doi: 10.1111/jop.12165
J Oral Pathol Med (2014) 43: 561–562 © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd wileyonlinelibrary.com/journal/jop
LETTER TO THE EDITOR
Salivary trace elements levels and BMS To the editor In their interesting prospective cross-sectional study, LopezJornet et al. note that patients with burning mouth syndrome (BMS) had a non-significant increased level of minerals and trace elements in unstimulated whole saliva samples collected and analyzed by inductively coupled plasma optical emission spectrometry (ICP-OES) (1). We would like to compliment the investigators on their prospective controlled trial; however, we believe that their conclusions deserve careful consideration. The authors do not consider or mention two of the most important transition metals that may have a role in burning mouth syndrome development: mercury and palladium. Mercury-containing dental amalgam restorations are still the most common filling dental material, and in individuals who carry mercury amalgams, the average background concentrations have often been reported to be elevated (2–4). During mastication and bruxing, the release of intra-oral mercury into saliva from dental amalgam has been associated with a very high salivary mercury levels (3, 5). First, exposure to elemental mercury (Hg0) continuously released from mercurycontaining dental amalgam fillings is by far the primary risk factor associated with BMS (5–9). Previous observational data from a large monocentric study of 491 patients suggested that BMS is the most common type of adverse events associated with mercury amalgam tooth fillings, with a prevalence of 17.9 percent (88 of 491) (10). As yet, the association of mercury-containing dental amalgam fillings and BMS has been described in case reports, (9, 11) in a review (12), and, more recently, in an observational case series (13). Second, there is an emerging consensus that even allergy and exposure to palladium-based dental prosthesis alloys may have a role in etiology of BMS (14–18). Because of this emerging risk profile, it seems prudent to avoid the use of these alloy dental restorations (e.g., mercury amalgams and palladium-based alloys) in patients with burning mouth disorder. We believe that assessment of minerals and trace elements (including mercury and palladium) in saliva may be clinically useful in the prediction of risk to the individual person and provide insight into the chemical pathways underlying the burning mouth syndrome.
Conflict of interest We have no conflict of interests connected with this work.
Funding None.
References 1. L opez-Jornet P, Juan H, Alvaro PF. Mineral and trace element analysis of saliva from patients with BMS: a cross-sectional prospective controlled clinical study. J Oral Pathol Med 2014; 43: 111–6. 2. Pizzichini M, Fonzi M, Sugherini L, et al. Release of mercury from dental amalgam and its influence on salivary antioxidant activity. Sci Total Environ 2002; 284: 19–25. 3. Leistevuo J, Leistevuo T, Helenius H, et al. Dental amalgam fillings and the amount of organic mercury in human saliva. Caries Res 2001; 35: 163–6. 4. Pigatto PD, Arancio L, Guzzi G, Severi G. Metals from amalgam in saliva: association with lichenoid lesions, leukoplakia, burning mouth syndrome. Toxicol Lett 2005; 158S: S169–70. 5. Pigatto PD, Minoia C, Ronchi A, Guzzi G. Mercury in Saliva: immunotoxic and Allergenic Metal. Allergy 2009; 64(Suppl. 90): 537. 6. James J, Ferguson MM, Forsyth A. Mercury allergy as a cause of burning mouth. Br Dent J 1985; 159: 392. 7. Albert D. Mercury allergy as a cause of burning mouth. Br Dent J 1986; 160: 186–7. 8. Forsell M, Larsson B, Ljungqvist A, Carlmark B, Johansson O. Mercury content in amalgam tattoos of human oral mucosa and its relation to local tissue reactions. Eur J Oral Sci 1998; 106: 582–7. 9. Pigatto PD, Guzzi G, Persichini P, Barbadillo S. Recovery from mercury-induced burning mouth syndrome due to mercury allergy. Dermatitis 2004; 15: 75–7. 10. Pigatto PD, Minoia C, Ferrucci SM, Ronchi A, Brambilla L, Guzzi G. Prevalence of mercury allergy and treatment of adverse events to dental materials. Allergy 2013; 68(Suppl. 97): 597–8. 11. Pigatto PD, Brambilla L, Guzzi G, Spadari F. Burning lips syndrome. Contact Dermat 2007; 57: 344–6. 