Burien WA Dentist Seahurst Dental Design PLLC
Burien WA Dentist Seahurst Dental Design PLLC
Burien WA Dentist Seahurst Dental Design PLLC

Amalgam Removal

We recognize that the removal of mercury fillings needs to be done cautiously, in order to protect the patient from exposure to additional mercury during the course of the dental procedures. It’s also very important to realize that removing amalgams from the mouth is only part of becoming mercury-free. The exposure during the life span of the amalgam fillings has resulted in some tissue accumulation. It takes some help to get rid of this accumulated mercury. The body doesn’t do it very effectively by itself.

There is a related issue on dental mercury in the environment. Just as mercury is toxic to humans, it is also well established that mercury is a significant environmental contaminant. Wastewater treatment facilities around the country have been concerned with mercury levels in wastewater entering the treatment plants. These plants are not designed to handle heavy metal pollutants, and some are finding that the levels are unacceptable. Studies in several municipalities have shown that a high percentage of this mercury is coming from dental offices, in some cases 70-80% or more!

Whenever an amalgam filling is placed or removed, there is a significant amount of amalgam sludge that is vacuumed up by the chair side dental assistant. It goes down the drain and into the office wastewater system. Historically in most offices, this goes completely unchecked. In this office, we have a state of the art mercury recapturing system that prevents this, and keeps our wastewater clear. We are proud to be among a handful of dental offices in this area to have installed such a device many years before King County finally made it mandatory in July, 2003. This is part of our ongoing effort to keep our office environmentally friendly.

In our office we follow the precautions recommend by IAOMT and published in 1992. Normally we use a rubber damn. This is our first choice for isolation during mercury removal procedures, however for those who cannot tolerate a rubber damn and some people cannot, we use a new device called Isolite. www.isolitesystems.com

International Academy of Oral Medicine and Toxicology

Protocol for Mercury/Silver Filling Removal

Patient protection:

First in every concerned doctor's mind is the protection of the patient from additional exposure to mercury. This is especially true of the mercury toxic patient. The mercury toxic patient may have been exposed to varying amounts of mercury from diet, environment, employment or from mercury/silver dental fillings. All forms are cumulative and can contribute to the body burden. The goal of this preferred procedure is to minimize any additional exposure of the patient, ourselves, or staff to mercury.

  1. During chewing the patient is exposed to intraoral levels which are several times the EPA allowable air concentration.
  2. During the removal or placement of amalgam the patient can be exposed to amounts which are a thousand times greater than the EPA allowable concentration.
  3. Once the drill touches the filling temperature increases immediately vaporizing the mercury component of the alloy. There are 8 steps to greatly reducing everyone's exposure.

Step one Keep the fillings cool

  1. All removal must be done under cold water spray with copious amounts of water. Once the removal has begun, the mercury vapor will be continuously released from the tooth.
  2. Therefore, a high volume evacuator tip should be kept near the tooth (1/2 inch) at all times to evacuate this vapor from the area of the patient. Polishing amalgam can create very dangerous levels of mercury and should be avoided especially for the mercury toxic patient.
  3. All patients having amalgam removed or placed should be provide with an alternative air source and instructed to not breathe through their mouth during treatment. A nasal hood such as is used with the nitrous oxide analgesia equipment is excellent. Air is best and oxygen is acceptable although not required. If just air is used it should be clean and free of mercury vapor preferably from outside the dental office.
  4. Particles of mercury alloy should be washed and vacuumed away as soon as they are generated. The filling should be sectioned and removed in large pieces to reduce exposure.

    5. At present the International Academy of Oral Medicine and Toxicology (IAOMT) has approved removal both with and without the use of a rubber dam. Some evidence exists to support both views since high levels of mercury and amalgam particles can be found under the dam. All members are agreed that whether or not a rubber dam is used the patient should be instructed to not breathe through their mouth or swallow the particles. Some experts feel that it is better to remove the amalgam first and then apply the dam if needed for restorative procedures.

  5. After the fillings have been removed, take off the rubber dam if one was used and lavage the patient’s mouth for at least 30 seconds with cold water and vacuum. Remove your gloves and replace them with a new pair. If a restorative procedure is next then reapply a new dam and proceed.
  6. Immediately change patient’s protective wear and clean their face.
  7. Consider appropriate nutritional support before, during and after removal.
  8. Install room air purifiers or ionizers and fans for everyone's well being.
Burien WA Dentist