Gerald

1. Gerald DENTAL FILLINGS / Mercury Poisoning / UCSF School Of Medicine-Winter 1989 Mercury is a Global Neurotoxin That Decreases Think, Command and Control Think- Higher Cognitive (Mental) Functions

2. Steps in finding Poison? • Gradual Onset of fine tremor (intention) led me to suspect poison. • This led to the approach of two UCSF medical professors, Michael Dae M.D. and Dorthlee Perloff M.D.

3. Medical Evaluation • Student Health Service/Toxicology-SFGH Charles Becker M.D. • Objective Findings: • Fine tremor • Low Blood Pressure • Normal White Blood Cell Count • Normal Red Cell Sedimentation Rate • Urine Hg: High Normal range [normal=<10 ug Hg/L] • Blood Hg: High Normal range [normal= (2-20ug) Hg/L] • (See The Heavy Metal Paradigm: No Safe Lower Limit even at levels found in the U.S. Population.)Urine= 3.1 ug Hg/L avg. ;range (0-34 ug Hg/L); Kingman (1994)

4. Medical Evaluation • Subjective Complaints • Headaches • Stags and Sways (Balance/Ataxia) • Hazy Vision (slight) • Decreased Higher Mental Functions or Decreased Cognition. • Speech • Insomnia

5. Medical Evaluation • Diagnosis/Treatment • Winter 1989 Neuropsychiatric Evaluation – Michael Shore PhD

6. Medical Evaluation • Diagnosis/Treatment • Cecil’s Textbook Of Internal Medicine

7. Medical Evaluation • . Revealed Decreased Global Cognitive Function-I.Q. drop of 22 pts. (1.5 Standard Deviations) From Age 9 yrs./4th grade- Jackson Mental Health Clinic • 1) Anxiety Neurosis -( Pt. Believed Falsely to the point of Mental Illness that He was being poisoned by Hg from dental fillings)

8. Medical Evaluation • 2)Depression- Medications • Antitremor- Inderal (Beta-Blocker)/ (Marc Gropper M.D.) -SHS • Antidepressants- Prozac, Trazedone, Elavil • Antianxiety- Valium (Mindy Fullilove M.D.); Xanax (Tim Summers M.D.); Insomnia-Restoril; Dalmane.

9. Apples vs. Oranges

10. Apples vs. Oranges

11. Apples vs. Oranges

12. Apples vs. Oranges

13. Apples vs. Oranges

14. Apples vs. Oranges

15. Medical Evaluation Dental Amalgam: A Scientific Review and Recommended Public Health Service Strategy for Research, Education and Regulation Final Report of the Subcommittee on Risk Management of the Committee to Coordinate Environmental Health and Related Programs Public Health Service January 1993 • Department of Health and Human ServicesPublic Health Service • Table of Contents • III: Evaluation of Risks Associated With Mercury Vapor from Dental Amalgam • FDA Position Statement on Dental Amalgams (Mainstream Position)

16. Standard Of Care • Early detection of subclinical inorganic and organic mercury intoxication This is the USPHS own (Peer reviewed) Position Statement on Dental Fillings! • Evaluation of Risks Associated With Mercury Vapor from Dental Amalgam • Mercury is a toxic substance. For high exposures, observed mostly in occupational settings, the severity of response correlates with the duration and intensity of the exposure. The relationship between the severity of response and the duration of exposure has, however, not been quantified at levels of exposure associated with dental amalgam restorations. In addition, subtle signs and symptoms of chronic mercury intoxication may not be found through routine physical examinations. The subtle changes previously described require special tests not commonly used in routine examinations—that is, nerve conduction studies, measurement of alterations in EEG, and measures of psychomotor functioning

17. Standard Of Care • The official recommendation by their own (UT-Tyler Public Health Library) Medical Toxicology Textbook- The Clinical Basis of Medical Toxicology. P. 1328. • "In addition to mercury assays, neuropsychiatric testing, nerve conduction studies and urine assays for N-acetyl B-D-glucosaminidase and beta-2-microglobulin are advocated for early detection of subclinical inorganic and organic mercury intoxication. (20, 28, 50)"

18. Dose response curve • Does Hg vapor have a dose response curve in biological systems (i.e. Humans) ? • Find the Answers below

19. Dose response curve • 1) Just what part of the dose response curve is a person on with dental fillings (40 Dental fillings) ? • 2) What part of the dose response curve causes a blue line on gums/gingivitis? • 3) What is the standard of care for an occupational environment/ setting where Hg vapor is a hazard? (For example, a Fluorescent lamp factory, Chloralkali factory, Thermometer factory, Dental office/workers) • 4) What is the standard of care for a person with dental fillings? • 5) How was the standard of care/response curves established ?

