ONE PROTOCOL for REMOVING AMALGAMS

There is, of course, no amalgam removal protocol that is endorsed by the American Dental Association, for this organization remains in denial of the documented health hazards posed by amalgam fillings and is invested in maintaining the status quo. Holistic dentists who practice mercury removal are thus on their own to devise safe protocols for amalgam removal. Many take guidance from The International Academy of Oral Medicine and Toxicology (IAOMT), “a membership organization for dental, medical and research professionals who seek to promote mercury-free dentistry, and raise the standards of scientific biocompatibility in dental practice (www.iaomt.org). The IAOMT has published guidelines (posted on their web site) and suggested protocols for safe removal of amalgam fillings.

While chewing increases the amount of mercury vapor emissions to several times the EPA allowable air concentration levels, the process of removing or replacing these fillings can expose the patient to “amounts which are a thousand times greater than the EPA allowable concentrations.”1 Heat increases the release of mercury vapor, and a great deal of heat is generated when a dental drill is used to remove an amalgam filling. As soon as the drill touches the filling, the amount of vapor coming off the tooth is immediately increased dramatically, posing a significant health risk to the patient, the dentist and any attending staff. It is for this reason that holistic dentists perceive a need to follow strict protocols that will reduce the amount of mercury exposure during amalgam removal procedures.

Scheduling

For those patients who have numerous amalgam fillings, the removal process will often be done over a period of time, perhaps a quadrant at a time.

Sequential Removal

Metallic fillings generate electric currents (a process known as “oral galvanism”) that can be measured in volts and micro-amps. Some dentists believe that removing amalgam fillings sequentially, starting with the one with the highest charge and ending with the one with the lowest, is necessary in order to minimize adverse reactions to the removal procedure. The IAOMT’s stand on this practice, however, is that, while it “seems to make sense … until there is scientific evidence to support this claim, it remains Clinical Folklore.”2

While amalgam replacement protocols differ somewhat from dentist to dentist and may even differ with a single dentist from patient to patient, depending upon their unique situation, there are certain general points regarding removal that can be made. Based on IAOMT mercury removal protocols, recommendations to dentists include:

Keep the fillings cool. This is accomplished by liberally and continuously applying a cold-water spray directed at the tip of the cutting bur throughout the entire removal process.

Use a high volume evacuator (suction tip).

Keeping such a tip ½” from the tooth being treated at all times during the removal process will direct mercury vapor away from the immediate area surrounding the patient.

Provide an alternative air (oxygen) source.

Both patient and operators should be provided with an appropriate nasal mask (an approved mercury filter mask for operators). The patient should be instructed not to breath through their mouth during treatment.

Provide protective facial gear.

Shaded eye protection is recommended for the patient and full transparent facial protection for operators.

Use a rubber dam, if possible.

This is a mouth-size rubber sheer that is stretched around the tooth being treated so that only that tooth is exposed. A well-fitting rubber dam will help prevent inhalation of mercury vapor and ingestion of amalgam particles, although it should be noted that vapor and amalgam particles may accumulate underneath the dam.

Section amalgams.

The fillings should be sectioned with a cutting bur and removed in large pieces to reduce vapor exposure.

Keep room air pure.

Use appropriate ventilation systems and room air purifiers to reduce ambient mercury vapor.

Clean up immediately.

Upon completion of amalgam removal, lavage the patient’s mouth for at least 30 seconds with cold water and vacuum. Change gloves (and rubber dam if one was used) before proceeding with restorative procedures. Change patient’s protective wear, and clean their face.

Consider appropriate suction waste water separation system.

Strict laws govern the disposal of mercury due to its high level of toxicity.

Consider nutritional and physical support.

The patient may be treated with (or referred for treatment with) such modalities as homeopathy, massage, acupuncture and nutrition to accelerate the detoxification process following amalgam removal.

Select appropriate biocompatible restorative materials.

Such selection should be made through use of specific testing (serum compatibility or skin galvanic response tests) or published research.

Interestingly, OSHA requires that employees be given written informed consent before the use of any toxic chemicals, which would include mercury.3 Furthermore, the National Institute of Occupational Safety and Health has recommended medical monitoring for any employees who use or remove mercury.4

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1 http://curezone.com/dental/dental_amalgam.asp 
2 www.iamot.org
3 Ibid.
4 Ibid

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Information on this site is for educational purposes only and is not to be construed as medical advice.  If you have a medical or dental condition,  please consult an appropriate health care provider.