Brief overview of general indications that should be implemented, regarding materials used by various professionals dealing with these diseases and by the patients themselves who have contributed by evaluating products on themselves over time.
MCS and EHS - what are they?
MCS: Multiple Chemical Sensitivity. Multiple Chemical Sensitivity, MCS, is an immuno-neuro-toxic inflammatory syndrome with a chronic and progressive course, characterized by intolerance to chemical substances present in the environment, even at doses far below those tolerated by the general population. Chemically sensitive individuals become ill when exposed to chemical substances present in many common products such as perfumes, tobacco smoke, new carpeting, room deodorizers, pesticides, paints and building materials, as well as many cleaning and laundry products. The most frequent symptoms are: olfactory hypersensitivity, non-allergic asthma, rhinitis, headache, muscle pain, fatigue, disorientation, dermatological problems (redness, itching), flu-like syndrome, accelerated heartbeat, swollen lymph nodes, arthralgia, digestive disorders, tiredness, palpitations, nausea, insufficient peripheral circulation, arthritis, vasculitis, dermatitis, etc., involving various physiological systems such as respiratory, endocrine, nervous system, etc
From a dental perspective, these individuals might present, for example, heavy metal intoxication such as mercury contained in dental amalgams, which should therefore be removed safely following the safe removal protocol to avoid the release of dust and vapors (see following information). With the aid of specific analyses, it is possible to resolve any doubts regarding medications to be used such as anesthetics, antibiotics, etc., and regarding dental materials to be used, which we will see later. For example, a very valuable tool is the Integrated Drug Metabolism Panel (D-MIFAR) and the Integrated Drug Metabolism Consultation (C-MIFAR) (if the patient has it). Therefore, with appropriate adjustments and precautions, even these individuals can be adequately treated. Some MCS patients also suffer from electromagnetic hypersensitivity EHS.
EHS: Electromagnetic Hypersensitivity. EHS, from the English acronym Electromagnetic Hypersensitivity, also called simply Electrosensitivity, is an environmental illness caused by physical agents, has an organic basis characterized by multiple pathogenetic mechanisms, which expresses itself in immuno-toxic damage mediated by the direct effects of EMF, which leads to organic damage and loss of tolerance towards Electromagnetic Fields (EMF) even when their intensity is far below the limits established by law. For these individuals, depending on their specific sensitivities, it is vitally important to remain protected from High Frequency EMF (generated by Wireless technologies – Radiofrequency and Microwave emissions) and/or Low Frequency EMF (generated by power lines and household appliances) otherwise a more or less severe immuno-toxic syndrome may develop.
In most patients, the signs and symptoms are very similar, albeit of different severity levels. They manifest during or after exposure and decrease upon moving away from the EMF source, ranging from physical pain (both during exposure and hours later), debilitating headache, muscle pain, even intense cardiac pain, abdominal pain, skin rashes, weakness up to Chronic Fatigue, flu-like syndrome, blood pressure fluctuations with nasal bleeding, memory and concentration problems, gastrointestinal problems, tinnitus, neurovegetative disorders, nausea, endocrinological disorders, etc. Many also suffer from MCS, making their situation even worse. The scientific literature is considerable, but to date these people have no form of protection or assistance.
From a dental perspective, everything previously stated for MCS applies, but to further protect the individual from EMF present in the practice, in addition to turning off Wireless connections, a shielding fabric large enough to wrap around the dental unit and cover the person well could be used.
General indications for practice access
If the person is severely affected and cannot leave home, there are dentists who make house calls in every region.
Have the person arrive possibly as the first in the morning, because after having received various patients in the practice, the air might be laden with perfumes, and to avoid contact with other patients who might have perfumes or wireless devices on them.
The dental practice should avoid scented products, turn off wireless connections and use any certified product for surface decontamination and subsequently steam could be used to remove chemical residues.
An ionizer or air purifier can be used, such as those from the brands Bio3Gen (Ozone Generator) or IQAir multi-gas air purifiers or Filair, easily available in Italy. The website Purenature https://www.purenature.de/ has suitable models for MCS. The ideal purifier model would be one made of metal and only 3% plastics.
The patient's seat on the dental unit is typically made of faux leather and some dentists cover it with nylon film for hygienic reasons. This material becomes impregnated with detergents, fabric softeners and various perfumes, so for the MCS person it is necessary to change it before they sit down. If the patient is reactive to plastic, rolls of examination table paper can be used; recently a non-woven fabric (TNT) material has also become available.
