8. Misleading Bibliography The ADA supports their argument with five references. Bibliography: Reinhardt, J.W. Risk assessment of mercury exposure from dental amalgams. J. Public Health Dent 48:172-7, 1988 Langan, D.C., Fan, P.L., Hoos, A.A. The use of mercury in dentistry: a critical review of the recent literature. JADA 115:867-880, 1987 Fan, P.L. Safety of Amalgam. CDA J 15:34-6 1987 The Mercury Scare. Consumer Reports, March 1986 Council on Dental Materials, Instruments, and Equipment and Council on Dental Therapeutics. Safety of amalgam-an update. JADA 119:204-5 1989 IAOMT Response The ADA bibliography cited is misleading. The total lack of valid science to support the continued use of amalgam is apparent in the ADA Special Reports bibliography. They cite only review articles and lay media reports and no primary research into either animal or human physiological or immunological reaction to dental amalgam metal. The review articles and lay reports rely almost exclusively on measurements of mercury from blood, and urine to support their conclusions. On page 396 of the Special Report the author partially quotes the conclusion of the 1984 NIDR Workshop on the Biocompatibility of Metals in Dentistry, "and there appears to be little correlation between (mercury) levels in urine, blood, or hair, and toxic effects." They thereby negate the validity of their own bibliographical references. The scientific literature clearly does not support such an approach. Quoting directly from the research, "Urinary mercury levels may give some indication of the degree of exposure. They are of limited value in the diagnosis of poisoning, since high levels can be found in human subjects who are symptom-free, and low levels in those exhibiting marked evidence of mercurialism. It has been suggested that, in some cases, failure to excrete mercury is a factor in the development of poisoning. Those investigators that have studied the subject are in almost unanimous agreement that there is poor correlation between the urinary excretion of mercury and the occurrence of demonstrable evidence of poisoning." 44 Moreover, none of the articles referenced in the ADA bibliography contain hard research. They merely cited other primary research papers to support their divergent conclusions. Many of the primary research scientists referenced in the review articles did not conclude that amalgam was safe. This bibliography would therefore be very misleading to anyone not familiar with the current research.