Most of us past a certain age have had — and may still have — amalgam fillings in our teeth. These types of restorations can last a long time.
But as long-lived and durable as amalgam fillings are, unlike composite materials, they are not adhesive so their placement requires rather invasive tooth structure removal to create undercuts, which mechanically hold them in place. In addition, amalgam is not as esthetic as tooth-colored composites.
Amalgam restorations are also subject to corrosion, which can leave margins vulnerable to caries, and they expand over time, which can lead to tooth fractures. So there are plenty of reasons patients may elect to get their amalgam fillings replaced with composites.
Removing Amalgam Fillings
The removal of amalgam fillings, especially in light of today’s environmental standards, requires specific protocols. Clinicians need to protect themselves and their patients from metal debris and dust. Protective eyewear is a must, and the use of isolation and suction is the best way to shield a patient’s airways and oral mucosa.
For isolation, dental dams are one solution. But comprehensive systems such as Isolite can enhance safety on many fronts. Featuring a flexible mouthpiece that isolates the field of operation and provides continuous suction, the Isolite dental isolation system also offers patient comfort by serving as a bite block. And while preventing accidental ingestion or aspiration of debris, Isolite can also improve visibility courtesy of the transparent mouthpiece and illumination.
But protection from airborne debris is only part of the equation. In regard to protection from mercury vapor, clinicians can use new dental burs to speed up the process; don filtered masks, face shields, and protective eyewear; and cover their hair. Patients can be draped with plastic aprons and dental bibs, and placement of activated charcoal or Chlorella on a cotton roll and under the isolation device catches any particles or dissolved metals that might seep through.
The patient’s face can be covered with a liner placed under the isolation device, eyes protected by goggles, and a cap placed over the head. A nasal mask can supply the patient with oxygen. Finally, a vapor ionizer can be used to bind mercury vapors through a negative ion flow and transport them to a positively charged ionizer plate.1Colson DG. A safe protocol for amalgam removal. J Environ Public Health. 2012:517391.
Disposal of Amalgam Fillings
Considered hazardous waste, amalgam must be handled and disposed of in accordance with an Environmental Protection Agency (EPA) ruling. The agency reports dental clinics are the main source of mercury discharges to publicly owned treatment works, and estimates 103,000 dental offices use or remove amalgam in this country.2US Environmental Protection Agency. Dental Effluent Guidelines. Available at: https://www.epa.gov/eg/dental-effluent-guidelines. Accessed August 21, 2018.
The installation of certified amalgam separators demonstrating at least 95% amalgam separation efficiency are required on dental office wastewater lines. Separators collect mercury and other metals that make up amalgam, allowing them to be recycled rather than discharged into sewers.3US Environmental Protection Agency. Dental Effluent Guidelines. Available at: https://www.epa.gov/eg/dental-effluent-guidelines. Accessed August 21, 2018.
To meet federal requirements, existing dental offices must install amalgam separators by July 14, 2020. Startup practices have 90 days to install such a device. Those practices that already have amalgam separators will have until July 14, 2027 to install compliant systems.4US Environmental Protection Agency. Dental Effluent Guidelines. Available at: https://www.epa.gov/eg/dental-effluent-guidelines. Accessed August 21, 2018.
For more information email: firstname.lastname@example.org or contact your state or regional EPA office.