TESTING FOR METAL TOXICITY
Metal toxicity, particularly from dental work but also through exposure at home, work or play, is common; symptoms range from skin rashes and flu-like symptoms to chronic neurological and auto-immune disorders. Visiting a Biological Dentists to remove metals from your mouth may save your life. This information is from the MELISA Medical Foundation, which you may find helpful in determining whether or not you require testing:
Every laboratory will offer different types of testing panels to help the patient choose what to test. Typically, the panels will be based on the types of dental metal restorations in the patient’s mouth, such as amalgam, gold or titanium implants.
Ideally, patients should contact their dentist to find out the exact composition of the fillings, crowns, wires, pin and/or implants, but often the dentist will not know. Already exisiting testing panels might be useful to select as they test for the metals most often found in certain types of dental restorations, and which are most likely to cause allergic reactions.
Some patients will not have any metal restorations but will be exposed to metals in other ways. You are welcome to fill in our pre-test questionnaire which will tell you which metals you are likely to be exposed to.
Sources of common metal exposure are:
• Dental restorations: fillings, crowns, pins, root-fillings, implants. Amalgam/silver fillings contain mercury, silver, tin, copper and zinc. Crown can contain gold, silver, palladium, copper, chromium, indium, gallium, iridium, nickel and more. Implants are often made of titanium, aluminium and vanadium.
• Orthopedic and body implants such as hip replacements, screws, nails, clips, usually made from titanium or stainless steel.
• Common implant alloys are:
• Stainless steel: Nickel, chromium, manganese, molybdenum
• Cobalt-chromium molybdenum steel: Chromium, molybdenum, nickel, iron, manganese, tungsten, aluminum, titanium, cobalt
• Vitallium: Cobalt, chromium, manganese, molybdenum
• Titanium: Aluminum, vanadium, nickel (trace)
• Nitinol: Titanium, nickel
• Oxinium: Zirconium (oxidized)
• Smoking: both active and passive, contains mercury, nickel, cadmium, manganese
• Vaccines: may contain thimerosal, a mercury-based preservative, and aluminum
• Medication: antacids contain aluminium and pills may have titanium dioxide (E171) or other metal oxides in their coating to enhance their appearance. Antiseptic preparations used to contain mercury and still do in some countries. Barium is found in x-ray fluids.
• Piercings and jewelry:
• Costume jewelry may contain a lot of different metals, most notably nickel, which often cause skin rashes in sensitive women. Lead may also be present.
• More expensive jewelry, such as yellow gold is made by mixing pure gold with copper and zinc; rose gold contains copper, and white gold is an alloy of gold and some white metals such as silver and palladium. Other metals used in jewelry are platinum, rhodium, tungsten and titanium. Titanium is often used for piercings and there are some rare cases of allergy to titanium alloy piercings.
• Cosmetics: Titanium dioxide (TiO2) is widely used in cosmetics, present in many eye shadow, blush, nail polish, lotion, lipstick, powder and sunscreen. Metal pigments are used to give colour and work as preservatives. The following metals may exist in costmetic products: lead, mercury, chromium, aluminium, arsenic, beryllium, nickel, thallium, cadmium and others.
• Food from contaminated areas contain more metals than others, whether its fish, meat, vegetables or fruit.
o Fish can contain high amounts of methyl mercury, which accumulates up in the food chain so that large predatory fish contain more mercury than smaller fish.
o Seafood may contain mercury, cadmium and arsenic.
o Nickel is found in bananas, cocoa, oatmeal, green vegetables and a variety of other foods.
o Vegetables from polluted areas may contain cadmium, palladium, lead etc.
o Tinned food can contain tin and aluminium.
o Wine can contain molybdenum, nickel and lead.
• Occupational exposure: construction workers, miners, electricians, rubber/wood/paper/textile industry workers, dentists, hairdressers and painters are some occupations that will be more exposed to metals in their work than others.
• Living close to a highway, airport, crematory and factory or in the same house as a dental clinic may lead to increased exposure to metals such as palladium, cadmium, lead and mercury.
