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ARTICLE CONTRIBUTORS

Dr Ewan J McKay, Dr Reza Ashrafi

Clinical Articles, Lead Article

When the dentist said: “Be still your beating heart!”

Working at a large University Teaching Hospital we are not unfamiliar to specialist cardiology clinics two or three times weekly. As many of you will have experienced on occasion we often encounter a patient history and apparent presenting complaint that we can not precisely and cleverly explain.

Our patient, Mr BW, a fit and active fifty-three year old gentleman, attended a routine appointment as an outpatient, as he had done many times previously due to difficulty with heart rate control with troubling symptoms secondary to atrial fibrillation. Coincidentally, he happened to have amalgam dental fillings. These fillings had been drilled some 18 months prior and since this his cardiac problems had escalated. There appeared no clear causality between the fillings and the patient’s atrial fibrillation but Mr BW himself was convinced there was a link.

Interestingly on the occasion of his most recent visit he explained that all had been well and he had remained symptom free. My first thought of course was: What had we done that was so different after all this time? How have we stumbled upon the solution? The only change had been that the patient had insisted in having has dental fillings removed and replaced.

iStock_000010301591XSmallFollowing a delve through internet archives it is obvious that there are a great many patients that are convinced of an apparent link connecting the development of their specific arrhythmia to their dental fillings as did our patient. We felt it important to assess as carefully as possible if indeed there are any plausible links.

At its most basic level there are two possible theories to explain this curious symptom. The first postulation to explain this phenomenon is electrical, the second chemical.

Firstly the electrical theory concerns the metals in the amalgam itself. This apparently can act either as a cathode or anode depending on their composition. This could form an electrical circuit with the body. There has been accepted work showing that there is a significant electrical current generated between dental filling alloys and the body.1 This current has been measured in studies, at up to 109mV2 and it may be that these currents are enough to tip susceptible individuals into arrhythmias.

The second potential theory regards the exact composition of the fillings with a variety of metals being used in day-to-day dentistry all with potential biochemical effects. It has been found that, for example, with mercury poisoning that there is an arrhythmogenic effect.3 This may occur due to small degrees of corrosion in the dental fillings releasing small but constant quantities into the bloodstream.

While not a clearly defined problem there are studies that have shown that the removal of dental amalgam has reduced patients complaints with reference to a variety of issues.4

We would suggest that a large retrospective analysis of those attending with arrhythmias be undertaken in an attempt to assess if indeed this is a genuine problem or just an unfortunate coincidence.

References

1 Nogi N. [Electric current around dental metals as a factor producing allergenic metal ions in the oral cavity]. Nippon Hifuka Gakkai Zasshi 1989;99:1243–54.

2 Ciszewski A, Baraniak M, Urbanek-Brychczynska M. Corrosion by galvanic coupling between amalgam and different chromium-based alloys. Dent Mater 2007;23:1256–61.

3 Ravasini JA, Mossop P, McLachlan CS. Homocysteine and heavy metal interactions in atrial fibrillation and ablation treatments. Europace 2008;10:1458; author reply -7.

4 Melchart D, Wuhr E, Weidenhammer W, et al. A multicenter survey of amalgam fillings and subjective complaints in non-selected patients in the dental practice. Eur J Oral Sci 1998;106:770–7.

Authors

Dr Ewan J Mckay, Cardiology Imaging Fellow, The Royal Oldham Hospital

Dr Reza Ashrafi, Cardiovascular Research Fellow, Aintree Cardiac Centre, University Hospital Aintree

Corresponding author

Dr Ewan J Mckay

Cardiology Imaging Fellow

The Royal Oldham Hospital

‪Rochdale Road,

Oldham,

Manchester OL1 2JH

email: Ewan.mckay@pat.nhs.uk

Citation

McKay EJ, Ashrafi R. When the dentist said: “Be still your beating heart!”.  Arrhythmia Watch 2011;Issue 19 (Dec)

Published on: December 1, 2011

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