revised final - Agency for Toxic Substances and Disease Registry ...

MERCURY 296
2. HEALTH EFFECTS
of inhaled mercury vapor nor a higher mercury concentration in blood and urine than in the control group.
The study provided no scientific support for the belief that the symptoms of the patients examined originated
from an enhanced mercury release from their amalgam restorations.
Bagedahl-Strindlund et al. (1997) evaluated Swedish patients with illnesses thought to be causally related to
mercury release during dental restorations, and mapped the psychological/psychiatric, odontological, and
medical aspects of the patients and their purportedly mercury-induced symptoms. A total of 67 consecutive
patients and 64 controls matched for age, sex, and residential area were included in the study.
Questionnaires were completed and a semi-structured psychiatric interview performed. The Comprehensive
Psychopathological Rating Scale was used to record psychopatholgical symptoms. The Karolinska Scales of
Personality (KSP) set was used to assess personality traits. The Toronto Alexithymia Scale and the
Schalling-Sifneos Personality Scale were completed. The Whitely Index was used to assess hypochondriacal
attitudes. The type and number of amalgam-filled surfaces was determined. The most striking result was the
high prevalence of psychiatric disorders (predominantly somatoform disorders) in the patients (89%)
compared to the controls (6%). The personality traits differentiating the patients according to the Karolinska
Scales of Personality were somatic anxiety, muscular tension, psychasthenia, and low socialization. More
patients than controls showed alexithymic traits. The prevalence of diagnosed somatic diseases was higher,
but not sufficiently so to explain the large difference in perceived health. The multiple symptoms and signs
of distress displayed by the patients could not be explained either by the odontological data or by the medical
examination. These data indicate that the patients show sociodemographic and clinical patterns similar to
those of somatizing patients. The number of amalgam-filled surfaces did not differ significantly between
patients and controls; 19% of the patients lacked amalgam fillings.
Grandjean et al. (1997a) evaluated the effects of chelation therapy versus a placebo on patient improvement
for patients who attribute their environmental illness to mercury from amalgam fillings. Succimer (meso-2,
3-dimercaptosuccinic acid) was given at a daily dose of 30 mg/kg for 5 days in a double-blind, randomized
placebo-controlled trial. Treatment of patients who attribute their environmental illness to mercury from
amalgam fillings is largely experimental. On the Symptom Check List, overall distress, and somatization,
obsessive-compulsive, depression, and anxiety symptom dimensions, were increased in 50 consecutive
patients examined, and Eysenck Personality Questionnaire scores suggested less extroversion and
increased degree of emotional lability. Urinary excretion of mercury and lead was considerably increased in
the patients who received the chelator. Immediately after the treatment and 5–6 weeks later, most distress