For people affected by EHS, limit x-rays and use low-emission ones (digital x-rays), evaluate the usefulness of a Cone Beam CT on a case-by-case basis.
Numerous metals and materials used in dentistry can cause Type IV allergy (allergy not mediated by specific IgE, but by cytotoxic lymphocyte reactions). Therefore, before starting dental work involving the insertion of new materials, it would be advisable to perform the lymphocyte transformation test (LTT Melisa) to establish possible allergy.
The LTT measures the inflammatory reaction typical of MCS and EHS.
Do not use Patch Tests due to the concentration of allergens used in the test: they could further sensitize these individuals.
Consider Biological Dentistry:
We cite the association Washom which aims for the brand of Systemic and Biological Dentistry, which aims to contextualize and return the role of Dentistry to its roots, Medicine, in its Systemic declination as a relationship of the stomatognathic system with the rest of the organism and Biological (as an expression of respect for life based on the use of biocompatible and metal-free materials) https://societaitalianamedicina.it/project/wasbom/.
For those wishing to delve deeper into the subject, whether patients and/or doctors, a reading that explains these aspects very well is Toxic Dentistry. Vital Dentistry. The damages of dentistry and the solutions by Dr. Antonio Miclavez.
Gloves and rubber dams:
- Use blue or green nitrile gloves or vinyl gloves.
- Use purple dam for allergy sufferers without latex and without flavorings, there is only one type.
- There are also white gloves, which are less odorous than colored ones.
- For amalgam removal, use Roeko Flexi Dam rubber dam without latex and without talc.
- Dental floss: Oral-B Essential floss unwaxed.
Teeth cleaning:
- The EHS patient can have scaling performed with manual instruments without ultrasound.
- For biofilm removal, use a flavor-free bicarbonate powder spray (also evaluate here case by case) while for polishing with the brush, use water and pumice.
Root canal treatments:
- As a general rule, devitalized teeth are potentially carriers of odontogenic foci.
- Teeth should not be root canal treated in these people due to the various solvent substances used for root canal treatments, which release toxicity into the mouth and bone, and over time would cause worse problems to emerge with local bone damage.
- Root canal treatment in some patients has created infection problems; the best thing would be to extract the tooth. If root canal treatment is unavoidable, use slightly diluted hydrogen peroxide to clean the canals.
- A good alternative is to use laser to disinfect.
- Do not use Gutta-percha to fill canals or use gutta-percha without eugenol because eugenol is a terpene and terpenes release VOCs (volatile organic compounds).
- To seal the root, zinc phosphate cement can be used, which dilutes after a couple of months.
- Do not use provisional cements containing eugenol, only eugenol-free provisional cements, such as Cavit.
- Do not use resin composites.
- Be careful with calcium hydroxide (product Calcimol LC Voco) has caused major problems for some people with these diseases.
Bisphenol A:
- These people are unable to excrete Bisphenol A from the body. Alterations in liver detoxification mechanisms and antioxidant defenses can determine the onset of a state of systemic oxidative stress.
- As recently demonstrated, Bisphenol A is contained in almost all dental composites and is also a fundamental molecule in the synthesis of many common plastics and additives.
- Be careful not to use substances that release fluorine.
- Do not use chlorhexidine, and methacrylates because they are substances that the patient cannot eliminate.
- The methacrylates under accusation are: HEMA, UDMA, TEGDMA, BIS-GMA.
Do not use aldehydes:
- In dentistry, aldehydes are used as disinfectants, but also materials containing formaldehyde.
- Formaldehyde is an aldehyde present in some dental materials, such as resin composites, adhesives, methacrylate and urethane dimethacrylate. These materials are used to rebuild teeth, fix fillings, and in prosthetics and orthodontics.
- Also, some sterilization agents used to disinfect dental instruments contain formaldehyde.
Anesthetics:
- For many patients, the use of sulfites and adrenaline is not at all suitable as these substances can cause even serious problems.
- Use local anesthetics without adrenaline. Mepivacaine without adrenaline is usually well tolerated.
- It is advisable to always perform compatibility analyses such as the basophil activation test (BAT).
- One can also opt for acupuncture, as for this technique special gold needles are used for those allergic to nickel.