Here are the top four metals that may be in your mouth:
Beryllium allergy has been found in patients with no known occupational exposure to beryllium. Beryllium is a very toxic substance but is nevertheless still used in certain dental materials. Beryllium is also found in cigarettes and may also be ingested by drinking contaminated water or foodstuffs.
Below are three case reports of patients who showed extremely strong lymphocyte sensitization (allergy) to beryllium in vitro, measured by the MELISA® test. In one case the gold crown was analyzed for beryllium and found to contain the metal. Generally beryllium does not cause mitogenic (non-specific) lymphocyte stimulation in vitro.
Case report 1: 57-years old nurse with fibromyalgia
• Past occupational exposure to metals
• Clinical metal sensitivity (does not tolerate cheap earrings)
• Suffered from fibromyalgia and hypothyroid function
• Dental status: 3 big gold crowns, metal-bound ceramics, 3 amalgams
In 1996 she suffered whiplash damage in a car accident. She suspected that dental amalgam might contribute to her ill health and started replacing her amalgam fillings in 2001. Amalgam fillings were replaced with composite and ceramic restorations. Her symptoms became aggravated after dental treatment and the worsening lasted for 2 months. However, her health status did not improve considerably.
MELISA® was performed 2002 and showed very strong reactivity to beryllium in the absence of any other reactivity detected (see diagram below). Since the patient was not aware of any recent beryllium exposure, her gold alloys might contain beryllium, so she decided to remove them. One gold crown was analyzed for the presence of beryllium by Analytica in Umeå, Sweden, according to modified EPA methods 200.7 (ICP-AES) and 200.8 (ICP-MS). Beryllium was detected in the concentration of 0,662 mg/kg (ICP-AES). In 2005, the patient still has metal-bound ceramic in her front teeth.
A Stimulation Index over 3 indicates a positive response or an allergic reaction. The reactivity of beryllium is SI: 68,9. A value over 10 is regarded as a strong reaction. Below is the response in MELISA® to three different concentrations of beryllium salts in the same patient.
Case report 2: 43-years old female
• Suffered from Multiple Chemical Sensitivity, Chronic fatigue, asthma, sinusitis
• Exposed to moulds in sick building for 10 years
• Clinical metal hypersensitivity
• Dental status: 3 root-fillings (one with brass pin), 7 amalgams, metal-bound ceramics in the front teeth
MELISA® testing showed extremely high positive reaction to beryllium and a positive reaction to inorganic mercury and nickel. After amalgam removal the patient’s symptoms persisted. There was no occupational exposure to beryllium and the patient never smoked. A possible exposure could be the beryllium in the metal-bound ceramics. The patient decided to keep the front teeth.
Case report 3: 67-years old female
Chronic health problems aggravated in connection with dental treatment
Exposed to passive smoking for 10 years
Inflammation in the jaw bone
Patch test showed weak positive reaction to nickel and chromium (beryllium was not tested)
Dental status: 3 root-fillings (one with brass pin), 7 amalgams, gold crowns and bridges, pivot tooth
The patient did not remove any dental fillings and her ill-health continues.
More information about beryllium allergy:
• Agency for Toxic Substances and Disease Registry’s fact sheet on Beryllium: http://www.atsdr.cdc.gov/tfacts4.html
• Berylliosis and occupational exposure
There are different types of mercury, depending on the structure of the mercury molecule. Every type has its different properties and is therefore utilized in different ways in dentistry, medicine and industries. Interestingly enough, allergy to mercury is specific, meaning that an individual can be allergic to one specific type of mercury and not another. This is because the cells involved in the so called Type IV allergic reaction, the memory cells, depend on the exact structure of the molecule to be activated. Naturally, it is possible that an individual can be allergic to all four types of mercury. In many cases it is important to locate the source of exposure that causes and inflammation in the body due to mercury allergy, so exposure can be stopped. The MELISA test can differentiate between allergy to four types of mercury.
