For many years amalgams or " metal based " fillings, crown and bridges made of various metallic alloys containing metals such as beryllium, palladium nickel ect... and titanium implants were the norm in restoring and replacing damaged teeth. Although not visually appealing these metals were regarded as the best solution for managing dental restorations. In the case of crown and bridges they were usually layered with a tooth coloured material to mask the metal for aesthetic reasons. Such metallic crowns were also placed directly over amalgam fillings, hiding them from view but not reducing ongoing exposure to mercury. In fact a metallic crown over amalgam may very well induce more galvanism.

A vigorous debate is still ongoing within and outside the dental profession about possible health risks resulting from having these various metals in a patient's mouth for a long period of time.

Today, metal-free dentistry completely side-steps the debate by providing non metallic, visually appealing and more structurally sound solutions for tooth restorations. Using state of the art synthetic, tooth coloured materials with distinct advantages over "old style " metals.

• These materials have high strength yet can be kinder to the natural dentition.

• They are attached to the existing tooth structure by bonding, with very high adhesion.

• The materials can be molded for a custom fit even after they have been bonded inside the mouth.

• They are tooth coloured for a more desirable aesthetic result.

• They do not corrode and do not release metallic ions ( electro-galvanism )

This said at the Integrative Centre for Dental & Natural Health, Dr. Jacques Imbeau is aware that metal-free, as frequently advertised, does not automatically mean " biocompatible dentistry " because many tooth coloured dental materials can also present their own problems including toxicity and estrogenicity. In fact we see a growing number of patients who had their amalgam replaced randomly with tooth coloured materials that were not biologically suitable for them.

If the materials are carefully selected to suit the biological and physico-mechanical needs of the individual patient, then a metal-free approach, as part of an integrative concept of oral health care, can be a biomimetic solution.

Why is it preferable to avoid metals in the mouth?

METALS CAN INDUCE IMMUNE EFFECTS SUCH AS CHRONIC INFLAMMATORY PROCESSES AND AUTOIMMUNE DISEASES.

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1- Immunomodulation by metals. Lawrence DA, McCabe MJ. Jr. Int Immunopharmacol. 2002 Feb;2(2-3):293-302.

Abstract

Occupational or environmental exposure to metals is believed to affect human health adversely. One mechanism whereby metals can alter health is through modulation of immune homeostasis. Imbalances in immune regulation by metals can lead to inadequate or excessive production of inflammatory cytokines. Alternatively, metals can lead to inappropriate activation of lymphoid subsets involved in acquired immunity to specific antigens. Some resultant pathologies may include chronic inflammatory processes and autoimmune diseases. Metals may change the response repertoire by direct and indirect means by influencing expression of new antigens, new peptides, and/or antigen presentation by modifying the antigen-presenting complex. The differences in metal-induced immune responses between humans and the mechanisms of metal immunomodulationare discussed.

2- Metal ion induced autoimmunity. Griem P., Gleichmann E. Curr, Opin. Immunolol. 1995. Dec;7(6):831-8

3-Immunology of mercury. Vas J. Monestrier M. Ann N Y Acad Sci. 2008 Nov;1143:240-67.

Abstract

The heavy metal mercury is ubiquitously distributed in the environment resulting in permanent low-level exposure in human populations. Mercury can be encountered in three main chemical forms (elemental, inorganic, and organic) which can affect the immune system in different ways. In this review, we describe the effects of these various forms of mercury exposure on immune cells in humans and animals. In genetically susceptible mice or rats, subtoxic doses of mercury induce the production of highly specific autoantibodies as well as a generalized activation of the immune system. We review studies performed in this model and discuss their implications for the role of environmental chemicals in human autoimmunity.

3a- Mechanisms of heavy metal induced autoimmunity.Rowley B., Monestier M., Mol. Immunol. 2005. May;42(7):833-8.

