Mercury Toxicity Questionnaire
This questionnaire is part of a US FDA approved study called an Institutional Review Board to assess how body burden of mercury is determined, toxicity levels etc. It will serve as a warning or alert to clinicians when patients have scores of 'yes' in five or more of the questions. It is recommended that such patients be referred to dentists with special knowledge of safe mercury amalgam removal and replacement.
- Have you had sore gums (gingivitis) often over the years?
- Have you had mental symptoms such as confusion, forgetfulness?
- Has severe depression been a frequent problem?
- Has ringing in the ears (tinnitus) been present?
- Have TMJ (temporal mandibular joint) problems been a concern?
- Have you had unusual shakiness (tremors) your hands or arms or twitching of muscles?
- Do you have 'brown spots' or 'age spots' under your eyes or elsewhere?
- Have you tended to have more colds, flu, and other infectious diseases than 'normal'?
- Have you had food allergies or intolerances?
- Have you been to many doctors and they have usually said “there is nothing wrong"?
- Do you have numbness or burning sensations in your mouth or gums?
- Do you have numbness or unexplained tingling in your arms or legs?
- Have you developed difficulty in walking (ataxia) over the years?
- Do you have ten or more amalgam fillings?
- Do you often have a 'metallic' taste in your mouth?
- Have you ever worked as a painter or in factories or in pulp/paper mills that used mercury?
- Have you worked as a dentist, or dental assistant?
- Have you ever had Candida or yeast infections (vagina, mouth, or stomach)?
- Do you have a lot of bad breath (halitosis) or white tongue (thrush)?
- Have you frequently had low basal body temperature, below 36,5?
- Do you have problems with constipation?
- Are you on antidepressants now or have you been in the past?
- Do you have heart irregularities or rapid pulse tachycardia?
- Do you have unexplained arthritis in various joints?
- Is your sleep poor or do you have frequent insomnia?
- Have you had frequent kidney infections or do you have significant kidney problems?
- Are you extremely fatigued much of the time and never seem to have enough energy?
- Do you have unidentified chest pains even when ECG, X-ray and heart studies are normal?
- Do you have irritability or dramatic changes in behaviour?
- Is it common for you to have a lot of mucus in your stools?