Safe (SMART) Mercury Amalgam Removal

It is known that mercury gas released during the removal of amalgam fillings and mercury particles scattered around pose a danger to the patient, physician and the environment (1). I have written a detailed article before about the damages that mercury can cause.

Due to these damages, it has been suggested to take some precautions to prevent the penetration of mercury into the body of the patient and the physician and at the same time to minimize the damage to the environment. IAOMT (International Academy of Oral Medicine and Toxicology), the organization that brought these measures together within the framework of the researches carried out to date and their own experiments, called this application “Smart Protocol”.

Let’s look at these measures recommended to be taken during amalgam removal in terms of patient, physician and environmental safety (1,2):

In terms of the patient:

• Amalgam removal is not recommended for pregnant women and breastfeeding women.
• Before the procedure, the patient should rinse his mouth and gargle with activated carbon, chlorella, bentonite, zeolite or similar agents that are said to hold mercury. Although this sentence reflects the general protocol proposed by IAOMT, I use only activated carbon, based on my own research. According to some opinions, chlorella can do more harm than good because it is poorly attached to mercury. According to another experiment, zeolite, which is famous for heavy metal retention, is extremely unsuccessful in this regard (6). There are opinions arguing that bentonite is similar to zeolite. Apart from these, there are also physicians who recommend that a cotton impregnated with the selected agent be placed on the floor of the mouth during the procedure (3). According to some protocols, this chelation agent is given to the patient before the procedure. In my practice, the patient first takes the activated charcoal capsule or tablet and then rinse the mouth with its liquid form.
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• The contact of the amalgam particles with the mouth should be prevented by applying a rubber dam to the mouth of the patient. In addition to this rubber cover, I think that a gingival barrier, which is in gel form and cured with the lights we fill, will provide better sealing, and I do my application in this way.
• Positive pressure air or oxygen should be given to the patient in order not to breathe the ambient air.
• There should be a vacuum device that filters the mercury, as in the photo below, in the immediate vicinity of the mouth.
• The patient’s hair, face and body should be covered. It was observed that the fragments removed during amalgam removal could jump up to the patient’s chest and knee. Covering the patient will prevent amalgam particles from being carried to the patient’s home through their clothes.
• During the procedure, a strong aspiration should be provided above and below the rubber cover.
• Disassembly should be done under plenty of water irrigation, and the filling should be prevented from getting hot and emitting more mercury vapor.
• It should be aimed to produce amalgam in as large pieces as possible.
• If possible, the room should be ventilated during the procedure and the windows should be opened.
• At the end of the procedure, the patient should rinse his mouth again with plenty of water and the binding agents mentioned above and gargle.

From the Perspective of Physicians:

• The physician should wear a special protective gas mask that can filter mercury vapor, goggles,  bonnet  in addition to the measures such as gowns and gloves that he routinely uses. In my opinion,  fabric masks that are said to filter mercury “smoke” are not enough. We need masks that filter gas, not smoke.

In the Name of Avoiding Environmental Pollution:

• In order to prevent the disassembled amalgam from harming the environment through the waste water pipe, it is recommended to place a device that can separate the amalgam in the waste water system (4).
• If amalgam can be removed in one piece, it should be stored in x-ray solution or in a lidded container in water, it should be collected and eliminated by authorized units (5).

The Period Before and After Amalgam Filling Removal

Even if the amalgam fillings are removed properly, some additional protocols may be required to remove mercury from the patient’s body before and after the procedure. Since these protocols will need to be tailored to the patient, ideally, the dentist evaluates the patient with a physician who can administer mercury detox.

In order to remove the mercury that has accumulated in the tissues over the years, both the detox systems must work well and the mercury must be extracted and removed from the tissues with chelation agents that can bind mercury.

Unfortunately, it is not possible to talk about a consensus among doctors about the agents to be used for chelation. Some “natural” products such as chlorella and coriander are widely used for heavy metal detox. recommended chelation agents in basic training I have attended so far in Turkey was always them. But personally, I find it quite remarkable to point out that these are not strongly bound to mercury, and therefore it moves mercury from one place to another. It is difficult to ignore the numerous stories of patients whose health has deteriorated even more with such agents. Apart from these, it is worth mentioning that fast chelation methods using high doses of agents such as DMPS and DMSA are also mentioned. That is why I want to emphasize again and again that one should be careful about chelation and not be taken lightly.