- Another useful method may be auriculotherapy.
Removal of amalgam fillings:
Amalgam removal must be done in total safety, scrupulously following the protocol reported here.
The protocol is drawn up by Prof. Max Daunderer based on his experience with over 2500 intoxicated patients. (Source: www.infoamica.it)
Safe removal to minimize patient exposure to mercury includes these precautions:
- oxygen mask / nasal cannula or supply of clean air from cylinder,
- protective plastic goggles (swimming type) if not available, place wet cotton on eyes;
- rubber or synthetic fiber dam and associate liquid dam to improve the seal;
- strong suction with a large cannula or special Clean-Up aspirator positioned above the operative field,
- technique of dislodgement i.e., drilling the tooth around the amalgam filling without touching it, trying to remove it whole. We know of at least one case of a person who became ill with MCS because the dentist cut the amalgam in half, even though he had used a rubber dam, suction and oxygen.
Other precautions for amalgam removal:
- The patient must be covered with a plastic apron under the dental bib to cover their clothing. It is also recommended to change clothes after removal to avoid contamination.
- To ensure minimal possible sublingual absorption, through mucosal tissues, and to minimize absorption of mercury vapor through the blood-brain barrier under the dam, use activated charcoal or local active chlorella, together with a cotton roll and gauze. This helps intercept particles and chelate dissolved metals penetrating inside the dam. Often particles have been found on sublingual tissues and lateral borders of the tongue.
- This must be avoided as it is a rapid route of absorption into the body.
- Very important when dislodging the amalgam is to use multi-blade tungsten carbide burs with a red ring multiplier contra-angle to mill with a low-speed, high-torque drill and prevent too high a speed from evaporating the mercury and intoxicating the person.
- Once finished: the gauze, cotton roll and activated charcoal/chlorella must be removed. The gauze is used to inspect the mouth and tongue, and ensure no particles have filtered under the dam. Once all mucosal tissues are completely checked and cleaned, the mouth should be rinsed with copious amounts of water, to avoid ingestion or absorption of amalgam particles.
- Prior to removal, the chewing gum test can also be performed for measuring metals in saliva, while metals in bone can only be measured if the tooth is extracted.
Implants:
- To evaluate suitable material, beyond various tests, it would be ideal for the patient to use, for a period, a piece of the material intended to be used. The patient, keeping it in their mouth, will be able to verify any adverse reactions. Exactly as described above, some dentists use composite balls to be held in the mouth like candies, for several hours a day so the patient can verify the compatibility or otherwise of the component.
- This empirical test has relative validity because it is conditioned by many variables, some of which cannot be controlled in advance.
- Ceramics would be the best thing but is very fragile.
- Zirconia is the most used; it does not corrode and does not conduct electricity. Zirconia can also be used for crowning, and for those who cannot have an implant, a removable prosthesis is made.
- All dental prostheses must be nickel-free.
PEEK (Polyether Ether Ketone) is a high-performance polymer material used for making dental implants and prostheses, particularly for crowns, bridges and abutments on implants. It is biocompatible and therefore used for allergic people. However, possibilities of reactions to any additives or contaminations that may occur during processing or use of this composite must be evaluated, which can be modified with additives such as reinforcements (e.g., carbon fiber) or colorants. Being wear-resistant, with bone-like flexibility, this material makes it ideal for complex prostheses and/or aesthetic restoration. It can be used to make structures on implants, acting as a shock absorber between the implant and bone.
- Dental frameworks, constructed from stainless steel (an iron alloy made stainless by adding a suitable concentration of nickel), can trigger an allergic reaction; the product can enter the circulation even in microscopic amounts and reach cells and tissues, thus making the product not tolerated by the patient. A chromium-cobalt alloy is also frequently used for frameworks.
- For frameworks, the only metal-free alternative is PEEK.
Attention: many people with these pathologies have vitamin D deficiency with very fragile bone that can break with an implant.
- Titanium implants are not indicated because they involve the release of microparticles of this material destined to spread throughout the body creating type IV allergy.
- Do not combine multiple metals for implants.
Materials for fillings and bridges:
It is not easy to find odorless materials free of solvent residues or free monomer. There are various types of plastic materials that are processed by hot injection into a mold and once cooled are inert plastics. Some names to look for:
- Valplast, Flexite, Flexione, acetal resin or nylon.
