Protocol for mercury replacement

When we replace your amalgam filling(s) we follow a protocol in order to do it in a safe way. This area is controversial but we have based our amalgam removal protocol on the best available evidence.

  • An activated charcoal solution is available before the procedure starts.
  • Ventilation – the surgeries are kept well ventilated with a good supply of fresh air.
  • A paper “filter” is placed over your face to cover your nose and your eyes to protect you from debris and mercury vapour while we work. Rubber dam – a rubber shield is used to catch any debris that is not immediately caught by the suction unit, meaning that far less amalgam debris will come into contact with the soft tissues of your mouth. This stage is controversial as some think that the rubber dam may allow mercury vapour to build up behind it. Studies however show that treatment with rubber dam reduces total mercury exposure during amalgam replacement and plasma levels of mercury are lower following treatment with rubber dam than without it.
  • High volume suction is used to remove mercury vapour, and debris as the filling is removed. Our practice has one of the most modern suction units available to ensure that the maximum amount of amalgam debris is safely removed as we work.
  • Keeping fillings cool: it is known that if you heat an amalgam restoration then the level of mercury vapour released will increase and for that reason we use lots of water and air to create a “cooling mist” around the tooth while we work.
  • Special burs: most dental drills grind teeth or fillings away. If you are concerned about mercury and dental amalgam this approach is not ideal as it generates heat which increases the release of mercury vapour. The grinding approach also creates lots of very small amalgam particles which are harder to vacuum away and are more likely to be swallowed, something that we want to avoid. The solution is to use special burs designed to cut the filling cleanly as well as a protocol called chunking to remove the old filling in as few (large) pieces as possible.
  • After removal of the old filling(s) we thoroughly wash your mouth and make sure that the cavity, where the old filling used to be, is completely clean from any small particles.
  • Finally a new white filling can be placed or an impression taken for a porcelain/composite inlay or crown.