Hindawi Publishing Corporation

Journal of Environmental and Public Health

Volume 2012, Article ID 517391, 4 pages
doi:10.1155/2012/517391

Review Article
A Safe Protocol for Amalgam Removal

Dana G. Colson
Dr. Dana Coloson & Associates, 1950 Yonge Street, Toronto, ON, Canada M4S 1Z4

Correspondence should be addressed to Dana G. Colson, [email protected]

Received 9 August 2011; Accepted 1 November 2011

Academic Editor: Margaret E. Sears

Copyright © 2012 Dana G. Colson. This is an open access article distributed under the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Today’s environment has different impacts on our body than previous generations. Heavy metals are a growing concern in
medicine. Doctors and individuals request the removal of their amalgam (silver mercury) restorations due to the high mercury
content. A safe protocol to replace the silver mercury filling will ensure that there is minimal if any absorption of materials
while being removed. Strong alternative white composite and lab-processed materials are available today to create a healthy and
functioning mouth. Preparation of the patient prior to the procedure and after treatment is vital to establish the excretion of the
mercury from the body.

1. Introduction have been the standard restorative filling for our molars and
premolars. At that time there was a lot of controversy about
In dentistry, there is a lot of controversy about the topic of its intraoral use. Silver mercury fillings began to take over
silver mercury fillings; are they safe or not safe? There are the cast gold and gold foil restorations. These were excellent
many articles written on the pros and cons of these types and lasted for years; however they were labour intensive
of fillings. It is difficult to quantify and to assess the effects and the cast gold required a lab process that centrifuged
in each individual. It is not easy to identify silver mercury gold into a wax pattern to fit the tooth accurately. This was
fillings as the cause if illness presents or if the fillings con- a two-appointment process with added expense. Gold foil
tributed to illness, except in extreme toxicity cases. Refer to restorations were often traumatic to the pulp of the tooth,
the beginning sections of this review paper concerning the creating necrosis and requiring root canal. The addition of
science and mechanism of how mercury interconnects with amalgams as a restorative filling was a welcomed opportunity
body tissues and functions. to offer at a substantial cost reduction as the mercury was
Environmental doctors investigate heavy metal toxicity as triturated with a pellet containing silver, copper, tin, and
part of their overall wellness regiment to help their patients zinc. This created a substance that could be placed into the
with health concerns. These doctors look at sources of metals cleaned out tooth structure where decay had been present. It
when the patient’s lab reports/diagnostic tests show high was packed, condensed, and allowed to harden within a few
levels of mercury and other metals. They investigate what minutes and then carved intraoral chairside. Today the extra,
sources are contributing and how to reduce the burden on unused amalgam is placed in a container for safe disposal.
the body. The doctor may prescribe the safe removal of silver This restoration is easily burnished to tooth structure to
mercury fillings so as not to create an additional burden on recreate the tooth to its original shape and size. The onset
the body and to help their patient heal. Thus, when removing
of amalgam allowed people to keep their teeth, rather than
amalgams, additional steps help ensure that the patient is
having them extracted if money did not allow for gold res-
protected.
torations. Keeping teeth enabled people to have better
digestion and supported a more balanced quality of life.
2. Introduction of Amalgam in Dentistry Today, with the increase of chemicals such as pesticides,
Dental amalgam restorations, also called silver mercury fill- preservatives, processed ingredients in food, and diverse con-
ings, were introduced to North America in the 1830s and taminants in our environment; sensitivities, allergies, and
2 Journal of Environmental and Public Health

