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Medical Forum / General / Dentistry / October 2004

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Mercury-Neurological Effects-Vapors

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Jan - 18 Oct 2004 00:55 GMT
Elemental mercury is found in liquid form, which easily vaporizes at room
temperature and is well absorbed through inhalation. Its lipid (fat)-soluble
property allows for easy passage through the alveoli into the bloodstream and
red blood cells. Once inhaled, elemental mercury is mostly converted to an
inorganic divalent or mercuric form by catalase in the red blood cells. This
inorganic form has similar properties to organic mercury. Small amounts of
non-oxidized elemental mercury continue to persist and account for CNS
toxicity. Elemental mercury, as a vapor, which escapes from fillings,
penetrates the blood-brain-barrier and enters the CNS, where it's ionized and
trapped, attributing to its significant toxic effects. It is not well absorbed
by the GI tract and, when ingested, is only mildly toxic. Inorganic mercury is
highly toxic and corrosive and is the most destructive form, but its
destruction is limited to where it's located. It doesn't have the ability to
move through tissues like other forms. It gains access orally or dermally and
is absorbed at a rate of 10% of that ingested. It has a nonuniform mode of
distribution, secondary to poor fat solubility, and accumulates mostly in the
kidney, causing renal damage

Millions of U.S. citizens are being exposed to mercury levels that exceed
established health standards. Occupational exposure to mercury is a hazard for
dental personnel. The only defense for its use comes from the total support of
organized dentistry. Science, in over 12,000 scientific studies, has not been
able to determine one constructive purpose served by the presence of this toxic
metal in the human body. No amount of exposure to mercury vapor can be
considered harmless. Once it has leached from the dental fillings and
infiltrated the body, mercury becomes a neurotoxin. Mercury is more neurotoxic
than arsenic and far more neurotoxic than lead. Mercury has been used quite
extensively by the medical profession in anti-fungal preparations, diuretics,
antiseptics, brain scans (radioactive mercury), etc. Merthiolate and
Mercurochrome, which were very common "first-aid" items in most households and
are still used extensively in hospitals, contain mercury.
Nerve endings in the peripheral nervous system constantly scan their
environment, engulfing foreign particles and bringing them across the cell
membrane for inspection. These substances may then travel all the way up from
the foot to the spinal cord to be presented to the nerve cells there. As it
travels up the axon, mercury destroys a substance called tubulin, used as
insulation for neurofibrils in the microtubules, effectively destroying the
nerves. Within 24 hours of injecting a minute dose of mercury into a muscle
anywhere in the body of test animals, it is detectable in the spinal cord and
brain. The mercury is also found in the kidneys, lungs, bloodstream, connective
tissue, adrenals and other endocrine glands. In the brain, it tends to
congregate in the hypothalamus, which regulates the autonomic nervous system,
and in the limbic system, believed to be the seat of emotions.
The most devastating effect of mercury in the nervous system is that it
interferes with energy production inside each cell. Nerve cells are impaired in
their ability to detoxify and nurture themselves. The cell becomes toxic and
dies, or lives in a state of chronic malnutrition. It is common for heavy
metals to migrate to and acumulate in nerve ganglia (nerve relay stations). As
a heavy metal (which means heavier than water), mercury tends to accumulate in
the lowest parts of the body, such as the floor of the mouth, the pelvic floor,
and the feet. Pelvic symptoms, in both men and women, are very commonly caused
by metal toxicity of the Frankenhauser's ganglion. This can account for
premature ejaculaton and an enlarged prostate in men, and endometriosis, pelvic
pain, and hormonal dysfunction in women. Neural therapy cleans up this area
through the painless injection of the Frankenhauser's ganglion (just above the
pubic bone) with a local anesthetic. This opens up most of the ionic channels
in the cell wall; the cell is then able to excrete much of its toxic
components. This spurs the body to dump large amounts of mercury into the
urine.

A dentist can't legally throw amalgam material or extracted amalgam filled
teeth in the trash, bury them in the ground, or put them in a landfill, but the
ADA and the EPA say it's okay to put it in people's mouths. In 1976, the U.S.
Congress requested that the FDA "classify" dental amalgam fillings. The Federal
Register recorded another such request in 1980. Multiple requests have been
made over the years, yet there is still no classification of dental amalgam.
The FDA has steadily refused to classify amalgam. The government agencies have
been defending the use of mercury. Consider for a moment the national
consequences if mercury in fillings were reported to be dangerous. The
offending parties (dentists, the ADA, dental manufacturers and distributors),
if found guilty, would be liable.

