Abstract: Neurocutaneous Syndrome (NCS) is a dental toxicity disorder causing various neurological and dermatological symptoms that are often confused by the lay patient as parasitological infections. The cases of 24 randomly selected patients determined to be NCS cases at Parasitology Center, Inc. (PCI) by OMA are presented. Previously reported and additional toxic sealants are reported. The dermatological and neurological symptoms characteristic of NCS were common to all 24 cases. Incubation period varied between a few hours and 19 years. Inaccurate interpretation of NCS symptoms by health care professionals is discussed. Faulty diagnosis undermines the patients physical and mental health and further traumatizes their quality of life especially when they are diagnosed with mental disorders and forced to submit to psychological treatment against their will. Medical professionals need to become more aware of NCS symptoms to properly tend to their patients well being.

Introduction

Neurocutaneous Syndrome (NCS), a newly discovered dental toxicity syndrome (Amin, 2001) is characterized by neurological and dermatological disorders as well as systemic and related dysfunctions. Patients experience, among other symptoms, pin-prick movement sensations and itchy cutaneous lesions that may invite various opportunistic infections. Components of the calcium hydroxide sealants Dycal, Life, and Sealapex, among others, have been identified as the source of the observed symptoms. The toxicity of sealants, compounding factors and case histories were discussed and management protocols practiced at Parasitology Center, Inc. (PCI) were proposed by Amin (2003, 2004). Lay NCS patients often confuse the movement sensations, itchy skin and related symptoms with parasitic infections and seek medical help under this assumption. Invariably, they are diagnosed with and treated for other etiologies often including arthropod infestation and/ or mental conditions such as psychosis. Patients are genuine clinical cases that should not be further compromised by inaccurate diagnosis, wrongly medicated or subjected to psychological treatment in mental health care facilities. On occasions, I spend time helping NCS patients out of mental facilities. The institutionalization of some patients seriously compromise their state of mental and physical health, self confidence, and their ability to make sound decisions.

This paper address the various aspects of diagnosis of NCS patients by MDs, dermatologists and other health care professionals as well as the symptoms and outcome of 24 NCS patients.

Materials and Methods

Files of 24 patients were randomly selected from among those examined at PCI and determined by OMA as NCS cases. Information on patients' dental history, symptoms, interpretation of NCS symptoms by health care professionals, diagnosis at PCI by OMA and outcome were compiled from our files and summarized in Table 1. All patients were personally interviewed and information provided was substantiated with documents, dental histories and personal observations. Dermatological symptoms were invariably documented by photos taken by OMA. Patients pursuing dental rehabilitation were initially referred to a holistic dentist, started off on a prescribed regimen of vitamins and supplements, required to take a biocompatibility blood test for sensitivity to dental material and, more recently, underwent laser and lymph drainage therapy at PCI.

Results and Discussion

Table 1. History of 24 randomly selected patients diagnosed with Neurocutaneous Syndrome (NCS) at Parasitology Center, Inc (PCI) and their diagnoses by other medical professionals.

