Mercury or amalgam fillings are still being placed as a dental restorative material all over the US. The mercury component (about 50%) of the dental filling has been scientifically demonstrated to have toxic emitting mercury vapors. Moreover, dental amalgam fillings also contain silver, tin and other heavy metals that can create a galvanic current, among other things.  

 

Scientific research demonstrates that dental mercury amalgam exposes not only patients and dental professionals to releases of mercury vapor but also unborn babies. 

Furthermore, mercury vapor is known to be released from dental mercury amalgam fillings at higher rates during brushing, cleaning, clenching of teeth, chewing, etc. 

If you have mercury or amalgam fillings, you may want to get them removed for the health reasons described above. However, mercury or amalgum fillings removal, if not done correctly, can do more harm than good thru the release of mercury. So, it is very important that proper protocol is followed.

Safe mercury amalgam removal technique (SMART) was developed and is regulated by the International Academy of Oral Medicine and Toxicology (IAOMT) using the available scientific evidence and technology.  There is an extensive list of safety recommendations for removal of existing dental amalgam safely.

Dr Hamdan is the only dentist in central Phoenix (one of only three in the Valley) who is SMART certified (Directory) . IAOMT provides rigorous training annually to dentists who wish to be trained in proper and safe dental amalgam removal procedures.

Some of the protocols are listed here below

  • An amalgam separator must be properly installed, utilized, and maintained to collect mercury amalgam waste so that it is not released into the effluent from the dental office.

  • Each room where mercury fillings are removed must have adequate filtration in place, which requires a high-volume air filtration system (such as an at source oral aerosol vacuum) capable of removing mercury vapor and amalgam particles generated during the removal of one or more mercury fillings.

  • The patient will be given a slurry of charcoal, chlorella, or similar adsorbent to rinse and swallow before the procedure (unless the patient declines or there are other contraindications making this clinically inappropriate).

  • Protective gowns and covers for the dentist, dental personnel and the patient must be in place. All present in the room must be protected because substantial quantities of particles generated during the procedure will elude collection by suction devices. It has been demonstrated that these particles can be spread from the patient’s mouth to the hands, arms, face, chest and other parts of the dental worker’s and patient’s anatomy.

  • Non-latex nitrile gloves must be utilized by the dentist and all dental personnel in the room.

  • Face shields and hair/head coverings are to be utilized by the dentist and all dental personnel in the room.

  • Either a properly-sealed, respiratory grade mask rated to capture mercury or a positive pressure, properly-sealed mask providing air or oxygen must be worn by the dentist and all dental personnel in the room.

  • In order to protect the patient’s skin and clothing, a full body, impermeable barrier, as well as a full head/face/neck barrier under/around the dam, need to be utilized.

  • External air or oxygen delivered via a nasal mask for the patient also needs to be utilized to assure the patient does not inhale any mercury vapor or amalgam particulate during the procedure.

  • A dental dam that is made with non-latex nitrile material must be placed and properly sealed in the patient’s mouth.

  • A saliva ejector must be placed under the dental dam to reduce mercury exposure to the patient.

  • During amalgam filling removal, the dentist must utilize an at source oral aerosol vacuum in close proximity to the operating field (i.e., two to four inches from the patient’s mouth) to mitigate mercury exposure.45, 88

  • High speed evacuation produces better capture when fitted with a Clean Up device, which is not mandatory but is preferred.

  • Copious amounts of water to reduce heat and a conventional high speed evacuation device to capture mercury discharges  are required to reduce ambient mercury levels.

  • The amalgam needs to be sectioned into chunks and removed in as large of pieces as possible using a small diameter carbide drill.

  • Once the removal process is complete, the patient’s mouth should be thoroughly flushed with water and then rinsed out with a slurry of charcoal, chlorella or similar adsorbent.

  • Dentists must comply with federal, state, and local regulations addressing the proper handling, cleaning, and/or disposal of mercury-contaminated components, clothing, equipment, surfaces of the room, and flooring in the dental office.

  • During the opening and maintenance of suction traps in operatories or on the main suction unit, dental staff should utilize the appropriate personal protection equipment described above.

 

To learn more about the hazards of dental amalgam and SMART technique, 

Please visit IAOMT.org

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