The main distinction is between organic mercury and inorganic mercury. The former is more toxic as it easily passes through the blood-brain barrier, which protects the brain from toxins.
Inorganic mercury, or ‘metallic mercury’, is a frequent source of metal allergy. Although extremely toxic in its own right, it makes 50% of dental amalgam fillings. Dental authorities accept that mercury vapour constantly evaporates from the fillings, but argue this is below a safe limit. However, for hypersensitive patients, there is no safe limit. Replacing amalgam fillings to ceramic substances has delivered radical improvements in patients who tested MELISA®-positive for mercury. In the body, bacteria can transform inorganic mercury into the organic form methylmercury.
Methylmercury is found naturally in fish which is why doctors advise pregnant women to avoid excessive amounts of fish to avoid exposing the baby. Infants and children are also at high risk from methylmercury-contaminated fish and breast milk contaminated by the mother. Like all forms of mercury, it is exceptionally toxic. It survives up the food chain, so the large fish at the top of the food chain such as shark, swordfish, and large mouth bass have the highest concentrations. It is distributed evenly across fish, and is not affected by cooking. This form of mercury is also found in contaminated soil and grain. Bacteria in the body can transform inorganic mercury into methylmercury.
Phenylmercury is the organic mercury most commonly found in dental root fillings. While it has been phased out in many countries, it is also used as a preservative in eye drops and nose drops. It is less toxic than methylmercury and ethylmercury, because it is rapidly metabolised. Phenylmercury is used to control the growth of fungus in some interior latex paints manufactured before 1991, some exterior and oil base paints, some caulks, some eye-area cosmetics, toiletries, and other products. When these products are used, mercury metal vapour gets into the air and can be inhaled.
Ethylmercury is a form of organic mercury. It is used in Thimerosal, a controversial substance used as a preservative in vaccines, eye drops and nasal sprays. Highly toxic in its own right, it is administered frequently to infants in countries such as the UK, where it is in the triple Diptheria, Typhoid and Pertussis (whooping cough) vaccine. The DTP jab used in the UK, for example, has enough thimerosal to deliver 25 micrograms of ethyl mercury in every shot of vaccine. It is also present in many flu vaccinations.
Thimerosal is one of the most controversial substances is modern medicine. Its main component is ethyl mercury (49.6% by weight), yet it is still used as a preservative in many child vaccines, flu vaccines and other health substances such as eye drops and contact lens solution. It is slowly being withdrawn from vaccines in some countries. It is the subject of a $3 billion lawsuit in the US filed by parents of autistic children who believe it to be responsible for neurologically harming their child. Its use is defended on the ground that the mercury amount is too small to pose danger. But to those who are hypersensitive, even trace amounts can be dangerous.
Full body autoradiography
To demonstrate that mercury binds to the body proteins, we can use a special form of mercury whose distribution in various organs of the body can be traced by sensitive photographic emulsion. Below are four pictures of mice, which were injected with mercury which was labeled with a radioactive isotope. Then, using autoradiography, a special picture is produced. The areas where the mercury was deposited are shown in white.
The pictures demonstrate widespread distribution of mercury in the body of the mice. Organs rich in fat – such as brain and collagen – are very prone to mercury binding. One of the reasons for this is that mercury is particularly keen to bind to two amino acids; methionine and cysteine. Both amino acids contain sulphur hydrogen (SH)-groups. This is a particularly attractive target for mercury. Fat tissues and collagen tissues are rich in SH-groups.
Pictures are from “Explorative study of tissue distribution of 203Hg2+ in mouse after oral administration of some chelating substances with and without vitamin C”, by Anette Seo, Safety Assessment, Astra AB, Södertälje and Institute for Pharmaceutic Bioscience, Department of Toxicology, Uppsala University, 1994. Thanks to Dr Anette Seo for permission use the material.
