S.M.A.R.T

Safe Mercury Amalgam Removal Technique 

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. Use a high-volume evacuator/suction

Our practice use more powerful suction system than the type used by most pro-amalgam dentists. This is one of the most important tools in minimizing the patient’s exposure to mercury vapor and amalgam particles. The suction 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 vapor and particles.

3. 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 vapor in through the mouth. We now know that mercury vapor 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.

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.

4. 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. 

5. 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.

6. Filtering air in the operatory

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.

7. Talk to Our Nutritionist Anamaria Pontes