President of American Academy of Pediatrics disregards their position on mercury

{rokbox title=|Judith Palfrey, president of the American Academy of Pediatrics|}images/stories/people/judith-palfrey.jpg{/rokbox}

Judith Palfrey,
President of the American Academy of Pediatrics

The President of the American Academy of Pediatrics (AAP) irresponsibly downplays the risks involved of exposure to mercury vapor from dental amalgam, directly contradicting the AAP’s offical policy position on mercury – “Mercury in all of its forms is toxic to the fetus and children”…”Inorganic and elemental mercury should not be present in the home or other environments of children”. Read on to learn how the president of the AAP fails to offer an accurate assessment of the risks of exposure to mercury vapor from dental amalgam.


Are Mercury Dental Fillings Safe?

My daughter is concerned that mercury from fillings slowly leaks into the body, possibly causing autoimmune problems and cancers. She also fears that removing them may pose even greater health dangers. Is she right?

Mercury can pose a serious risk to our health, and your daughter is right to ask questions such as this. Fortunately, though, Man Wai Ng has offered the following information, which should ease her concerns and provide her with current information about the very low risk of health effects of mercury from dental amalgam. Ng is the chief of pediatric dentistry at Children’s Hospital Boston.

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Man Wai Ng,
Chief of pediatric dentistry at Children’s Hospital Boston.

The information Judith Palfrey provides as coming from Man Wai Ng is greatly surprising, considering this is the same Man Wai Ng who was on the scientific advisory panel at the 2006 FDA dental products panel hearing on the safety of dental amalgam. The “White Paper” presented by the FDA dental division staff to the Scientific Advisory Panel in September, 2006, purported to represent the available scientific literature on mercury exposure from amalgam dental fillings, and which supported the notion of amalgam safety. The panel ultimately voted 13-7 to reject the idea that the literature was adequately searched and that amalgam safety was proven. According to FDA transcripts, Man Wai Ng voted against the FDA “white paper” assertion of amalgam safety.

There are several types of materials used in dental fillings. Newer “white” polymer resin materials do not contain any metals or mercury. “Silver” filling or dental amalgam contains mercury and several metals, including silver, tin, and copper.

It is important to note, Mercury makes up to 50% of dental amalgam “silver fillings”

The mercury in amalgam chemically binds with the other metals, which makes it stable and safe to use in dental applications.

Stable ? Only if one were to ignore the definition of the word “stable”. Please read our section on Dental Myths to find out more about the “Instability of Amalgams“.

 “Safe”? Nothing could be further from the truth as The No Observable Effects Level (NOEL) for mercury is ZERO. In other words there is NO safe level of mercury vapor (Criteria 118 World Health Organization 1991). From the time a dental amalgam filling is being installed patients are exposed to hundreds of micrograms of mercury vapor. This level is more than double the maximum limit OSHA allows employees to be exposed to at any time. In addition the freshly installed amalgam releases large amounts of mercury vapor over the next several days until the level gradually goes down to a lower level. But this lower levels is a constant daily dose of mercury, which is added upon all the other exposures our population has to mercury (cumulative).

Dental amalgam has been used for over 150 years to restore decayed teeth. There has been no clinical evidence in humans that dental amalgam has caused harmful health effects, although a very small number of people are allergic to amalgam.

The FDA’s estimation that the risk of allergic reaction is “rare” is undocumented and unscientific. In fact, the scientific literature reflects that between 3.8% and 38.7% of the population with amalgams is allergic to mercury. Despite acknowledging that a risk of allergy exists, FDA’s 2009 Final Rule fails to take any steps to address this health risk. Please read more about mercury allergy here.

The U.S. Food and the Drug Administration (FDA) considers dental amalgam to be safe to use.

At one tme the FDA’s website claimed:

“Dental amalgams contain mercury, which may have neurotoxic effects on the nervous systems of developing children and fetus.”