Nickel triggers more hypersensitive reactions than any other metal – up to 15% of the population suffers from some form of nickel allergy, mostly women. Nickel is exceptionally common: in cigarettes, jewellery, buttons and in coins (including the Euro). It may be found in dental restorations, prostheses (hip, knee, cochlear and cardiac implants), colour pigments, cosmetics, stainless steel cutlery and pots. Even hard cleaning of kitchenware has been shown to release nickel in washing-up water. Nickel can pollute drinking water near factories which use it. Nutritionists have developed low-nickel diets, which cuts out certain foods (e.g. coco, chocolate, broccoli, nuts).
Please note that the information below is taken from various sources and may not reflect the situation in your country, For example, a clinic in USA states that potatoes are high in nickel, while analysis by the Swedish Food Administration found only a low nickel content in potatoes. The discrepancy is most likely due to the mineral and metal content vegetables are grown in.
The US Food and Drug Administration has issued a warning that patients who are having stents fitted should discuss metal allergy with their surgeon prior to having a stent net fitted. While nickel allergy may present as a rash or localised contact dermatitis it may also have a systemic effects including chronic fatigue and muscle pain and widespread skin conditions.
The major dietary source of nickel is plant foods. Nickel-rich food items include nuts, beans, peas, grains and chocolate. Animal foods are low in nickel. Total daily dietary intakes of nickel vary depending on the amount of plant and animal foods consumed. Diets high in plant foods, such as the ones listed above, supply about 900 micrograms daily of nickel. Nickel intake in the United States ranges from 69 to 162 micrograms daily. A daily dietary requirement of 25 to 35 micrograms has been suggested.
Nickel may be found in prepared foods (tinned foods) at markedly higher concentrations than the safe threshold laid down for hypersensitive patients. Some foodstuffs cooked in stainless-steel utensils attack the metal and thus contain much more nickel than when enamel or aluminum saucepans are used. Among the natural organic acids which may be responsible for dissolving stainless-steel, oxalic acid is the most active at equivalent concentrations.
Source: Contact Dermatitis. 1979 Jan;5(1):43-5.
Nickel in food: the role of stainless-steel utensils., Brun R.
The normal daily intake of nickel by American adults is about 0.3 to 0.6mg. About 1 to 10% of nickel in food is absorbed in the gastrointestinal tract and the remainder is excreted. The nickel content of food is partially determined by the components of the soil, in which the food was grown, pesticides used on it and the equipment used in the handling of the food. Nickel in food may vary considerably from region to region. Certain foods are routinely high in nickel content. Legumes, nuts, grains, potatoes, chocolate and fish are among the food high in nickel. In summary, ingested nickel either from food beverages or cooking utensils can cause a flare of dermatitis is some individuals. Accordingly, motivated persons may see improvement if they can reduce their ingestion of nickel through dietary changes.
NICKEL CONTENT IN FOODS
(more than 0.5 mg/kg)
MUSSELS, DARK CHOCOLATE, COCOA POWDER, LICORICE, HAZEL NUTS, ALMONDS, PEANUTS, PISTAGE NUTS, WALNUTS, ALPHA SEEDS, BROWN BEANS, SOYBEANS, PULSES (GREEN), MUNG BEANS, CHICK PEAS, YELLOW PEAS, LINSEED, POPPY SEED, OATMEAL, WHEAT BRAN, OAT BRAN, MILLET, SOY FLOUR, BUCKWHEAT
VARIOUS MUSHROOMS, OYSTERS, MILK CHOCOLATE, EGGS, RASPBERRIES, BLACKCURRANTS, CLOUDBERRIES, KALE, PARSLEY, GARLIC, PARSNIP, HORSERADISH, CORN FLOUR, RYE, BARLEY, RICE
(less than 0.1 mg/kg)
MEAT, HAM, SAUSAGE, POULTRY, LIVER, KIDNEY, CUCUMBER, CHEESE, MILK, YOGURT, ONION, CABBAGE, BEETS, SPINACH, CORN, FLOUR, SALAD, CARROTS, POTATOES, FISH, SQUASH, APPLES, PEARS, STRAWBERRIES
As analysed by the Swedish Food Administration
Titanium allergy is barely recognized in mainstream medicine – yet laboratories using the MELISA® technology have reported that about 4% of all patients tested to titanium will be allergic to it (Valentine-Thon E., et al. “LTT-MELISA® is clinically relevant for detecting and monitoring metal sensitivity”. Neuro Endocrinol Lett 2006; 27(Suppl 1):17–24). For those affected with titanium allergy, the symptoms can be multiple and bewildering. These can range from simple skin rashes to muscle pain and fatigue.