	Patient	Dental History	Symptoms	Diagnosis given*	PCI Diagnosis / outcome
1	DB: white female from California born on 4-9-65	10 amalgam restorations in 1982 and 1983 using Life.	NCS symptoms first noted in 2001/2002. Sores, swelling, diffuse rash, black specks (fungal spores), pin prick and subcutaneous crawling sensations.	Anxiety disorder Sores dismissed as not clinically genuine. Patient declared normal.	Diagnosed with NCS on 12-12-02. Treatment in progress. Fig. 6 (Amin, 2003, 2004).
2	JB: white female from Arizona, born on 6-19-74	10 fillings: 6 amalgam (1978-88), 2 caulk (zinc oxide & eugenol, 1988) sealant, 2 silux composite (1990)	Open sores, rashes, excretions, pin prick & crawling sensations, high fever, joint pain	Hypertension, referred to Pulmonary. Staphylococcus (11-11-03) Impetigo (9-2-03), sebaceous cysts (11-14-03, blood pressure medication,	Diagnosed with NCS on 11-24-03. Follow up information not available.
3	ME: white female from Sweden, born on 5-26-51	Dycal sealants in 20 teeth in 1985; allergic to sulfa. Dycal removed in 1991, 92 and initially replaced with Harvard cement. Initial healing period was painful.	Typical sulfa toxicity symptoms, oozing diffuse skin and nasal sores, memory loss, kidney pain, sensitivity to light and electricity, pin prick and crawling sensations, itching, breathing difficulties. Photosensitivity produced blotchy skin with severe burning sensations in face, throat and chest. Fatigue.	Polyneuropathy, atopic dermatitis. Toxic ulcerative dermatitis.	Diagnosed in Sweden with Dycal related syndrome. Severe musculo skeletal pain and bowel disturbances during initial stages of dental rehabilitation. Complete recovery since 1992 after 1 year of rehabilitation. Case no. 1 in Amin (2003)
4	BG: white male from New Mexico, born in 1962	Allergic to bonding sealant (Heraeus Albabond ET) in 3 of 4 crowns removed (much amalgam underneath). One filling and 2 overlays redone on 4-24-03.	Skin sores and lesions. Burning eyes, recurrent respiratory infections, memory loss, blurred vision, allergies.	Not taken seriously Told lesions were self inflicted, depression.	Diagnosed with NCS on 4-17-04. Follow up information not available.
5	LG: white female from California, born in 1957	Dycal in tooth #18 on 9-18-1998. Allergic to sulfa. Removed Dycal in April, 2002 and replaced with Starflow and Aria.	Symptoms started same day. Lesions, open sores, grayish secretions with springtails and fibers, pin prick, movement sensations, high blood pressure, fatigue, heart palpitations, valve prolapse, fatigue, swelling, weight loss.	Crazy, self inflicted wounds, stress, anxiety, almost admitted to insane asylum. Scabies (no mites demonstrated).	Diagnosed with NCS in Jan. 2002. All symptoms resolved by May, 2002. Case no. 3 in Amin (2003, 2004).
6	AH: white American female born on 1-21-1932	Used Life and Sealapex; date undetermined.	Inflammation, rashes, movement sensations, Used Sulfa derm once on face; discontinued because of irritation.	Dermatitis (1-23-00), treated with Clobetasol. Scabies (10-9-01, no mites demonstrated), treated with Mebendazole.	Diagnosed with NCS. Follow up information not available.
	Patient	Dental History	Symptoms	Diagnosis given*	PCI Diagnosis / outcome
7	EJ: white female from Norway, born on 5-22-71	7 fillings using Dycal & Life (ethyltoluene sulfonamide, zinc oxide) with Clearfil SE primer (2-hydroxyethyl-methacrylate, dimethacrylates) bond in 1979 (at age 7). Root canal in 1 tooth using Procosol in 1995. Highly reactive to Dycal & Life (bio-compatibility test).	NCS symptoms first observed in 1989. Dental decay, sores, pin prick, crawling sensations, heart palpitations, memory loss, breathing and intestinal disturbances, swelling, fatigue, insomnia, electro-magnetic sensitivity, night fevers/ sweats, trauma, gray gum tissue and tongue.	Delusionary parasitosis, cancer, unspecific dermatitis, scabies (no skin samples taken and no mites or parasites recovered). Treated with Dalacin, Tetracycline Arco, Differin; no improvement.	Diagnosed with NCS on 4-23-04.Completed dental rehabilitation within 1 month. Supplements, laser treatment and lymph drainage continue. Neurological symptoms resolved in 8 months.
