TODENTJ-25-03-2019_TODENTJ-10-739 1553506905 Bentham Open doi@benthamopen.net Bentham Open The Open Dentistry Journal TODENTJ 1874-2106 12 30 2016 10 1 Agnete Egilsdatter Kristoffersen Terje Alræk Trine Stub Harald Johan Hamre Lars Björkman Frauke Musial Background: Many patients have complex health complaints they attribute to dental amalgam. There is some evidence of symptom relief after removal of amalgam. Objective: The aims of this study were to assess the total symptom load in patients with all their amalgam fillings removed, and to investigate the self-reported improvement of health with regard to precautions taken under amalgam removal and time since removal. Methods: The survey was distributed to all members (n=999) of the Norwegian Dental patients association in 2011. The study participants returned the questionnaires anonymously by means of a pre-stamped envelope. The questionnaire asked for sociodemographic data, subjectively perceived health status, complaints persisting after amalgam removal and self-reported changes in symptoms after amalgam removal. Results: A total of 324 participants were included in the study. The majority of the participants reported improved health after amalgam removal, even though the mean degree of severity of complaints was still high. Exhaustion and musculoskeletal complaints were most severe, and reflects the fact that 38% of the participants reported poor to very poor current health. With regard to amalgam removal, associations between improved health, number of precautions applied, and time since removal were found. Conclusion: Most of the participants in this study reported improvement of health after amalgam removal even though they still suffered a high complaint load. Since absolute symptom load is a robust predictor for general health outcome and socioeconomic burden for society, a possible intervention, which enables patients to further improve their health status is desirable. 12 30 2016 739 751 TODENTJ-10-739 1 10.2174/crossmark_policy opendentistryjournal.com benthamopen.com true Peer Reviewed Single blind Checked with iThenticate 2016-06-28 2016-12-06 2016-12-12 2016-12-30 https://creativecommons.org/licenses/by/4.0/legalcode 10.2174/1874210601610010739 1553506905 https://opendentistryjournal.com/VOLUME/10/PAGE/739/ https://opendentistryjournal.com/contents/volumes/V10/TODENTJ-10-739/TODENTJ-10-739.pdf https://opendentistryjournal.com/contents/volumes/V10/TODENTJ-10-739/TODENTJ-10-739.pdf https://opendentistryjournal.com/contents/volumes/V10/TODENTJ-10-739/TODENTJ-10-739.pdf https://opendentistryjournal.com/contents/volumes/V10/TODENTJ-10-739/TODENTJ-10-739.pdf https://opendentistryjournal.com/contents/volumes/V10/TODENTJ-10-739/TODENTJ-10-739.pdf https://opendentistryjournal.com/contents/volumes/V10/TODENTJ-10-739/TODENTJ-10-739.pdf https://opendentistryjournal.com/contents/volumes/V10/TODENTJ-10-739/TODENTJ-10-739.pdf https://opendentistryjournal.com/contents/volumes/V10/TODENTJ-10-739/TODENTJ-10-739.xml Scand. J. Prim. Health Care Aamland A. 31 95 2013 10.3109/02813432.2013.788274 Aamland A, Werner EL, Malterud K. Sickness absence, marginality, and medically unexplained physical symptoms: a focus-group study of patients experiences. Scand J Prim Health Care 2013; 31 (2) : 95-100. Psychother. Psychosom. Konnopka A. 81 265 2012 10.1159/000337349 Konnopka A, Schaefert R, Heinrich S, et al. Economics of medically unexplained symptoms: a systematic review of the literature. Psychother Psychosom 2012; 81 (5) : 265-75. Psychother. Psychosom. Mayou R. 59 69 1993 10.1159/000288650 Mayou R. Somatization. Psychother Psychosom 1993; 59 : 69-83. J. Advance Med. Godfrey M.E. 7 19 1994 Godfrey ME, Campbell N. Confirmation of mercury retention and toxicity using 2,3-Dimercapto-1-Propane-Sulphonic Acid Sodium Salt (DMPS). J Advance Med 1994; 7 (1) : 19-30. J. Dent. Res. Melchart D. 87 349 2008 10.1177/154405910808700410 Melchart D, Vogt S, Köhler W, et al. Treatment of health complaints attributed to amalgam. J Dent Res 2008; 87 (4) : 