As long as (non-allergic-) amalgam-related illness is not an accepted diagnosis, very few dentists will minimise your mercury exposure during amalgam removal more than what standard procedure requires (water-cooling and high volume suction) unless you your self demand it (and sometimes (often?) not even then). If a patient has an amalgam-related illness the standard procedure of today is insufficient which is demonstrated by the following: Molin (1990) reported that: if using standard procedure only, all amalgams in a mouth is drilled out in one day, the mercury level of the blood-plasma immediately after the drilling will raise with 300-400% compared to the levels before drilling. In the same way the mercury levels in urine and erythrocytes will both raise by 50%. Then it will take 70-90 days before the levels have returned to the levels present before the amalgam removal. Begerow (1994) made a similar investigation as Molin (1990) although he measured only urinary mercury. He found a 30% raise in urinary mercury immediately after amalgam removal, but here the time for urinary mercury levels to return to the levels present before the amalgam removal was counted in single days. There are other examples of why you need to study the subject - but the background is the same; it is not a commonly accepted diagnosis. And therefore, if you are really convinced that you do have a (non-allergic-) amalgam-related illness, you will have to take greater part in your treatment than what is needed in commonly accepted diseases.
5.2 Potential dangers with amalgam removal.
If you are convinced / believe / suspect that at least some of your symptoms are (non-allergic-) amalgam-related, you should know that it is NOT proven if one can or can't have an (non-allergic-) amalgam-related illness. If you still want to take the chance of having your amalgam-fillings exchanged, to see if you will benefit from it, as other people and inconclusive reports have pointed out to be possible, you should be aware of some of the potential risks with amalgam-removal, to be able to make a well grounded decision:
At least seven risk factors, to be considered, before you have your amalgam-fillings exchanged, have been pointed out:
- A) Failure to detect another (treatable) disease because you are so concentrated on the amalgam issue (that you fail to see a doctor as you yourself have found the "cause").
- B) Failure to treat a proposed psychogenic cause because you are so concentrated on the amalgam that you do not believe in other possible causes to your symptoms.
- C) Loss of tooth substance.
- D) Less technically good material.
- E) Over-sensitivity to the inserted material.
- F) Wasting money for nothing.
- G) A period of elevated exposure to mercury during an amalgam-removal-period.
- A-B could be avoided by seeing a physician (and a dentist) and attending psychotherapy, if this is recommended, parallel to the amalgam-removal.
- C can be reduced, but not excluded, by using plastic materials such as composite and glass ionomer cement.
- D - seems to be a smaller problem now than some years ago, but it is still something to be considered. On the other hand amalgam has been reported to expand and crack the TEETH in some cases.
- E - there IS a certain risk, just like there IS with amalgam, that you can be allergic or develop allergy to any of the alternative materials. It has been hypotethical concern that composite could cause even non-allergic negative health effects. It has been hypothetical concern that composite could cause even non-allergic negative health effects.
- F - as (non-allergic-) amalgam-related illness is only a (scientifically non-proven) probability diagnosis it could be the case that a person do remove his / her amalgam-fillings with no positive effect.
- G - could be lowered but maybe not excluded. There has been special concern about foetuses of amalgam-bearing pregnant mothers who want to exchange their amalgam.
5.3 Minimise Hg-exposure / absorption.
5.3.1 In the dental chair.
During eventual amalgam removal, the dentist could, hopefully, substantially reduce your exposure to / absorption of mercury further, compared to standard procedure (water-cooling and high volume suction), by;
- Putting a rather big transparent plastic bag over your head / shoulders with overpressured fresh air blown into it. In front of the mouth the plastic bag should be reinforced with cofferdam and pressed into the mouth. This way the only thing exposed to the amalgam powder / mercury vapour is the tooth the dentist is working on.
- Drilling as little as possible in the filling, try to lift large parts of the fillings out, so that as little as possible of the filling is pulverised.
- Having well ventilated treatment and waiting rooms and letting air-evacuation equipment discharge its exhaust outside the office.
If the plastic bag/cofferdam above won't work the dentist could at least:
- Use a cofferdam in your oral cavity - it is a rubber sheet and only the tooth with its filling will be sticking out from it. When the dental session with amalgam removal is over the rubber sheet is easily lifted out together with amalgam-particles. No significant increase in mercury levels in urine, erythrocytes or blood-plasma of patients was detected after removing all their amalgam fillings in one day "using rubberdam, water spray cutting and high volume vacuum evacuator" (Molin 1995) but increased levels of mercury in the these body fluids was detected when the same procedure was used but without rubberdam (Molin 1990).
- Use a complement to the suction handle that encloses the tooth on all sides but the chewing side. The one I know about is "Clean-Up" by the Swedish firm Agda-group AB (see section 10.10).
- Let you breathe through your nose only, using some kind of equipment that provides fresh air (coming from the outside of the building?...) or a letting you have a Hg-industry-breathing mask (3M HgMask number 9908) over your nose, during the amalgam removal session.
- Maybe an extra air-suction-device / mechanical exhaust ventilation outside the patients mouth could diminish some of the mercury exposure. One such, hands-free, device I know of is "DentoSafe" (see section 10.10).
You yourself could maybe lower the mercury uptake in conjunction with amalgam-removal by following these two steps:
- Ingesting 5 g activated charcoal 15 minutes before and 5 g immediately after the dental session.
- Take a shower with hair-wash and changing clothes after the dental session.
Also make sure to read these books:
Poison in Your Teeth: Mercury Amalgam (Silver) Fillings...Hazardous to Your Health! and Mercury Detoxification by Tom McGuire