Teratological aspects of dental amalgam

The teratogenic effect is determined by four factors: (1) the agent, (2) the dose, (3) the stage of embryonic development, and (4) the genetic constitution of the embryo. The first two factors are of particular interest and warrant further comment. It should be emphasized that the mercury released from dental amalgam is mainly metallic mercury vapor. The dose of mercury vapor from dental amalgam fillings in the order of 5 micrograms/day is very low compared with the doses in a teratological study and is not likely to exceed the threshold necessary for a teratogenic effect to occur. The concentration of the teratogen at the target tissue is determined not only by the degree of placental transfer but also by other factors, such as the distribution within the maternal organism, the affinity to the fetal liver and blood, the hematocrit value, and the passage through the ductus venosus. These factors might help to explain toxicological mechanisms and species differences and have to be considered if the results of animal experiments are to be extrapolated to human conditions. Neither epidemiological data nor animal experimental data indicate that the release of metallic mercury vapor from dental amalgam therapy should cause teratogenic effects. A comparison with the incorporation of the fetotoxic methyl mercury might be justified.