349-53. J. Orthomol. Med. Lichtenberg H. 8 145 1993 Lichtenberg H. Elimination of symptoms by removal of dental amalgam from mercury poisoned patients as compared with a control group of average patients. J Orthomol Med 1993; 8 (3) : 145-8. J. Orthomol. Med. Lichtenberg H. 11 196 1996 Lichtenberg H. Symptoms before and after proper amalgam removal in relation to serum globulin reaction to metals. J Orthomol Med 1996; 11 (4) : 196-203. Neuroendocrinol. Lett. Lindh U. 23 459 2002 Lindh U, Hudecek R, Danersund A, Eriksson S, Lindvall A. Removal of dental amalgam and other metal alloys supported by antioxidant therapy alleviates symptoms and improves quality of life in patients with amalgam-associated ill health. Neuroendocrinol Lett 2002; 23 (5-6) : 459-82. J. Orthomol. Med. Siblerud R.L. 5 95 1990 Siblerud RL. Health effects after amalgam removal. J Orthomol Med 1990; 5 (2) : 95-106. Altern. Ther. Health Med. Kidd R.F. 6 49 2000 Kidd RF. Results of dental amalgam removal and mercury detoxification using DMPS and neural therapy. Altern Ther Health Med 2000; 6 (4) : 49-55. J. Orthomol. Med. Zamm A.V. 5 138 1990 Zamm AV. Removal of dental mercury: often an effective treatment for the very sensitive patient. J Orthomol Med 1990; 5 (3) : 138-42. Community Dent. Oral Epidemiol. Lygre G.B. 33 227 2005 10.1111/j.1600-0528.2005.00223.x Lygre GB, Gjerdet NR, Björkman L. A follow-up study of patients with subjective symptoms related to dental materials. Community Dent Oral Epidemiol 2005; 33 (3) : 227-34. J. Psychosom. Res. Nerdrum P. 57 103 2004 10.1016/S0022-3999(03)00542-7 Nerdrum P, Malt UF, Høglend P, et al. A 7-year prospective quasi-experimental study of the effects of removing dental amalgam in 76 self-referred patients compared with 146 controls. J Psychosom Res 2004; 57 (1) : 103-11. Neuroendocrinol. Lett. Prochazkova J. 25 211 2004 Prochazkova J, Sterzl I, Kucerova H, Bartova J, Stejskal VD. The beneficial effect of amalgam replacement on health in patients with autoimmunity. Neuroendocrinol Lett 2004; 25 (3) : 211-8. Neuroendocrinol. Lett. Wojcik D.P. 27 415 2006 Wojcik DP, Godfrey ME, Christie D, Haley BE. Mercury toxicity presenting as chronic fatigue, memory impairment and depression: diagnosis, treatment, susceptibility, and outcomes in a New Zealand general practice setting (19942006). Neuroendocrinol Lett 2006; 27 (4) : 415-23. Nasjonale faglige retningslinjer for utredning og behandling ved mistanke om bivirkninger fra odontologiske biomaterialer [National guidelines for assessment and treatment for suspected adverse effects from dental biomaterials] Oslo: Hesedirektoratet, avdeling omsorg og tannhelse; Available from: https://helsedirektoratet.no/ retningslinjer/nasjonal-faglig-retningslinje-for-utredning-og- behandling-ved-mistanke-om-bivirkninger-fra-odontologiske-biomaterialer 2008. updated 19.10.; cited 2015 19.10. Hamre HJ, Björkman L. Pasientsikkerhet ved amalgamutskiftingsprosjekt. Forbundet Tenner og Helse 2009; pp. 18-26. Patient safety in amalgam removal project[The Norwegian Dental Patient Association ] Bendiksen B. Tiltak ved amalgamsanering. Bergen: Forbundet Tenner og Helse 2008. actions during amalgam removal[The Norwegian Dental Patient Association ] Lidmark AM. Lidmark AM Är de verkligen sjuka? Beskrivning av elöverkänsliga och tandvärdsskadade i samhället Slutrapport från HET-projektet [Are they really ill? Description of electromagnetic hypersensitivity and dental injured patients in the society Final report from the HET-project] Stockholm: Elöverkänsligas Riksförbund och Tandvvårdsskadeförbundet 2008. Acta Pharmacol. Toxicol. (Copenh.) Kudsk F.N. 23 263 1965 Kudsk FN. The influence of ethyl alcohol on the absorption of mercury vapour from the lungs in man. Acta Pharmacol Toxicol (Copenh) 1965; 23 (2) : 263-74. BMC Complement. Altern. Med. Kristoffersen A.E. 16 22 2016 10.1186/s12906-016-0996-1 Kristoffersen AE, Musial F, Hamre HJ, et al. Use of complementary and alternative medicine in patients with health complaints attributed to former dental amalgam fillings. BMC Complement Altern Med 2016; 16 : 22. BMC Complement. Altern. Med. Kristoffersen A.E. 16 22 2016 10.1186/s12906-016-0996-1 Kristoffersen AE, Musial F, Hamre HJ, et al. Use of complementary and alternative medicine in patients with health complaints attributed to former dental amalgam fillings. BMC Complement Altern Med 2016; 16 (1) : 22. Brähler E, Hinz A, Scheer JW. GBB-24 - Der Gießener Beschwerdebogen Manual. 