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Dentist: How To Replace Amalgam Fillings, mercury health risk Once the removal has begun, the
mercury vapor will be continuously released from the tooth. 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.
Protocol for Amalgam-Mercury-Silver Filling Removal
By
International Academy of Oral Medicine and Toxicology HOME - Health Dental Risk Page - CANCER Page -
Amalgam Replacement Protocol - Disclaimer
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.
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.
1. Keep the fillings cool
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. Use a high volume evacuator
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. Provide an alternative air source
All patients having amalgam removed or placed should be provided 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. Immediately dispose of the mercury alloy
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.
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 exist 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. Lavage, and change gloves
After the fillings have been removed, take off the rubber dam if one was used and lavage the
patients 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 clean patient
Immediately change patient's protective wear and clean their face.
7. Consider nutritional support
Consider appropriate nutritional support before, during and after removal.
8. Keep room air pure
Install room air purifiers or ionizers and fans for everyone's well being.
STAFF PROTECTION
OSHA4 5 requires that employees be given written informed consent before the use of any toxic
chemicals of which mercury is one. Elemental mercury vapor is one of the most toxic forms of mercury
and should not breathed. Women of child bearing age should be exposed to no more than 10% of the
OSHA MAC6. Women who are pregnant should be exposed to no mercury.7 If you use mercury or remove
mercury in any form the National Institute of Occupational Safety and Health (NIOSH) has recommended
that your employees be medically monitored annually.
ANY MERCURY EXPOSURE REQUIRES THAT THE EMPLOYEE WEAR AN APPROVED MERCURY FILTER MASK.
An approved mask is appropriate for wearing during all dental procedures which will expose you or
your staff to mercury.8
The manner in which dentists operate their equipment dramatically affects the amount of mercury
released. Never drill on mercury high dry. It is hazardous to you, your staff, and your patient.
Levels as high as 4000 m g/M3 have been measured 18" from the drill when used high dry. Levels over
1000 m g/M3 are measurable upon opening an amalgam mixing capsule.
One out of 7 California dental offices tested over the OSHA TWA of 50 m g/M 3 . 100% of the vacuum
cleaner exhaust tested over 100 m g/M 3 . Any office where mercury is used should be tested
regularly and staff should be monitored for exposure. Testing services are available and a mercury
sensor badge is available for personnel monitoring. They should test inside storage areas and along
baseboards where mercury might have dropped. Office spills can go undetected for years and are
extremely hazardous.
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REFERENCES
1 IAOMT Standards of Care Preferred Procedure Approved 9/27/92
2 EPA United States Environmental Protection Agency Office of Health and Environment Assessment
Mercury health effects update Final Report EPA-600/8-84-019F 1971 EPA
3 Cooley RL, Barkmeier WW: Mercury vapor emitted during ultraspeed cutting of amalgam. J Indiana
Dent Assoc 57:28-31, 1978
4 OSHA Job Health Series: Mercury.(2234)8/1975
5 Hazard Communication Program Federal Register/ Vol. 52. No. 163 / Monday, August 24, 1987
6 OSHA MAC is Threshold Limit Value of 100 micrograms/ cubic meter or 100 PPM This is a never to be
exceeded standard.
7 Koos BJ and Lango LD , Mercury Toxicity in the pregnant woman, fetus, and newborn infant. A review
Am J Obstetrics and Gynecology 126(3):390-409, 1976
8 Mine Safety Association high levels and 3M mercury dust mask lower levels
Preferred Procedures when having Defective Mercury/Silver (AMALGAM) Dental Fillings Removed
First in every concerned doctor's mind should be the protection of the patient from additional
exposure to mercury. This is especially true of the mercury toxic patient as they may have been
exposed to varying amounts of mercury from diet, environment, employment, or from mercury/silver
dental fillings. All forms of mercury are cumulative and can contribute to the body burden. The goal
of this preferred procedure is to minimize any additional exposure of the patient and staff to
mercury. According to Toxicologist References, during chewing, patients are exposed to intraoral
levels which are several times the EPA allowable air concentration. During the removal or placement
of amalgam the patient may be exposed to amounts which are a thousand times greater than the EPA
allowable concentration. During amalgam removal, once the drill touches the filling, temperature
increases and immediately vaporizes the mercury component of the alloy. There are eight protective
steps to greatly reduce everyone's exposure. So; EDUCATE, EDUCATE, EDUCATE to maximally protect
yourself! Medical and Research Toxicologists emphasize when having amalgam (mercury) silver fillings
removed it is extremely important not to breath or ingest mercury laden particles or vapors.
Potential Risk may be Reduced by providing you with a clean source of air to breath, (i.e. an oxygen
mask), consider a rubber dam to keep large particles from being ingested and minimize vapor
exposure, using a protective device on the end of the suction tip, have well ventilated operatories,
mercury air filtration system's and consider other critical environmental controls. It is strongly
advised that patients should be under the guidance and care of their supportive heath care
practitioners during and after mercury/silver (amalgam) fillings removal for proper elimination from
their body tissues and organs.
Need for Extreme Caution Upon Removal!! In replacing defective (Amalgam) dental fillings, what are
the most important factors? Certainly do not run out and have your fillings just "ground out". Many
dentists have shared horror stories about medically compromised people who have just had their
fillings removed and say they are in worse shape than ever have been. Why? Obviously, we now feel
there is a proper and safe way to have these fillings removed. Probably many people have had
fillings removed with much insult to their bodies - so, Do Not run out to the first dentist you know
without becoming educated and by reading as much as your interest, problems or curiosity dictates.
Find a willing and cooperative dentist who is open-minded to the minimal guidelines of a protective
protocol. (The International Academy of Oral Medicine and the Great Lakes Association of Clinical
Medicine are the only scientific groups we know of to have on going studies or are developing
patient protocols to effectively and through proper and legal channels to help patients eliminate
body burdens of heavy metals like mercury). Remember as of early 1990's most dentists run a risk of
losing his or her license if they mention that mercury might be harmful. For information on a
technically trained dentist (familiar with a safe Protocol) you may wish to call Wanza Webb @ (407)
293-3185. *author of the wonderfully informative book, "It's All in Your Head". (Available from Dr.
McIlwain's Office).