Dental amalgam is a very common restorative material, with various types being used in dentistry since the 1830s. While most contemporary restorative dentistry utilises inert ceramics and composite resins, amalgam still makes up a considerable proportion of existing restorations in Australian mouths. Most metal fillings are removed and replaced in response to clinical symptoms, which commonly include chips, cracks, or fractures to the filling or tooth structure, or as a result of new decay. However there are circumstances where a patient may request the removal and replacement of these restorations.
Health concerns and environmental impact
While it is not acknowledged by the FDI (World Dental Federation) that amalgam restorations are unsafe, there is recognition of the broader environmental impact of mercury, which typically constitutes approximately 50% of dental amalgam. The United Nations Minamata Convention policy document on mercury which was adopted by the FDI and the ADA (Australian Dental Association) in 2014 has called for a “phase-down” in the use of dental amalgam, and cites potential occupational risk to oral health personnel, and the potential environmental pollution concerns relating to correct collection and disposal of mercury.
This means that it is recognised that oral health care workers are at risk of exposure to potentially unsafe levels of mercury, and any dental amalgam removed from the mouth poses a threat to the environment. As a result, we do not place amalgam restorations, and we take the removal of amalgam restorations very seriously.
The World Health Organisation lists the following key facts about mercury:
- Mercury is a naturally occurring element that is found in air, water and soil.
- Exposure to mercury – even small amounts – may cause serious health problems, and is a threat to the development of the child in utero and early in life.
- Mercury may have toxic effects on the nervous, digestive and immune systems, and on lungs, kidneys, skin and eyes.
- Mercury is considered by WHO as one of the top ten chemicals or groups of chemicals of major public health concern.
- People are mainly exposed to methylmercury, an organic compound, when they eat fish and shellfish that contain the compound.
We generally recommend amalgam removal when:
- An amalgam filling shows signs of deterioration
- When an amalgam filling breaks
- When there is a crack in the tooth adjacent to an amalgam filling
- When there are health concerns relating to mercury levels (often by referral from the GP or Naturopath)
Clinical methods used for safe amalgam removal
We follow the recognised clinical protocol for safe amalgam removal which includes:
- The use of rubber dam isolation
- Copious irrigation and cooling throughout the removal process
- High speed evacuation
- The use of tungsten carbide burs to minimise metal aerosolisation
- A strategic approach to material removal
- An alternative source of medical air is available wherever necessary
- In office air filtration
Managing the amalgam removal process for patients with systemic health concerns
Often a white (composite resin) filling can be used to replace a metal filling. However, if amalgam fillings are large or there is not much remaining strong tooth structure, other options may need to be considered including fillings made of ceramic or crowns that cover and protect the entire tooth.
The process of removing amalgam fillings needs to be planned appropriately. We will not usually replace all metal fillings in one visit as we aim to minimise the potential aerosol exposure load to the patient. For this reason, a consultation is the first step in planning for amalgam filling removal to enable a safe strategy for this process.
For more information, click here to visit the World Health Organisation mercury fact sheet.
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Please note: Any surgical or invasive procedure carries risk. Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner.
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