Clear Tendencies Toward Somatization In Amalgam Complaints

J Oral Rehabil 2002 Aug;29(8):705-713
Multidisciplinary examination of patients with illness
attributed to dental fillings.

Langworth S, Bjorkman L, Elinder CG, Jarup L,
Savlin P. Department of Public Health Sciences,
Division of Occupational Medicine, Karolinska
Hospital and Karolinska Institutet, Stockholm,
Sweden, Department of Odontology, Karolinska
Institutet, Stockholm, Sweden, and National
Registry of Adverse Reactions to Dental Materials,
Bergen, Norway, Department of Renal Medicine,
Huddinge University Hospital and Karolinska
Institutet, Huddinge, Sweden, Department of
Epidemiology and Public Health, Imperial College
School of Medicine, London, UK, and Institute
of Environmental Medicine, Karolinska Institutet,
Stockholm, Sweden, and Department of
Environmental Health, Stockholm County Council,
Norrbacka, Stockholm, Sweden.

Objective and methods. In 1993, a special
Amalgam Clinic was established at Huddinge
University Hospital. Residents in the Stockholm
County area with morbidity attributed to dental
fillings ('amalgam disease'), were referred to
this clinic. Patients were examined by a dentist
(n 428), a physician (n 379), and a psychologist
(n 360). Sixty-nine per cent were women and 31%
men; the mean patient age was 46 years.

Results. Oral symptoms included tender or aching
teeth (60%), metallic taste (54%), sore mouth
(43%) and dry mouth (43%). Signs of moderate
or severe temporomandibular joint dysfunction
were found in 81 cases, glossitis in 30 and oral
lichen in 26 cases. Common general symptoms
included diffuse pain (78%), general weakness
(75%), extreme fatigue (68%) and dizziness
(68%). Seven per cent of the patients suffered
from previously undiagnosed medical conditions
(thyroid dysfunction, anaemia, cardiopathy, renal
disease, cancer). In 26 subjects, skin patch
testing revealed allergy to mercury, gold or
palladium. The median concentration of mercury
was 10 nmol L-1 in whole blood, 3 nmol L-1 in
plasma and 10 nmol L-1 in urine, i.e. normal
levels. Earlier mental trauma was common, and
in the psychological questionnaire SCL-90, clear
tendencies to somatization were found. Only a few
cases of severe psychiatric illness were observed.
No positive correlation was found between the
amount of amalgam and somatic symptoms or
psychological effect parameters.

Conclusions. The results do not support the
hypothesis that release of mercury from amalgam
fillings is the cause of amalgam disease', but
suggest that there may be various explanations
for the patient's complaints.