Amalgam Removal or Cavitation Surgery – Which Should Come First?

©2004 Suzin Stockton

This is a question I’m often asked, and about which I’ve only recently begun to have a solid point of view. I would say that the majority of dentists today, influenced by the ADA party line, would respond that neither amalgam removal nor cavitation surgery is necessary! And I would guess that the majority of ‘holistic’ dentists — even those familiar with cavitations (and not all are) — would answer that amalgam removal should be the top priority. I believe this perspective is born more out of greater familiarity with the amalgam issue than anything else. If we take a close look at the facts, several good reasons emerge for addressing the cavitation issue first, at least diagnostically.

First, let me emphasize that a cavitation is a hollow area of dead (necrotic) or dying bone in the jaw. While bacteria may exist at cavitation sites, more often than not, few, if any, are found there, according to oral pathologist Jerry Bouquot. Bacterial trauma may certainly initiate the cavitation process, but by the time a cavitation is fully formed, infection is usually not a dominant clinical feature. A jawbone cavitation is predominantly an ischemic condition, one involving compromised blood flow to the area. The presence of dead bone interferes with blood supply, and any tooth remaining at the site slowly dies from lack of nourishment, lack of oxygen and inability to rid itself of toxins. This being the case, the treatment of choice is thorough surgical removal of any dead or dying bone in the jaw, along with extraction of any teeth at such sites. This will remove the conditions that may give rise to infection and prevent the spreading of jawbone necrosis (cavitations).

Because jawbone cavitations are largely a result of trauma to the jawbone, and the majority of that trauma for most of us comes from standard dental treatment (drilling of teeth, extractions, root canal therapy, etc.), it stands to reason that the condition can be aggravated in the course of amalgam replacement, which involves more drilling, more trauma to tooth and bone. These lesions (cavitations) tend to spread, and their spreading may be a causative factor when the patient with newly placed mercury-free restorations complains of jaw pain or toothache where none had been before.

Because many people have widespread necrosis in the jawbone (as evidenced through bone sonography Cavitat scans), the reality is that some degree of tooth loss is often necessary in order to get at dead bone to remove it and stop the bone loss process. This (cavitational) process has been referred to as gangrene of the jawbone by Colorado Springs cardiologist Thomas Levy. I like that description because it conveys the gravity of the situation, as well as an image of spreading tissue rot – exactly what we have with cavitations. Now, come into my common sense corner for a minute: From what you already know about cavitations, can you tell me which teeth are likely candidates for extraction? Those that have been filled, root canal treated or capped! And, if those restorations happen to contain mercury, how much sense does it make to further traumatize the tooth (and bone) by removing the amalgam-containing restoration and placing a biocompatible material without first checking the condition of the jawbone?? If the patient first gets a Cavitat scan, s/he may well find that some (or possibly all) of the teeth that would otherwise have undergone amalgam replacement will have to be extracted to get at the underlying bone necrosis. Now, who wants to undergo the trauma and expense of amalgam replacement, just to have it followed by loss of the very teeth that were just restored? And this is what may well happen if the person has a chronic cavitation problem. Since cavitations are often silent (i.e., cause no local symptoms), the patient (and dentist) may be totally unaware of the presence of this serious condition, and so not take it into consideration when planning amalgam replacement. This oversight may set the patient up for more dental problems down the road, even though all concerned had the best of intentions.

