Mercury Filling Removal can be a very hazardous procedure. Be sure your dentist is willing to
follow the following guidelines that are designed to protect you from unnecessary mercury poisoning.
1. Provide the patient with an alternative source of air
It is essential to provide dental patients with an alternative air source while their amalgam fillings are being
removed. This is not necessary after the removal process when the tooth is being prepared for the new filling or
while the new filling is being placed. But during the actual removal of the mercury filling, the patient should be
provided with a protective mask through which to breathe either compressed air from a tank, air from a source
outside the office, or oxygen from a tank. The patient should be instructed to breathe through the nose and
avoid breathing through the mouth while the fillings are being removed. This is absolutely necessary for
removing amalgam fillings from the teeth of pregnant and nursing mothers, patients who have allergies, immune
system problems, or any other health issues related to chronic mercury poisoning.
2. Use a rubber dental dam
A rubber dam isolates the tooth or teeth being worked on. It was believed that the rubber dam would protect
the patient from breathing mercury vapor in through the mouth. We now know that mercury vapor can readily
pass through a rubber dam made out of latex, the most commonly used rubber dam material. Many patients
have heard that the rubber dam offers a great deal of protection and should absolutely be included as part of
the safe removal protocol. Some people will even insist on its use to protect them from mercury vapor.
3. Use a high-volume evacuator
Most mercury free dentists use a more powerful suction system than the type used by most pro-amalgam
dentists. This is one of the most important tools in minimizing the patient’s exposure to mercury vapor and
amalgam particles. The evacuator tip should be kept to within 1⁄2 inch of the filling during the entire time the
filling is being removed. This helps capture more of the mercury vapor and particles. All mercury free dentists
should follow this procedure.
4. Keep the fillings cool during removal
Drilling out an amalgam filling generates a tremendous amount of heat, which causes a significant increase in
the release of mercury, both as a vapor and in amalgam particles, during the entire removal process. Cooling
the filling with water and air while drilling substantially reduces the amount of mercury vapor the filling releases.
5. Cutting the Amalgam into Chunks
Most mercury-free dentists use a removal process that’s commonly referred to as chunking. This involves less
drilling, because the dentist only drills enough to cut the filling into chunks, which can then be easily removed by
a hand instrument or suction. Both chunking and keeping the filling cool during removal are very important and
all mercury free dentists should follow this procedure.
6. Cover the patient's face and eyes
Mercury can easily be absorbed through the skin and especially the eyes. Many drugs are currently being
administered through the use of skin patches because the skin is a very good delivery method for chemicals to
enter the blood stream. The patients face should be covered with cloth or paper and goggles should be
used to protect the eyes from mercury dust and vapor.
The use of the first six steps listed in the protocol will provide the greatest source of protection from mercury
vapor for the patient. But while the rubber dam offers little protection against mercury vapor it does make it
easier to evacuate the filling material and prevent amalgam particles from being swallowed.
If a composite filling is used to replace a mercury amalgam filling, the rubber dam offers an isolated and dry field
for placing the composite filling. The dentist will decide when it is necessary. It does take some time to place and
remove the rubber dam, it can be a little uncomfortable, and some patients simply cannot tolerate its use. There
are other exceptions to its use because the position or location of some teeth, particularly 3rd molars, or so-
called wisdom teeth, may make it impossible to place a rubber dam.
Whether your dentist uses a rubber dam or not you should always focus on breathing through your
nose during the entire time the amalgam fillings are being removed.
7. Remove gloves and clean the patient’s mouth
Once the filling(s) have been removed and replaced, the dentist and the assistant should remove and
dispose of their gloves and the rubber dam, and thoroughly rinse and vacuum the patient’s entire
mouth for at least 15 seconds. This will help remove amalgam particles and residual mercury vapor from the
mouth. The patient should make every effort not to swallow during the rinsing procedure. It is also suggest that
after the rinsing procedure, the patient use a small amount of water and gargle as far back into his throat as
possible. The patient should not swallow this watery residue! Instead, he or she should spit it into a sink or cup.
All mercury free dentists should follow this procedure but it won't hurt to remind him or her.
8. Immediately clean up
After the fillings have been removed and replaced, the dentist or dental assistant should immediately remove
and dispose of the patient’s protective covering and thoroughly clean his/her face and neck. All
mercury free dentists should routinely do this but remind the assistant if he or she forgets, after all you don't
want to take any mercury home with you.
9. Use additional air purification
Some mercury free dentists use an additional air filtering system that’s placed as close to the patient’s
mouth as is practical. The more popular ones resemble an elephant’s trunk and have openings about 4 inches
in diameter. This can be helpful, but many mercury free dentists believe that the patient can be adequately
protected without such a system. More and more mercury free dentists are using this type of purification system
and while it’s a nice addition to the removal protocol, it is more important for the dentist and assistant than the
10. Filtering air in the operatory
There are a number of effective ways to purify the air in the dental office. I’m not making specific
recommendations. But many mercury free dental offices filter the office air, as they work in it all day and it’s to
their benefit to do so. This is more important for the dentist and staff than for the patient. Although mercury free
offices don’t place amalgam fillings, they certainly are required to remove them. Keep in mind that you will only
be at the office for a short period of time but the dentist and his or her staff will be removing these fillings many
times throughout the day. All mercury free dentists should want to take the necessary precautions to protect
themselves and their entire staff from excessive exposure to mercury.
11. Use chlorella
There’s some evidence that chlorella taken 10-15 minutes before amalgam removal can bind smaller particles
of swallowed mercury, allowing them to be harmlessly passed out of the intestine via the feces rather than
absorbed into the brain and nervous system. See instructions for patients for more info on chlorella usage.
Dr. Webster can refer you to a qualified mercury-free dentist and chelate the existing mercury from your
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