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22 What Is An Acceptable Amalgam Replacement Protocol


This article is from the Amalgam and Mercury-free Dentistry FAQ.

22 What Is An Acceptable Amalgam Replacement Protocol

A guiding principal for any dental office should be to minimize
patient exposure to toxic chemicals and materials. Unfortunately, in
the case of dentists who look only to the ADA for guidance and
information, most have little appreciation of the dangers of chronic
exposure to mercury vapor and do very little to protect themselves or
you the patient, from unnecessary exposure. . Conversely, mercury-free
dentists are critically aware of the potential health effects of
chronic exposure to mercury vapor and most go to extraordinary lengths
to protect themselves, their patients and staff from all unnecessary
exposure to this insidious poison. Remember, you cannot smell, taste
or see mercury vapor, consequently without special instruments to
measure its presence, there is no way of knowing how contaminated a
dental office may be.

Chemically sensitive individuals walking into a mercury contaminated
dental office will in all likelihood react immediately, without ever
realizing what they are reacting to. That is another reason why
dentists who practice mercury-free usually have various types of
specialized mercury vapor filtering devices and systems, designed to
reduce office background levels of mercury vapor.

There are also special techniques utilized to properly remove mercury
amalgam fillings. If done properly, there is minimum exposure to
increased levels of mercury vapor caused by the removal
procedure. However, we feel it important that you should be aware of
certain aspects related to removing mercury from the oral environment:

* The office and operatory should be well-ventilated.

* The dentist should have an assistant present to assist in minimizing
their exposure, and yours, to any mercury vapor. The correct
protocol requires the use of high volumes of cold water both from
the drill and separate irrigation by the assistant, who should also
be simultaneously using high volume suction evacuation of the vapor
and particles resulting from the removal procedure. The requirement
for copious amounts of cold water during amalgam removal is well
documented and cannot be overly emphasized. Even dentists who are
not mercury-free should know this. Failure of a dentist to be aware
of this should be considered a sign of a lack of knowledge on the
subject. Sadly, some dentists still drill out old amalgam with very
little or even no water spray or may even do it without an assistant
helping. Should you encounter a dentist who is unaware or
inattentive to this, you would be well advised to seek treatment

* It is the volatility of mercury that necessitates all the
precautions and correct techniques. Mercury vapor pressure doubles
with every ten degree centigrade rise in temperature. Once
acceptable procedure that minimizes extensive grinding (which
generates great temperature increases) involves sectioning the
amalgam into chunks versus just grinding it out.

* In some dental offices the dentist may ask you to breathe through a
nose piece that will permit you to draw air from another area of the
operatory or office. If the dentist has nitrous oxide\oxygen
available and you have elected to use it, this will accomplish the
same thing.

* The use of the rubber dam during the amalgam removal procedure is
still controversial at this time. Some believe it to be essential,
while others maintain that it results in amalgam particles and
mercury vapor being trapped under the dam during the entire
procedure. Those believing the latter contend that careful attention
to removal and evacuation results in lower mercury exposure to the

* Clean Up is a recently developed new type of oral
aspirator/evacuator product from Sweden that is now available in the
United States and Canada. The Clean Up device fits over the tooth
being worked on and applies a constant high speed suction to the
immediate work area, thereby greatly reducing extra-oral aerosol
spray and possible infectious particulate.

* During amalgam removal, the dentist and his or her assistant are at
greater risk to mercury vapor exposure than the patient. To protect
themselves, they will putting on specially mercury trapping masks
and rubber gloves to protect them during repeated removal

* There are several different types of chair side mercury vapor
filtering devices available. Some are specialized vacuum systems,
that exhaust the mercury vapor from the patient's head area into
activated carbon filters, that trap and bind the mercury preventing
its recirculation in the operatory. Hopefully, the dentist you
select to do your work will have one or more of these specialized
filters available in the operatory.

* Don't be in a hurry. Current information indicates that it is better
to replace only a few amalgams at a time, with several weeks in
between appointments.


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