20. Dose response curve • The toxicity of mercury and its compounds, recognized since antiquity and widely acknowledged in industry, has recently been reviewed (7-12). • Clinically significant effects (erethism, intention tremor, gingivitis) have not been reported below air concentrations of 100 µg Hg/m3. [The OSHA limit = 50 ug Hg/m3 x 8hr/day: not to exceed 50 hrs/wk] . Most effects observed in persons exposed to mercury in air concentrations below 100 ug Hg/m3 are preclinical e.g., slowed nerve conduction, short term memory loss, special instrumental tests for tremor

21. Dose response curve • However The prideful and Pathetically Incompetent BIG GOOFS AND FUCK-UPS AND RUDY POOTS AND COUNTRY BUMPKINS AND MEDICALLY IRRESPONSIBLE LOOSE CANNONS ON DECK and refuse to Back Down UT-Tyler Toxicology Attendings try to go around this with the statement "The vast majority of descriptions in our limited understanding of the detailed literature of mercury poisoning contain a BLUE LINE. Therefore we think that you should have one as well". • What is wrong with the statement above?

22. The Heavy Metal Paradigm • The Heavy Metal Paradigm • (There is no safe lower limit for Lead and Mercury at the doses found either in the occupational environment or from Dental Amalgams) • Normal Values Urine= <10 ug Hg/L; Blood= (0.2-2 ug) Hg/100 ml [2-20 ug Hg/L] • There is considerable overlap among concentrations of mercury found in the normal population, asymptomatic exposed individuals, and patients with clinical evidence of poisoning. There is no definitive correlation between blood and urine mercury levels with mercury toxicity. 9,23

23. The Heavy Metal Paradigm • U.S. Population Hg Levels (Kingman 1994) • Urine= 3.1 ug Hg/L avg. ;(0-34 ug Hg/L) • These levels are mainly due to either dental amalgams or methyl mercury from seafood/fish consumption. These overlap with the doses in several studies (see above; Aphoshian-1998)which have produced Hg toxicity.

24. The Heavy Metal Paradigm FDA n=550 Reports • Adverse effects information—collected from FDA's Medical Device Reporting (MDR) and Problem Reporting Programs (PRP) n=550 Reports concerning Dental Amalgams • Not Measured (expected to be in normal range) • A plethora of reports (n=550) have been filed (FDA) with chief complaints that were claimed to be resolved with the removal of amalgam/mercury restorations A Blue Line nor Gingivitiswas not reported, even during the process of removal.(See Below-Bjorkman:1997)

25. Dose response curve • Study/Conc. Hg ug/m3 (air) Effects (gingivitis) Yang (1994)- Taiwanese Lamp socket Factory worker • 945 ug Hg/m3; (Urine= 610ug Hg/L); (Blood=237ug Hg/L) • Prominent gingivitis, ataxia, blurred vision, dysarthria, tremors (usually postural and intentional), unsteady gait, and slow mental response

26. PEL (Maximum Permissible Exposure Limit) OSHA, WHO, ACGIH • 100 ug Hg/m3 and above • See Below; Only brief exposures are advised w/o respiratory protection

27. Dose response curve • Scientific Literature100 ug Hg/m3 and below Clinically significant effects (erethism, intention tremor, gingivitis) have not been reported below air concentrations of 100 µg Hg/m3. [The OSHA limit = 50 ug Hg/m3 x 8hr/day: not to exceed 50 hrs/wk] . Most effects observed in persons exposed to mercury in air concentrations below 100 ug Hg/m3 are preclinical e.g., slowed nerve conduction, short term memory loss, special instrumental tests for tremor

28. Dose response curve • Ehrenberg et al. (1991): Thermometer plant workers • 76 ug Hg/m3 • Difficulty with heel-to-toe gait was observed in thermometer plant workers.

