Amalgam Removal

When should amalgam fillings be replaced?

What is it?

Amalgam fillings are silver in color and found widely in mouths around the world. Amalgams are a mixture of mercury with other metals such as silver, tin, and copper in various phases. The liquid mercury and powdered metals are mixed to create an “alloy” of various metal phases that all it to be packed/pushed into a tooth that has been drilled out. Amalgams were introduced in the 1800s and became widely popular because they are cheap and not technique sensitive to place.

Mechanical retention

Amalgam fillings are held into the tooth through undercuts made by the dentist when the cavity is drilled out. They are not bonded to the tooth but instead mechanically locked into place. The micro-gap between the tooth and amalgam filling leak bacteria and saliva over time, leading to decay underneath. This is often visualized as “grey shadowing” seen where the tooth would otherwise be white. THE MAJORITY of amalgams that have been in the mouth for 5+ years have EXTENSIVE DECAY underneath. This decay is difficult to detect on x-rays as x-rays cannot see through the metal amalgam filling.

Is it more conservative to wait?

A tooth must be drilled out to certain dimensions to hold an amalgam filling, meaning more tooth structure has to be removed for amalgam fillings than for tooth colored composite fillings. Also, if the amalgam filling has been in the mouth for along time, it almost certainly has decay under it. Waiting longer to update it allows decay under it to grow extensively, leaving little healthy tooth structure behind once it has all been cleaned up.

Cracks and undercuts

Amalgam fillings are metal, meaning they expand and contract over time with hot and cold temperatures. This causes the outer enamel of the tooth to crack. Cracks can be present for many years without causing pain, however, most people report “cracking a tooth on a soft piece of food.” This means the tooth was already cracked (often from the metal filling), but simply never caused pain until it finally broke completely off. Also, the undercuts drilled into the tooth to hold the amalgam filling in place weaken the tooth, and when combined with cracks in the tooth, lead to perfect conditions for catastrophic failure. It is best to fend off these problems before they happen since teeth often crack in ways that cannot be fixed.

Electrogalvanism

Amalgam fillings oxidize, or corrode over time, in the same way that batteries corrode. This means that an electric current is moving in them. This galvanic current is noticeable when the amalgam metal is in contact with other amalgam fillings or other metals such as gold crowns, silver crowns, or even porcelain fused to metal crowns.

Cosmetics

Amalgam fillings are cosmetically unacceptable when we have durable, predictable dental materials to use as an alternative. Amalgam fillings are non-cosmetic and do not follow biomimetic and minimally invasive principles aligned with modern, evidence-based dentistry.

Source of mercury

Amalgam fillings contain mercury in various forms: inorganic mercury, ethyl mercury and methyl mercury. The highest risk of exposure to mercury in any amount is when the amalgam is pressurized. This occurs during placement and removal, along with daily chewing, clenching, and grinding. The ADA standpoint is that amalgam fillings are safe, however some individuals may be hypersensitive or have personal concerns about mercury.

Option for those with metal sensitivities

  • Facility Controls

    LAT Dentistry has properly installed and maintained amalgam separator to collect mercury waste.

    Each treatment suite has individually supplied HEPA filtered air.

    Personal protective equipment (PPE) is utilized during the opening and replacement of dental unit suction traps.

    LAT Dentistry is in compliance and far exceeds all federal / state and local laws for air quality and water quality.

  • Procedural Controls

    We use high-volume evacuation (HVE) suction to collect particulates, vapors, and particles in the air during the procedure.

    We don nitrile gloves, glasses/side shields for dental personnel, and lab coats for protection.

    We use copious amounts of water to reduce heat and to laden vapors/particulates into droplets that are easily removed via high volume evacuation.

    We use a small diameter carbide drill to section the amalgam into large chunks and remove in as large/undisturbed pieces as possible.

  • Patient Protection

    Activated charcoal nasal filters may be utilized during the appointment.

    Patient goggles are placed to protect the eyes.

    Patient facial drape may be utilized to cover hair and minimize exposed facial skin. A water repelling clothing drape is also used.

    A nitrile rubber dam / rain shield is used to protect from any small particulates, particles and air plumes from reaching the sensitive oral soft tissues. The rubber dam is properly sealed around the tooth / teeth being treated.

    A dry shield high volume suction or saliva ejector suction may be placed below the rubber dam to collect any penetrating vapors below the rubber dam.

  • Pre and Post Procedure Rinses

    Pre-appointment steps to discuss with Primary Care Provider:

    Some may consider taking chlorella regularly leading up to appointment in accordance with PCP supervision and recommendations. IAOMT sources recommend ranges often from 1/10 teaspoon to one tablespoon (1/2-14 capsules).

    Other dietary items may help eliminate any further concern for acute symptoms such as regularly eating cilantro and taking vitamins such as Vitamin E and Vitamin C. Any dietary and supplement changes should be discussed with the PCP in advance.

    Some individuals may discuss the option to swallow pre-procedure charcoal rinse and/or chlorella pre-procedure rinse the day of the appointment.

    Following the procedure:

    We rinse the area with copious amounts of treated, distilled water.

    You may choose to rinse with a slurry of activated charcoal and chlorella (2 capsules) post procedure.

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Disclaimer

LAT Dentistry and Dr. Thorn make no claims to improve or change any disease or health condition unrelated to the oral cavity by removing amalgam fillings. We will remove and update amalgam fillings in the safest way possible and add additional levels of protection per each individual’s requests, needs, and concerns. Amalgam fillings should be replaced for any of the problems or concerns listed above. Rest assured that LAT Dentistry will not recommend replacement of amalgam restorations without a clinical, biological, or individual reason to do so.