We have been asked on many occasions how we go about removing dental amalgams for individuals who are concerned about the release of mercury vapour during this process. This page outlines what we do. This area is controversial but we have based our amalgam removal protocol on the information available to us currently.
Amalgam removal protocol
- We provide an activated charcoal solution for you to drink before the procedure starts
- Ventilation – the surgeries are kept well ventilated with a good supply of fresh air
- Dampened eye patches and safety glasses are provided to protect you from debris and mercury vapour while we work.
- Keeping fillings cool- it is known that if you heat an amalgam restoration then the level of mercury vapour released will increase- for that reason we use lots of water and air to create a “cooling mist” around the tooth while we work
- Special burs- most dental drills grind teeth or fillings away. If you are concerned about mercury and dental amalgam this approach is not ideal as it generates heat which increases the release of mercury vapour. the grinding approach also creates lots of very small amalgam particles which are harder to vacuum away and are more likely to be swallowed, something that we want to avoid. The solution is to use special burs designed to cut the filling cleanly as well as a protocol called “chunking” to remove the old filling in as few (large) pieces as possible.
- High volume suction is used to remove mercury vapour, and debris as the filling is removed. Our practice has 2 of the most modern suction units available to ensure that the maximum amount of amalgam debris is safely removed as we work.
- Rubber dam – a rubber shield is used to catch any debris that is not immediately caught by the suction unit, meaning that far less amalgam debris will come into contact with the soft tissues of your mouth. This stage is controversial as some think that the rubber dam may allow mercury vapour to build up behind it. Studies however show that treatment with rubber dam reduces total mercury exposure during amalgam replacement and blood plasma levels of mercury are lower following treatment with rubber dam than without it.
- After removal of the old filling/s we replace the rubber dam with a new one to eliminate any traces of the old filling material and also wipe down your face thoroughly to get rid of any small particles that may have landed there.
- Finally a new white filling can be placed or an impression taken for a porcelain inlay or crown. Information on alternatives to amalgam fillings can be found on the website.
Environmental Issues With Amalgam Removal
It is known that heavy metals build up in the food chain so in essence waste products that we wash down the drain can eventually end up back in our food supply. The mercury in our environment is converted to methyl mercury in the sea and absorbed / consumed as part of feeding by fish and shellfish. This is the reason that certain fish species, related to their feeding patterns, are known to be at greater risk of having higher mercury levels in their tissues than others. Indeed in America the Environmental Protection Agency advise pregnant women to limit their consumption of certain types of fish during pregnancy for this reason.
As we remove many amalgam fillings every week we take our environmental responsibility seriously and do everything we can to protect the environment. When cutting old amalgam fillings out in as few pieces as possible ( a process called chunking ) to reduce the volume of small amalgam particles that we produce. The large chunks are collected in our first stage filtration. The smaller particles enter a high speed centrifugal separator that is highly efficient at removing amalgam particles from our waste water. In all we filter, separate and remove remove nearly 99% of all of our amalgam waste by weight from our waste water before it leaves the building. By choosing new mercury free restorations you are reducing the volume of mercury waste that will need to be dealt with in future.