμα, αποτελούνται από υδράργυρο, άργυρο, χαλκό, κασσίτερο και ψευδάργυρο. Το αποτέλεσμα είναι να δημιουργούνται γαλβανικά ρεύματα τα οποία διαλύουν τα μέταλλα του αμαλγάματος. Τα μέταλλα σε μορφή ιόντων εξαπλώνονται σε όλο τον οργανισμό μας. Ακόμη χειρότερη κάνει την κατάσταση η ύπαρξη χρυσών δοντιών τα οποία λειτουργούν σαν καταλύτες. Το αποτέλεσμα; Σχεδόν 10μg ελευθερώνονται υδραργύρου ελευθερώνονται καθημερινά στον οργανισμό μας.Συνέπειες την ελευθέρωσης υδραργύρου από το αμάλγαμα:Η ποσότητα αυτή του υδραργύρου συγκεντρώνεται κυρίως στον εγκέφαλο μας, στα νεφρά και στο συκώτι με ιδιαίτερα άσχημες συνέπειες για την υγεία μας:1. Παθολογικά και νευρολογικά προβλήματα2. Απώλεια μνήμης και απώλειας συγκέντρωσης3. Υψηλότερες πιθανότητες για γέννηση αυτιστικών παιδιών.4. Ορμονικά προβλήματα5. Πρόβλημα στον προστάτη (ατροφία) και στα νεφρά.6. Μείωση αναπαραγωγικών δυνάμεων.7. Νόσους του ανοσοποιητικού συστήματος8. Αλλεργίες.9. Καρδιολογικά προβλήματα.10. Οδοντικά προβλήματα.Επιγραμματικά, αυτά τα προβλήματα σχετίζονται με την χρήση αμαλγάματος στην οδοντιατρική, ωστόσο αν θέλουμε να μιλήσουμε πιο αναλυτικά, η διεθνής βιβλιογραφία αναφέρει πάνω από 60.000 περιπτώσεις κατά τις οποίες η αντικατάσταση του αμαλγάματος οδήγησε στην θεραπεία ή βελτίωση προβλημάτων υγείας.
Πρωτόκολλο αντικατάστασης μεταλλικών σφραγισμάτων:- Χρήση ειδικής ισχυρής χειρουργικής αναρρόφησης που να αγκαλιάζει το δόντι από το όποιο αφαιρείται το αμάλγαμα. - Χρήση ελαστικού απομονωτήρα και άφθονου κρύου νερού από το αερότορ. - Τεμαχισμός του αμαλγάματος και απομάκρυνσή του σε όσο το δυνατόν μεγαλύτερα τεμάχια. -Χρήση μάσκας προστασίας και γυαλιά για τον γιατρό. - Διπλά γάντια για τα χέρια του γιατρού που πρέπει να ξεπλένονται συχνά όταν γεμίζουν με ρινίσματα αμαλγάματος. - Φίλτρο για συγκράτηση του μετάλλου στο οδοντιατρικό μηχάνημα ώστε να μην μολύνουμε το περιβάλλον μέσω την αποχέτευσης. - Αερισμός του χώρου σε μικρά χρονικά διαστήματα. - Αποφυγή αφαίρεσης αμαλγάματος σε έγκυες. - Αφαίρεση 2-3 αμαλγαμάτων κάθε 7-10 μέρες.
