A systematic review in 2009 demonstrated that mercury released from amalgam restorations does not give rise to toxic effects on the nervous system of children. In 2014, a Cochrane Systematic review found "insufficient evidence to support or refute any adverse effects associated with amalgam or composite restorations." Those opposed to dental amalgam suggest that mercury from dental amalgam may lead to nephrotoxicity, neurobehavioural changes, autoimmunity, oxidative stress, autism, skin and mucosa alterations, non-specific symptoms and complaints, Alzheimer's disease, calcium-building in the kidneys, kidney stones, thyroid issues, and multiple sclerosis. Autoimmune disorders Both those opposed and those not opposed to dental amalgam recognize that amalgam has been found to be a rare contributor to localized and temporary tissue irritation known as oral lichenoid lesions. These mild, lichenoid reactions have also been reported in composite resin fillings. Those opposed to amalgam believe that amalgam fillings are also associated with increased risk of other autoimmune conditions such as multiple sclerosis (MS), lupus, thyroiditis, and eczema. Consumer Reports considered these alleged associations between amalgam and chronic disease made by some health practitioners as "prospecting for diseases". The National Multiple Sclerosis Society (USA) similarly has stated, "There is no scientific evidence to connect the development or worsening of MS with dental fillings containing mercury, and therefore no reason to have those fillings removed. Although poisoning with heavy metals-such as mercury, lead, or manganese can damage the nervous system and produce symptoms such as tremor and weakness, the damage is inflicted in a different way than occurs in MS and the process is also different." The Lupus Foundation of America also states on their website, "At the present time, we do not have any scientific data that indicates that dental fillings may act as a trigger of lupus. In fact, it is highly unlikely that dental fillings aggravate or cause SLE." Dental staff impact In 2006, a literature review was undertaken to evaluate the research on amalgam and its potential health effects on dentists and dental staff. It was reported that there is currently no conclusive epidemiological evidence regarding risks for adverse reproductive outcomes associated with mercury and dental professionals. It is mentioned that evidence to date fails to account for all confounding variables (such as alcohol consumption) and recommends more comprehensive and rigorous studies to adequately assess the hazards faced by dental personnel. Removal of amalgam The American College of Medical Toxicology and the American