International Academy of Oral Medicine & Toxicology Protocol for Mercury/Silver Amalgam Removal

When removing mercury fillings from a patient’s teeth, two concerns are of utmost importance; the protection of the patient as well as the dentist and his or her assistant from exposure to the toxic mercury vapors that will inevitably be released. As at Healthy Healing Center we sometimes co-operate with dentists in the additional care necessarily accompanying this procedure we are sharing here today excerpts from the treatment protocol suggested by the International Academy of Oral Medicine & Toxicology. Its sole aim is to minimize the additional toxic load, which can be substantial in cases when no or only insufficient precautions are taken. Both patient and dentist can inhale and swallow more mercury in the removal process than they would over a period of several years through the vapors gradually released by the fillings. Which means that anyone considering removing their toxic mercury fillings, and every dentist should be informed. Unfortunately, especially here in India, many are not.

Seven of the eight following points deal with the actual process of removal; point #7 concerns the additional care, which we will discuss in a separate posting. Now, to the actual protocol:

“[Whereas] during chewing the patient is exposed to intra-oral levels [of mercury] which are several times the EPA [Environmental Protection Agency] allowable air concentration, during removal or placement of amalgam the patient can be exposed to amounts, which are a thousand times greater than the EPA allowable concentration. 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:

All removal must be done under cold-water spray with copious amounts of water…

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… Polishing amalgam can create very dangerous levels of mercury and should be avoided especially for the mercury toxic patient.

All patients having amalgam removed or placed should be provided with an alternative air source and instructed not to 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 free of mercury vapor, preferably from outside the dental office.

Particles of mercury alloy should be washed and vacuumed and washed away as soon as they are generated. The filling should be sectioned and removed in large pieces to reduce exposure… Removal both with and without the use of a rubber dam is possible.

After the fillings have been removed, take off the rubber dam if one was used and lavage the patient’s 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.

Consider appropriate nutritional support before, during and after removal.

Install room air purifiers or ionizers and fans for everyone’s wellbeing.

Staff also needs to be protected. Women of childbearing age, whether patients or staff, need to be extra careful to avoid over exposure. Pregnant women should not be exposed to mercury at all. Any potential exposure to mercury requires that the dentist/employee wear an approved mercury filter mask. Furthermore, the manner in which dentists operate dramatically affects the amount of mercury released. For example, never drill on mercury high dry.