Amalgam Removal

Amalgam consists of 50% mercury, a highly toxic element. Specifically, mercury, a heavy metal, is the element with the highest toxicity.

Mercury enters the body through various pathways:

Warm beverages and foods can cause amalgam fillings to heat up and release vapors. This has been observed and documented by illuminating the amalgam with UV light. Since mercury has the distinctive property of absorbing the wavelength of 254 nm, a vapor shadow originating from the amalgam filling can be seen.

As the temperature increases, the release of mercury molecules also increases. During vaporization, the primary mode of absorption is through inhalation into the lungs.

Through any form of friction, fine particles of amalgam are released from the filling. The greater the friction, the more pronounced the abrasion.

For example, when polishing an amalgam filling with a rubber cup and white toothpaste, the filling may turn gray. The particles are clearly visible due to the change in color. This should always be taken into consideration during dental hygiene practices.

Even during eating, tooth brushing and teeth grinding, fine particles are released into the oral cavity, with a preference for entering the gastrointestinal tract.

An extreme form of abrasion occurs during improper removal of amalgam. This can lead to a high mercury exposure for the patient, resulting in health consequences.

Saliva is a saline solution that causes a corrosion/rust process in metals, and amalgam is no exception. Components of amalgam, including mercury, are released in ionic form into saliva. This leads to absorption through the oral mucosa and the gastrointestinal tract.

If other metals, such as titanium or gold, are present in the oral cavity, corrosion is intensified. This forms a so-called galvanic element, similar to a battery. The involved metals release even more ions into saliva, thereby significantly increasing the exposure.

The released mercury has a detrimental impact on health at both a toxic and immunological level. As the amalgam filling ages, the surface becomes rougher, and more porosities and cracks develop, increasing the health burden of amalgam with the age of the filling.

Mercury is capable of blocking and altering the function of various proteins, enzymes, and nucleotides. Additionally, mercury effectively displaces the essential trace element zinc. Furthermore, mercury increases oxidative stress, further intensifying the toxic burden. The toxic effects can occur in any tissue and organ, severely hindering bodily functions.

Mercury can bind to various endogenous proteins, altering their structure. This altered protein structure is recognized by the immune system as foreign, leading to the production of pro-inflammatory immune messengers. The immune system is activated, resulting in a generalized inflammation.

In addition, the immune system attacks the body’s own proteins altered by mercury. This attack is carried out by autoantibodies, antibodies directed against the body itself, leading to the development of various autoimmune reactions.

An increasing number of major players in the dental market are gradually withdrawing from the amalgam business. In 2022, companies such as Dentsply Sirona and Kerr bid farewell to the sale of amalgam.

The production and use of amalgam in dental practices have been steadily decreasing year by year.

In 2017, the Minamata Convention came into effect, signed by 140 countries, outlining a gradual phase-out of dental amalgam. The current goal is complete cessation by the year 2030.

Switzerland’s Chemical Risk Reduction Ordinance addresses dental amalgams as follows: “The use of dental amalgam is prohibited if, for medical reasons, preference can be given to another filling material.” In Swiss dental practices, the use of dental amalgams is less than 1%. This means that out of 1000 fillings, fewer than 10 are made using dental amalgam.

In Germany, too, the use of dental amalgam is slowly decreasing. According to the European Center for Environmental Medicine, usage is still below 10%, significantly higher than in Switzerland. Therefore, dentists in Germany choose the mercury-containing material in less than 100 out of 1000 filling cases.

When a posterior tooth requires a filling, German health insurance covers only the cost of an amalgam filling. If a patient prefers a tooth-colored composite filling, they often have to bear the additional cost themselves. As many patients are unwilling to cover the extra expenses, the decision is often made in favor of amalgam.

If someone decides to have old amalgam fillings removed, it’s crucial to follow proper protective measures and adhere to a biological concept. Amalgam removal without protection can expose the patient to high concentrations of mercury and lead to lasting damage.

Protective Measures:

Unfortunately, patients with previous amalgam fillings often have amalgam in the jawbone. Complete cleaning of the jawbone is a crucial part of amalgam detoxification and should not be neglected.

Amalgam splinters can enter the tissue in various ways:

Deciding whether to keep or remove amalgam is a personal choice. From a health perspective, there is a strong inclination towards removing amalgam, given the significantly increased risk of developing chronic issues associated with amalgam fillings. For retaining amalgam fillings, the material’s longevity is a strong argument. Indeed, there are few materials that can match the durability of amalgam. However, this durability is also a disadvantage because mercury exposure can continue for many decades.

The only durable and healthy alternative is ceramic fillings.

For those unwilling to compromise on longevity and durability, choosing ceramic as a filling material is recommended. Ceramic fillings or inlays demonstrate excellent biological compatibility and can surpass amalgam fillings in terms of longevity. Depending on the individual situation, the type of ceramic used can be decided. The method of attachment can also be individually chosen, either through adhesive bonding with a flowable composite or a cement bonding.

Through our in-house dental laboratory, ceramic replacements, tailored to the patient’s preferences, can be done in the same session as amalgam removal. This ensures that amalgam fillings are removed under protection, and ceramic fillings are placed on the same day.

After safely removing amalgam fillings and replacing them with ceramic or composite materials, the body can gradually be detoxified.

As long as amalgam is present in the oral cavity, detoxification is not possible and can be dangerous, as it may lead to a redistribution of toxins.

Various methods can be employed for amalgam detoxification. The most effective detoxification can be achieved using chelating agents such as DMPS, DMSA, or EDTA. Natural substances like alpha-lipoic acid or glutathione also exhibit good detoxifying properties for mercury.

Detoxification should always be guided and monitored by an experienced therapist.

Many patients carry amalgam fillings for an extended period and are uncertain about whether to opt for safe amalgam removal. Here are some frequently asked questions on the topic.

The additional information aims to provide you with a better understanding of the broader topic.