8	JK: white female from Wisconsin, born in 1950	4 root canals using Gutta Percha and Sultan in 1996-98.	Itchy sores, crawling sensations, Allergy to metals.	Sores dismissed as self-inflicted. Sensations declared imaginary.	Diagnosed with NCS on 3-16-2004. Dental rehabilitation in progress.
9	SK: white female from California, born 9-17-56	Porcelain veneers cemented with zinc oxide and Durelon in the 1990's.	Pain, inflammation, widely diffused lesions, itching, shaking, joint pain, coated tongue, fungal infections, recurrent reaction to sulfa drugs.	Superficial and deep perivascular dermatitis. Treated with Augmentin, Vicodin, Tinidazole, cod liver oil.	Diagnosed with NCS in December, 2002. (Fig. 5 in Amin, 2003, 2004). Follow up information not available.
10	GK: white female from Alaska, born in 1954.	5 resin fillings (silicate based methyl methacrylate, 9-13-00); 2 gold crowns (biogold, 8-2001); 2 root canals (Gutta Percha, 2002); 2 porcelain crowns (9-2002).	Rash all over body, crawling sensations, breathing difficulties, angina, pain. Sensitivity to sulfa.	Pericarditis, meningitis, encephalitis. Treated with Biotics ADP and heavy metal protocol.	Diagnosed with NCS on 4-15-03. Removed affected teeth same month. Dermatological, neurological & other systemic problems resolved within a few weeks.
11	JM: white female from Arizona/ Colorado on 4-17-65	17 fillings; 16 with Dycal. Dycal removed in 2001. Followed by initial episodes of sickness, sweats & vomiting.	First NCS symptoms noted in 1991. Rash, ulcerations, crawling and pin prick sensations, vomiting, joint and dental pain, insomnia, swelling, skin peeling & tracks, elevated veins, red hot face and chest, body tremors, hair loss, night fevers, coughing, heavily medicated.	Psychotic; delusional parasitosis; not taken seriously as a genuine clinical case by medical professionals or family/ friends.	Diagnosed with NCS in Sept., 2000. Complete resolution of all symptoms by mid 2002. Case no. 2 in Amin (2003, 2004).
12	KM: white female from Arizona born in 1966.	Life in 3 teeth (1987, 91, 93).	Skin sores, crawling & pin prick sensations, scalp irritation, changes in hair quality, respiratory difficulties.	Walking pneumonia, environmentally induced asthma (11-2002). Treated with Doxipin, Capex shampoo, Stromectal.	Diagnosed with NCS on 12-16-02. Follow up information not available. Figures 1, 2 (Amin, 2003, 2004).
	Patient	Dental History	Symptoms	Diagnosis given*	PCI Diagnosis / outcome
13	KM: white female from California, born in 1964	3 fillings using Dycal: 2 in 1982 & 1 in 2002. Dycal removed on 12-2002.	Crawling sensations in upper quadrant started in 1997. Cutaneous sores & rashes started in spring 2002 preceeded by extensive treatment with topical sulfa products for possible "mite infestation." Hot-red skin.	Scabies (never demonstrated). Treated with Elimite, Ivermectin and herbs.	Diagnosed with NCS on 11-19-02. Progressive resolution of all symptoms following removal of Dycal.
14	MM: white female from California, born on 9-2-50	Fynal in 6 teeth in 1981 and in 1 tooth in 1986. Life in 2 teeth in 1985 & 1988 (root canal, impacted teeth, metal rods, crowns). Highly reactive to Life and Dycal (compatability test).	Large mucoid lesions on face, pain, black specks (fungal spores), excretions, intense itching, ringing in ears, crawling sensations, poor circulation, compromised immunity.	Psychosis (2-1999); hyperkeratosis, hemachromatosis mercury poisoning, over use of anti- biotics (1998).	Diagnosed with NCS in 1999. Finally undertook total dental rehabilitation in May and June, 2004. Fig. 4 (Amin, 2003, 2004).
15	TR: white female from Nevada, born on 10-8-64.	5 molars using Dycal; records not available. Removed all molars in September 2003.	Diffuse skin eruptions throughout entire body, severe itching, crawling sensations, fatigue.	Delusional parasitosis, dermatitis.	Diagnosed with NCS on 2-13-2003. All NCS symptoms resolved shortly after removal of toxic molars.
