Amalgam removal is an essential part of Biological Dentistry and is becoming an increasingly important issue for patients.
Several decades ago, silvery amalgam fillings were placed very often by dentists. The use of amalgam in Switzerland is now less than 1%.
In this article you will find important information on the subject of amalgam, to assist in the decision of getting amalgam removed or not.
Amalgam and the release of mercury
Amalgam consists of 50% mercury, a highly toxic element. Mercury is a heavy metal and is considered the most toxic element.
Mercury enters the body in various ways:
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 shadow 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.
Any kind of friction causes fine amalgam particles to be given off.
The stronger the friction, the greater the abrasion.
An example: When 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 a dental cleaning.
Fine particles are also released into the oral cavity when eating, brushing teeth and grinding teeth, in which the particles tend to get into the gastrointestinal tract.
An extreme form of abrasion occurs when amalgam fillings are removed improperly. The mercury exposure of the patient can be very high and can lead to serious health issues.
Saliva is a saline solution and causes a corrosion/rusting process on metals. This also happens with amalgam fillings. In this process, components of 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 increases. A so-called galvanic element is formed, like in a battery. These metals in the mouth tend to release even more ions into the saliva, which greatly increases the load and burden on the body.
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Health effects of amalgam
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 interfere with and hinder bodily functions.
2. Immunological burden
Mercury can bind to various proteins in the body and change their 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.
Additionally, the body’s own proteins can be changed and be 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 decreasing amalgam production. 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.
The Swiss Chemical Risk Reduction Ordinance comments on dental amalgams as follows: The use of dental amalgam is prohibited if, for medical reasons, another filling material can be preferred. In Swiss dental practices, the use of dental amalgams falls below 1%. This means that out of 1000 fillings, less than 10 are amalgam fillings.
Similarily, the use of dental amalgam is also declining in Germany. 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 cost in most cases. Since many patients are not willing to bear the additional cost, amalgam is still chosen frequently.
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 patient to high concentrations of mercury and cause permanent damage.
- 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 tooth and completely encloses it (Clean UP suction cup). A high performance air suction machine is of great importance.
- Powerful suction maschine 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 mask. Alternatively, FFP3 masks can also be used, but they have a poorer filtration value compared to the gold mask.
- A rudder dam 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. The complete cleaning of the jawbone is also an important part of amalgam removal and should not be neglected.
Amalgam particles can get into the tissue/bone in various ways:
- If amalgam fillings are removed incorrectly, small fragments can enter the tissue at a high speed.
- When removing teeth that have amalgam fillings, fragments of amalgam can fall into the open tooth socket and remain there.
- When removing a tooth, parts of an 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 press onto the amalgam filling.
Should amalgam fillings be removed?
Each person must decide for themselves whether they want to remove the amalgam or leave it in place.In terms of health, it is reccomended to remove amalgam fillings. 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 have 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.
The only long-lasting and healthy alternative are ceramic fillings.
Ceramic fillings – a healthy alternative to amalgam fillings
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 tolerability. They can also surpass the longevity of amalgam fillings. Depending on the individual situation, either zirconium oxide or hybrid ceramics can be used to replace amalgam. For attatching the ceramic filling/inlay to the tooth, an adhesive bond with thin-flowing composite or an adhesive-cement compound can be selected individually.
With our in-house dental laboratory, upon patient’s request, amalgam removal and a replacement with ceramics can be done in one session.
Amalgam fillings are removed under protection and ceramic fillings can be placed on the same day.
After amalgam removal – detoxification of mercury
After 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 for mercury.
In general, detoxification treatments should always be overseen and controlled by an experienced doctor/therapist.
FAQ about amalgam removal
What is the difference between amalgam removal and amalgam replacement?
How is amalgam removal related to biological dentistry?
Complete amalgam removal is an important treatment for patients with many chronic conditions, in order to reduce exposure to mercury. Therefore it is an important part of biological dentistry.
Does the removal of amalgam have a negative effect on the body?
In our practices, we have various protection and safety measures when removing amalgam, so that the exposure to amalgam is kept to a minimum. These safety measures are implemented to protect the patient, dentist and assistant.
Is it necessary to have a dental cleaning before removing amalgam?
Before removing amalgam fillings, a dental cleaning is not necessary.
You have had amalgam removed without protective measures. What should you do?
Are amalgam fillings in dead teeth more dangerous?
Can amalgam be removed before pregnancy?
Can amalgam be removed during pregnancy?
Can amalgam be removed while breastfeeding?
What should be considered in terms of dental hygiene if one has amalgam fillings?
Can amalgam fragments in the tissue impair the elimination of heavy metals?
How can amalgam fragments be diagnosed?
Amalgam toxicity - which factors influence the degree of toxicity?
- The ability to detox. Some patients are able to detoxify quickly and effectively, whereby others have difficulty detoxifying. The ability to detox is mainly determined by genetics.
- The amount of amalgam fillings in the oral cavity. The more amalgam fillings, the higher the load of murcury/burden of heavy metals.
- Protective measures during amalgam removal
- Additional/other metals in the mouth. If other alloys are present in the mouth, a galvanic cell forms and thus a battery effect will occur. This increases the release of metallic ions into the saliva. Examples of other metals are gold and titanium.
- Age of the fillings. The older the filling, the more murcury is emitted.
- Presence of amalgam particles/fragments in the bone.
How can the amalgam load in the body be tested?
- Saliva test
- Provocation test with DMPS
Old amalgam fillings - is the burden/load higher?
How is the amalgam disposed of?
How is it possible to prevent amalgam from getting into the wastewater?
Can a tooth become sensitive after amalgam removal?
During any dental treatment, a tooth can be subject to trauma and eventually die. In our dental practices we take precaution to ensure that that teeth, even with deep caries or amalgam fillings, cause as little touble as possible.
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