Our Guidelines for Safe Removal of Mercury Amalgam/Silver 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 vapor and in amalgam particles, during the entire removal process. Cooling the filling with water and air while drilling substantially reduces the amount of mercury vapor the filling releases.
2. Cutting the Amalgam into Chunks
We use a process that’s commonly referred to as chunking. This involves less drilling, because we only drill 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.
3. Use a high-volume evacuator
We use a very powerful suction system than the type used by most dentists. This is one of the most important tools in minimizing the exposure to mercury vapor and amalgam particles. The evacuator tip are be kept close to the filling during the entire time the filling is being removed. This helps capture more of the mercury vapor and particles.
We also use DRYSHIELD System, which combines the tasks of high-suction evacuator, saliva ejector, bite block, tongue shield, and oral pathway protector in one easy-to-use device. It’s an intelligent breakthrough in isolation, bringing ease and comfort to patients.
4. Providing an alternative source of air
An alternative air source while their amalgam fillings are being removed will be provided. An alternative source of air isn’t necessary when the tooth is being prepared for the new filling and while the new filling is placed. But during the actual removal, the patient will be provided with a nasal hood through which to breathe oxygen from a tank. Concentrate on breathing through the nose and avoid breathing through the mouth while mercury amalgam silver fillings are being removed.
The consensus is to not remove mercury amalgam fillings during a pregnancy or during nursing. 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 that could be related to chronic mercury poisoning.
5. Use of 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 vapor in through the mouth. We now know that mercury vapor can readily pass through rubber dam made out of latex, the most commonly used rubber dam material so we use a special nitrile dam that's not latex to minimize this. 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.
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. Dispose gloves and clean the patient’s mouth
Once the filling(s) have been removed and replaced, we will remove and dispose the gloves and the rubber dam, and thoroughly rinse and vacuum the patient’s entire mouth for 15 seconds. This is to remove amalgam particles and residual mercury vapor from the mouth. Patients should make every effort not to swallow during the rinsing procedure. we 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.
7. Immediately clean up
After the fillings have been removed and replaced, the dentist or dental assistant will immediately remove and dispose of the patient’s protective covering and thoroughly clean his face and neck. As a mercury safe dentist we routinely do this, 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, we 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 operatory
There are a number of effective ways to purify the air in the dental office. At our dental office, we filter the office air, as we work in it all day. This is important for the dentist and staff and the patient. Although we don’t place amalgam fillings, we certainly specialize in removing them. We use many precautions to protect the entire staff and other patients from excessive exposure to mercury.
10. Use of 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. Although very little elemental or inorganic mercury is absorbed through the intestine, but if you are in the high risk category, we recommend this highly.