February 9, 2003
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Neuroendocrinology Letters incl. Psychoneuroimmunology & Chronobiology

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Reproductive Medicine, Chronobiology
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ISSN 0172–780X


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Published in
Vol.23 No. 5/6, 2002
Abstract and pdf

Removal of dental resorative materials
may ameliorate chronic disease

(Ulf Lindh et al)

Seven out of ten patients with long-lasting illness and a multitude of symptoms experienced less and reduced symptoms as well as improved quality of life after removal of mercury amalgam dental fillings and other metal alloys. The method of treatment called the "Uppsala Model" also includes antioxidant supplementation. It was developed by dentists and medical doctors at the Department of Clinical Metal Biology, Uppsala University Hospital. Results from a study of 463 patients is presented in Neuroendocrinology Letters.

Data indicate that it was not coincidental which patients recovered and which did not. Those who improved had greater differences in plasma mercury before and after treatment than the others and there were also other differences related to the outcome.

These astonishing results demonstrate that there are methods to identify the patients who may be cured of the serious side effects from dental amalgam mercury and other metal alloys. According to Ulf Lindh, professor at Uppsala University: "We also have developed an effective methods to help these sick people. With today's knowledge we can effectively help 70% of the patients. For the rest, further research is needed."


A number of studies have been performed in which patients with symptoms suspected to be related to dental restorative materials, have experienced improved health following removal of amalgam fillings and replacement with nonmetallic materials. However, this treatment is seldom tried by regular health care providers due to the lack of confirmed laboratory tests.

To address this issue the Department of Clinical Metal Biology was established in 1991 by the Uppsala County Council in Sweden. The main objective was improved health care for patients complaining about lack of relevant treatment regarding side effects from dental materials. The clinic was commissioned to develop both diagnostic procedures and adequate treatment for these patients.

This study was comprised of patients who were treated at the clinic until October 1996 and completed dental materials replacement before the end of 1998. The patients came from all areas of Sweden. They were referred by either a physician or dentist and had previously sought help from many health care practitioners and institutions with no conclusive results. In that sense they had constituted a "wandering queue" of patients with low quality of life causing high costs for medical care, drugs, sick leave and increased early retirements. The majority of the patients were 45 to 60 years old and more than two thirds were women.

All patients had experienced a multitude of symptoms with a characteristic of chronic fatigue. Skin problems from contact with metals such as jewelry and jeans buttons were common. From the comprehensive anamnesis it was often clear that these symptoms worsened after dental treatment.

The Uppsala Model

The Uppsala Model patients were evaluated by both a physician and dentist. Knowledge in the field of dental materials, their composition and properties was fundamental, as well as knowledge of techniques to reduce exposure from material emissions during dental work. In addition, the Uppsala Model involved experts in trace-element biology and methods to determine and survey metals in various parts of the body.

"To our knowledge, this is the first study based on the development of new diagnostic methods and protocols for treatment, in which close co-operation between physicians and dentists is essential." says Professor Ulf Lindh, leader of the group and first author of this study.

Examining the patients

The first visit to the clinic included taking the patient's thorough history aided by extensive questionnaires completed by the patients in advance. This was followed by a somatic examination and a panel of routine blood tests. This procedure was repeated after treatment.

In addition a number of special blood tests, related to metal exposure, were performed before and after treatment. These tests included measurement of mercury in plasma by means of inductively coupled plasma mass spectrometry (ICP-MS) and levels of trace elements in single blood cells by means of nuclear microscopy (NM) with particle induced X-ray emission (PIXE). Results of NM measurements have been published elsewhere.

To investigate hypersensitivity to metals an optimized lymphocyte transformation test in vitro (MELISA®) was used before and after treatment. A regular patch test used in parallel initially was soon abandoned due to an unacceptable rate of side effects. Results of MELISA® have been published elsewhere.

In cases with emphasis on the deterioration of higher cerebral functions, an investigation of the spinal fluid was performed with respect to proteins, methyl-malonic acid, B12 and metal concentrations.

Individual exposure profiles

In the analysis of exposure, potentially toxic or allergenic environmental chemicals, medicines and dental materials were emphasized, together with any related clinical observations. To establish these exposure profiles dental restorative materials in each individual were recorded. Dental amalgam contains approximately 50% mercury, with the remainder consisting mainly of copper, silver and tin. Dental "gold" is always an alloy of numerous metals, often containing some nickel. Adhesive resin-based dental materials (white composites) contain a number of components that are potentially allergenic. All of these restorative materials release compound, which can be swallowed with varying degrees of distribution and uptake in organs. Individual sensitivity to this exposure varies widely, as do the potential symptoms.

If other sources of exposure were obvious or suspected in the patient's home or occupational environment, this was further investigated by an occupational engineer.


In most cases there was no indication for any remedial treatment other than reduction of exposure to implicated metals in the dental restorative materials. Other approaches had often been tried earlier. The recommendation to remove or substitute dental materials was founded on the general precautionary principle of allergists: It means if possible, avoid exposure to compounds that may cause allergy or hypersensitivity.

To counteract oxidative stress during removal of dental materials, each patient was prescribed a standard regiment of antioxidants. This included vitamin C, vitamin B-complex, vitamin E and selenium supplementation. In cases with positive markers for vitamin B-12 deficiency in the cerebrospinal fluid, treatment with B-12 and folic acid was added.

Removal of incompatible dental materials

Based on previous examination and laboratory results, the possible removal of implicated dental materials was discussed with each patient, and most of them chose to perform the recommended dental treatment.
For some patients the symptoms worsened considerably during the period of dental treatment. To cope with this, a working relationship between dentists and physicians was necessary. About half the patients, among them the most sensitive, had their ensuing dental treatment performed at a few dental offices in Uppsala, where a protocol for removal of incompatible dental materials (RID) and bite restoration with individually compatible materials was implemented. At these offices precautionary arrangements had been made to minimize exposure particularly to mercury vapor. This included equipment, such as catalytic mercury vapor traps and high-volume suction devices.

Dental amalgam was found to be the most offending material, followed by various gold alloys and non-precious metal alloys, e.g. titanium alloys or chromium-vanadium alloys. In almost all clinical cases non-metallic materials could be used instead, due to recent improvements of their mechanical properties.


To evaluate the outcome of the treatment, a questionnaire was constructed in co-operation with a group of scientists from the Uppsala, Umeå and Lund Universities in Sweden. It was comprised of questions regarding symptom and quality of life changes before and after treatment. The symptoms included in the questionnaire were selected to represent those most relevant from clinical experience in this field. Two earlier Swedish studies on results of amalgam removal were based on similar questionnaires. The result shows that more than 70 percent of the patients report better health after treatment..

Published in:
Vol. 23 No.5/6, 2002
Neuroendocrinology Letters www.nel.edu
Abstract and pdf: here

More information available: publisher@nel.edu


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