{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T10:15:11Z","timestamp":1788862511795,"version":"build-2803163510"},"reference-count":31,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T00:00:00Z","timestamp":1776988800000},"content-version":"vor","delay-in-days":7,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004359","name":"Swedish Research Council","doi-asserted-by":"publisher","award":["2016\u201302349"],"award-info":[{"award-number":["2016\u201302349"]}],"id":[{"id":"10.13039\/501100004359","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004359","name":"Swedish Research Council","doi-asserted-by":"publisher","award":["2017\u201300777"],"award-info":[{"award-number":["2017\u201300777"]}],"id":[{"id":"10.13039\/501100004359","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004359","name":"Swedish Research Council","doi-asserted-by":"publisher","award":["2020\u201301998"],"award-info":[{"award-number":["2020\u201301998"]}],"id":[{"id":"10.13039\/501100004359","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100006636","name":"Swedish Research Council for Health, Working Life and Welfare","doi-asserted-by":"publisher","award":["2015\u201300195"],"award-info":[{"award-number":["2015\u201300195"]}],"id":[{"id":"10.13039\/501100006636","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100006636","name":"Swedish Research Council for Health, Working Life and Welfare","doi-asserted-by":"publisher","award":["2019\u201300697"],"award-info":[{"award-number":["2019\u201300697"]}],"id":[{"id":"10.13039\/501100006636","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003792","name":"Swedish Brain Foundation","doi-asserted-by":"crossref","award":["FO2020-0077"],"award-info":[{"award-number":["FO2020-0077"]}],"id":[{"id":"10.13039\/501100003792","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100003792","name":"Swedish Brain Foundation","doi-asserted-by":"crossref","award":["FO2022-0123"],"award-info":[{"award-number":["FO2022-0123"]}],"id":[{"id":"10.13039\/501100003792","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100003792","name":"Swedish Brain Foundation","doi-asserted-by":"crossref","award":["FO2024-0344"],"award-info":[{"award-number":["FO2024-0344"]}],"id":[{"id":"10.13039\/501100003792","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100006310","name":"Swedish Medical Research Council","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100006310","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Margaretha af Ugglas Foundation, and the Swedish Foundation for MS Research"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,4,17]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Concerns about the neurotoxic potential of dental amalgam in multiple sclerosis (MS) persists but its impact on disease risk and progression remains unclear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We used data from a Swedish population-based case\u2013control study (2386 cases, 4849 controls) to investigate the association between dental amalgam exposure and MS risk. Odds ratios (ORs) with 95% confidence intervals (CIs) were estimated by using logistic regression and interaction with smoking was evaluated. Relapsing-onset MS cases born between 1965 and 1985 (n\u2009=\u20091191) were followed longitudinally by using clinical data from the Swedish MS registry. The time to confirmed disability worsening (CDW) and Expanded Disability Status Scale (EDSS) 3 and 4 were assessed by using Cox regression; EDSS trajectories were analysed by using linear mixed-effects models.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Amalgam exposure was associated with increased MS risk in a dose-dependent manner (OR for trend 1.14, 95% CI 1.08\u20131.20). A significant interaction with smoking was observed (attributable proportion due to interaction 0.25, 95% CI 0.10\u20130.40). In the longitudinal cohort, those with at least six fillings had increased risk of CDW [hazard ratio (HR) 1.35, 95% CI 1.07\u20131.71] and progression to EDSS 3 (HR 1.48, 95% CI 1.07\u20132.05) and EDSS 4 (1.68, 95% CI 1.01\u20132.83). Associations were stronger among current smokers, those diagnosed after age 40\u00a0years, and individuals on low-efficacy therapies. The EDSS trajectories also showed faster progression in the high-exposure group (P\u2009=\u2009.044).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Dental amalgam exposure may be associated with both increased risk of MS and faster disability progression. Findings support a potential synergistic effect with smoking and raise the hypothesis that mercury may contribute to MS-related neurodegeneration.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ije\/dyag059","type":"journal-article","created":{"date-parts":[[2026,4,8]],"date-time":"2026-04-08T11:45:12Z","timestamp":1775648712000},"source":"Crossref","is-referenced-by-count":3,"title":["Dental-amalgam exposure and the risk and progression of multiple sclerosis"],"prefix":"10.1093","volume":"55","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6104-9957","authenticated-orcid":false,"given":"Jie","family":"Guo","sequence":"first","affiliation":[{"name":"Department of Nutrition and Health, China Agricultural University , Beijing,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomas","family":"Olsson","sequence":"additional","affiliation":[{"name":"Department of Clinical Neuroscience, Karolinska Institutet , Stockholm,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lars","family":"Alfredsson","sequence":"additional","affiliation":[{"name":"Institute of Environmental Medicine, Karolinska Institutet , Stockholm,","place":["Sweden"]},{"name":"Centre for Occupational and Environmental Medicine, Region Stockholm , Stockholm,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6612-4749","authenticated-orcid":false,"given":"Anna Karin","family":"Hedstr\u00f6m","sequence":"additional","affiliation":[{"name":"Department of Clinical Neuroscience, Karolinska Institutet , Stockholm,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,4,24]]},"reference":[{"key":"2026042409161993800_dyag059-B1","doi-asserted-by":"crossref","first-page":"1212676","DOI":"10.3389\/fimmu.2023.1212676","article-title":"Risk factors for multiple 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