Mercury Vapor

Silver mercury fillings are not stable. These fillings emit mercury vapor at a
rate of 2.8 micrograms per cubic meter of air breathed in the resting state,
and their emission rate accelerates dramatically (as high as 49 mgs) after
minimal mechanical, chemical, and temperature stimulations. It is also very
volatile. This means that "metallic" mercury gives off mercury vapor when
agitated, compressed or exposed to increases in temperature. Mercury
vapor--which is colorless, tasteless and odorless--if inhaled into the lungs,
passes into your bloodstream for distribution to all body tissues. It is at
this point that biotransformation begins. Some of the mercury vapor remains
unchanged, and some of it is oxidized. (This means to remove a pair of hydrogen
atoms and to combine with oxygen. Chemically it means the increase of a
positive electrical charge and the decrease of the negative charge, which in
effect ionizes the vapor). The unchanged portion exists dissolved in the blood
lipids (fats). The toxic effects are produced by that portion that is oxidized
into mercuric ions which occurs partly in the blood, partly in the tissues but
mainly in the red blood cells.
Several researchers, beginning with Jernelov in 1969, have demonstrated the
microbial conversion or methylation of mercury by various microorganisms. This
was demonstrated in the laboratory as well as inside the bodies of animals. In
1975, Edwards and McBride demonstrated the methylation of mercuric chloride in
human feces. It was also in 1975 that Rowland, Grasso and Davies determined
that most strains of staphylococci, streptococci, yeasts and escherichia coli
found in the human intestine (these are bacteria and yeasts of different forms
and shapes that are normally present in the human gut) were capable of
methylating mercury. It was in 1983 that Heintze and his associates made the
startling discovery that saliva can also methylate mercury being released from
the amalgam fillings.
Confirmation of the escape of mercury vapor and ions from amalgam dental
fillings is provided by The World Health Organization (WHO) Environmental
Health Criteria 118 document (EHC 118) on inorganic mercury. It clearly states
that the largest estimated average daily intake and retention of mercury and
mercury compounds in the general population, is from dental amalgams, not from
food or air. Mercury vapor inhaled into the lungs is absorbed almost 100
percent and immediately passes into the bloodstream. It takes approximately
four minutes before mercury is converted or oxidized into an ionic state from
its elemental vapor state. While in its elemental form, mercury vapor is lipid
(fat) soluble and readily passes through the blood-brain barrier or the
placental membrane.
It can also accumulate in other organs and tissues of the body. The estimated
average daily intake of mercury from dental amalgams is 3.8 - 21 micrograms per
day. Two-thirds of the body burden of mercury is derived from the mercury vapor
released from amalgams. The static, unstimulated release of mercury vapor from
amalgam fillings, which goes on 24 hours a day, 365 days a year, is a major
contributor to total mercury body burden. Large amounts of mercury vapor are
released during chewing. After only ten minutes of gum chewing, there is an
average increase in mercury release of 15.6 times more than during the resting
state in test subjects. That converts to a 1,560% increase in mercury
release."The World Health Organization has calculated that the average human
daily dose of mercury from various sources are: Dental amalgam = 3.0-17.0
mg/day (Hg vapor) Fish and Seafood = 2.3 mg/day (methylmercury) Other food =
0.3 mg/day(inorganic Hg) Air & Water = Negligible traces (NOTE mg =
Micrograms)" (World Health Organization Figures, from Environmental Health
Criteria 118: Inorganic Mercury, Geneva, 1991. These figures confirm Amalgam as
#1 average source for Environmental Mercury exposure.)"You wouldn't take a
leaky thermometer, put it in your mouth, and leave it there 24 hours a day, 365
days a year. Yet that's exactly what happens when an amalgam filling is
installed in your mouth."--Dr Michael Ziff.Mercury Vapor AnalyzerThe <I
style="mso-bidi-font-style: normal">Jerome 431-X Mercury Vapor Analyzer uses a
patented gold film sensor for the detection and measurement of toxic mercury
vapor in the air, including the air in your mouth. It is a portable hand-held
unit, weighing only seven pounds that can easily be carried to locations where
there is a concern about mercury. It is the same unit used for chemical
toxicology testing by OSHA and the EPA to monitor industrial hygiene, mercury
spill cleanups and mercury exclusion testing. It is also suitable for
monitoring mercury concentrations in a dental office during a daily routine.The
simple push-button operation allows users to measure mercury levels in just
seconds. The detection range is from 0.000 to 0.999 mg/m3 Hg. The gold film
sensor is inherently stable and selective to mercury, eliminating interference
common to ultraviolet analyzers, such as water vapor and hydrocarbons. When the
sample cycle is activated, the internal pump in the 431-X draws a precise
volume of air over the sensor. Mercury in the sample is adsorbed and integrated
by the sensor, registering it as proportional change in electrical resistance.
The instrument computes the concentration of mercury in milligrams or nanograms
per cubic meter, and displays the final result in the LCD readout.The 431-X
includes features not available in older Jerome models. When attached to either
a data logger or computer, the analyzer automatically regenerates the sensor
when it becomes saturated and then resumes sampling. An improved film
regeneration circuit makes the sensor last even longer. It can operate up to
six hours on a fully charged nickel-cadmium battery.This analyzer can easily be
used to measure mercury vapor concentration on a patient before and after
chewing a piece of gum for 5 minutes. Chewing, or tooth grinding, increases the
heat between teeth and, thus, enhances the release of mercury from
amalgams.This is an insightful eye-opener for those skeptical dentists who
still refute the possibility of mercury leaking out of dental amalgams and
their own health and their patients’ health being in jeopardy by their
refusal to acknowledge something that is clearly visible with this machine.Some
reported measurements of dental patients’ oral mercury vapor have been twice
the OSHA standard of 50 µg/cubic meters which would place them in violation of
the OSHA standard based on an employee’s 8-hour work exposure for a 40-hour
work period seven days a week. Once measurements are taken, you will realize
that the most toxic spaces may not be at one of the EPA’s superfund sites,
but simply right under your nose.