Another consideration in amalgam removal with someone who may have cavitations is the effect it could have on the microbial population of the oral cavity. Mercury, with all its associated problems, was once used extensively in medicine (and still is to a limited degree — some hemorrhoid preparations contain it). In the 1300s, it was used in the form of ore cinnabar to treat syphilis. It was also once used to treat tuberculosis and rheumatism. The metal has been used medicinally because of its antiseptic qualities, a result of the denaturing of the enzymes of microorganisms. The anti-fungal effects of mercury are well known today. That’s why it’s used in some paints to retard mold. Could it be that mercury plays a similar role when placed in the teeth, that its presence controls the microbial population in the mouth to some degree? While I’m all for amalgam removal because of the well-documented insidious effects of mercury on the body, IF that amalgam lives in a mouth where there is oral infection, and then that mercury-containing amalgam is suddenly removed, it would seem possible that a result could be a proliferation of microbes in the mouth, causing a worsening of the infection. Given this possibility, it would seem wise to remove the conditions giving rise to “focal infection” (a walled off area of concentrated toxins and necrotic and/or infected tissue — a cavitation!) prior to removing the mercury. Please understand clearly that I’m not arguing against amalgam removal, simply speculating that it may be in the body’s best interest to first treat cavitation sites (by removing necrotic bone). Far from protecting the body from microbes, over the long haul, mercury will do just the opposite by weakening the immune system. Mercury contaminated neutrophils (immune macrophages that consume microorganisms) lose their ability to ingest yeast, allowing Candida and other yeast and fungi to overtake the body.

Finally, let’s look at what can happen if amalgams are removed, cavitations go untreated, and the patient embarks upon an oral chelation program using a formula that contains the sulfur-containing amino acids methionine and cysteine. It is known that gram-negative anaerobic bacteria (the kind that may be found at cavitation sites) desulfurate these amino acids, resulting in the formation of volatile sulfur compounds – hydrogen sulfide and methyl mercaptan. These compounds, in turn, form complexes with mercury that greatly increase its toxicity. While the anaerobic bacteria will also take sulfur from the amino acids in the protein food we eat, and we can’t do without protein to starve out the microbes, we can avoid giving them extra sulfur through our ingestion of it in oral chelation products. So if you’re undergoing oral chelation following amalgam replacement and think you may have cavitations, it may be wise to use a chelating agent that does not contain methionine or cysteine. If you haven’t yet replaced your amalgams, you may wish to treat cavitations first to eliminate any gram-negative anaerobic bacteria. Then there should be no problem in using a chelation formula that contains sulfur-bearing amino acids.

With regard to all of the above considerations, I would conclude that it is imperative to assess the condition of the jawbone (through use of bone sonography) before embarking upon amalgam replacement – or any type of restorative dental work. If the jawbone is shown to be in good condition, I see no contraindications to proceeding with amalgam replacement. If some of the amalgam-restored teeth are living in necrotic bone, then the patient may wish to have those teeth extracted in conjunction with cavitation surgery and then proceed to have the remaining mercury-containing restorations replaced. OR the order may be reversed. I don’t have a strong point of view about this, though I do tend to favor handling cavitations first. What matters most is that amalgam replacement is not initiated without regard to condition of the jawbone, so that money isn’t wasted restoring essentially dead teeth. Whichever order of treatment the patient chooses, I do believe there should be as little time as possible put between the two events. Left untreated, cavitations will spread, and so should be promptly addressed following amalgam replacement. If the cavitation surgery is done first, and mercury remains in the mouth, then a significant source of toxicity has gone unaddressed, and this will impede the healing process.

Another point that many miss is that oftentimes, after proper amalgam removal, some teeth subsequently die, contributing to cavitation formation. So it’s important to have the jaws re-examined with sonography after amalgam removal, especially if one or more teeth become or remain sensitive.

I believe it is very important that both patients and dentists become more acutely aware of the importance of assessing the condition of the jawbone prior to initiating any treatment that will traumatize it and possibly cause the spreading of cavitations. Since bone sonography is the most reliable and detailed method of doing such as assessment, it is imperative that the technology be made available on a larger scale than it is now. There is also a clear and pressing need for more dentists who are trained in diagnosis and treatment of cavitations. Dentists may contact Cavitat Medical Technologies (303-755-2688) for information on bone sonography equipment and Dr. Wesley Shankland (614-794-0033) for information on an in-depth surgical training course that offers instruction in clinical application of bone sonography and gives continuing education credits.

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