Please fill out my Survey

March 1997

The ADA says no one has suffered from mercury in their teeth, only some people are allergic. Many of us know this is not true and have suffered from the 50% mercury in the silvery dental filling amalgam and with galvanic contact with gold crowns.

Micromercurialism is the slow chronic build-up of mercury in tissues, in its acute stage shows signs of mercury poisoning. The symptoms are gradual and can include memory and concentration loss, chronic fatigue, repetitive motion fatigue, digestion problems, lowered immune system, joint pains, cell changes, vision problems and birth complications.

Amalgams often result in excessive drilling, tooth breakage, galvanism and the release of mercury vapors.

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Please complete this form to the best of your ability.

1) Please tell me your name:

2) Please tell me your email:

3) Please tell me your homepage:

4) Male Female

5) How old are you?
No comment Under 18 years old Between 19 and 24 years old Between 25 and 34 years old Between 35 and 44 years old More than 45 years old

6) How many of your teeth have contained amalgam?
No comment None 1-8 8-16 Over 16

7) How many amalgams were replaced with new amalgam?
No comment None 1-8 8-16 Over 16

8) Have you had tooth breakage with amalgams?
No comment Yes No

9) Do you have a medical diagnosis for which the doctor cannot determine the cause?
No comment Yes No Possibly

10) Have you noticed galvanism with amalgam? (electrical activity)
No comment Yes No Possibly

11) How did you notice galvanism?

12) Did you have your amalgams removed?
No comment Yes No Not all

13) After amalgam removal was there any change in any of your symptomatology?
No comment Yes No

14) What were the symptoms that changed?

15) What was the percentage of improvement?
No comment 0% 1-25% 25-50% 50-75% 75-99% 100%

16) Did you experience adverse effects during amalgam removal?
No comment Yes No

17) What were the adverse effects during amalgam removal?

18) Do you have any side effects from these dental materials?

Amalgam

Palladin

Gold

Composites

Injections

Solvents/glues

19) Would you like more information on:

Amalgam.

Amalgam removal.

Finding a dentist to remove amalgam.

How to return the body to optimal health following amalgam removal.

Options on dental materials.

Finding a support group.

Education, publicity or non-profit support.

20) Comments:

21) Would you like me to show the results with your identity concealed?
This entry will not be shown Yes I would like my identity concealed No I am only interested in totals Yes but INCLUDE MY IDENTITY (email first)

Thank you for taking the time to complete my survey.