Mercury (Hg) burden in children: The impact of dental amalgam

The risks and benefits of using mercury (Hg) in dental amalgam have long been debated. This study was designed to estimate Hg body burden and its association with dental amalgam fillings in 182 children (ages: 5-15 years) living in Taif City. Hg was measured in urine (UHg), hair (HHg) and toenails (NHg) by the Atomic Absorption Spectrophotometer with Vapor Generator Accessory system. Urinary Hg levels were calculated as both micrograms per gram creatinine (μg/g creatinine) and micrograms per liter (μg/L). We found that children with amalgam fillings (N = 106) had significantly higher UHg-C levels than children without (N = 76), with means of 3.763 μg/g creatinine versus 3.457 μg/g creatinine, respectively (P = 0.019). The results were similar for UHg (P = 0.01). A similar pattern was also seen for HHg, with means of 0.614 μg/g (N = 97) for children with amalgam versus 0.242 μg/g (N = 74) for those without amalgam fillings (P = 0). Although the mean NHg was higher in children without amalgam (0.222 μg/g, N = 61) versus those with (0.163 μg/g, N = 101), the relationship was not significant (P = 0.069). After adjusting for many confounders, the multiple logistic regression model revealed that the levels of UHg-C and HHg were 2.047 and 5.396 times higher, respectively, in children with dental amalgam compared to those without (P < 0.01). In contrast, a significant inverse relationship was seen between NHg levels and dental amalgam fillings (P = 0.003). Despite the controversy surrounding the health impact of dental amalgam, this study showed some evidence that amalgam-associated Hg exposure might be related with symptoms of oral health, such as aphthous ulcer, white patches, and a burning-mouth sensation. Further studies are needed to reproduce these findings. The present study showed that significant numbers of children with or without amalgam had Hg levels exceeding the acceptable reference limits. The detrimental neurobehavioral and/or nephrotoxic effects of such an increased Hg on children should be a cause of concern, and further investigation is warranted. Our results are alarming and indicate an urgent need for biomonitoring and assessment of exposure. Changes in dental practices involving amalgam, especially for children, are highly recommended in order to avoid unnecessary exposure to Hg. - Research Highlights: → The extent of Hg exposure in children 5-15 years of age with and without dental amalgam fillings was examined. → Hg was measured in urine, hair and toenails to assess their sensitivity, specificity, and reliability as biomarkers of Hg exposure. → The levels of UHg-C and HHg were significantly higher in children with dental amalgam compared to those without. → The reliability of nails to determine associations with dental amalgam fillings may be limited, especially if the levels of Hg in nails are low. → This study showed some evidence that amalgam-associated Hg exposure might be related with symptoms of oral health.