12. Pigatto PD, Guzzi G. Burning Mouth Syndrome. SKIN med 2012; 10: 135–4. 13. Pigatto PD, Minoia C, Ronchi A, et al. Allergological and Toxicological Aspects in a Multiple Chemical Sensitivity Cohort. Oxid Med Cell Longev 2013; 2013: 356235. 14. Larese FF, Uderzo D, Bagnato E. Sensitization to palladium chloride: a 10-year evaluation. Am J Contact Dermat 2003; 14: 78–81. 15. Pigatto PD, Feilzer AJ, Valentine-Thon E, Zerboni R, Guzzi G. Burning mouth syndrome associated with palladium allergy? Eur J Dermatol 2008; 18: 356–7. 16. Durosaro O, el-Azhary RA. A 10-year retrospective study on palladium sensitivity. Dermatitis 2009; 20: 208–13. 17. Pigatto PD, Spadari F, Bombeccari G, Guzzi G. Palladium sensitization in the United States: dermatology and dentistry connection. Dermatitis 2010; 21: 297–8. 18. Steele JC, Bruce AJ, Davis MD, Torgerson RR, Drage LA, Rogers RS 3rd. Clinically relevant patch test results in patients with burning mouth syndrome. Dermatitis 2012; 23: 61–70.
Letter to the Editor
562
Paolo D. Pigatto1, Francesco Spadari2, Anna Ronchi3, Gianpaolo Guzzi4 1 Department of Bioscience for Health Dermatological Clinic, IRCCS Galeazzi Hospital, University of Milan, Milan, Italy; 2 Department of Biomedical, Surgical and Dental Sciences, Unit of Oral Pathology and Medicine, Ospedale Maggiore Policlinico Fondazione Ca’ Granda IRCCS, University of Milan, Milan, Italy;
J Oral Pathol Med
3
Laboratory of Environmental and Toxicology Testing “S. Maugeri” IRCCS, Pavia, Italy; 4 Italian Association for Metals and Biocompatibility Research – A.I.R.M.E.B. Milan, Italy Tel: +39 02 782 561 Fax: +39 02 367 355 40 Email: [email protected]
J Oral Pathol Med (2014) 43: 561–562 © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd wileyonlinelibrary.com/journal/jop
LETTER TO THE EDITOR
Salivary trace elements levels and BMS To the editor In their interesting prospective cross-sectional study, LopezJornet et al. note that patients with burning mouth syndrome (BMS) had a non-significant increased level of minerals and trace elements in unstimulated whole saliva samples collected and analyzed by inductively coupled plasma optical emission spectrometry (ICP-OES) (1). We would like to compliment the investigators on their prospective controlled trial; however, we believe that their conclusions deserve careful consideration. The authors do not consider or mention two of the most important transition metals that may have a role in burning mouth syndrome development: mercury and palladium. Mercury-containing dental amalgam restorations are still the most common filling dental material, and in individuals who carry mercury amalgams, the average background concentrations have often been reported to be elevated (2–4). During mastication and bruxing, the release of intra-oral mercury into saliva from dental amalgam has been associated with a very high salivary mercury levels (3, 5). First, exposure to elemental mercury (Hg0) continuously released from mercurycontaining dental amalgam fillings is by far the primary risk factor associated with BMS (5–9). Previous observational data from a large monocentric study of 491 patients suggested that BMS is the most common type of adverse events associated with mercury amalgam tooth fillings, with a prevalence of 17.9 percent (88 of 491) (10). As yet, the association of mercury-containing dental amalgam fillings and BMS has been described in case reports, (9, 11) in a review (12), and, more recently, in an observational case series (13). Second, there is an emerging consensus that even allergy and exposure to palladium-based dental prosthesis alloys may have a role in etiology of BMS (14–18). Because of this emerging risk profile, it seems prudent to avoid the use of these alloy dental restorations (e.g., mercury amalgams and palladium-based alloys) in patients with burning mouth disorder. We believe that assessment of minerals and trace elements (including mercury and palladium) in saliva may be clinically useful in the prediction of risk to the individual person and provide insight into the chemical pathways underlying the burning mouth syndrome.
Conflict of interest We have no conflict of interests connected with this work.
Funding None.
