Patients' experiences of changes in health after removal of dental amalgam - quantitative and qualitative approaches

Abstract

Patients with medically unexplained health complaints attributed to dental amalgam often wish to have their amalgam fillings replaced with other materials. The main purpose of this thesis was to explore how patients with health complaints attributed to dental amalgam experienced changes in health after removal of all amalgam fillings. Forty patients with health complaints attributed to dental amalgam were included and assigned to a treatment group (n=20; amalgam removal) and a reference group (n=20; no treatment). An external reference group (n=441) from the general population was also used for comparisons with the treatment group. Follow-up in the treatment group included measurements of mercury in serum and urine and questionnaires with numeric rating scales for 6 intraoral, 5 extraoral, and 12 general health complaints. The same questionnaire was also used in the reference groups. After the final follow-up, twelve of participants in the treatment group were asked to participate in semistructured qualitative interviews exploring their experiences of changes in health after amalgam removal. Patterns and themes in the participants’ descriptions were identified through an explorative and thematic analysis of the transcribed interviews. In the treatment group, mercury concentration in serum and index scores for intraoral and general health complaints declined significantly three years after amalgam removal. In the reference group there was as a slight, but not significant, increase of index scores in the same period. Comparisons with the external reference group showed that even after amalgam removal, participants in the treatment group reported a significantly higher level of complaints for 6 of the 23 complaints. In the interviews, participants described feeling better after amalgam removal, but were reluctant to point to the removal as the only cause for their improved health. Despite not being sure of the importance of amalgam removal, all participants expressed that it had been important for them to get rid of the amalgam fillings. The mechanisms behind the reduced levels of health complaints after amalgam removal are probably compounded and not limited to reduced exposure to mercury. This was also acknowledged and underscored by the participants in the interview study.