- Occlufast Rock, vinylpolysiloxane material for dental occlusion impressions. This material is supplied by Zhermack.
- As dental composite: Venus Diamond Kulzer without bisphenol A (does not contain methacrylates either).
- Composite: Ename! Plus HRI Bio Function Micerium without BIS-GMA, without BPA (contains fluoride), adhesive system Ena Bond Micerium.
- Composite: Admira Fusion 5 Voco without Bisphenol A, without methacrylates (no BIS-GMA, no TEGDMA, no UDMA, etc.)
- As adhesive: Ibond Kulzer without bisphenols.
- As etchant: a 37% orthophosphoric acid, any.
- Harvard Cement is a zinc phosphate cement produced by Harvard Dental International GmbH. Ideal for dental fillings, for fixing crowns, bridges and inlays. Material more compatible than others due to presence of zinc which plays a role in mercury detoxification. Being a porous material, it drains tooth toxins outward. To be preferred over sticky preparations.
- Recommended glass ionomer cements: Fuji.
- Adhesive: 3M Scotchbond Universal Plus without Bisphenol A.
- DoxaDent is a ceramic-based composite material that hardens directly in the tooth cavity, hermetically sealing it to form a solid filling.
Important warning: when the dentist places the adhesive on the floor, do not breathe, protect nose and mouth in presence of the rubber dam. The composite should not be spread all at once but in layers, each layer cured with the lamp so the inside of the cavity has also polymerized and not just the surface.
- If bridges are needed, better to make them removable with analog material specific for MCS. Valplast Nylon Thermoplastic is recommended.
- Dental Flex, company for flexible prostheses.
- There are also fully polymeric bio-prostheses, base similar to nylon.
- Dental inlay: Cerec in full ceramic.
- If the patient requires a bone graft, evaluate the quality of the calcium which can be calcium sulfate or other calcium solutions. It is advisable to perform the LTT test (Lymphocyte Transformation Test) first.
- Bone regeneration used in areas where there is bone loss, e.g., after tooth extraction or due to periodontal diseases, has created very serious problems for some of these people. Evaluate the bone matrix to be used for dental reconstruction and perform all tests before making any choice.
Document completed on 18-05-25
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PHYSICIANS:
Dr. Lina Pavanelli
Associate Professor of Anesthesia
Lecturer in Environmental Medicine A.S.S.I.M.A.S.
Ferrara
Currently retired
Dr. Donatella Fava
Specialist in Anesthesia and Resuscitation
Medical Director ASL LT
Formia
Currently retired
Dr. Rosanna Di Giosaffatte
Graduate in Medicine
Specialist in Odontostomatology
Biological Dentistry
Pescara
Dr. Paolo Genangeli
Dental Physician with 30 years of training and activity in Biological Dentistry and expert in Homeopathy and Homotoxicology. He has trained in Clinical Environmental Medicine and is a member of A.S.S.I.M.A.S.
Genzano di Roma (RM)
ASSOCIATIONS and COMMITTEES:
Association A.N.Chi.Se. Onlus
President: Ester Lupo
e-mail: anchiseonlus@libero.it
Tuscan MCS Committee
President: Marco Orlando
e-mail: comitatotoscanomcs@gmail.com
Committee Beyond MCS
President: Roberta Borghese
e-mail: comitato@oltrelamcs.org
A.N. Recognition MCS OdV
President: Luigi Sarno
e-mail: info@associazionenazionalemcs.it
A.S.S.I.M.A.S.
Italian Association Medicine Environment Health
President: Dr. Justina Claudatus
e-mail: info@assimas.it
Veneto Chemical Sensitivity Committee
President: Claudio Fiori
e-mail: comitatomcs@gmail.com
Umbria MCS Association OdV
President: Ruggero Martellini
e-mail: associazioneumbriamcs@gmail.com
A.D.A.S. Association for Defense of Environment and Health
President: Marisa Falcone
e-mail: adas.presidente@gmail.com
Association of Environmental Patients AS.M.AMB.
President: Giuseppina Marazia
e-mail: giusim2729@gmail.com
A.I.E. Italian Association of Electrosensitives
President: Paolo Orio
e-mail: presidente@elettrosensibili.it
Informal Committee SOS SENSIBILI
Referent: Elisabetta Saviotti
Facebook page: SOS-Sensibili