29. OSHA Limit • OSHA Limit • 50 ug Hg/m3 x 8hr/day: not to exceed 50 hrs/wk • See Above (mostly preclinical)

30. Dose response curve • Fawer,. et al. (1983): Mercury-exposed workers in 3 industries (n=26) • 26 ug Hg/m3 • Hand tremor induced by industrial exposure to metallic mercury. a study of workers exposed to a time weighted average of 26 ug/m3 for an average of 15.3 years with an increase in intentional tremor compared to the control group These results clearly indicate that metallic mercury, even at concentrations below the current OSHA TLV-TWA of 50 ug Hg/m3, can lead to neurological disorders.

31. WHO Limit • WHO Limit • 25 ug Hg/m3 x 8hr/day: not to exceed 50 hrs/wk • The World Health Organization (WHO) adopted a health-based recommended limit for occupational exposure of 25 ug/m3 . The WHO Study Group selected this value to ensure a reasonable degree of protection not only against tremor but against mercury-induced nonspecific symptoms (17). Effects induced by exposures that exceed these levels have been well documented (7,9,10,16)

32. ACGIH Limit • ACGIH LimitACGIH - American Congress of Governmental Industrial Hygienists • 25 ug Hg/m3 x 8hr/day: not to exceed 50 hrs/wk • The American Congress of Governmental Industrial Hygienists (ACGIH) adopted a health-based recommended limit for occupational exposure of 25 ug/m3See WHO study.

33. Dose response curve • Piikivi, L., Tolonen, U. (1989): Chloralkali workers (n=41) • 15-25ug Hg/m3 • Comparison of computer-supported evaluation of EEGs obtained from mercury exposed and control workers showed those from the exposed group were significantly slower and more attenuated. This difference was most prominent in the occipital region, became milder parietally, and was almost absent frontally

34. Dose response curve • Ngim (1992) Dentists (n=98) 14 ug Hg/m3 • Dentists (n=98, mean age 32, range 24–49) with an average of 5.5 years of exposure to low levels of mercury showed impaired performance on several neurobehavioral tests. The dentists showed significantly poorer performance on finger tapping (measures motor speed), trail making (measures visual scanning), digit symbol (measures visuomotor coordination and concentration), digit span, logical memory delayed recall (measures visual memory), and Bender-Gestalt time (measures visuomotor coordination). The dentists had a higher aggression score than the controls..

35. Dose response curve The Double-Double Effect • Echeverria, Aposhian (1998) Dentists (n=49) • (Urine pre= 0.94 ug Hg/L avg.; 9.1post ug Hg/L) • By using an approach (pre and post chelation Urine Hg levels) that distinguishes recent Hg exposure from Hg body burden, subtle associations were observed between Hg and symptoms, mood, motor function, and nonspecific cognitive alterations in task performance in an occupationally exposed group (dentists) with Hg Urine levels comparable to the general U.S. population. (0-4 ug Hg/L). Some of the subclinical findings were due only to the Hg source derived from their own dental amalgams. This study is evidence that Hg toxicity (CNS is Target) can occur from the low-levels emitted by dental fillings, By using the pre/post chelation technique of course some had toxicity due to both sources, occupational (DENTAL OFFICES AVG. 20-40 ug Hg/m3 8 hrs/day x 40hrs/wk) and dental amalgams, YET NONE HAD A BLUE LINE ON GUMS. Application of this approach may be particularly useful in defining thresholds of Hg toxicity and for establishing safe limits of exposure to mercury from dental amalgam material, the restoration itself, diet, and other sources.

36. Dose response curve • Dental Amalgams (Björkman et al. 1997; Lorscheider et al. 1995). • 1-100ug Hg/day (weight) depends on no. and (highest to lowest peak levels during) drilling, installation, chewing, acidic, tooth brushing, hot liquids etc…Gingivitis or Blue Line on gumshas not been reported per FDA’S own review of literature. (175 STUDIES) & 550 case reports

37. Dose response curve • What this means is that the mercury released from dental amalgams has a definite dose response curve in the human body just like food or a drug like Bayer Aspirin.Thehighest Hg vapor/plasma/urine peaks ever measured are during removal (requires drilling one by one), the next highest, during installation, the next during heavy chewing esp. w/ acidic foods, tooth brushing w/abrasive grit toothpaste, then hot liquids but yet a Blue Line on Gums was never seen/observed or reported. • Removal of dental amalgams in people who have no indication of adverse effects is not recommended and can put the person at greater risk, if performed improperly. (ATSDR -1999)

38. MRL (Minimum Risk Level) • 0.2 ug Hg/m3 = MRL continuous • (26 ug Hg/m3) x (8/24 hrs/day) x (5/7 days/wk) /10 variability /3 minimal effect • Dose and end point used for MRL derivation: 0.026 mg/m3; increased frequency of tremors. • Since the duration of exposure does influence the level of mercury in the body, the exposure level reported in the Fawer et al. (1983) occupational study was extrapolated from an 8-hour/day, 40-hour/workweek exposure to a level equivalent to a continuous 24 hour/day, 7 days/week exposure as might be encountered near a hazardous waste site containing metallic mercury.

