The removal of amalgam is becoming an increasingly important issue for many patients.
Several decades ago, the silvery amalgam fillings were placed, often and willingly by dentists. The use of amalgam in Switzerland is now less than 1%.

In this article you will find all the important information on the subject of amalgam, in order to easily make a decision to remove amalgam fillings or not.

Amalgam and the release of mercury


Amalgam consists of 50% mercury, a highly toxic element. More specifically, the heavy metal mercury is the most toxic element.

Mercury enters the body in various ways:

1. Evaporation

The amalgam fillings are warmed up by warm drinks and food and begin to evaporate. This was determined and documented by illuminating the amalgam with UV light. Since mercury has the distinctive property of absorbing the wavelength of 254 nm, a vaporous shower could be seen emanating from the amalgam filling.

As the temperature rises, the release of mercury molecules increases. In the case of vaporisation, absorption occurs mainly via inhalation into the lungs.

2. Abrasion

Any kind of friction causes fine amalgam particles to be given off.
The stronger the friction, the greater the abrasion.

An example: While polishing over an amalgam filling with a rubber polishing cup with white toothpaste, it turns grey. The particles can clearly be seen by the colour change. This should always be taken into account during dental cleaning.

Fine particles are also released into the oral cavity when eating, brushing teeth and grinding teeth, during which the particles tend to get into the gastrointestinal tract.

An extreme form of wear occurs when amalgam is removed improperly. The mercury exposure of the patient can be very high and can lead to health consequences.

3. Corrosion

Saliva is a saline solution and causes a corrosion/rusting process on metals. This is no different with amalgam fillings. n the process, components of the amalgam, including mercury, are released into the saliva in an ionic form. It is absorbed through the oral mucosa (tissue) and the gastrointestinal tract.

If other metals are also present in the oral cavity, e.g. titanium or gold, corrosion is increased. A so-called galvanic element is formed, like in a battery. These metals in the mouth release even more ions into the saliva, which greatly increases the load and burden on the body.

Health effects of amalgam


The emission of mercury has negative effects on health in both toxicological and immunological ways. The older the amalgam filling, the rougher the surface. Additionally, old amalgam fillings tend to be more porous and have cracks. As a result, the health burden of amalgam increases with the age of the filling.

 

1. Toxic burden

Mercury is able to block various proteins, enzymes and nucleotides and change their function.
In addition, the vital trace element zinc can be repressed by mercury.
Furthermore, mercury increases oxidative stress, which further increases the toxic load.
The toxicity can affect all organs and tissues and can impede bodily functions.

2. Immunological burden

Mercury can bind to various proteins in the body and change the structure. This altered protein structure is recognised by the immune system as a foreign body, whereupon pro-inflammatory immune messengers are formed. The immune system is activated and a generalised inflammation occurs.

In addition, the body’s own proteins, which have been altered by mercury, are attacked by the immune system. The aggravation is carried out by autoantibodies, i.e. antibodies that are directed against your own body. This leads to the development of various autoimmune reactions.

Manufacturing and use of dental amalgams


More and more large companies in the dental market are gradually parting with amalgam. In 2022, the companies Dentsply Sirona and Kerr stopped selling amalgam.

The production and use of amalgam in dental practices is steadily decreasing year after year.

In 2017, the Minamata Convention of Mercury was implemented and signed by 140 countries. This agreement regulates the gradual decrease of amalgam use in dentistry. The current goal is to phase it out completely by 2030.

Switzerland
The Swiss chemical risk reductions ordinance takes the following position on dental amalgams: “The use of dental amalgam is prohibited if another filling material can be preferred for medical reasons. In Swiss dental practices, the use of dental amalgams falls below 1%. This means that out of 1000 fillings, fewer than 10 are made of amalgam.

Germany
In Germany, similarly, the use of dental amalgam is also declining. However, according to the European Center for Environmental Medicine, the use is still below 10%, which is significantly higher than in Switzerland. Therefore, dentists opt for the mercury-containing material in less than 100 cases out of 1000 fillings.

Reasons for frequent usage:
If a posterior tooth requires a filling, the German health insurance only covers the cost for an amalgam filling. If the patient wants a tooth-coloured filling made of composite, the patient has to bear the additional price in most cases. Since many patients are not willing to bear the additional cost, the decision is made in favour of the amalgam.

Safe Amalgam Removal


If one decides to have old amalgam fillings removed, the correct protective measures and the biological concept should be taken into consideration.
An amalgam removal without protection can expose the affected patient to high concentrations of mercury and cause permanent damage.

