Safe Amalgam Removal

I remove amalgams from teeth on a daily basis as a dentist. The reasons why I remove amalgams vary from new decay around an existing amalgam; a patient doesn't like the way the amalgam looks and would like something tooth colored; the amalgam or the tooth with the amalgam broke and the tooth needs a crown; the tooth has an existing crown with decay and the old buildup in the tooth was amalgam.

Recently I was asked the following questions by a potential new patient and I thought others might be interested in the questions and my responses.

Here are the questions:

How long have you been doing safe amalgam removal? Did you have to have special training in this procedure? Do you do any kind of health assessment on the patient before starting? Do you recommend any supplements before and after removal? Do you check the electrical potential of the fillings to determine where to start? I understand you use a rubber dam. Do you have a special vacuum or vapor control system? Do you use an electric drill or an air turbine drill? How much time do you recommend between extractions?

Here was my answer:

I have been doing safe amalgam removal since completing dental school at UCLA in 2003. I use an electric handpiece with sufficient water spray to minimize the mercury vapors when removing amalgams. I do all amalgam removals with a rubber dam and high speed evacuation. When removing amalgam fillings I do so by quadrants of the mouth and I start in the quadrant that has fillings with underlying decay or breakdown of the existing amalgam. I recommend waiting at least a week between quadrants. Sometimes a tooth can be sensitive after an amalgam is removed and a new tooth colored filling is placed. It is important to make sure the teeth have fully recovered and are feeling good before any further work is done. I leave it up to the patient to decide how they want to spread out the treatment. I recommend to all my patients that they take a multi-vitamin, but nothing in particular for amalgam removal.

I have a patient that is currently being treated for high levels of mercury and lead in her system. She only has three fillings in her adult teeth and none of them are amalgams. The patient doesn't know how she ended up with such high levels of mercury or lead in her system. The patient is seeing an internal medicine doctor that has been placing her on a drug called Dimercaptosuccinic acid (DMSA). Also, the doctor recommends taking mineral supplements, specifically Vitamin C. Prior to this treatment, the doctor recommends her patients have any amalgams in the mouths removed so as not to counteract her treatment protocol. The treatment with the DMSA is closely monitored with urine tests to see if the levels of mercury decrease.

I can be reached via the contact page on my website familycaredentists.com with any further questions.

Kari Ann Hong, DDS
1000 Newbury Road, Suite 190
Thousand Oaks, CA 91320
www.familycaredentists.com