From foodstuff to medicine, titanium is now an everyday metal. Several brands of candy, such as Skittles and M&M, have titanium dioxide in the coating – often described by its E-number: E171. Some brands of toothpaste contain titanium particles. Hospitals use titanium implants to rebuild bones after accidents.
More than just a rash: the effects of titanium allergy
Like all metals, titanium releases particles through corrosion. These metals become ions in the body and bind to body proteins. For those who react, the body will try to attack this structure. This starts a chain reaction which can lead to many symptoms including Chronic Fatigue Syndrome. The MELISA® test is the only scientifically-proven test which can objectively diagnose titanium allergy and measure its severity.
Those who test positive are advised to avoid exposure if possible. This may include switching to titanium-free toothpaste and cosmetics, or in some cases, consider removing a titanium implant from the body.
Titanium: where to find it
Titanium dioxide (TiO2) is widely used in consumer products, as it is non-toxic – even though it triggers allergies in certain people. It is known as a “pearling agent” as it makes paper and paint glossy and white. Always check the content of food stuff, pills and cosmetics for titanium dioxide. It is found in the following:
• Body implants, such as Brånemark (for teeth) or to rebuild bones.
• Dentistry: as a colour pigment in composites
• Sunscreen agents: Finely ground titanium dioxide will block the harmful ultraviolet rays from the sun.
• Confectionery: Used to make candy look brighter and adding a crunchy coat to for example chewing gum.
• Cosmetics: Used to brighten and intensify the colour of make-up. It is regularly found in shadow, blush, nail polish, lotions, lipstick and powder.
• Toothpaste: Used as a pigment agent to make the toothpaste whiter.
• Paint: TiO2 will improve the durability of coatings and gives white colour.
• Plastic carrier bags: Improves durability and gives white colour.
• Medical pills and vitamin supplements may also get their white coating from titanium dioxide.
• Piercing & Jewellery: For example watches and all types of body piercing. Less people are allergic to titanium than for example to nickel.
Titanium polluted with nickel
Several studies show that titanium alloys contain traces of nickel as a result of the production process. This can pose trigger health problems in patients with nickel allergy, and also mean that a reaction may be falsely attributed to titanium itself.
Do you suspect you have titanium allergy?
If a health problem starts after you have received a titanium implant it is possible that you are allergic to titanium. You can take a MELISA® test for titanium allergy through one of the clinics we cooperate with or send a sample to a laboratory. If you are planning to have a test before receiving a titanium implant it is advised to find out the exact composition of the implant. Vanadium, aluminium and other metals are sometimes added to improve the properties of titanium implants, and allergy to these metals can also be tested.
How about clinical studies?
The articles Hypersensitivity to titanium: Clinical and laboratory evidence and LTT-MELISA® is clinically relevant for detecting and monitoring metal sensitivity published in 2006 can be downloaded from our Article page.
In the former article fifty-six (56) patients who had developed clinical symptoms after receiving titanium-based implants were tested in MELISA® against 10 metals including titanium. Out of 56 patients, 54 were patch-tested with titanium as well as with other metals. The implants were removed in 54 patients (2 declined explantation), and 15 patients were retested in MELISA®.
Of the 56 patients, 21 (37.5%) were positive, 16 (28.6%) ambiguous, and 19 (33.9%) negative to titanium. In the latter group, 11 (57.9%) showed lymphocyte reactivity to other metals, including nickel. All 54 patch-tested patients were negative to titanium. Following removal of the implants, all 54 patients showed remarkable clinical improvement. In the 15 retested patients, this clinical improvement correlated with normalization in MELISA® reactivity.