16	TS: white female from Arizona, born in 1969.	5 teeth sealed: 3 with IRM and 2 with Sultan U/P; 14 teeth with Gluma One Bond and Scotch Bond (containing hydroxyethyl methacrylate)(1995-96).	Severe open lesions on arms and face, crawling sensations, pain, night sweats, chills, fever, nausea, headaches, stomach- aches.	Unspecific dermatitis.	Diagnosed with NCS 3-4-2003. Follow up information not available.
17	PS: white female from Arizona, born on 2-28-53	9 teeth with Dycal: 3 in 1977, 2 in 82, 1 in 83, 1 in 85, 2 in 87. Durelon and Fugi cement also used.	Diffuse rashes, fibers, crawling sensations, sleep disorders, GI problems.	Psychosis, anxiety disorder (4-18-2000), eryhtroporetic protoporphyria (March 98), neurodermatitis.	Diagnosed with NCS in Dec., 2002. Rehabilitation in progress.
18	CS: white female from Arizona, born on 4-19-35	5 teeth with Dycal; records not available.	Skin lesions, itching, biting sensations, fibers, superimposed fungal infection.	Delusional parasitosis, Dermatitis, blood bacteria (1-27-02), seborrheic keratosis (2-10-03).	Diagnosed with NCS on 2-10-03. Extracted 2 compromised teeth in late 2003 and 3 remaining teeth on 5-21-04. Some symptoms relieved. Recovery in progress.
	Patient	Dental History	Symptoms	Diagnosis given*	PCI Diagnosis / outcome
19	KS: white female from Arizona, born ca. 1965	cemented veneer in #24. Tooth extracted in early Nov., 2002.	First noted NCS symptoms in 3-2002. Sore & facial lesions, crawling and pin-prick sensations.	Dismissed with mental disorders and psychosis, under psychiatric care in mental facility for weeks until helped out by author.	Diagnosed with NCS on 10-23-02. Full recovery by end of Nov., 2002.
20	JT: white male from California, born in 1951.	4 fillings in 1984-87 with crowns, bridge. Apicoectamy in 1 molar, 1 extraction, 2 fillings in 1988. 4 teeth extracted in 1991, 94, 95, 98 because of extreme pain. 1 tooth filled with Tetric (Mono & DiMethacrylates & Titanium dioxide) in 1998.	First noted NCS symptoms in 2003. Lesions, hyper-sensitivity, painful sores, itching, pin prick, crawling & burning sensations, brain fog, memory loss, inflamed gums, dental decay & abcesses, breathing disturbances, sinus infections, depression.	Scabies & lice (2003; mites not demonstrated). Depression; sleeping aids, e.g., Trazodone.	on 4-20-04. Dental rehabilitation in progress.
21	KT: white female from Illinois	Presumptive Dycal treatment; dental records not available.	First NCS symptoms noted in 2003. Skin pistules, scabs, biting pain, itching, crawling sensations, swelling, black specks (fungal spores). Allergic to sulfa.	Scabies (8-14-03; mites not demonstrated), treated with Pyrmythrin, Elimite,Prednisone. Dermal candidiasis, angular chelitis (6-10-99).	Diagnosed with NCS on 8-19-03. Follow up information not available.
22	JT: white female from Georgia	Fynal in 8 teeth, Eugenol used as cement in 1992.	Extensive skin lesions, crawling sensations, memory problems, insomnia, dizziness, fatigue, headaches, joint pain, fibers & filaments.	Delusional parasitosis & fibromyalgia.	Diagnosed with NCS on 3-25-03. Follow up information not available.
23	TV: white female from Arizona, born on 8-4-61	Root canal on 4-9-02; Dycal used but not documented. Decay and leakage.	Whitish/ gray skin excretions, sores, rash, itching, burning sensation, gastric discomfort, cramps, diarrhea.	Body lice (1-17-03; not demonstrated). Treated with Elimite. Bacterial vaginosis, parasitosis (8-14-02).	Diagnosed with NCS on 3-26-03. Follow up information not available.
24	CW: white female from Arkansas	Two teeth compromised with Dycal; date not available.	First NCS symptoms noted in 2002. Diffuse rash, itching, superimposed fungal infections.	Delusionary parasitosis, pruritis (3-18-03), chronic dermatitis, superficial lymphocytic dermatitis with eosinophils.	Diagnosed with NCS on 4-24-03. The 2 compromised teeth were rehabilitated. Full recovery shortly afterwards.