After the FDA published their 2009 amalgam ruling, in which it declared mercury amalgam to be safe for anyone and everyone, without regard to age, reproductive status, or any of the known factors that make a person unusually susceptible to the effects of mercury exposure. the statement of neurotoxic effects on the nervous systems of developing children and fetus was withdrawn from ther website.

During chewing and tooth grinding, very low levels of mercury vapor may be released from the amalgam in the mouth that can be inhaled.

Although high levels of mercury vapor exposure are associated with adverse effects in the brain and the kidneys,

Disregarding potential risk to health from chronic low level mercury exposure is irresponsible. This is what the Agency for Toxic Substances and Disease Registry (ATSDR – an agency within the CDC) has to say about CHRONIC MERCURY EXPOSURE.

Repeated or continuous exposure to elemental mercury can result in accumulation of mercury in the body and permanent damage to the nervous system and kidneys. Classic symptoms of poisoning include neuropsychiatric effects, renal impairment, and oropharyngeal inflammation. The neuropsychiatric effects include tremor, anxiety, emotional lability, forgetfulness, insomnia, anorexia, erethism (abnormal irritation, sensitivity, or excitement), fatigue, and cognitive and motor dysfunction.

Although less common, neuromuscular changes (weakness, muscle atrophy, and muscle twitching) and polyneuropathy (paresthesias, stocking-glove sensory loss, hyperactive tendon reflexes, slowed sensory and motor nerve conduction velocities) have also been reported.

A delayed idiosyncratic non-allergic hypersensitivity to mercury called acrodynia (pink disease) is sometimes seen in children chronically exposed to mercury vapor; in some cases, it occurs when exposure lasts for only a few days. Symptoms include irritability, sleeplessness, sweating, severe leg cramps, and a painful peeling rash.

Chronic exposure may be more serious for children because of their potential longer latency period.

the amount of mercury measured in the bodies of people with dental amalgam fillings is well below levels associated with adverse health effects.

This assertion is stating the complete opposite of what decades of peer reviewed scientific studies have found.

In actuality, daily amounts of mercury from non-dental sources, such as from food, water, and air, exceeds the very small amount released from amalgam fillings.

By this point Ng and Palfrey have gotten so many other aspects to this issue totally wrong it’s not surprising they put forth another piece of misinformation that has been proven inaccurate over 20 years ago.

Dental amalgam constitutes the greatest source of mercury for the general population – up to ten times more than all other sources combined. – WHO 2003. Mercury vapor from amalgam is the single largest source of systemic mercury intake: Persons with amalgam fillings have an average daily exposure of 3-17 ug of mercury per day; Other sources are: Fish 3 ug per day, Water .05 ug per day, Air .04 ug per day. Criteria 118 (1991), section 5.1. General population exposure, Table 2.

So not only are amalgams the largest daily source of mercury in people, but since mercury retention is cumulative it is important to reduce all exposure to mercury as background levels may push people into a more toxic state. Example: From 1999 – 2006 Americans inorganic mercury levels rose 30% and was associated with a elevated risk of liver, pituitary and immune dysfunction.

Removing amalgam fillings that are in good condition in teeth with no decay below the fillings is not recommended.  Removing sound amalgam fillings may result in unnecessary loss of healthy tooth structure and exposure to additional mercury vapor released during the removal process.

It is hypocritical that dentists are concerned about excess healthy tooth removal ONLY when talking about removing amalgams, but they don’t mention the amount of healthy tooth they have to carve out when installing amalgams. Here is a quote for you to remember from Dr. Harold Loe, the Director of the National Institute of Dental Research ( NIDR), who stated in the September, 1993 edition of “Dental Products Report”:

That first filling is a critical step in the life of a tooth. Using amalgam for the first filling requires removing a lot of the tooth substance, not only diseased tooth substance but healthy tooth substance as well. So, in making the undercut you sacrifice a lot, and this results in a weakened tooth.The next thing you know the tooth breaks off, and you need a crown. Then you need to repair the crown…and so it continues to the stage where there is no more to repair and you pull the tooth. With the first filling you should do something that can either restore the tooth or retain more healthy tooth substance. Use new materials-composites or materials you can bond to the surface without undercuts. You can do this with little removal of the tooth substance so that the core of the tooth is still there.”

