Safe Mercury Fillings Removal

Dental silver filling is a filling material used to fill cavities. It is also called dental silver amalgam filling.

Dental amalgam is a mixture of metals consisting of liquid mercury (about 50%) and a powdered alloy composed of silver (about 25%), tin (about 14%), zinc (about 8%) and copper. The liquid mercury reacts with the three metals to form a paste. Before the chemical reaction is completed, dentists can pack the paste into a cleaned cavity, then carve out the shape and anatomy before the paste becomes hard.

It is a strong, cheap, and durable material for cavity filling. It has been in use since the early 1800s. The silver amalgam has an antibacterial effect with a self-sealing property that contributes to its longevity. However, there are potential risks with mercury fillings.

Potential Risks:

  1. It contains elemental mercury that can release in the form of a vapour that can be inhaled. Exposure to high levels of mercury vapour, which may occur in some occupational settings, has been associated with adverse effects on the brain and the kidney.
  2. Fetuses and young children whose developing neurological systems are more sensitive to the neurotoxic effects of mercury vapour. In light of this, there are concerns about using mercury fillings in pregnant women with their developing fetuses, women planning to become pregnant, nursing women, and young children.
  3. People with pre-existing neurological diseases and people with impaired kidney function.
  4. People with known heightened sensitivity (allergy) to mercury or other dental amalgam components (silver, copper, tin).

In July 2018, the European Union prohibited amalgam for the dental treatment of children under 15 years and pregnant or breastfeeding women.

Due to the “potential risks” and the poor cosmetic results, I have not been doing silver amalgam fillings for over two decades. In fact, my office does not have mercury amalgam materials at all.

Suppose you fall into any of the greater risk groups listed above; both Health Canada and the Food and Drug Administration (FDA) recommend not to use mercury amalgam filling in those groups mentioned earlier in this blog.

I do not recommend anyone remove or replace existing amalgam fillings in good condition unless necessary – patients with medical conditions mentioned, physiological reactions to this material, or holistic propensity. Removing intact amalgam fillings can result in unnecessary loss of healthy tooth structure and a temporary increase in exposure due to additional mercury vapour during the removal process.

The International Academy of Oral Medicine and Toxicology (IAOMT) has provided guidelines on a safe amalgam removal protocol dubbed Safe Mercury Amalgam Removal Technique (SMART). At Affinity Dental Care, we closely follow the guidelines and have the following equipment and protocols.

  • An amalgam separator filters all the wastewater from our dental high volume suction to collect mercury waste such that no mercury is released in our effluent into the public sewer system. A certified medical waste disposal company safely disposes of the amalgam separator once full.
  • The operatory is equipped with a MedEVAC Airflow chairside unit that can remove mercury vapour from the air during amalgam filling removal. The nozzle is placed close to the operating field.
  • A non-latex rubber dam isolates the teeth from the rest of the oral space to keep the amalgam pieces from entering the mouth before a high-volume waste suction removes them.
  • The patient’s face and head are covered with a disposable sheet to prevent accidental contact with the mercury alloy during the removal.
  • A high-volume evacuation suction is used thorough the removal and cleanup procedure. After completely removing the amalgam filling, the area will be thoroughly washed with water and then with a slurry of charcoal before removing the rubber isolation dam and head/face cover.
  • A saliva ejector is placed under the dental dam to reduce mercury exposure to the patient.
  • The amalgam is to be sectioned into chunks and removed in as large pieces as possible, using a small diameter carbide drill under a copious amount of water.
  • We avoid any amalgam filling removal for women who are pregnant or breastfeeding.

We do not stock any mercury materials and restore teeth with composite white fillings to avoid mercury exposure. We use porcelain, lithium disilicate (Emax), and Zirconia materials for crowns and bridges.

If you are interested in having the silver amalgam fillings removed safely and holistically, please call our office to book a consultation appointment.


Airway Dentistry

I recently heard the term airway dentistry, and I was curious about what that exactly is. I have been researching and noticed that it is just another term for dentistry that focuses on the mouth’s structure and how those impacts breathing. It involves looking for signs of sleep breathing disorder like tooth wear, the position of the tongue and the condition of the soft tissue. The goal is to recognize signs and symptoms of breathing disorders that could lead to obstructive sleep apnea.

I have been practicing dental sleep medicine emphasizing sleep-related disorders like obstructive sleep apnea. I have also been looking for potential developmental issues in children who show signs and symptoms of craniofacial discrepancy that can cause nasal obstruction and mouth breathing habits.

Essentially, wellness and holistic dentistry encompass airway dentistry. I practice my dentistry by looking beyond the teeth, nose, throat, muscles of the tongue, face, neck, and rest of the body. Our entire system and organs are interconnected. I mentioned in my previous blog about the effects and the subsequent diseases that can arise from a single disorder – a breathing disorder. The compromised airway should be treated rigorously and as soon as it is diagnosed, as it can lead to many other conditions. The list of the conditions is long, ranging from poor facial aesthetics and hunched posture to debilitating congestive heart failure. Please see my previous blogs on Nurturing, Sleep Apnea, Tongue-tie and Lip-tie.

Sleepiness and narcolepsy during the day despite 7 to 8 hours of the sleeping time the night before can be the sign of obstructive sleep apnea or hypoxia for adults. Snoring, teeth grinding, and excessive enamel wear are signs of sleep-related breathing disorder. Infants who have trouble breastfeeding could have tongue and lip ties or even upper nasal airway obstruction. Tongue and lip ties can themselves lead to the craniofacial discrepancy that, in turn, causes a narrow upper airway.

There are many reasons you should breathe in through your nose instead of the mouth. You can take deeper breaths, which provides more oxygen to the body. Chronic mouth breathing causes teeth to crowd and narrow, long faces. Mouth breathers are more likely to have sleep-related breathing disorders, dry mouth, swollen gums and other gum diseases.

Airway enhancement is part of holistic wellness dentistry. The recognition and referral to medical colleagues to make the diagnosis of the underlying diseases and related treatments could be the first step in helping patients. Besides the recognition and proper referrals, dentists can provide treatments like palatal expansion, mandibular advancement, oral myofunctional therapy, air-centric orthodontic treatment etc. Dentists can help lactating mothers understand the importance of breastfeeding and proper unprocessed diets for their infants to enhance airway development and immune system development. If the infants have tongue and/or lip tie problems that affect breastfeeding, frenectomy or frenotomy should be done.

Integrative Dental Medicine is a term to describe the modern-day dentistry that dentists should be practicing to provide the best outcomes to our patients. It comprises airway dentistry, air-centric orthodontics, wellness and holistic dentistry.

At Affinity Dental Care, we practice dentistry the way I blog.