Safe Removal of Mercury Fillings - Dental Health for Life

Drilling out an amalgam filling generates a tremendous amount of heat, which causes a significant increase in the release of mercury, both as a vapour and in amalgam particles, during the entire removal process. Cooling the filling with water and air while drilling substantially reduces the amount of mercury vapour the filling releases.

Most mercury-safe dentists use a removal process that’s commonly referred to as chunking. This involves less drilling, because the dentist only drills enough to cut the filling into chunks, which can then be easily removed by a hand instrument or suction. Both chunking and keeping the filling cool during removal are very important and I believe all mercury safe dentists should follow this procedure.

Most mercury safe dentists use a more powerful suction system than the type used by most pro-amalgam dentists. It may well be the most important tool in minimizing the patient’s exposure to mercury vapour and amalgam particles. The evacuator tip should be kept to within 1⁄2 inch of the filling during the entire time the filling is being removed. This helps capture more of the mercury vapour and particles. All mercury safe dentists should follow this procedure.

The patient should be provided with an alternative air source while their amalgam fillings are being removed, even if steps 1 & 2 are done.

An alternative source of air isn’t necessary after the removal process when the tooth is being prepared for the new filling and while the new filling is placed, but, during the actual removal, the patient should be provided with a nasal hood through which he or she can breathe either compressed air from a tank, air from a source outside the office, or oxygen from a tank. The patient should be instructed to breathe through the nose and avoid breathing through the mouth while mercury amalgam silver fillings are being removed.

The consensus is not to remove mercury amalgam fillings during a pregnancy or during nursing. But if for whatever reason that procedure is done, I personally believe that an alternative source of air should be provided when removing amalgam fillings from the teeth of pregnant and nursing mothers, patients who have multiple allergies and sensitivities, immune system problems, or any other health issues related to chronic mercury poisoning. This I would recommend even if a high volume evacuator were being used, as these people will want to maximize their protection.

A rubber dam isolates the tooth or teeth being worked on. It was believed that the rubber dam would protect the patient from breathing mercury vapour in through the mouth. We now know that mercury vapour can readily pass through a rubber dam made out of latex, the most commonly used rubber dam material. Many patients have heard that the rubber dam offers a great deal of protection and should absolutely be included as part of the safe removal protocol. Some people will even insist on its use to protect them from mercury vapour.

My personal opinion is that, because the rubber dam does not protect you from inhaling mercury vapour during the removal process, it does not absolutely have to be used when removing amalgam fillings. Incorporating the first 4 steps listed above will provide the greatest source of protection from mercury vapour for the patient. But while the rubber dam offers little protection against mercury vapour it does make it easier to evacuate the filling material and prevent amalgam particles from being swallowed. (Even though swallowed amalgam particles contain mercury it is not believed to be released during its process through the intestine, it is sound procedure to prevent as much of it as possible from being swallowed. So the particles are not a threat to your health.)

If a composite filling is used to replace a mercury amalgam filling, the rubber dam offers an isolated and dry field for placing the composite filling. The dentist will decide when it is or isn’t necessary. It does take some time to place and remove the rubber dam, it can be a little uncomfortable, and some patients simply cannot tolerate its use. There are other exceptions to its use because the position or location of some teeth, particularly 3rd molars, or so-called wisdom teeth, may make it impossible to place a rubber dam.

A Note to the Patient…

Whether your dentist uses a rubber dam or not you should always focus on breathing through your nose during the entire time the amalgam fillings are being removed. This is especially important if an alternative source of air is not available.

Once the filling(s) have been removed and replaced, the dentist and the assistant should remove and dispose of their gloves and the rubber dam, and thoroughly rinse and vacuum the patient’s entire mouth for at least 15 seconds. This will help remove amalgam particles and residual mercury vapor from the mouth. The patient should make every effort not to swallow during the rinsing procedure. I also suggest that after the rinsing procedure, the patient use a small amount of water and gargle as far back into his throat as possible. The patient should not swallow this watery residue! Instead, he or she should spit it into a sink or cup. All mercury free dentists should follow this procedure but it won’t hurt to remind him or her.

After the fillings have been removed and replaced, the dentist or dental assistant should immediately remove and dispose of the patient’s protective covering and thoroughly clean his face and neck. All mercury safe dentists should routinely do this but remind the assistant if she forgets, after all you don’t want to take any mercury home with you.

Some mercury safe dentists use an additional air filtering system that’s placed as close to the patient’s mouth as is practical. The more popular ones resemble an elephant’s trunk and have openings about 4 inches in diameter. This can be helpful, but I agree with those mercury safe dentists who believe that the patient can be adequately protected without such a system. More and more mercury safe dentists are using this type of purification system and while it’s a nice addition to the removal protocol, it is more important for the dentist and assistant than the patient.

There are a number of effective ways to purify the air in the dental office. I’m not making specific recommendations. But many mercury safe dental offices filter the office air, as they work in it all day and it’s to their benefit to do so. This is more important for the dentist and staff than for the patient. Although mercury safe offices don’t place amalgam fillings, they certainly are required to remove them. Keep in mind that you will only be at the office for a short period of time but the dentist and his or her staff will be removing these fillings many times throughout the day. I believe all mercury safe dentists would want to take the necessary precautions to protect themselves and their entire staff from excessive exposure to mercury.

There’s some evidence that activated charcoal taken 10-15 minutes before amalgam removal can bind smaller particles of swallowed mercury, allowing them to be harmlessly passed out of the intestine via the feces. I consider this to be optional, as very little elemental or inorganic mercury is absorbed through the intestine, but it can’t hurt to add it, especially if you are in the high risk category.