Once the removal has begun, the mercury vapor will be
continuously released from the tooth. During the removal or placement of amalgam the
patient can be exposed to amounts which are a thousand times greater than the EPA
Protocol for Amalgam-Mercury-Silver Filling Removal
International Academy of Oral Medicine and
HOME - Health Dental Risk Page - CANCER
Page - Amalgam Replacement Protocol - Disclaimer
First in every concerned doctor's mind is the protection of the patient from
additional exposure to mercury. This is especially true of the mercury toxic patient. The
mercury toxic patient may have been exposed to varying amounts of mercury from diet,
environment, employment or from mercury/silver dental fillings. All forms are cumulative
and can contribute to the body burden. The goal of this preferred procedure is to minimize
any additional exposure of the patient, ourselves, or staff to mercury.
During chewing the patient is exposed to intraoral levels which are several times the EPA
allowable air concentration. 2 During the
removal or placement of amalgam the patient can be exposed to amounts which are a thousand
times greater than the EPA allowable concentration.3 Once the
drill touches the filling temperature increases immediately vaporizing the mercury
component of the alloy. There are 8 steps to greatly reducing everyone's exposure.
1. Keep the fillings cool
All removal must be done under cold water spray with copious amounts of water.
Once the removal has begun, the mercury vapor will be continuously released from the
2. Use a high volume evacuator
Therefore, a high volume evacuator tip should be kept near the tooth (1/2 inch)
at all times to evacuate this vapor from the area of the patient. Polishing amalgam can
create very dangerous levels of mercury and should be avoided especially for the mercury
3. Provide an alternative air source
All patients having amalgam removed or placed should be provided with an
alternative air source and instructed to not breathe through their mouth during treatment.
A nasal hood such as is used with the nitrous oxide analgesia equipment is excellent. Air
is best and oxygen is acceptable although not required. If just air is used it should be
clean and free of mercury vapor preferably from outside the dental office.
4. Immediately dispose of the mercury alloy
Particles of mercury alloy should be washed and vacuumed away as soon as they
are generated. The filling should be sectioned and removed in large pieces to reduce
At present the International Academy of Oral Medicine and Toxicology (IAOMT) has approved
removal both with and without the use of a rubber dam. Some evidence exist to support both
views since high levels of mercury and amalgam particles can be found under the dam. All
members are agreed that whether or not a rubber dam is used the patient should be
instructed to not breathe through their mouth or swallow the particles. Some experts feel
that it is better to remove the amalgam first and then apply the dam if needed for
5. Lavage, and change gloves
After the fillings have been removed, take off the rubber dam if one was used
and lavage the patients mouth for at least 30 seconds with cold water and vacuum. Remove
your gloves and replace them with a new pair. If a restorative procedure is next then
reapply a new dam and proceed.
6. Immediately clean patient
Immediately change patient's protective wear and clean their face.
7. Consider nutritional support
Consider appropriate nutritional support before, during and after removal.
8. Keep room air pure
Install room air purifiers or ionizers and fans for everyone's
requires that employees be given written informed consent before the use of any toxic
chemicals of which mercury is one. Elemental mercury vapor is one of the most toxic forms
of mercury and should not breathed. Women of child bearing age should be exposed to no
more than 10% of the OSHA MAC6. Women who
are pregnant should be exposed to no mercury.7 If you use
mercury or remove mercury in any form the National Institute of Occupational Safety and
Health (NIOSH) has recommended that your employees be medically monitored annually.
ANY MERCURY EXPOSURE REQUIRES THAT THE EMPLOYEE WEAR AN APPROVED MERCURY FILTER MASK.
An approved mask is appropriate for wearing during all dental procedures which
will expose you or your staff to mercury.8
The manner in which dentists operate their equipment dramatically affects the amount of
mercury released. Never drill on mercury high dry. It is hazardous to you, your staff, and
your patient. Levels as high as 4000 m g/M3 have been measured 18" from the drill
when used high dry. Levels over 1000 m g/M3 are measurable upon opening an amalgam mixing
One out of 7 California dental offices tested over the OSHA TWA of 50 m g/M 3 . 100% of
the vacuum cleaner exhaust tested over 100 m g/M 3 . Any office where mercury is used
should be tested regularly and staff should be monitored for exposure. Testing services
are available and a mercury sensor badge is available for personnel monitoring. They
should test inside storage areas and along baseboards where mercury might have dropped.
Office spills can go undetected for years and are extremely hazardous.
NEW! DENTAL CLEANSE
DISCUSSION AND SUPPORT GROUP
"One of the most important thing
that you can do for your health"--Dr.Hal Higgins
the archives of Dentalcleanse Support Group
1 IAOMT Standards of Care Preferred Procedure Approved
2 EPA United States Environmental Protection Agency Office of Health
and Environment Assessment Mercury health effects update Final Report EPA-600/8-84-019F
3 Cooley RL, Barkmeier WW: Mercury vapor emitted during ultraspeed
cutting of amalgam. J Indiana Dent Assoc 57:28-31, 1978
4 OSHA Job Health Series: Mercury.(2234)8/1975
5 Hazard Communication Program Federal Register/ Vol. 52. No. 163 /
Monday, August 24, 1987
6 OSHA MAC is Threshold Limit Value of 100 micrograms/ cubic meter or
100 PPM This is a never to be exceeded standard.
7 Koos BJ and Lango LD , Mercury Toxicity in the pregnant woman, fetus,
and newborn infant. A review Am J Obstetrics and Gynecology 126(3):390-409, 1976
8 Mine Safety Association high levels and 3M mercury dust mask lower
Dental Health Risks
"Mercury from Amalgam fillings contributes 3 to 4 times
more mercury to our bodies than all the environmental sources combined."
Dental health Forums:
Dental Care & Amalgam
Other Recommended books:
- The Mercury In Your Mouth---Quicksilver Associates, 10 East 87 Street, New
York, NY 10128. Tel: 212 423 3074 Fax - 289 3046
- The End of Cancer by Charlotte Dubois & John Lubecki, D.C.
- Root Canal Cover Up by George Meinig
- Toxic Metal Syndrome by Casdorph & Walker
- Dental Mercury Detox by Ziff
Dentists have the highest suicide and divorce rates among professional. Female
dental personnel have a higher spontaneous abortion rate, a raised incidence of premature
labour, and an elevated perinatal mortality.
Research has demonstrated that 100% of all root canals result in residual
infection due to the imperfect seal that allows bacteria to penetrate. The toxins given
off by these bacteria are more toxic than mercury. These toxins can cause systemic
diseases of the heart, kidney, uterus, and nervous and endocrine systems.
"Electrogalvanism is frequently the cause of lack of concentration and
memory, insomnia, psychological problems, tinnitus, vertigo, epilepsy. To name a
few."---Edward Arana, D.D.S.