Health effects of dental amalgam exposure: a retrospective cohort study

BACKGROUND: Whether dental amalgam fillings (containing mercury) are hazardous is a long-standing issue, with few epidemiological investigations. Allegations have particularly involved nervous system disorders, such as multiple sclerosis, Alzheimer's disease, and chronic fatigue syndrome. This retrospective cohort study, the largest of its kind, contained people in the New Zealand Defence Force (NZDF) between 1977 and 1997. The NZDF has its own dental service, providing all personnel with regular and consistent treatment. Comprehensive treatment records are maintained and archived. METHODS: Yearly dental treatment histories, including amalgam filling placements, were compiled from individual records. To minimize amalgam exposure misclassification the cohort was restricted to people who, at NZDF entry, were aged <26 years and had all their posterior teeth. The cohort was linked with morbidity records. Data were analysed with a proportional hazards model, using a time-varying exposure unit of 100 amalgam surface-years. RESULTS: The final cohort contained 20 000 people, 84% males. Associations with medical diagnostic categories, particularly disorders of the nervous system and kidney, were examined. Of conditions allegedly associated with amalgam, multiple sclerosis had an adjusted hazard ratio (HR) of 1.24 (95% CI: 0.99, 1.53, P = 0.06), but there was no association with chronic fatigue syndrome (HR = 0.98, 95% CI: 0.94, 1.03), or kidney diseases. There were insufficient cases for investigation of Alzheimer's or Parkinson's diseases. CONCLUSIONS: Results were generally reassuring, and provide only limited evidence of an association between amalgam and disease. Further follow-up of the cohort will permit investigation of diseases more common in the elderly.