Amalgam Filling Removal

What is Amalgam?

Amalgam is a special mixture formed by mixing metal powders such as silver (Ag), copper (Cu), zinc (Zn), tin (Sn) with mercury (Hg). The reaction that occurs when amalgam powder is wetted with mercury is called amalgamation.

Amalgam Filling

Amalgam is a filling material used in dentistry since ancient times. However, today, the mercury contained in amalgam has been replaced by resin-based filling materials in terms of local, systemic and aesthetic aspects. 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 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 no more than twice at a time and filled with a non-allergenic filling material.

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 the sudden electric discharge. It also causes the formation of white lesions in the oral mucosa. (Lichen-like.) 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 may be given vitamin C in tablet form at the dose recommended by the physician or intravenous vitamin C may be administered. This is 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 cylinder).
• 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 and vacuum device 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.).

Dental Amalgam, What is Mercury?

Millions of dentists worldwide routinely use amalgam as a filling material for decayed teeth. This material, often called “silver fillings,” contains 45-55% metallic mercury. Mercury is a known neurotoxin that can harm humans, especially children, pregnant women, and fetuses. In a 2005 World Health Organization (WHO) report on mercury: “In addition to causing lung damage, it can have harmful effects on the nervous, digestive, respiratory, immune systems, and kidneys. Adverse health effects of mercury exposure can include: tremors, vision and hearing impairment, paralysis, insomnia, emotional instability, developmental deficiencies during fetal development, and attention deficit and developmental delays in childhood. " emphasized that it is possible to live.

Dental Amalgam Side Effects and Reactions Related to Mercury in Fillings

The following table is a brief list of some of the symptoms most commonly associated with breathing elemental mercury vapors:

The symptoms most commonly associated with inhalation of elemental mercury vapors include:

• Acrodynia or similar symptoms such as emotional instability, loss of appetite, general weakness and skin changes
• Anorexia
• Cardiovascular problems, frequent changes in heart rate, tachycardia (abnormally fast heartbeat)
• Cognitive/neurological disorders, memory loss, decreased mental function, difficulties with verbal and visual processing
• Delusions, delirium, hallucination
• Dermatological conditions, dermographism (skin condition characterized by raised red marks), dermatitis
• Deterioration/enlargement of the thyroid gland
• Symptoms such as irritability, abnormal responses to stimuli, and emotional instability
• Fatigue
• Headache
• Hearing loss
• Immune system disorders
• Insomnia
• Neuromuscular changes such as nerve response changes, peripheral neuropathy, decreased coordination, decreased motor function, polyneuropathy, weakness, muscle atrophy and twitching
• Oral manifestations, gingivitis, metallic taste, oral lichenoid lesions
• Psychological problems/mood swings related to anger, depression, excitability, irritability, mood swings, and nervousness
• Kidney problems/proteinuria/nephrotic syndrome
• Respiratory problems/bronchial irritation/bronchitis/cough/dyspnoea (difficulty breathing), pneumonia, respiratory failure
• Shyness (extreme shyness)/social withdrawal
• Shake
• Weight loss

Not all patients experience the same symptoms or combination of symptoms. In addition to the symptoms above, numerous studies have documented risks for other health conditions associated with dental amalgam. In fact, scientists have linked mercury in amalgam fillings to Alzheimer's disease, amyotrophic lateral sclerosis (Lou Gehrig's disease), antibiotic resistance (anxiety, autism spectrum disorders, autoimmune disorders/immunodeficiency, cardiovascular problems, chronic fatigue syndrome, depression, infertility, kidney disease, multiple sclerosis, Parkinson's disease, and other health problems.

https://iaomt.org/resources/dental-mercury-facts/dental-mercury-amalgam-side-effects/ (Used.)