Mercury Ingestion

Mercury readily mixes with food and is swallowed with it. The body uptake from
inorganic mercury, swallowed with saliva, can be as much as hundreds of
micrograms per day for individuals with a large number of amalgam fillings.
Urinary excretion is a common indicator of mercury toxicity, even though fecal
excretion of mercury is twenty times greater than the corresponding urinary
excretion. There is a statistical correlation between the mercury concentration
in saliva and the number of amalgam fillings. The United States government has
determined and ruled that the continual exposure to mercury from amalgam
fillings is not without risk to patients. We are concerned over picograms and
micrograms of mercury in apples and are looking the other way when milligrams,
one million times more, are being implanted directly into a child's mouth.
There is a phenomenon that occurs in the mouth that can contribute to the
release of mercury, and is called corrosion. Corrosion is similar to "rust" and
means that surface particles of the filling material are being chemically
broken down and released into the oral cavity.

Mercury vapor is released when you chew or grind. Additionally, minute rusted
particles of the amalgam are being abraded and taken up by your food or saliva
and swallowed. Intestinal enzymes and bacteria both produce methylmercury, an
even more toxic form than elemental mercury, may act upon these minute
particles of mercury filling. Although several sources contributing to the
domestic mercury concentrations have been identified, human wastes (feces and
urine) from individuals with dental amalgam fillings are believed to be the
most significant source--greater than 80 percent. Conventional amalgam was
routinely placed until 1976, when the new state-of-the-art amalgams (50%
mercury and 30% copper) were introduced. They emit up to 50 times more mercury
than the earlier, conventional amalgam fillings. That means that every new
high-copper amalgam filling placed today has the effective toxic equivalent of
fifty of the older amalgam fillings. If other fillings are in the mouth, such
as gold crowns, nickel crowns, and removable bridges or braces, the mercury
emission further increases from the amalgam. This is due to the electrical
current generated by the presence of dissimilar metals in an electrolyte such
as saliva. Heat will reliably increase the rate of escape of mercury vapor from
amalgam fillings. Vapor detectors, held above amalgams, revealed an increase
from 3 micrograms to over 500 micrograms ten seconds after a hot drink was
swallowed."Worldwide there are over 4000 research papers indicating mercury is
a highly toxic substance. How can dentists be so thoughtless as to place one of
the deadliest toxins in existence *two* inches from our brain?"--Tom Warren"The
mercury uptake from amalgam is the dominating source for inorganic mercury in
the central nervous system and is the major source of total mercury uptake in
the population."--Maths Berlin, a leading Swedish toxicologist