The conclusion of the article is that these data clearly demonstrate that titanium can induce clinically relevant hypersensitivity in a subgroup of patients chronically exposed via dental or endoprosthetic implants. Below, you will also find several articles which discuss the issue of corrosion of titanium implants and possible reactions due to hypersensitivity.
How about patients’ stories?
On our Patients’ stories page, you can read about two young people who recovered from their serious health problems after being diagnosed with titanium allergy and having their titanium implants removed.
Medical abstracts relating to titanium:-
• Titanium allergy or not? “Impurity” of titanium implant materials. Harloff T, et al.. Health 2010(2)4:306-310
• Metal Allergens of Growing Significance: Epidemiology, Immunotoxicology, Strategies for Testing and Prevention. Forte G. et al. Inflamm Allergy Drug Targets. 2008 Sep;7(3):145-62.
• Full-mouth oral rehabilitation in a titanium allergy patient using zirconium oxide dental implants and zirconium oxide restorations. A case report from an ongoing clinical study. Oliva X. et al. Eur J Esthet Dent. 2010 Summer;5(2):190-203.
• Study on patch test reagent for titanium. Nakajima K. Kokubyo Gakkai Zasshi. 2007 Jun;74(2):92-8.
• Allergies to dental metals. Titanium: a new allergen. Evrard L, Waroquier D, Parent D. Rev Med Brux. 2010 Jan-Feb;31(1):44-9.
• Implant failure due to Titanium hypersensitivity/allergy? – Report of a case SADJ February 2007
• Ultrafine titanium dioxide particles in the absence of photoactivation can induce oxidative damage to human bronchial epithelial cells Toxicology 2005
• Titanium particles stimulate bone resorption by inducing differentiation of murine osteoclast J Bone Joint Surg Am. 2001
• Immunohistochemical study of the soft tissue around long-term skin-penetrating titanium implants Biomaterials 1995
• Titanium dermatitis after failure of metal-backed patellas, Am J Knee Surg 1993
• In vitro corrosion of titanium Biomaterials. 1998
• Sensitivity to titanium. A cause of implant failure? J Bone Joint Surg Br. 1991
• A case of allergic reaction to surgical metal clips inserted for postoperative boost irradiation in a patient undergoing breast-conserving therapy Breast Cancer. 2001
• Biocompatibility of dental casting alloys Crit Rev Oral Biol Med. 2002
• Validity of MELISA® for metal sensitivity testing Neuro Endocrinol Lett. 2003
• Das Allergiepotenzial von Implantatwerkstoffen auf Titanbasis A. Schuh, et al. Der Orthopäde Volume 34, Number 4, 327-33
• Tissue reaction to bone plates made of pure titanium: a prospective, quantitative clinical study. A. Ungersboeck, et al. Journal of Materials Science: Materials in Medicine Volume 6, Number 4, 223-229
• Maternal exposure to nanoparticulate titanium dioxide during the prenatal period alters gene expression related to brain development in the mouse. M Shimizu et al. Particle and Fibre Toxicology 2009, 6:20
WHAT HEALTHTALKLIVE.COM THINKS
Metal, and even chemical, toxicity is a part of everyday life. Some of the natural remedies that can be used to bind to and expel metals and chemicals include chlorella, spirulina or blue-green algae and Proteolytic Systemic Oral Enzymes in combination, such as NSC Immzymes or WobenzymN with Source Natural Yaeyama Chlorella or PerfectlyHealthy Mega Greens powder or capsules. Of course, these may not be used if you take certain prescription drugs, so be sure to weigh-in with ideas, questions and concerns in the Live Chat Forum here at HealthTalkLive.com at:
This is no way endorses any particular laboratory for testing metals; it is merely used as a suggestion to lead you toward the path of natural health in realizing that any metals you may have in your mouth, or that you may be exposed to in your home, at work or at play could effect your health.