39. MRL (Minimum Risk Level) • During the development of toxicological profiles, Minimal Risk Levels (MRLs) are derived when reliable and sufficient data exist to identify the target organ(s) of effect or the most sensitive health effect(s) for a specific duration for a given route of exposure. For Hg (inorganic/ organic) the target organ is the CNS. • An MRL is an estimate of the daily human exposure to a hazardous substance that is likely to be without appreciable risk of adverse noncancer health effects over a specified duration of exposure. • MRLs are based on noncancer health effects only and are not based on a consideration of cancer effects. These substance-specific estimates, which are intended to serve as screening levels, are used by ATSDR health assessors to identify contaminants and potential health effects that may be of concern at hazardous waste sites. • Additional studies or pertinent information which lend support to this MRL: The ability of long-term, low level exposure to metallic mercury to produce a degradation in neurological performance was also demonstrated in other studies. • (Ngim et al. 1992); (Ehrenberg et al. 1991) See Above. • Abnormal nerve conduction velocities have also been observed in chloralkali plant workers at a mean urine concentration of 450 µg/L (Levine et al.1982).These workers also experienced weakness, paresthesias, and muscle cramps. • Tremors have also been reported in occupationally exposed workers with urinary mercury concentrations of 50–100 µg/g creatinine, and blood levels of 10–20 µg/L (Roels et al. 1982). • (Piikivi et al. 1984), decreases in performance on tests that measured intelligence (similarities) and memory (digit span and visual reproduction) were observed in chloralkali workers exposed for an average of 16.9 years (range, 10–37 years) to low levels of mercury when compared to an age-matched control group..

40. References • REFERENCES • . DHHS. 1993. Dental amalgam: A scientific review and recommended public health service strategy for research, education and regulation. Department of Health and Human Services, Public Health Service, Washington, D.C • Björkman L, Sandborgh-Englund G, Ekstrand J. 1997. Mercury in salvia and feces after removal of amalgam fillings. Toxicol Appl Pharmacol 144:156-162 • Ehrenberg RL, Vogt RL, Smith AB, et al. 1991. Effects of elemental mercury exposure at a thermometer plant. Am J Ind Med 19(4):495-507 • Fawer, R.F., DeRibaupiere, Y., Guillemin, M. et al. (1983): Measurement of hand tremor induced by industrial exposure to metallic mercury. Br J Ind Med 40:204-208 • Levine SP, Cavender GD, Langolf GD, et al: Elemental mercury exposure: peripheral neurotoxicity. Br J Ind Med 1982 May; 39(2): 136-9[Medline] • Ngim CH, Foo SC, Boey KW, et al. 1992. Chronic neurobehavioural effects of elemental mercury in dentists. Br J Ind Med 49(11):782-790 • Piikivi L, Hanninen H, Martelin T, et al. 1984. Psychological performance and long term exposure to • mercury vapors. Scand J Work Environ Health 10:35-41. • Piikivi L, Hanninen H. 1989. Subjective symptoms and psychological performance of chlor-alkali workers. Scand J Work Environ Health 15(1):69-74. • Piikivi, L., Tolonen, U. (1989): EEG findings in chlor-alkali workers subjected to low long term exposure to mercury vapour. Br J Ind Med 46:30-35 • Roels HA, Lauwerys R, Buchet JP, et al. 1982. Comparison of renal function and psychomotor • performance in workers exposed. Int Arch Occup Environ Health 50:77-93. • Yang Y-J, Huang C-C, Shih T-S, et al. 1994. Chronic elemental mercury intoxication:clinical and field studies in lampsocket manufactures. Occup Environ Med 51(4):267-270

41. Dose response curve • Translation: There are no published reports of a blue line on gums (gingivitis) from either occupational exposure below 100 ug Hg/m3 • or • Dental Fillings • This is what is wrong with it! • There are no applications of the dose response curve of Hg Vapor to this approach. • Like any drug or just like food, Hg vapor has a dose response curve just like Bayer Aspirin. • You are pathetic failures in Pharmacology!  • This Evidence cannot be scientifically refuted by any trained PhD. or M.D. in Medical Toxicology

42. SUMMARY Of course the UT-Tyler Attendings can try to get a publication In the Journal of Toxicology As to how the Blue Line on Gums can be used to track low-term, low-dose Effects of Exposure to HG vapor, However no peer reviewed Toxicology Journal would let you Publish, Because, I almost forgot The Studies have already been done. Is that what they meant by “got”? A small child can see that you don’t have (ain’t got) a lick Of sense.