Blood-Brain Barrier

The blood-brain barrier is a normal mechanism that is supposed to restrict the
entry of substances into the brain. The transfer of substances such as
nutrients, waste products, oxygen and carbon dioxide, hormones, and poisons in
and out of the cells of the body is accomplished through the smallest of blood
vessels, the capillaries. The capillaries of the brain have a special
structural design to provide extra protection for the critical brain cells.
Unlike capillaries elsewhere in the body, the cells lining the brain
capillaries are overlapped and less porous. This special structure prevents
many substances from passing into or out of the brain that would easily pass to
and from other body cells.
Substances that can dissolve in fats readily penetrate the membranes of cells,
as these membranes have large amounts of fat-containing molecules. Elemental
mercury vapor and methylmercury are fat-soluble and therefore easily penetrate
cell membranes, including those of the placenta and the blood-brain barrier.
This barrier does, however, selectively allow passage of certain smaller
water-soluble substances necessary to the brain, such as glucose and essential
amino acids. Mercury vapor has no electrical charge (non-ionic) and is
fat-soluble, which accounts for its extremely potent toxicity in the elemental
vapor form. The oxidation of mercury vapor occurs in the blood and in the body
cells. Ionic mercury is the harmful form of mercury because it is chemically
active and can readily combine with tissues, exerting its toxic influence in
that manner.
Elemental mercury vapor, after entering the bloodstream, is oxidized through
the mercurous into the mercuric ion. These reactions requires several minutes
for completion; because of this delay, elemental mercury stays in the blood
long enough to reach all tissues and organs. In its elemental form, mercury
easily penetrates the blood-brain barrier and infiltrates nerve cells, where
final oxidation proceeds. By easily overcoming the blood-brain and placental
barriers, elemental mercury is particularly dangerous during long-term or
chronic exposures, representing a potentially serious hazard in many
occupations. Once mercury has penetrated the blood-brain barrier, its oxidation
to the ionic form is completed. This ionic mercury now has an electrical charge
and is no longer fat-soluble. Ionic mercury is very active chemically and
readily combines with body substances, thereby exerting its toxic effect.

This ionic mercury can no longer easily penetrate the blood-brain barrier and
is very resistant to removal from the brain. Mercury is retained in brain
tissue for extremely long periods of time. Autopsy studies have demonstrated a
definite correlation between levels of mercury found in the brain and the
number and surfaces of dental amalgam fillings present. When mercury ions are
absorbed into the bloodstream, even in minute amounts (less than 1.0 parts per
million), they are capable of impairing the blood-brain system within 4-6
hours, allowing passage of normally barred plasma solutes into the brain from
the blood, that otherwise would be denied entry. Mercury will not only damage
the brain but it will also increase exposure of the brain to other harmful
substances in the blood. The blood-brain barrier is also an active site for the
regulation of the uptake of metabolites from the blood to the nervous system.
The impairment of the blood-brain barrier, together with the possible
inhibition of certain associated enzymes by the mercury, is probably
responsible for the great reduction of the uptake of amino acids and other
metabolites by the nervous system after mercury administration. Amino acids are
the building blocks of proteins which are the structural materials used to
construct the cells of the body, along with physiological materials such as
enzymes and hormones. There is no scientific evidence that brain cells can be
regenerated. This is why mercury damage to the brain is permanent and
irreversible. Since mercury vapor readily traverses the placental membrane, the
oxidation of mercury vapor in the fetal blood or at the fetal blood-brain
barrier itself no doubt results in damage to the fetal blood-brain barrier. But
the damage to the fetal blood-brain barrier may be even more important,
preventing the uptake of vital amino acids for the construction of the
irreplaceable brain cells.
There is absolutely no doubt that exposure to methylmercury in pregnant women
presents a serious threat to the fetus. A number of studies have described the
effects on infants of prenatal exposure to methylmercury, while the exposed
pregnant mothers exhibited little or no observable signs or symptoms from
exposure. The neurological effects on these infants were as severe as cerebral
palsy and even death, but less easily recognizable symptoms were more common,
such as delayed mental development, delayed speech development, delayed motor
development, and learning deficits. The major influence of mercury vapor on the
fetus is not the promotion of birth defects; but rather the toxic effect on the
body cells, particularly those of the brain. In spite of the wealth of
information strongly demonstrating the potential risk of elemental mercury
vapor to the unborn child, the scientific community has not yet seen fit to
responsibly investigate this awesome question."It is sobering to realize that
the original "quacks" were dentists who advocated the use of mercury amalgam
and that most dentists are still advocating it today."---"The maximum amount of
mercury that the Environment Protection Agency allows people to be exposed to
is 5,000 times smaller than the permissible amount of lead exposure; in other
words the EPA apparently considers mercury to be 5,000 times more toxic than
lead."--Marcia Basciano DDS

