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Periodontal disease and environmental cadmium exposure.

We were pleased to see the article by Arora et al. (2009), which describes an association between environmental exposure to cadmium and periodontal disease.

In their cross-sectional study among U.S. adults, Arora et al. (2009) found periodontal disease in 15.4% of a nationally representative sample of 11,412 participants. The authors reported that for individuals with periodontal disease, as defined in their study, the geometric mean concentration of urinary Cd (0.50 [micro]g/g creatinine) was significantly higher than for persons with no evidence of periodontitis (0.30 [micro]g/g creatinine).

Arora et al. (2009) correctly stated that the main source of human exposure to environmental Cd is smoking. They proposed that additional sources of Cd in the general population are "emissions from industrial activities, including mining, smelting, and manufacturing of batteries, pigments, stabilizers, and alloys" (Arora et al. 2009).

However, in our view, one Cd source has been overlooked: intraoral dental alloys. Individuals with dental alloy restorations are regularly exposed to a number of trace elements that are continuously released from intraoral alloys (Wataha 2000).

Cadmium may be released from intraoral alloys in dental patients and may be accumulated in both teeth and oral tissues, binding tightly to metallothioneins (Goyer and Clarkson 2001; Munksgaard 1992). For example, the intermetallic compound dental amalgam may contain approximately 4.5 [micro]g/g Cd in the metal-matrix alloy (Minoia et al. 2007). Two metals other than Cd--lead (Dye et al. 2002) and mercury (Trivedi and Talim 1973)--probably contribute to periodontitis.

In a study of 268 avulsed teeth analyzed by atomic absorption spectrometry, Alomary et al. (2006) reported that the levels of Cd in tooth specimens were significantly higher in samples with dental amalgam fillings than in teeth with no amalgam. These findings suggest that exposure to Cd released from dental alloy restorations may influence many aspects of mineralized hard tissue of teeth and their immediate surrounding periodontal tissues. Another potential source of Cd is a metal dental bridge in which a Cd-containing alloy has been used for soldering.

In rare cases, Cd-containing dental alloys may lead to systemic intoxication (Borowiak et al. 1990). Even in dental acrylic-based resin for removable dentures, Cd might be used as a pigment.

It is therefore plausible that the release of Cd from both metal and/or nonmetal dental materials (i.e., resin-based materials) into the oral cavity may contribute to periodontal disease among adults.

The authors declare they have no competing financial interests.

Gianpaolo Guzzi

Italian Association for Metals and Biocompatibility Research-A.I.R.M.E.B.

Milan, Italy


Paolo D. Pigatto

Department of Technology for Health Dermatological Clinic

IRCCS Galeazzi Hospital

University of Milan

Milan, Italy

Anna Ronchi

Claudio Minoia

Laboratory of Environmental and Toxicology Testing

"S. Maugeri"-IRCCS

Pavia, Italy


Alomary A, Al-Momani IF, Massadeh AM. 2006. Lead and cadmium in human teeth from Jordan by atomic absorption spectrometry: some factors influencing their concentrations. Sci Total Environ 369:69-75.

Arora M, Weuve J, Schwartz J, Wright RO. 2009. Association of environmental cadmium exposure with periodontal disease in U.S. adults. Environ Health Perspect 117:739-744.

Borowiak K, Dutkiewicz T, Marcinkowski T. 1990. Chronic cadmium intoxication caused by a dental prosthesis. Z Rechtsmed 103:537-539.

Dye BA, Hirsch R, Brody DJ. 2002. The relationship between blood lead levels and periodontal bone loss in the United States, 1988-1994. Environ Health Perspect 110:997-1002.

Goyer RA, Clarkson TW. 2001. Toxic effects of metals. In: Casarett & Doull's Toxicology: The Basic Science of Poisons (Klaassen CD, ed). 6th ed. New York:McGraw Hill, 811-837.

Minoia C, Ronchi A, Veronese I, Giussani A, Guzzi G. 2007. The confounding effects of intraoral metals in salivary biomarkers [Letter], Occup Environ Med 64:856.

Munksgaard EC. 1992. Toxicology versus allergy in restorative dentistry. Adv Dent Res 6:17-21.

Trivedi SC, Talim ST. 1973. The response of human gingiva to restorative materials. J Prosthet Dent 29:73-80.

Wataha JC. 2000. Biocompatibility of dental casting alloys: a review. J Prosthet Dent 82:223-234.

doi: 10. 1289/ehp-0901189
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Article Details
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Title Annotation:Correspondence
Author:Guzzi, Gianpaolo; Pigatto, Paolo D.; Ronchi, Anna
Publication:Environmental Health Perspectives
Article Type:Report
Geographic Code:1USA
Date:Dec 1, 2009
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