Why should amalgam fillings be replaced by composite fillings? We discuss only two of the many reasons:
1. Mercury!
James Hobby
“I wanted to write to thank you for replacing my 8-9 amalgam fillings in one go back in August and let you know how things are now going. For the last three decades I have been suffering on and off from panic attacks, palpitations (apparently no medical reason for this), recurrent infections and other strange things such as cold hands and feet. The first month nothing changed but then suddenly I started to feel a lot better and the angst and arrythmias have decreased dramatically; I feel much happier and no longer take tablets. I am not sure if this is to do with the removal of the amalgam fillings or not but it is an odd coincidence if not. I hope things continue on this trajectory. I do not know much about these matters but have you heard of such things before? I now also take a good dose of vitamin C daily.”
Thanks and best regards,
2. Marginal leakage and secondary decay
Secondary decay develops underneath existing fillings after they have been placed.
Because there is no direct bond between amalgam and tooth structure, the dentist has to make undercuts when preparing the tooth for an amalgam filling to make it possible for the filling to stay in. By destroying the healthier tooth substance, the tooth is left weaker than before and therefore prone to developing cracks and fractures later in life. Pictures in the middle column depict the condition of teeth with decay exposed after an old amalgam filling is removed. However they all look and feel good after all decay is removed and a new invisible filling placed.
Safe mercury removal and mercury amalgam replacement begins with an understanding of what mercury is and what makes it so harmful to humans.
Mercury in its natural state is an element that is a liquid metal.
This silvery looking liquid metal is somewhat stable in this elemental form. You could probably swallow this liquid elemental metal without any noticeable adverse effects. However, when it turns into a vapor or gives off the invisible gas form of mercury, it becomes potentially very deadly–so much so that many scientists consider mercury vapor as one of the most toxic substances around.
Mercury vapor readily combines with fat rich tissues (the lining of every cell membrane and neurological tissue, especially the brain). When it binds to sulfur (breakdown products of bacterial activity) it becomes methyl mercury, the more deadly form.
(When dentists defend mercury and their fillings, they refer to the safer elemental mercury and forget that the fillings release vapor, especially with heat and chewing; and when it combines with methyl products of bacterial activity in the mouth, deadly methyl mercury vapor may be formed. In addition, most air turbine dental drills produce tremendous heat from friction, as well as a vapor aerosol.)
Therefore, when removing mercury amalgam dental fillings, it becomes very important to follow safety protocols and assess the patient to protect him/her from toxic exposure by reducing any mercury vapor during the procedure, aiding the eliminating of this toxic element from the body.
Dentists who do not believe that mercury amalgam fillings are potentially harmful should be avoided as they most likely will do nothing to protect the patient.
There are three basic groups of filling material which may be used to replace mercury amalgams: Gold inlays, porcelain or composite inlays and direct-placed composites – each, has its advantages and each its disadvantages- as yet, there is no ‘perfect’ filling material.
In the majority of cases as far as the dentist is concerned, direct composites, because of their durability, moderate cost and good handling characteristics, is generally the material of choice.
After completion of the treatment, it is important to carry on the precautions for about three months, while mercury continues to be excreted from the body. It is possible also, that some of the largest fillings exhibit some hot and cold sensitivity for a while afterwards, but usually passes off in good time.
However it must be said, that it is impossible to guarantee that removal of mercury amalgams will result in resolution or improvement of symptoms for every patient. At the very least, although you can be certain that your mouth has been rid of one of the most toxic substances on the planet.
Safe Removal Guidelines for Amalgam Fillings
1. Keep the fillings cool during removal:
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.
2. Cutting the Amalgam into Chunks:
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.
3. Use a high-volume evacuator:
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.
4. Provide the patient with an alternative source of air:
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.
5. Use a rubber dam:
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.
6. Remove gloves and clean the patient’s mouth:
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.
7. Immediately clean up:
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.
8. Use additional air purification:
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.
9. Filtering air in the surgery:
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.
10. Use activated charcoal:
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.
Precautions for Amalgam sensitive patients who are to have replacement fillings
Before embarking on a course of mercury amalgam removal, it must be stressed that, if you are under treatment by your doctor or hospital physician, or if you have a condition or symptoms which have not been investigated, you must consult him/her first, before going ahead with either the treatment or the nutritional supplementation.
Good nutrition is vitally important in helping the body to eliminate, not only the mercury from the teeth, but also that which has been “locked into” the body’s cells.
- Restrict your diet to fresh, whole organic (additive and chemical-free foods)
- Avoid sugar, caffeine, chocolate, dairy produce and smoking.
- Do not drink coffee or eat fish for 3 months following replacements
- Drink plenty of pure or boiled water.
Unfortunately, because of the inadequacies of so many foodstuffs available today, supplements may be necessary to ensure that the vitamins and minerals required are readily accessible. (Some patients may already be on a supplementation regimen from their nutritionist or therapist, in which case, he/she should be consulted first). Supplement your diet, beginning about two weeks before treatment with.
- A good daily multi-vitamin/mineral, such as Nature’s Own Food state Multivitamin. And Mineral. Take 1 per day with breakfast.
- Vitamin C. Begin with 500mg. three times a day, with meals and slowly build up the dosage until you are taking up to 6-8000mg., in divided doses throughout the day. This is probably most conveniently taken as ascorbic acid powder, dissolved in water or fruit juice. Build up the dosage slowly to avoid diarrhea due to excretion of excess and tail down slowly afterward, to avoid ‘rebound’ infections. Long term use of large doses may aggravate stomach ulcers and may deplete calcium and magnesium. Also, those with kidney stones should seek medical advice. Vitamin C alters the effects of low-dose contraceptive pill into those of a high-dose pill, possibly enhancing adverse effects; therefore, take Vitamin C and the contraceptive pill at least 4 hours apart. Also, be aware of the view which says that Vitamin C does not have the protective properties, for which it has been extensively used by so many thousands for so many years.
- Selenium 50 mcg. Tabs (Biocare, Cytoplan, Lamberts etc). Take 50 mcg. Twice a day, timed to be about 2 hours before the Vitamin C.
- Charcoal tablets. Take 3 tabs. Half an hour before treatment, plus 3 tabs after the appointment and drink as much water as possible, over the next few hours.
- Other supplements such as zinc, vitamin E, potassium citrate, vitamin B6, co-enzyme Q10 and acetyl cysteine may also be recommended following the consultation appointment.
For further information or to book an appointment, contact us on 01249 445111.
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