Health Complaints Attributed to Dental Amalgam: A Retrospective Survey Exploring Perceived Health Changes Related to Amalgam Removal

Evaluating the accuracy of Chat Generative Pre-trained Transformer version 4 (ChatGPT-4) responses to United States Food and Drug Administration (FDA) frequently asked questions about dental amalgam

BACKGROUND

The use of artificial intelligence in the field of health sciences is becoming widespread. It is known that patients benefit from artificial intelligence applications on various health issues, especially after the pandemic period. One of the most important issues in this regard is the accuracy of the information provided by artificial intelligence applications.

OBJECTIVE

The purpose of this study was to the frequently asked questions about dental amalgam, as determined by the United States Food and Drug Administration (FDA), which is one of these information resources, to Chat Generative Pre-trained Transformer version 4 (ChatGPT-4) and to compare the content of the answers given by the application with the answers of the FDA.

METHODS

The questions were directed to ChatGPT-4 on May 8th and May 16th, 2023, and the responses were recorded and compared at the word and meaning levels using ChatGPT. The answers from the FDA webpage were also recorded. The responses were compared for content similarity in "Main Idea", "Quality Analysis", "Common Ideas", and "Inconsistent Ideas" between ChatGPT-4's responses and FDA's responses.

RESULTS

ChatGPT-4 provided similar responses at one-week intervals. In comparison with FDA guidance, it provided answers with similar information content to frequently asked questions. However, although there were some similarities in the general aspects of the recommendation regarding amalgam removal in the question, the two texts are not the same, and they offered different perspectives on the replacement of fillings.

CONCLUSIONS

The findings of this study indicate that ChatGPT-4, an artificial intelligence based application, encompasses current and accurate information regarding dental amalgam and its removal, providing it to individuals seeking access to such information. Nevertheless, we believe that numerous studies are required to assess the validity and reliability of ChatGPT-4 across diverse subjects.

Can removal of amalgam restorations reduce health complaints in patients with medically unexplained physical symptoms?

Design Three groups of non-equivalent patients using a prospective cohort study design. Patients who credited their medically unexplained symptoms (MUPS) to their dental amalgam restorations (amalgam cohort) were compared to two other groups: patients with MUPS who did not credit their symptoms to amalgam (MUPS cohort) and those who recognised themselves as healthy (healthy cohort). All participants initially filled in a questionnaire (Q1) which included the primary outcome: General Health Complaints index (GHC-index). The SF-36 Physical and Mental Component Summary was also included as a secondary outcome. Other outcomes, including blood, were collected but results will be reported in other publications. Patients in the amalgam and MUPS cohorts were assessed by their general physician (GP) to ensure their complaints met the criteria for MUPS. The amalgam cohort then had their amalgams removed by their dentist and, one year later, filled in the questionnaire again (Q2). The MUPS and healthy cohorts completed the Q2 two years after the Q1.Cohort selection Recruitment information for the amalgam cohort was sent to all dentists and GPs in Norway, and advertised via the Directorate of Health website and the Norwegian Dental Association. Once potential participants were identified, they were required to be assessed by both a dentist and GP to declare that oral and systemic diseases were adequately treated. The risk of deterioration of dental and medical health through participation in the study was also disclosed. For the amalgam cohort, patients had to have at least one amalgam filling and attribute the presence of these restorations to unexplained health complaints which had been present for at least three months. Patients in the MUPS cohort were recruited by their GP. These patients also had to have had unexplained health complaints for at least three months; however, the key difference being they did not attribute these complaints to amalgams. The healthy cohort was primarily recruited via dentists taking part in the study and patients self-assessed as being healthy. Both the MUPS and healthy cohorts were recruited regardless of amalgam status.Data analysis Descriptive statistics presented continuous data, and categorical data were presented as frequencies. Differences between the cohorts were analysed with analysis of variance (ANOVA) with covariate adjustment. Potential predictors of the primary outcome variable were analysed using multivariate analysis.Results In the amalgam, MUPS and healthy cohorts, 32, 28 and 19 patients, respectively, completed participation in the study. The GHC-index significantly reduced (p <0.001) between Q1 and Q2 in the amalgam cohort but not in the other cohorts. The change in the GHC-index (change in score) was greater in the amalgam cohort compared to the MUPS cohort and this was statistically significant (p = 0.004), indicating a greater reduction in health complaints.Conclusions General health complaints in patients with MUPS, that attributed their symptoms to their dental amalgams, reduced after removal of dental amalgam restorations.

Removal of dental amalgam restorations in patients with health complaints attributed to amalgam: A prospective cohort study

BACKGROUND

The Norwegian Ministry of Health and Care Services initiated a project including experimental treatment for patients with health complaints attributed to amalgam restorations.

OBJECTIVE

The aim was to evaluate changes of general health complaints in patients who participated in the project and had all amalgam restorations removed.

METHODS

The project was designed as a prospective cohort study and organised by the Dental Biomaterials Adverse Reaction Unit in Bergen, Norway. The dental treatment was provided by the patient's local dentist. The main target group consisted of patients with medically unexplained physical symptoms, attributed to dental amalgam restorations (Amalgam cohort). The primary comparison group consisted of patients with medically unexplained physical symptoms without attribution to dental amalgam restorations (MUPS cohort). Primary outcome was self-reported general health complaints (GHC index) at follow-up 12-months after completed amalgam removal.

RESULTS

In the Amalgam cohort, a significant reduction of GHC index from 43.3 (SD 17.8) at baseline to 30.5 (SD 14.4) at follow-up (mean reduction 12.8, SD 15.9; n = 32; P < .001) was observed. The change scores for GHC index indicated that the reduction of complaints was significantly higher (P = .004) in the Amalgam cohort compared with the MUPS cohort (mean reduction 1.2, SD 12.3, n = 28). After adjustment for age, gender, education and baseline GHC index, the mean adjusted difference was -8.0 (95% confidence interval from -15.4 to -0.5; P = .036).

CONCLUSION

In a group of patients with medically unexplained physical symptoms, which they attributed to dental amalgam restorations, removal of amalgam restorations was followed by a significant reduction of health complaints.

Metals, autoimmunity, and neuroendocrinology: Is there a connection?

It has been demonstrated that metals can induce autoimmunity. However, few studies have attempted to assess and elucidate the underlying mechanisms of action. Recent research has tried to evaluate the possible interactions of the immune system with metal ions, particularly with heavy metals. Research indicates that metals have the potential to induce or promote the development of autoimmunity in humans. Metal-induced inflammation may dysregulate the hypothalamic-pituitary-adrenal (HPA) axis and thus contribute to fatigue and other non-specific symptoms characterizing disorders related to autoimmune diseases. The toxic effects of several metals are also mediated through free radical formation, cell membrane disturbance, or enzyme inhibition. There are worldwide increases in environmental metal pollution. It is therefore critical that studies on the role of metals in autoimmunity, and neuroendocrine disorders, including effects on the developing immune system and brain and the genetic susceptibility are performed. These studies can lead to efficient preventive strategies and improved therapeutic approaches. In this review, we have retrieved and commented on studies that evaluated the effects of metal toxicity on immune and endocrine-related pathways. This review aims to increase awareness of metals as factors in the onset and progression of autoimmune and neuroendocrine disorders.