Protective measures:

  • Correct removal technique. The amalgam filling is removed in one piece. This can reduce exposure to mercury significantly.
  • Use of an intraoral suction cup, which is placed around the affected tooth and completely encloses it (Clean UP suction cup). A high performance central suction machine is of great importance.
  • Powerful suction outside the oral cavity, directing the airflow away from the patient.
  • Close-fitting nose protection with gold coating for the patient. The gold can effectively bond and hold mercury vapor. This prevents hazardous vapors from entering the respiratory tract. The dentist and assistant also wear a gold-coated face mask. Alternatively, FFP3 masks can also be used, but they have a poorer filtration value.
  • A rudder dam is made of latex or nitrile and is stretched around the tooth. Since the rubber dam has both advantages and disadvantages, the use is decided individually.

Amalgam fragments in the jawbone


Unfortunately, it is a frequent occurrence that patients with previous amalgam fillings also have amalgam particles in the jawbone. These get into the tissue in different ways:

  1. If the amalgam fillings are removed incorrectly, small fragments can enter the tissue at a high speed.
  2. When removing teeth with amalgam fillings, fragments of the amalgam can fall into the open tooth socket and remain there.
  3. When removing a tooth, parts of the adjacent amalgam filling can also break off and get into the open wound. This is caused by instruments like dental extraction forceps or dental elevators which rub or press onto the amalgam filling.

Splinters of amalgam in the tissue can be a massive burden on health and should be removed carefully.

Should amalgam fillings be removed?


Each person affected must decide for themselves whether they want to remove the amalgam or leave it in place.
The health side definitely speaks in favour of amalgam removal. The probability of developing chronic health issues is significantly higher with amalgam fillings.

The fact that the material is very durable speaks in favour of leaving the amalgam fillings in place. In fact, there are few materials that can match the longevity of amalgam. At the same time however, the durability is also a disadvantage because exposure to mercury can therefore last for many decades.

Long-lasting, healthy alternative to amalgam


For those who don’t want to forego longevity and durability, ceramic is the material of choice.
Ceramic fillings or ceramic inlays show the best biological compatibility and can surpass amalgam fillings in terms of longevity.

Depending on the individual situation, a decision can be made as to whether zirconium oxide or hybrid ceramics should be used. For the attachment, an adhesive bond with thin-flowing composite or an adhesive-cement compound can also be selected individually.

Thanks to our in-house dental laboratory, the ceramic replacement can be carried out according to the exact needs of the patient, in the same session.
The amalgam fillings are removed under protection and the ceramic fillings are placed on the same day.

Durable healthy alternative to amalgam

After amalgam removal – the detoxification of mercury


After the amalgam fillings have been safely removed and replaced with ceramic or composite, the body can be gradually detoxified again.

As long as the amalgam is present in the oral cavity, detoxification is not possible and is sometimes dangerous because toxins can be redistributed.

There are various ways of removing amalgam from the body.
The most effective detoxification can be done with the help of chelating agents such as DMPS, DMSA or EDTA. However, natural substances such as alpha-lipoic acid or glutathione also show good detoxifying properties with mercury.

In general, the detoxification treatment should always be overseen and controlled by an experienced therapist.

FAQ


What is the difference between amalgam removal and amalgam replacement?
These two terms have the same meaning, to completely remove amalgam from the teeth as well as tissue in the oral cavity.
How is the amalgam disposed of?
Amalgam is classified as hazardous waste and is accordingly collected in special containers and handed over to specialised disposal companies.
How is it possible to prevent amalgam from getting into the wastewater?
The wastewater from all dental chairs must be filtered by an amalgam separator. The filtered water then enters the wastewater system.
Are amalgam fillings in dead teeth more dangerous?
The body’s own bacteria convert the inorganic mercury into an even more toxic form, organic methyl mercury. Various germs nest in the microscopic canals of dead teeth, which further accelerate the methylation process.
Can amalgam be removed before pregnancy?
Yes, many doctors recommend having the amalgam removed prior to a planned pregnancy. The reason is the mercury can easily pass through the placenta – i.e. the transfer of mercury via the placenta to the embryo.
Can amalgam be removed during pregnancy?
No, amalgam removal should be avoided during pregnancy. Despite the highest protective measures, exposure to mercury can never be ruled out 100%.
Can amalgam be removed while breastfeeding?
No, amalgam removal should be avoided while mothers are breastfeeding. The mercury can easily pass into the breast milk and affect the infant.
What should be considered in terms of dental hygiene if one has amalgam fillings?
Any kind of friction can loosen particles from the amalgam filling. This is also the case with dental cleanings. When polishing with the polishing paste or with a rubber polisher, mercury is released into the oral cavity. The same goes for dental devices like ultrasonic scalers and air polishers, which should be taken into consideration.
Can amalgam fragments in the issue impair the elimination of heavy metals?
Yes, as long as there is amalgam in the teeth or tissue, heavy metal detoxification is not possible.
How can amalgam fragments be diagnosed?
Metallic splinters are best diagnosed by X-ray, for example with a DVT (3D Digital Volume Tomography) or a head CT (Computer Tomography).
How can the amalgam load in the body be tested?
  • Saliva Test
  • Provocation test with DMPS
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