References 1. L opez-Jornet P, Juan H, Alvaro PF. Mineral and trace element analysis of saliva from patients with BMS: a cross-sectional prospective controlled clinical study. J Oral Pathol Med 2014; 43: 111–6. 2. Pizzichini M, Fonzi M, Sugherini L, et al. Release of mercury from dental amalgam and its influence on salivary antioxidant activity. Sci Total Environ 2002; 284: 19–25. 3. Leistevuo J, Leistevuo T, Helenius H, et al. Dental amalgam fillings and the amount of organic mercury in human saliva. Caries Res 2001; 35: 163–6. 4. Pigatto PD, Arancio L, Guzzi G, Severi G. Metals from amalgam in saliva: association with lichenoid lesions, leukoplakia, burning mouth syndrome. Toxicol Lett 2005; 158S: S169–70. 5. Pigatto PD, Minoia C, Ronchi A, Guzzi G. Mercury in Saliva: immunotoxic and Allergenic Metal. Allergy 2009; 64(Suppl. 90): 537. 6. James J, Ferguson MM, Forsyth A. Mercury allergy as a cause of burning mouth. Br Dent J 1985; 159: 392. 7. Albert D. Mercury allergy as a cause of burning mouth. Br Dent J 1986; 160: 186–7. 8. Forsell M, Larsson B, Ljungqvist A, Carlmark B, Johansson O. Mercury content in amalgam tattoos of human oral mucosa and its relation to local tissue reactions. Eur J Oral Sci 1998; 106: 582–7. 9. Pigatto PD, Guzzi G, Persichini P, Barbadillo S. Recovery from mercury-induced burning mouth syndrome due to mercury allergy. Dermatitis 2004; 15: 75–7. 10. Pigatto PD, Minoia C, Ferrucci SM, Ronchi A, Brambilla L, Guzzi G. Prevalence of mercury allergy and treatment of adverse events to dental materials. Allergy 2013; 68(Suppl. 97): 597–8. 11. Pigatto PD, Brambilla L, Guzzi G, Spadari F. Burning lips syndrome. Contact Dermat 2007; 57: 344–6. 12. Pigatto PD, Guzzi G. Burning Mouth Syndrome. SKIN med 2012; 10: 135–4. 13. Pigatto PD, Minoia C, Ronchi A, et al. Allergological and Toxicological Aspects in a Multiple Chemical Sensitivity Cohort. Oxid Med Cell Longev 2013; 2013: 356235. 14. Larese FF, Uderzo D, Bagnato E. Sensitization to palladium chloride: a 10-year evaluation. Am J Contact Dermat 2003; 14: 78–81. 15. Pigatto PD, Feilzer AJ, Valentine-Thon E, Zerboni R, Guzzi G. Burning mouth syndrome associated with palladium allergy? Eur J Dermatol 2008; 18: 356–7. 16. Durosaro O, el-Azhary RA. A 10-year retrospective study on palladium sensitivity. Dermatitis 2009; 20: 208–13. 17. Pigatto PD, Spadari F, Bombeccari G, Guzzi G. Palladium sensitization in the United States: dermatology and dentistry connection. Dermatitis 2010; 21: 297–8. 18. Steele JC, Bruce AJ, Davis MD, Torgerson RR, Drage LA, Rogers RS 3rd. Clinically relevant patch test results in patients with burning mouth syndrome. Dermatitis 2012; 23: 61–70.
Letter to the Editor
562
Paolo D. Pigatto1, Francesco Spadari2, Anna Ronchi3, Gianpaolo Guzzi4 1 Department of Bioscience for Health Dermatological Clinic, IRCCS Galeazzi Hospital, University of Milan, Milan, Italy; 2 Department of Biomedical, Surgical and Dental Sciences, Unit of Oral Pathology and Medicine, Ospedale Maggiore Policlinico Fondazione Ca’ Granda IRCCS, University of Milan, Milan, Italy;
J Oral Pathol Med
3
Laboratory of Environmental and Toxicology Testing “S. Maugeri” IRCCS, Pavia, Italy; 4 Italian Association for Metals and Biocompatibility Research – A.I.R.M.E.B. Milan, Italy Tel: +39 02 782 561 Fax: +39 02 367 355 40 Email: [email protected]