Fertility

Mercury has been shown to pass the placental membrane in pregnant women and
cause permanent damage to the brain of a developing baby. A special
relationship regarding mercury distribution exists between the mother and the
fetus. Much higher levels of methylmercury have been reported in cord blood
versus that contained in maternal blood. In animal experiments it has also been
shown that there is a much higher accumulation of mercury in the fetal brain
tissue than in the maternal brain tissue. Mercury exposure leads to hormone and
immune disturbances that can reduce fertility. Reduced fertility among dental
assistants with occupational exposure to mercury is a common problem. Many of
the female fertility cycle events are related to posterior pituitary activity,
so amalgam is another factor that can disturb fertility as well as functions
unrelated to pregnancy. Estrogen function can also be influenced by amalgam.
Blood serum phosphorus is a guideline to endocrine balance. If the phosphorus
is below 3.5 mg%, there is an endocrine disturbance, somewhat related to the
degree of drop below 3.5. The most effective hormones in balancing the
phosphorus level are the sex hormones. All males and all females produce both
estrogen and testosterone. The males produce more testosterone and the females
more estrogen, but there is a balance between the two in both sexes. Small
doses of both hormones are used in both sexes to balance the serum phosphorus.

The menstrual and reproductive cycles are controlled by a very complex feedback
mechanism between the ovaries, hypothalamus, and the pituitary. In the case of
follicle stimulating hormone (FSH), there is a negative feedback relationship
with estradiol at all times. When estrogen levels are low, the release of
leutinizing hormone (LH) is increased, and when estrogen levels are high, LH is
decreased. This ebb and flow controls the hormonal function leading to
ovulation and the mid-cycle surge of both LH and FSH and the reduction of LH
and FSH at the luteal phase relate to a feedback relationship with
progesterone. Progesterone is not secreted by the ovary until just before
ovulation. This, in turn, provokes ovulation--progesterone secretion, which
undergoes a tremendous increase. The high levels of progesterone and estrogen
associated with the luteal phase combine to suppress FSH and LH during the
corpus luteum phase. Mercury inhibits release of FSH from the pituitary by
damaging membranes of cells in the anterior pituitary.
Chronic inhalation of mercury vapor from amalgam fillings for twenty years or
more can result in accumulation of pathologic quantities of mercury in the
brain and other critical organs and tissues. Human autopsy studies of accident
victims have shown a positive correlation between the numbers of mercury
amalgam dental fillings and the concentration of mercury in the brain. The
onset of clinically observable signs or symptoms of mercury toxicity may take
as long as 20-30 years to appear, depending on a person's biochemical
individuality. Lubricated condoms and birth control creams or gels have mercury
as the primary spermicide. It is not required that the word mercury appear on
the label, as it is assumed that everyone knows mercury is in there. The uterus
is a collection center for mercury. Hal Huggins reported that more than 90% of
the imbalances, created by sex hormone disturbances were corrected within a few
weeks of amalgam removal. His patients noted differences in fertility, less
pain during periods, relief from endometriosis, and a trend toward optimization
of the days of menstrual flow. PMS is one of the most common symptoms to change
after amalgam removal. Amenorrhea, or the complete absence of a menstrual flow,
responds to amalgam removal. This is usually in women in their twenties or
thirties. Even in women who have gone through a sort of premature menopause in
their early forties, the periods may start up again for a couple of years. This
has resulted in surprise pregnancies. Women should avoid pregnancy for at least
six months after amalgam removal.

