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It was the aim of this investigation to treat 20 volunteers with maximally 5 amalgam fillings by the same comprehensive protocol in which all removals with (n = 8) and without (n = 12) rubber dam had been performed within a few months. Nine amalgam-related parameters indicated a close matching of both groups before removal. In the group without rubber dam, mercury (Hg) levels in plasma increased significantly above preremoval values at days 1 and 3 after removal; they decreased significantly below preremoval values at day 30 in the rubber-dam group and at day 100 in both groups. Excretion rates did not increase significantly in either group, but decreased significantly at day 100 in the protected group. Peak plasma-Hg was 0.6 ng/mL on average at day one and decreased with halftimes of 3 and 43 d in subjects protected by rubber dam. The results indicated that concentrations of total mercury in plasma responded rapidly to changes in the amalgam status and reflected the actual absorption most reliably. Notably, plasma-Hg levels were sensitive enough to detect a transient attenuation of the additional exposure by using rubber dam during the removal of only a few fillings. However, being small in magnitude and lasting 100 d at best, the rubber-dam effect had minor toxicological relevance.

The aims of this study were to examine whether there is a difference in symptoms between patients with amalgam fillings and patients without such restorations, to investigate the relationship between particular symptoms and the number of amalgam filled surfaces, and the differences in symptoms between patients with and without removal of amalgam fillings. Data from 6744 consecutive patients in 34 dental offices located throughout Germany were documented. Patients completed a questionnaire answering 48 items, and the current oral findings in the patients were registered. The analysis was restricted to 4,787 patients aged 21 to 60 yr because of special dental conditions in children and elderly persons. The study did not show any significant correlation between the intensity of complaints or particular groups of symptoms and the number of amalgam-filled surfaces. A higher number of symptoms as well as a higher intensity of symptoms were found in patients before amalgam removal compared to the remaining patients. The question remains open whether or not there may be a certain kind of relationship between the complaints and amalgam fillings in individual patients.