3rd ed. Bern Verlag Hans Huber 2008. Acta Odontol. Scand. Lygre G.B. 71 560 2013 10.3109/00016357.2012.697577 Lygre GB, Sjursen TT, Svahn J, et al. Characterization of health complaints before and after removal of amalgam fillings3-year follow-up. Acta Odontol Scand 2013; 71 (3-4) : 560-9. Hanson M. Effects of amalgam removal on health. Stockholm: Tandvårdsskadeförbundet: Swedish Assosciation of Dental mercury Patients 2004. BMJ Sharpe M. 305 147 1992 10.1136/bmj.305.6846.147 Sharpe M, Hawton K, Seagroatt V, Pasvol G. Follow up of patients presenting with fatigue to an infectious diseases clinic. BMJ 1992; 305 (6846) : 147-52. Br. J. Psychiatry Bentall R.P. 181 248 2002 10.1192/bjp.181.3.248 Bentall RP, Powell P, Nye FJ, Edwards RH. Predictors of response to treatment for chronic fatigue syndrome. Br J Psychiatry 2002; 181 (3) : 248-52. Tannmaterialer og helse: Erfaringer fra klinisk utredning av pasienter med mistanke om bivirkninger fra tannmaterialer [Dental Materials and health: Experiences from clinical evaluation of patients with suspected adverse effects from dental materials] Bergen: Bivirkningsgruppen for odontologiske biomaterialer; 2006. Biol. Trace Elem. Res. Frisk P. 113 247 2006 10.1385/BTER:113:3:247 Frisk P, Lindvall A, Hudecek R, Lindh U. Decrease of trace elements in erythrocytes and plasma after removal of dental amalgam and other metal alloys. Biol Trace Elem Res 2006; 113 (3) : 247-59. Int. J. Qual. Stud. Health Well-being Sjursen T.T. 10 28157 2015 10.3402/qhw.v10.28157 Sjursen TT, Binder PE, Lygre GB, Helland V, Dalen K, Björkman L. Patients experiences of changes in health complaints before, during, and after removal of dental amalgam. Int J Qual Stud Health Well-being 2015; 10 : 28157. Health Serv. Res. Halbesleben J.R. 48 913 2013 10.1111/1475-6773.12002 Halbesleben JR, Whitman MV. Evaluating survey quality in health services research: a decision framework for assessing nonresponse bias. Health Serv Res 2013; 48 (3) : 913-30. Pain Turner J.A. 137 467 2008 10.1016/j.pain.2008.03.029 Turner JA, Turk DC. The significance of clinical significance. Pain 2008; 137 (3) : 467-8. Scand. J. Prim. Health Care Aamland A. 30 147 2012 10.3109/02813432.2012.704812 Aamland A, Malterud K, Werner EL. Phenomena associated with sick leave among primary care patients with Medically Unexplained Physical Symptoms: a systematic review. Scand J Prim Health Care 2012; 30 (3) : 147-55. J. Psychosom. Res. Ladwig K.H. 68 427 2010 10.1016/j.jpsychores.2010.01.009 Ladwig KH, Marten-Mittag B, Lacruz ME, Henningsen P, Creed F. Screening for multiple somatic complaints in a population-based survey: does excessive symptom reporting capture the concept of somatic symptom disorders? Findings from the MONICA-KORA Cohort Study. J Psychosom Res 2010; 68 (5) : 427-37. Nat. Rev. Drug Discov. Enck P. 12 191 2013 10.1038/nrd3923 Enck P, Bingel U, Schedlowski M, Rief W. The placebo response in medicine: minimize, maximize or personalize? Nat Rev Drug Discov 2013; 12 (3) : 191-204. Prev. Treat. Kirsch I. 1 1998 Kirsch I, Sapirstein G. Listening to Prozac but Hearing Placebo: A meta-Analysis of Antidepressant medication. Prev Treat 1998; 1 (0002a) J. Clin. Epidemiol. Kaptchuk T.J. 53 786 2000 10.1016/S0895-4356(00)00206-7 Kaptchuk TJ, Goldman P, Stone DA, Stason WB. Do medical devices have enhanced placebo effects? J Clin Epidemiol 2000; 53 (8) : 786-92. J. Neurol. de Craen A.J. 247 183 2000 10.1007/s004150050560 de Craen AJ, Tijssen JG, de Gans J, Kleijnen J. Placebo effect in the acute treatment of migraine: subcutaneous placebos are better than oral placebos. J Neurol 2000; 247 (3) : 183-8.