Amalgam Filling and Removal

What is Amalgam?

Amalgam Filling

Amalgam is a filling material that has been used in dentistry for many years. However, today, the mercury contained in amalgam has been replaced by resin-based filling materials, both locally, systemically and aesthetically. We can say that composite filling materials, also known as white fillings among the public, have replaced amalgam in the long term.

Broken, discolored, or secondary caries amalgam fillings should not be left in the person's mouth and must be replaced. Various systemic disorders (tachycardia, GI diseases, etc.) have been observed in people with too many amalgam fillings in their mouths, and it has been reported that these diseases disappear when the amalgam fillings are replaced. This may be due to the amount of free mercury in the amalgam filling and the passage of this mercury into the oral environment.

Among the factors that provide this situation;

1. Eating frequency
2. .Gum chewing habit
3. Frequent intake of hot foods and drinks
4. Acidity of food (Acidity in food can increase wear on fillings)
5. It can be considered a habit of grinding teeth, especially at night.

In people who are allergic to amalgam, amalgam fillings should be removed, not more than twice at a time, the cavity should be closed with a healing paste (ZNO2) and the filling should be done with a non-allergenic filling material after the complaints have subsided.

A second local effect of amalgam is the “Galvanic Current” that can occur due to another metal or amalgam in the mouth. Galvanic current is defined as the formation of an electric current between two different metals due to the effect of saliva. Galvanic current causes a metallic taste in the patient’s mouth and a shooting pain due to sudden electric discharge. It also causes white lesions to form in the oral mucosa (like lichen). No maximal or minimal value is given for these symptoms. These findings vary from patient to patient, according to the patients’ personal perceptions and current levels.

How Should Amalgam Filling Removal Be Done?

• Before the amalgam filling is removed, the patient should be given vitamin C in tablet form at the dose recommended by the physician or intravenous vitamin should be administered. Because mercury's desire to bind to vitamin C in the blood is greater than its desire to bind to body tissues.
• Before removing the amalgam filling, a closed room should be selected.
• Before amalgam fillings are removed, a rubber dam, which is used to isolate the entire mouth and expose only the tooth from which the amalgam filling will be removed, should be applied to the tooth and the tooth should be isolated from the oral tissues.
• A saliva ejector should be placed under the rubber dam and any liquids that may leak from under the rubber sheet should be removed.
• An alternative respiratory source should be provided for the patient (such as an O2 tank).
• A highly absorbent surgical aspirator should be used by the assistant.
• An ionizer should be present in the environment in order to isolate the mercury vapor released during the removal of amalgam fillings, and a powerful absorbent aspirator should be present to prevent the spread of mercury vapor into the environment during the process.
• The physician, patient and assistant should wear protective aprons, bonnets and goggles, and in addition, the physician and assistant should use carbon fiber masks specially provided for amalgam filling removal.
• After the amalgam filling is removed from the cavity, the rubber dam should be carefully removed.
• After the amalgam filling is removed, the patient must rinse their mouth with metal-binding oral solutions, and if necessary, the doctor must clean the inside of the mouth with special solutions. The remaining small metal residues can also cause heavy metal accumulation in the body, which can lead to systemic disorders in the future.

More than 2 amalgam fillings should not be removed at a time because the toxicity of mercury vapor produced during amalgam filling removal is very high. If a large number of amalgam fillings are to be removed, at least one month should be allowed between appointments.

Amalgam Filling Removal in Pregnant Women 

Due to the high toxic effect of mercury released during amalgam filling removal, amalgam filling removal is not preferred in pregnant women unless there is a very urgent situation (acute pain, abscess, etc.).

The information contained in the site is for the purpose of informing visitors to our website. This information does not replace a physician's examination of the patient or diagnosis.

Source: http://dergipark.ulakbim.gov.tr/sdutfd/article/download/1089001206/1089001330