Abstract

Chemical exposure can trigger or accelerate the development of autoimmune manifestations. Although elementary chemical  heavy metals are structures, they can have profound and complex effects on the immune system. In genetically susceptible mice or rats, administration of subtoxic doses of mercury induces both the production of highly specific autoantibodies and a polyclonal activation of the immune system. We review in this article some of the mechanisms by which heavy metal exposure can lead  to autoimmunity.

3b-How can a chemical element elicit complex immunopathology? Lessons from mercury-induced autoimmunity. Schiraldi M, Monestier M. Trends Immunol. 2009 Oct;30(10):502-9.

Abstract

Although most autoimmune diseases develop without a manifest cause, epidemiological studies indicate that external factors play an important role in triggering or aggravating autoimmune processes in genetically predisposed individuals. Nevertheless, most autoimmune disease-promoting environmental agents are unknown because their relationships to immune function are not understood. Thus, the study of animal models of chemically-induced autoimmunity should shed light on the pathways involved and allow us to identify these agents. The rodent model of heavy metal-induced autoimmunity is one of the most intriguing experimental systems available to address such questions. Although the ultimate pathophysiology of this model remains mysterious, recent studies have started to elucidate the mechanisms by which heavy metal exposure leads to immune activation and loss of self-tolerance.

4- Mercury-induced inflammation: Yet another example of ASIA syndrome.

5- Metal-induced inflammation triggers fibromyalgia in metal-allergic patients

6- Orthopaedic surgery in a patient with metal sensitivity. Adala R, Chakravarthy M, Srinivas V, Pai S. J Cutan Aesthet Surg. 2011 Jan-Apr; 4(1): 67-68.

7- Metal sensitivity in patients with orthopaedic implants: a prospective study. Frigerio, E., Pigatto, P. D., Guzzi, G. and Altomare, G. (2011). Contact Dermatitis, 64:273–279.

8-The role of environmental factors in autoimmune thyroiditis.

9-Diagnosis and treatment of metal-induced side-effects.

10-LTT-MELISA is clinically relevant for detecting and monitoring metal sensitivity.

11-Hypersensitivity to titanium: Clinical and laboratory evidence. 

12-Increased levels of transition metals in breast cancer tissue. 

13-Micro analysis of metals in dental restorations as part of a diagnostic approach in metal allergies. 

14-The beneficial effect of amalgam replacement on health in patients with .autoimmunity.

15-Removal of dental amalgam decreases anti-TPO and anti-Tg autoantibodies in patients with autoimmune thyroiditis.

16-Validity of MELISA for metal sensitivity testing.

17-A novel lymphocyte transformation test (LTT-MELISA) for Lyme borreliosis.

18-Metal-specific lymphocyte reactivity is downregulated after dental metal replacement.

19-Les amalgames dentaires constituent-ils un risque pour la sante? 

20-The role of metals in autoimmunity.

21-Metal-specific lymphocytes: biomarkers of sensitivity in man.

22-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.

23-Nickel allergy is found in a majority of women with chronic fatigue syndrome and muscle pain – and may be triggered by cigarette smoke and dietary nickel intake.

24-Metal-specific lymphocytes: biomarkers of sensitivity in man.

25-Mercury-specific lymphocytes: an indication of mercury allergy in man.

26-Sensitization to inorganic mercury could be a risk factor for infertility. 

27-Immunological & brain MRI changes in patients with suspected metal intoxication

28-Health observations before and after amalgam removal.

29-Mercury and nickel allergy: risk factors in fatigue and in autoimmunity.

30-MELISA – an in vitro tool for the study of metal allergy.

31-Human hapten-specific lymphocytes: biomarkers of allergy in man.

32-Immunologic basis for adverse reactions to radiographic contrast media.

33-Lymphocyte transformation test for diagnosis of isothiazolinone allergy in man.

34-The lymphocyte transformation test for diagnosis of drug-induced occupational .allergy.

35-Alum, an aluminium-based adjuvant, indices Sjogren's syndrome-like disorder in mice. Bagavant H, Nadula SR, Kaplonek P, Rybakowska PD, Deshmukh US. Clin Exp Rheumatol. 2014 Mar-Apr;32(2):251-5. Epub 2014 Apr 9.