Also, IMPROPERLY removing amalgams WILL expose the patient to harmful levels of mercury vapor… which is why Man Wai Ng should have mentioned the PROPER, SAFE way to have them removed. This method was pioneered by the International Academy of Oral Medicine and Toxicology who wrote the book on PROPERLY removing amalgams

Many dentists consider amalgam to be the material of choice in particular circumstances. We advise you and your daughter to share her concerns with her dentist. If additional dental fillings are needed in the future, discuss with her dentist the available choices for filling materials, along with their risks and benefits.

Considering Man Wai Ng is pediatric dentistry at Children’s Hospital Boston her stance that exposure to mercury vapor (from dental amalgam) is safe is highly irresponsible 

But what’s even more concerning is that neither Judith Palfrey or Man Wai promoted the actual stance of the American Academy of Pediatrics in regards to mercury exposure.

The 2001 American Academy of Pediatrics (AAP)  review on the state of science related to mercury toxicity entitled, “Technical Report: Mercury in the Environment: Implications for Pediatricians
concluded,“Mercury in all of its forms is toxic to the fetus and children”…”Inorganic and elemental mercury should not be present in the home or other environments of children” “It would seem prudent for the FDA to carefully examine all uses of mercury in pharmaceuticals, particularly pharmaceuticals that are used by infants and pregnant women.” [J Pediatr 2001; 108: 197-205].


1. Mercury in all of its forms is toxic to the fetus and children, and efforts should be made to reduce exposure to the extent possible to pregnant women and children as well as the general population. (ME: unless it is dental amalgam, in which case the chronic exposure to mercury vapor released from this material, has been found magically not to induce harm)Pediatricians can contribute to the effort of decreasing the amount of mercury in the waste stream by phasing out mercury-containing devices, such as thermometers and sphygmomanometers, from their offices and other medical facilities and encouraging parents to remove mercury thermometers from their homes.

2. Inorganic and elemental mercury should not be present in the home or other environments of children. (ME: But placing directly in the mouths of children under the age of 6 is acceptable???) Pediatricians need to be aware of traditional folk uses of mercury like in Santeria or in ethnic remedies and work sensitively with such families, who may initially be unwilling to discuss such factors with physicians and with people outside of their cultural group. Public health agencies, community organizations, pediatricians, and other child health providers should work together to identify the diverse cultural practices that may lead to mercury exposure. 

3. The most important source of methylmercury exposure is fish consumption by the mother before or during gestation and by young children. (ME: According to the WHO mercury from fish in one’s diet only represents 3 micrograms, where as daily exposure to mercury vapor from dental amalgam is 1 – 27 micrograms a day – WHO 2003 – Mercury vapor from dental amalgams is the most significant source for those of the amalgam bearing population – over 120 million people) Parents can reduce methylmercury exposure to their children by limiting the amount of fish with high mercury content consumed during pregnancy and lactation and amounts eaten by children. Recreational and subsistence fishers need to heed warnings and advisories from state health departments not only about mercury but also about other contaminants, such as PCBs, in fish.

4. As part of an ongoing review of biological products in response to the Food and Drug Administration Modernization Act of 1997, the FDA is reviewing the use of mercury in biological products and pharmaceutical preparations. It would seem prudent for the FDA to carefully examine all uses of mercury in pharmaceuticals, particularly pharmaceuticals that are used by infants and pregnant women. The FDA is working with the pharmaceutical industry and the medical community to decrease or eliminate exposures to mercury in vaccines and other products. (ME: Yes, all other products except Dental Amalgam).

MERCURY EXPOSURE: There has been ample science to support a ban on dental amalgam but there is no political will. and as long as organizations remain silent about mercury vapor exposure from dental amalgam, then people will remain uninformed as to the advsere health effects from mercury vapor from dental amalgam.

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