other illnesses are increasing rapidly. The Brain Wash pos- wear/attrition on their teeth, pressures exerted, type of diet
tulates that the toxins in our society are not additive but consumed on a daily basis, their oral hygiene, and other
synergistic. For example, the average apple contains residue metals in their mouth. Often amalgam restorations exist
of eleven different neurotoxins and is sprayed with pesticides under crowns and amalgam tattoos (discoloration along the
seventeen times prior to being picked from a tree [1]. Our gum) are noted. Amalgams have also been used to seal the
food intake of many pesticides and additives is most often apex of root canal treated teeth. If heavy pressures are
unknown. The level of materials such as mercury that our exerted by an individual or there is evidence of grinding and
bodies could tolerate several decades ago may not be what clenching, then the longevity of a composite restoration may
we can sustain today. be compromised. The size of the restoration will also influ-
ence the choice of materials. Tooth cusps often fracture over
3. Amalgam and Composite Fillings time, as well as with excessive pressure, requiring an indirect
restoration to be fabricated by a lab. Today the increasing
Silver mercury amalgam restorations are comprised of 50% trend is to work with a computer-generated restoration to
mercury, with the balance being silver, copper, tin, and zinc secure/repair the tooth in the long term. Bite plates to prevent
[2]. Over time the exposed surface changes. The fillings cor- grinding and clenching help preserve these new restorations
rode, and surface texture becomes rough. People who chew from excessive wear and pressure.
gum create a smooth, shiny surface on their fillings. Mercury When the patient is seen for an initial exam, a thorough
vapor is released by chewing grains, nuts, seeds, and gum, as medical and dental history is taken. Records including radio-
detected using mercury vapor analyzers [3]. A study in 2010 graphs and intraoral pictures are taken, and a comprehensive
looked at the wearability of composite (white) restorations exam follows. Previous films are requested or brought in by
compared to amalgams. It showed that over 12 years, the the patient. Lengthy conversations ensue to make sure that
group of patients that were not prone to decay, with resin/ the patient is properly prepared and that we are working
composite-filled restorations, were better off than the group with their physician, in a timely manner, to complement the
of patients with silver amalgam restorations [4]. Today with detoxification process that their doctor has prescribed and is
awareness of diet, home care, and education, the majority of administering. The physician evaluates the overall health of
people who seek preventative dental care are less prone to the body and the ability of the individual to eliminate toxins.
decay. The author has worked with alternative restorations For example, if a patient has a leaky gut, physicians restore
for over 27 years. this prior to removal as it is difficult to flush out toxins [5].
The advantage of white composite restorations is that If a woman is pregnant or breast feeding, amalgam removal
composite binds to composite and the base of the tooth does not occur until she has completed breast feeding her
rarely needs to be disturbed once the amalgams are removed. child [6]. It has been reported that the mercury concentra-
Dental restorative materials have various components, and tion in the blood of the fetus can be thirty times greater
individual Material Safety Data Sheets (MSDSs) are available than the mother’s blood [7]. Supplements are helpful and are
from the manufacturer. If an individual has concerns or is prescribed on an individual basis by the physician. Vitamin
sensitive to materials, one can refer to these reference sheets. C intake is recommended, often with other supplements,
For example, there are many composites and bonds available prior to and following amalgam removal. Once the amalgam
today without bisphenol A. Psychological benefits are also a restorations have been removed, the physician continues to
positive factor for patients. People feel that they now have a work with the patient to help with the detoxification of
mouth without the “scars” of the past. They are no longer mercury that is stored in the body.
self-conscious when smiling, laughing, and singing.
With the introduction of composite restorations, many
modifications have been made with the materials and ap-
5. Chairside Procedures
plications due to the extensive ongoing technology and The following steps are taken when removing silver mercury
research. The concerns with good marginal seals and pre- fillings, to ensure minimal if any absorption sublingually, or
vention of recurrent decay have been diminished. Wear and through the mucosal tissues, and to minimize mercury vapor
polishability of the composite materials with nanohybrid absorption through the blood/brain barrier [8–10].
particulates can withstand stronger chewing forces. Com- In office, the patient is prepared as follows, prior to amal-
posites are technique sensitive, and various aids can be used gam removal:
to ensure a proper seal of the restorative material to the
tooth structure and to create tight contacts to the adjacent (i) the patient is draped with a plastic apron under the
tooth to prevent food impaction between teeth. Today we dental bib to cover their clothing;
aim for minimally invasive dentistry to maintain integrity of
(ii) a dental dam (“raincoat”) is customized to fit the ex-
the tooth structure, and white composite materials are ideal
isting tooth/teeth to prevent particulates from con-
for these restorations.
tacting the oral mucosa;
4. Considerations prior to Amalgam Removal (iii) underneath the dam, activated charcoal or chlorella is
placed, along with a cotton roll and gauze. This helps
When examining a patient for amalgam removal upon to intercept particles and to chelate dissolved metals
request, many factors must be looked at including the rate of that seep under the dam. Often the particles are
Journal of Environmental and Public Health 3