43. Ongoing Studies of Long-Term Low Dose Exposure to Hg Vapor • Echeverria, D • Battlle Centers, Public Health and Evaluation, Seattle, WA • Neurologic Effects of Metallic Mercury Exposure In Dental Personnel • National Institute Of Dental Research

44. Ongoing Studies of Long-Term Low Dose Exposure to Hg Vapor • Factor-Litvak, P • Columbia University, New York, New York • Dental Amalgams and Neuropsychological Function • National Institute Of Dental Research

45. Ongoing Studies of Long-Term Low Dose Exposure to Hg Vapor • Crawford, S. New England Research Institute • Health Effects of Dental Amalgam in Childrenhttp://www.neri.org/html/research/clinical/cat.asp • Children's Amalgam Trial • - CAT Funding: National Institute of Dental and Craniofacial Research • Safety will be measured in two ways Cognitive function (IQ) is the primary outcome, given the hypothesis that mercury vapor, released from amalgam may affect neuropsychological development in children. Dr. David Bellinger (Children's Hospital, Harvard Medical School and Dr. David Daniel (University of Maine, Farmington) are providing leadership in these measurements. Kidney (renal) function, the other important system likely to be adversely affected by mercury, is being measured in the laboratories of Dr. Tom Clarkson (U. Rochester, NY)and Dr. Lars Barregard (U. Goteborg, Sweden) • Originally funded by the National Institute of Dental and Craniofacial Research in 1996, this trial has been funded for another 5 years in order to complete the planned 5 years of dental treatment and follow-up measurement originally planned. A sister trial "Casa Pia", is also funded by the same Institute, to complete similar treatment and measurement on children in Portugal

46. Ongoing Studies of Long-Term Low Dose Exposure to Hg Vapor • DeRuen, T. • University of Washington • The Casa Pia Study [ Portugal ] of Dental Amalgam in Children (See Above) • National Institute Of Dental Research • The target organs of mercury exposure are renal and neurological. Baseline and annual repeated measures are taken on all subjects for renal function, nerve conduction velocityanda large battery of neurobehavioral tests. Follow-up is planned for a period of 7 years

47. Conclusions Your Gimp Asses Would Kill them waiting on a Blue Line to show up. UT-Tyler Attendings in Toxicology. Orange Peels for Brains

48. Medical Malpractice This fact is so obvious, GIMP UT-Tyler Attendings in Toxicology that it is Surreal. You Truly are the Fuck-Ups, Big Goofs and Rudy Poots of The Entire Country-Country Bumpkins. Incompetent, Bumbling, Inept, UT Tyler Toxicology Attendings, Big Goofs, Big Fuck-Ups, Rudy Poots and Country Bumpkins whose approach to the detailed literature of HG poisoning is Causal ,Shallow, Lackadaisical, Lassie-Faire, Misapplied as an Apple is to an Orange, Non- Committal ,Half-Ass, Not Tolerated , grossly medically incompetent and gets a grade of "F"

49. Medical Malpractice • Sensory distal latency correlated significantly with more than half of the urine mercury exposure indices used. Motor distal latency also showed significant correlation with mercury indices. These manifestations of toxicity were not apparent through standard physical examinations. In workers from a chloralkali plant (Levine et al. 1982). • These workers also experienced weakness, paresthesias, and muscle cramps. • JUST WHEN DO THE UT-TYLER ATTENDINGS ADVOCATE • DIAGNOSIS/TREATMENT/REMOVAL FROM EXPOSURE? • BLINDNESS 2) CRIPPLED OR 3) CRAZY • This is why • The UT-Tyler Attendings themselves need to be sued for medical malpractice/negligence as well.

50. Medical Malpractice • When asked these questions in a court of law in a scientific, medical and/or medical-legal context there is one answer that can be given by experts in Hg poisoning and any medically trained professional inc. UT-Tyler Attendings w/o BLATANT LYING UNDER OATH.