Safe Amalgam Removal

Yes, the most common element in amalgam fillings, also known as black dental fillings or silver fillings, is mercury.

Amalgam fillings contain 50% mercury by weight. Considering the filling weights, a filling may contain 150 – 750 mg of mercury depending on the size of the filling. This is approximately the size of 1 medium-sized painkiller pill.

When amalgam fillings are first made, they are silver-coloured and shine. However, over time, it may corrode and become black or dark grey and lose its shine. Fillings with metallic colour as in the photo below are amalgam fillings. It can also be detected by X-ray

Yes, over time, it corrodes and darkens due to the effect of bacteria in the mouth and galvanic flow.

Amalgam filling is normally not white, but sometimes we may encounter situations where the entire amalgam is not removed and composite filling or crown is made on it. In this case, the amalgam inside is not visible from the outside. The amalgam under the composite can be seen on the x-ray, but if there is amalgam under the coating, it can only be detected by removing the crown.

The information taught during dental education is “If there is no problem in the amalgam filling, the filling is not removed because more mercury is released during removal”. (Even this is a confession. The dental profession admits that it uses this filling even though it is aware of this damage. Because while the filling is done also the patient exposed to high amounts of mercury during the treatment). My opinion is that all amalgam fillings should be removed by taking safety precautions. Because if they are not removed, the mercury in them will pass into the body day by day. Even if years have passed since the filling was made, mercury release continues. In addition, this release increases when the filling is broken, cracked or leaking. If mercury accumulates in critical organs, the damage may occur many years later. In order to reduce our toxic load, I think that the filling should be dismantled even if there is no visible problem. However, if safety measures cannot be taken, I recommend that it should not be dismantled unless it is necessary, because exposure to higher doses of mercury at one time can lead to more serious health problems.

Some dentists do not want to touch amalgam fillings because there are often cracks under these fillings and the fillings can extend under the gum. In this case, the degree of difficulty of the fillings to be replaced may be high. Of course, if the physician thinks that it will not provide an advantage compared to the old one, he may not want to do these fillings. Sometimes the filling may be very close to the nerves of the tooth and of course the dentist does not want the tooth to go to the root canal during the removal of the filling. In today’s dentistry, these problems can be overcome with the use of rubber dam and a biomimetic approach. It is possible to replace the fillings of even the most difficult amalgam filled teeth without damaging the tooth with methods such as working with magnification (loupe or microscope) to prevent the tooth from going into the root canal, preventing unnecessary loss of tooth tissue by using decay determining dyes and providing a clean working area by using rubber dam. In amalgam fillings, the gap between the tooth and the filling is larger and saliva can leak into this gap (we cannot see it visually, but we know this from the measurements made). In addition, amalgam expands and creates a pressure on the tooth. This may cause the walls of the tooth to crack and these cracks may turn into fractures in the long term. When composite or porcelain fillings are applied with a biomimetic approach, they provide a solution to these problems and also to the problem of mercury release.

Amalgam fillings can be replaced for two reasons. Firstly, there are problems such as pain, ache, decay, fracture, etc. in the filled tooth. Secondly, the patient does not want to be exposed to mercury contained in the amalgam. Unless there is an emergency such as pain or inflammation, it is not recommended to change fillings in pregnant and breastfeeding women (even if safety precautions are taken). In addition, since it is difficult to take the necessary precautions for safe amalgam removal in children, the procedure may be postponed until an age when the child can cooperate, or if it is a deciduous tooth, tooth extraction may be considered depending on the condition of the underlying teeth.

The fractures we see in amalgam fillings are usually in the form of fractures of the weak tooth wall around the filling. In this case, more amalgam surface is exposed. It has been confirmed by a study that an amalgam in this state releases more mercury. Even if the amalgam filling is broken, this tooth can still be saved if the fracture line does not reach the root and does not split the tooth in half. It is often possible to repair the tooth with composite or porcelain fillings after the amalgam has been safely removed and the other remaining weak walls have been organised.

Amalgam-filled teeth may occasionally have an smell. One of the reasons for smell is the reoccurrence of decay in the tooth. Amalgam fillings expand and cause cracks in the tooth walls and biofilm leaking through these crack lines can decay the tooth. Another factor is that amalgam fillings can spread over time and therefore their harmony with the tooth may be disturbed. We often encounter excessively overflowing amalgam fillings, and these overflowing areas cause food residues to accumulate easily. (Secondary caries formation and flooding problems can also be seen in composite and porcelain fillings and veneers, they are not specific to amalgam, but the reasons for their occurrence are different). In addition, many of our patients with amalgam say that they feel a metallic taste in their mouths. Apart from this, amalgam fillings can also change the bacterial flora and cause a flora that is resistant even to antibiotics. It is possible to speculate that this may also be related to smell.

For the safe removal of amalgam fillings with the SMART protocol by taking the precautions you can see here, the price we apply as of June2024 is 120 Euros for a single tooth. You can contact my clinic for the fees for the applications to be performed after the removal of the filling