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Mercury Toxicity Questionnaire

The patients of the Dr. Keith W. Sehnert Clinic in Minneapolis are given the following questionaire. Patients who score more than five "yeses" are referred to a dentist familiar with "silver" amalgam removal.

• 1. Have you had sore gums (gingivitis) often over the years?
• 2. Have you had mental symptoms such as confusion, forgetfulness?
• 3. Has severe depression been a frequent problem?
• 4. Has ringing in the ears (tinnitus) been present?
• 5. Have TMJ (temoral mandibular joint) problems been a concern of yours?
• 6. Have you had unusual shakiness (tremors) of your hands or arms or twitching of other muscles?
• 7. Do you have "brown spots" or "age spots" under your eyes or elsewhere in the skin of your body?
• 8. Have you tended to have more colds, flu, and other examples of infectious diseases than "normal"?
• 9. Have you had food allergies or intolerances?
• 10. Have you been to many doctors for your health problems and they have usually said "There is nothing wrong"?
• 11. Do you have numbness or burning sensations in your mouth or gums?
• 12. Do you have numbness or unexplained tingling in your arms or legs?
• 13. Have you developed difficulty in walking (altaxia) over the years?
• 14. Do you have 10 or more "silver" fillings?
• 15. Do you often have a "metallic" taste in your mouth?
• 16. Have you ever worked as a painter or in manufacturing/chemical or pesticide/fungicide factories or in pulp/paper mills that used mercury?
• 17. Have you worked as s dentist, hygienist, or dental assistant?
• 18. Have you ever had Candida-Related Complex (CRC) or yeast infections (vagina, mouth, or GI tract)?
• 19. Do you have a lot of bad breath (halitosis) or white tongue (thrush)?
• 20. Have you frequently had low basal axillary temperature (below 97.4 degrees F.) over the years?
• 21. Do you have problems with constipation?
• 22. Do you have heart irregularities or rapid pulse (tachycardia)?
• 23. Do you have unexplained arthritis in various joints?
• 24. Is it common for you to have a lot of mucus in your stools?
• 25. Do you have unidentified chest pains even after EKG's, X-ray, and heart studies are normal?
• 26. Is your sleep poor or do you have frequent insomnia?
• 27. Have you had frequent kidney infections or do you have significant kidney problems?
• 28. Are you extremely fatigued much of the time and never seem to have enough energy?
• 29. Do you have irritability or dramatic changes in behavior?
• 30. Are you on antidepressants now or have you been in the past?