Amalgam removal is an essential part of biological dentistry and is becoming increasingly important for many patients.
Several decades ago the silvery amalgam fillings were placed by dentists very often. Nowadays, the use of amalgam in Switzerland is less than 1%.
In this article you will find important information about amalgam fillings, to help you decide whether or not to remove amalgam fillings.
Amalgam and Mercury Release
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.
Health Effects of Amalgam
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.
1. Toxic Load
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.
2. Immunological Load
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.
Production and Use of Dental Amalgams
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.
Reasons for Higher Usage:
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.
Safe Amalgam Removal:
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.
- Correct technique during removal: The amalgam filling is removed in one piece, significantly reducing mercury exposure.
- Intraoral suction, which is placed around the affected tooth, fully covering it (Clean UP suction). A central suction machine with high power is essential.
- Powerful external suction, diverting the airflow away from the patient.
- Well-fitted nose protection with gold coating for the patient. Gold effectively binds and retains potential mercury vapors, preventing dangerous fumes from entering the respiratory system. The dentist and assistant also wear gold-coated masks. Alternatively, FFP3 masks can be used, although they have a lower filtration value.
- The use of a rubber dam, a latex or nitrile stretch rubber, placed around the tooth. As rubber dam has both advantages and disadvantages, its use is decided individually.
Amalgam Splinters in Jawbone:
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:
- During incorrect removal of amalgam fillings, small splinters can be propelled into the tissue at high speed.
- When removing teeth with amalgam fillings, fragments can fall into the open tooth socket and remain there.
- During tooth extraction, parts of the adjacent amalgam filling can break off and enter the open wound.
Amalgam splinters in tissues can pose a significant health burden and should be gently removed.
Amalgam Removal or Retention:
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.
Ceramic Fillings – A Healthy Alternative to Amalgam:
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 Amalgam Removal – Mercury Detoxification:
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.
Dr. Artur Hein
The removal of amalgam should be done with safe protective measures to avoid poisoning due to exposure. We will be happy to advise you.
FAQ on Amalgam Removal
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.
Both the terms amalgam removal and amalgam remediation describe one and the same thing – the complete removal of amalgam from the teeth and tissue.
Complete amalgam remediation is an important treatment for many chronic diseases in order to reduce exposure to mercury. It is therefore an important aspect of biological dentistry.
Various protective measures are taken in our practice to ensure that as little mercury as possible enters the body during amalgam removal. This protection serves both the patient and the dentist and assistants.
If amalgam has been removed without protection, the body may have absorbed a large amount of mercury. It is therefore advisable to consult a doctor who specializes in detoxifying the body. They can determine the extent to which the body has been poisoned and take appropriate measures.
The body’s own bacteria convert the inorganic mercury into even more toxic organic methyl mercury. Various germs settle in the microscopic tubules of the dead teeth, which further accelerate the methylation process.
Yes, many doctors recommend having amalgam removed before a planned pregnancy. The reason for this is the high placental permeability of mercury – i.e. the transfer of mercury to the embryo via the placenta.
No, it should not be used during pregnancy, as despite the highest protective measures, exposure can never be 100% ruled out.
No, breastfeeding mothers should also refrain from amalgam treatment. The mercury can easily pass into the breast milk and contaminate the infant.
Any kind of friction can release particles from the amalgam. This is also the case with dental hygiene. When polishing with polishing paste or a rubber polisher, mercury is released into the oral cavity. The same applies to ultrasonic and powder jet devices and should always be taken into account.
Yes, as long as there is amalgam in the teeth or in the tissue, heavy metal elimination is not possible.
Metallic splinters are best diagnosed by X-ray, with a CBCT or CT (computer tomography) of the head.
Amalgam poisoning can be influenced by various factors:
- The ability to detoxify. Some patients can detoxify quickly and effectively, while others have more difficulty detoxifying. The ability to detoxify is mainly genetically determined.
- Number of amalgam fillings in the mouth. The more amalgam fillings there are, the higher the mercury exposure
- Protective measures for amalgam restoration
- Other metals in the oral cavity. If there are other alloys in the mouth, a galvanic element and thus a battery effect occurs. This increases the release of metallic ions into the saliva. Other metals include gold and titanium.
- Age of the fillings. The older the amalgam filling, the higher the release of mercury.
- Presence of amalgam splinters in the bone
- Saliva test
- Provocation test or mobilization test with DMPS
Old amalgam fillings often have cracks and a rough surface. The older they become, the more uneven and fissured their structure and the higher the release of metal ions.
Amalgam is classified as hazardous special waste and is collected accordingly in special containers and handed over to specialized disposal companies.
The waste water from all dental chairs must be filtered by an amalgam separator. The filtered water then enters the waste water pipes.
Every time a tooth is treated, it can suffer trauma and possibly die. In our dental practice, we have taken various precautions to ensure that the tooth remains calm, even in the case of deep caries or amalgam fillings.