* Diagnosis given by other medical professionals re NCS symptoms.

Patients
The NCS patient population clearly includes many more females than males. The reported random sample of 24 patients included two 42 and 53 years old males (mean 47) and 22 33-79 years old females (mean 45). Twenty-two patients were from the United States and two from Europe, Norway & Sweden. The predominance of females among NCS cases is not fully understood in cases of toxicity disorders. Whether susceptibility to toxins such as sulfa may be differentially mediated by hormones or not is unknown.
Dental History
The sealants incriminated in the 24 NCS cases studied (Table 1) included the zinc oxide/ ethyltoluene sulfonamide sealants Dycal, Life and Sealapex, among others, previously reported to be toxic (Amin, 2003, 2004). Other dental material including zinc oxide, e.g., Caulk and Gutta Percha that were not reported by Amin (2003, 2004) were also involved in new NCS cases reported herein e.g., cases no. 2, 8 and 10. Most cases seen by me within the last two years were compromised by dental work using toxic material as early as 1978 (case no. 2) while others as recent as 2002 (case nos. 10, 19) (Table 1).
Symptoms
The most common dermatological and neurological symptoms of NCS were observed in all 24 patients. Some of these patients had well documented sulfa sensitivity. Other systemic difficulties, e.g., respiratory, intestinal were also noted (Table 1). The time between the original dental procedure and first appearance of symptoms (incubation period) varied between a few hours (case no. 5) and 19 years (cases nos. 1 & 20) (Table 1). We have other records of incubation periods of up to 32 years. Amin (2004) indicated that “the toxicity of ethyltoluene sulfonamide is determined by the concentration of this compound in the sealant used, the amount of sealant used and number of teeth involved” and that “the patient's reaction will depend on the degree of sensitivity to the compounds. These variables determine the time after which the patient will begin to experience symptoms.”
Diagnosis Given
Diagnosis given by health care professionals usually involved arthropods (that are never recovered), and unspecific dermatitis for which patients were medicated but showed no improvement. What is most disturbing is diagnosing patients with various mental disorders, e.g., psychosis, anxiety disorder, delusional parasitosis or the charging that the dermatological symptoms were self inflicted. Thirteen patients (54%) were given diagnosis of mental disorders (Table 1). The ensuing trauma has driven a few of my patients to the edge, contemplating suicide. Medical professionals do need to have a better understanding of NCS as a genuine clinical syndrome and deal with their patients from that perspective.
Diagnosis at PCI
Most of the reported patients were diagnosed with NCS at PCI by OMA within the last two years. Those that followed up with our treatment recommendations (Amin, 2004) had invariably recovered (cases nos. 5, 10, 12, 13, 15, 19, 24). Recovery of a few other patients is partial or underway; more time is needed. Depending on the toxicity variable mentioned above (see symptoms), recovery can take anywhere between a few weeks and up to one year. Fully recovered patients, however, may retain some sensitivities to mold or humid un-aerated places. Early stages of healing can become quite painful, e.g., case no. 3 (Table 1).

References

Amin, O. M. 2001. Neuro-cutaneous Syndrome (NCS); a new disorder. Explore, 10: 55-56.

Amin, O.M. 2003. On the diagnosis and management of neurocutaneous syndrome (NCS), a toxicity disorder from dental sealants. Explore, 12: 21-25.

Amin, O.M. 2004. Dental sealant toxicity: Neurocutaneous Syndrome (NCS), a dermatological and neurological disorder. The Communicator, Holistic Dental Association Journal, 2004: 1-15.