found on the sublingual tissues and lateral borders of Dentists by law in Ontario [12] and elsewhere in Canada
the tongue. This must be prevented as this is the must have a certified amalgam separator on the wastewater
fastest absorption route into the body; lines in dental offices in their practices and must use a certi-
(iv) the patient’s face is draped under the dam, with a fied hazardous waste carrier for the recycling and disposing
liner; of amalgam waste.
(v) goggles for the eyes and hair cap or bonnet protection
are placed; 6. After Amalgam Removal
(vi) oxygen is supplied to the patient with a nasal mask A 2011 Norwegian study showed a 3-year followup after
and the mercury vapor ionizer is turned on. The va- amalgam removal with precautions in a treatment group
por ionizer is a specialized air filtration system that is compared to a reference group. It showed significant reduc-
used to bind mercury vapors that are attached by the tions in intraoral and general health complaints [13].
negative ion flow and are then carried to a positively The following is a list of outcomes that I repeatedly hear
charged ionizer plate at the opposite end of the room. from my patients over the years. Although I have not scien-
tifically collected them, after amalgam removal and detoxifi-
The operators also protect themselves with a filtered
cation, they have also been reported in the literature. Com-
mask, eye and hair protection, and face shields.
ments include that
The removal of amalgam commences as follows:
(a) patients no longer have a metallic taste in their
(i) a new dental bur is used in the handpiece to ensure
mouth;
easy removal;
(ii) high volume suction and a continual addition of wa- (b) patients feel as if they have more energy;
ter spray are supplied to the site where the amalgam (c) patients are able to concentrate better and make
is being extracted; decisions easier (the “brain fog” is gone);
(iii) if possible, the amalgam restoration is sectioned and (d) their body responds better to other treatments, as if a
then scooped out to eliminate as much mercury barrier has been lifted.
vapor release as possible [11]. The vitality of the tooth
is always a concern and the less trauma to the tooth, To achieve effective results one must include an integra-
the healthier the pulp, which supplies blood vessels tive approach with a physician and health care team with
and nerve supply to the tooth. The deeper the restora- attention to detoxification and diet over several months, with
tion, the greater the chance of pulpal degeneration, laboratory tests to monitor progress.
causing necrosis and subsequent abscess at the apex
of the tooth, as well as bone loss.
Disclosure
Once the amalgam is removed completely,
Dr. D. G. Colson is a D.D.S. at Dr. Dana Colson & Associates
(i) the oxygen and protective coverings are taken away; as well as the author of “Your Mouth: The Gateway to a
Healthier You.”
(ii) an immediate inspection under the dental dam oc-
curs. The gauze, cotton roll and activated charcoal/
chlorella are wiped away. Gauze is then used to in- References
spect the floor of the mouth and tongue to make sure
[1] M. S. Cook, The Brain Wash: A Powerful, All-Natural Program
no particulates seeped under the dam;
to Protect Your Brain Against Alzheimer’s, Chronic Fatigue Syn-
(iii) once all mucosal tissues are fully inspected and drome, Depression, Parkinson’s, and other Diseases, John Wiley
cleaned, the mouth is flushed with copious amounts & Sons, Mississauga, Canada, 2007.
of water, again to ensure no ingestion or absorption [2] B. M. Eley, “The future of dental amalgam: a review of the
of amalgam particulates. literature part 1 : dental amalgam structure and corrosion,”
British Dental Journal, vol. 182, no. 7, pp. 247–249, 1997.
The tooth is then restored to a healthy state of form and [3] G. M. Richardson, R. Wilson, D. Allard, C. Purtill, S. Douma,
function. Materials are taken into consideration as discussed and J. Gravière, “Mercury exposure and risks from dental
previously on an individual need. Often environmental amalgam in the US population, post-2000,” The Science of the
healthcare providers give direction on the preferred choice Total Environment, vol. 409, no. 20, pp. 4257–4268, 2011.
of materials to be used through biocompatibility testing. It [4] N. J. M. Opdam, E. M. C. Bronkhorst, B. A. Loomans, and
M.-C Huysmans, “12-year survival of composite vs. amalgam
is the dentist’s ultimate responsibility to advise the patient
restorations,” Journal of Dental Research, vol. 89, no. 10, pp.
about the strengths and limitations, if they cannot tolerate 1063–1067, 2010.
some materials. It has been the author’s experience that once [5] D. Hollander, “Intestinal permability, leaky gut, and intestinal
the amalgam materials have been removed and the patient disorders,” Current Gastroenterology Reports, vol. 1, no. 5, pp.
detoxes under the supervision of their physician, the range 410–416, 1999.
and variety of materials increase, allowing the dentist to [6] The Safety of Dental Amalgam, Health Canada, Department
create the best prognosis for the tooth. of Supply and Services Canada, 1996.
4 Journal of Environmental and Public Health

[7] B. J. Koos and L. D. Longo, “Mercury toxicity in the pregnant

woman, fetus, and newborn infant. A review,” American
Journal of Obstetrics and Gynecology, vol. 126, no. 3, pp. 390–
409, 1976.
[8] M. Nylander, L. Friberg, and B. Lind, “Mercury concentrations
in the human brain and kidneys in relation to exposure from
dental amalgam fillings,” Swedish Dental Journal, vol. 11, no.
5, pp. 179–187, 1987.
[9] T. W. Clarkson, “Metal toxicity in the central nervous system,”
Environmental Health Perspectives, vol. 75, pp. 59–64, 1987.
[10] F. L. Lorscheider, M. J. Vimy, and A. O. Summers, “Mercury
exposure from “silver” tooth fillings: emerging evidence
questions a traditional dental paradigm,” The FASEB Journal,
vol. 9, no. 7, pp. 504–508, 1995.
[11] S. M. Koral, IAOMT Safe Removal of Amalgam Fillings,
International Academy of Oral Medicine & Toxicology, 2007.
[12] Ontario. Service Ontario, Dentistry Act, chapter 24, 1991.
[13] T. T. Sjursen, G. B. Lygre, K. Dalen et al., “Changes in health
complaints after removal of amalgam fillings,” Journal of Oral
Rehabilitation, vol. 38, no. 11, pp. 835–848, 2011.