The Placenta

The circulatory systems of the mother and fetus are separated by a very thin
membrane in the placenta. The purpose of this membrane is to ensure that there
is no actual mixing of maternal blood with the fetal blood. This placental
membrane was formerly called the placental barrier. Its function was assumed to
be one of protecting the fetus from possible damage from any of the potentially
toxic drugs or substances that might be present in the mother's blood. The
Thalidomide disaster in 1961 demonstrated that the passage of toxic substances
from mother to fetus did occur and could result in tragic birth defects and
deformities. Mercury reduces the blood's ability to carry oxygen and, although
fetal blood flow might be normal, the reduced oxygen content of the blood would
parallel the hypoxic condition. Mercury may affect the balance or status of
most of the body's essential nutrients. No scientific study has ever addressed
the relationship between chronic mercury exposure and placental weight/birth
weight. From the time of fertilization until birth, the offspring is dependent
upon maternal sources for all nutrition.
There are four major areas that are considered to be critical or determinants
in the outcome of fetal development: (1) the mother's nutritional status, (2)
the structural and functional quality of the placenta, (3) the genetic makeup
of the offspring, and (4) the presence of physical, chemical, or mechanical
insults to mother and child during pregnancy. Mercury can also affect the
satisfactory outcome of fetal development in all four of these areas.
A possibly contributory factor in cadmium and mercury fetotoxicity may be an
effect on the transmembrane transport of nutrients, such as amino acids, across
the placenta to the fetus. An inhibition of nutrient transport may cause fetal
death, congenital malformations, or growth retardation. The toxic effects of
cadmium and mercury may be found in the placenta where presence of these metals
prevent the passage of required nutrients to the embryo/fetus. The placental
membrane will stop many substances. However, it is made of fat molecules, and
mercury vapor and methylmercury, being fat-soluble, will penetrate the
membrane. The lack of knowledge concerning the mechanisms of mercury toxicity
as they relate to the human reproductive cycle is compounded by the scarcity of
scientific studies investigating the effects of mercury vapor. The majority of
scientific studies on mercury have dealt with methylmercury or inorganic
mercury. Very little attention has been paid to the threat posed by low-level
chronic exposures to toxic metals.
A great deal of the available scientific data was derived from observation of
acute exposures where a large single injection of the toxic metal being
investigated was administered and the results examined. While there is no
barrier preventing the transfer of mercury, there is a slight barrier to the
transfer of lead, and the greatest barrier is to the transfer of cadmium.
Mercury vapor enters the body and its cells far more readily than most other
forms of mercury. Researchers have found that the placental transfer of mercury
varies with the chemical form of mercury; that is, methylmercury is more
readily transferable than mercuric nitrate.
The mercury concentrations in the placenta and the infant's hair are directly
related to the infant's body burden of mercury

Environmental chemicals taken into the body may considerably increase the fetal
body burden of mercury and its concentration in certain tissues, like the liver
or thyroid, after mercury vapor inhalation. Most scientists and researchers are
ignoring elemental mercury vapor in their research and in their recommendations
for critical future research areas. These researchers either do not know or
have forgotten that, once in the blood, elemental mercury vapor remains in its
elemental form for minutes, during which time it can penetrate most tissues
easily. It is this capability that permits it to also readily move through the
placenta to the embryo or fetus, as does organic mercury. Most of the published
research has assumed that the only exposure to elemental mercury vapor is from
a minute amount contained in the atmosphere. Most research therefore has only
focused on probable exposure from dietary mercury, which is usually in the form
of organic methylmercury. A glaring omission has been made by not considering
the exposure to elemental mercury vapor from mercury amalgam dental fillings
Joel M. Eichen - 18 Oct 2004 04:10 GMT
>Elemental mercury is found in liquid form, which easily vaporizes at room
>temperature and is well absorbed through inhalation. Its lipid (fat)-soluble
[quoted text clipped - 13 lines]
>distribution, secondary to poor fat solubility, and accumulates mostly in the
>kidney, causing renal damage

I recognize Jan's writing style .......

no attributions?

>Millions of U.S. citizens are being exposed to mercury levels that exceed
>established health standards. Occupational exposure to mercury is a hazard for
[quoted text clipped - 393 lines]
>of organic methylmercury. A glaring omission has been made by not considering
>the exposure to elemental mercury vapor from mercury amalgam dental fillings
 
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