Mercury In Dentistry Part 2

SCMC 12-1-2013by Chris Edwards, DDS

December/January 2013

Amalgams Contain Inorganic Mercury

SILVER DENTAL FILLINGS, or amalgams,contain inorganic mercury. Mercury fillings in your mouth release mercury vapor that is absorbed into your body via the lungs, ending up in your body. It is deposited in your organs, including your brain, where it accumulates over time. Thebody does have ability to remove some mercury via the liver, kidney, hair and sweat.


In Part 1 of this two-part article, we discussed why mercury (Hg) is the most toxic, non-radioactive substance known to man. It is in the air we breathe, the fish we eat and the dark silver amalgam fillings that are in our mouths. A dental amalgam is 50 percent mercury. Testing for mercury toxicity is difficult and only a medical professional can make the diagnosis of mercury toxicity, not a dentist.

Amalgam fillings are removed for the following reasons: a recommendation by a medical professional, dental caries, fracture of tooth structure, cosmetic concerns and personal choice.

Mercury Removal Has Risks

The use of amalgam fillings is declining. Less than half the dentists continue to use amalgam fillings due to the fact that more modern choices for dental restorations are available. However, less than 1 percent of dentists follow safe mercury removal protocols.

Dental amalgam is the proper term to refer to the silver material that is used in dental procedures like fillings. This material is actually a combination of mercury and at least one other metal, like tin.

Mercury vapor is released from an amalgam filling with chewing, brushing or putting your teeth together. When an amalgam filling is initially placed, a high mercury burden is placed on the body. The same is true when the amalgam filling is removed. Placement and removal releases a vapor, which is the main concern. The mercury vapor can be inhaled into the lungs, and the central nervous system, presumed to be the most sensitive target organ for mercury vapor exposure, is also at risk for toxic damage.

Adherence To Safe Mercury Removal Protocols Is Key

Scientific studies show that removing mercury amalgam unsafely, without precautions, increases the mercury levels in the blood stream. The International Academy of Oral Medicine and Toxicology (IAOMT) has established a safe mercury removal protocol, which includes:

• The use a pure oxygen source for the patient to breathe,
• A rubber dam applied to isolate and capture amalgam particles,
• A high volume water spray used on the dental drill,
• The use of a special bur that minimizes vapor,
• Removing the amalgam filling in chunks,
• Utilization of a vacuum is to remove mercury vapor,
• Utilization of a respirator when clinically indicated,
• Proper disposal of the mercury waste.

The best way to avoid mercury from dental amalgams is to never need one to be placed in your mouth in the first place. An ounce of prevention is worth a pound of cure. But, if caries occur there are many mercury and metal free alternatives.

Minimally Invasive Dentistry

The best restoration is accomplished using Minimally Invasive Dentistry (MID), which preserves as much of the tooth as possible. MID involves early diagnosis of pit and fissure cavities using the Diagnodent, a laser cavity detector. Teeth should be evaluated soon after eruption because pits and fissures are often open and difficult to detect. If open, caries is inevitable and hastened with a poor diet. With MID and early diagnosis it is not necessary to wait for the cavity to get to the right size to place a somewhat effective amalgam filling. MID removes only the diseased tooth structure, evaluating and cleaning the remaining grooves. Air abrasion cleans the pits and fissures and removes the caries. Removal of decay with lasers and air abrasion is often achieved without local anesthesia. The utilization of ozone assures the eradication of any remaining bacteria.

Modern ‘Filling’ Agents Replace Traditional Mercury Amalgam

Modern bonding agents and flowable resins seal out further decay. Most dentists use composite resin fillings as a replacement for mercury amalgam fillings. Rivaling amalgams for longevity, they are more technique sensitive. Providing there is adequate tooth structure to support the filling, resins are a viable replacement. Many different shades to match tooth structure are available. Modern “bonding” techniques can conservatively repair a chip or fracture and can even change the look of a crooked or discolored tooth.

MID And Non-Metallic Technology

Another example of how MID has changed the approach to tooth reconstruction is the CEREC Cad Cam technology, which allows for the creation of a one-visit crown. Bonding technologies eliminate the use of metal. Healthy enamel and tooth structure are preserved by the cosmetic blending of all-ceramic technology. An On-lay is a CEREC restoration that preserves part of the chewing surface of the tooth, only replacing the diseased, missing or fractured part of the tooth.

Missing teeth have been traditionally restored with bridges with metal substructures. Bridges are now made with non-metallic options. Shorter bridges can be made with all ceramic materials and longer bridges and implant abutments with Zirconium, another nonmetallic substitute for traditional crowns and bridge metals.

Affordable New Technologies

More than 150 years ago, amalgam fillings were created for those who couldn’t afford a gold crown and didn’t want a tooth pulled. Mercury was known to be toxic even back then. Prior to modern materials and technology, mercury amalgam fillings saved many teeth, in spite of the toxicity.

Prevention is the best way to keep amalgams out of your mouth. Safe removal protocols are available if they are already there and you want or need them to be removed. Safe restorative techniques and materials are available. Consult a qualified health professional if you are concerned that you are affected by mercury.


Dr. Edwards graduated from the United States Merchant Marine Academy and Temple University School of Dentistry. He completed a general practice residency at the Queens Medical Center in Honolulu. To reach Dr. Edwards you may call 321-751-7775 or visit