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Safe Amalgam Removal

Dr. Ward is a member of the International Academy of Oral Medicine and Toxicology. He has done much research and completed many courses offered on amalgam removal. Dr. Ward follows a strict protocol in the removal of amalgam filings, in return minimizing the mercury exposure to the patient, himself, and staff members. The following is the protocol that is provided by the IAOMT and that is followed by Dr. Ward and his staff. We invite you to read through the steps, so that you are familiar with the process of removing amalgam at your appointment.

Cut and Chunk, Keep it Cool

If you remove and old amalgam by slicing across it and dislodging big chunks, you will aerosolize less of the contents than if you grind it all away. If you keep it under a constant water spray while cutting, you will keep the temperature down, and reduce the vapor pressure within the mercury. Dr. Ward uses a slow speed hand piece with a water attachment; this reduces the temperature of the amalgam and minimalizes the mercury vapors.

Suction!

The best tool for removing mercury vapor and amalgam particulates from the operating field is the high volume evacuation (HVE). By keeping it right next to the patient’s tooth until we are finished with the removal and clean-up process, it dramatically reduces the spatter of particles, directing the amalgam efficiently into the suction tube.

Rubber Dam or No Rubber Dam?

Dr. Ward prefers to use a rubber dam whenever possible. A rubber dam helps contain the majority of the debris of amalgam grinding.

However, mercury vapor will diffuse right through the rubber dam, and some of the particulates will often sneak past it. So:

  1. Dr. Ward always uses a saliva ejector behind the rubber dam to evacuate air that may contain mercury vapor.
  2. Dr. Ward also rinses the rubber dam during the procedure to reduce the amalgam particulates.
  3. Upon completion of removing the amalgam filling. Dr. Ward will remove the rubber dam and rinse your mouth. This will remove the mercury vapors and particulates that may have escaped into the mouth.

If the situation arises that Dr. Ward cannot use a rubber dam, the “Clean-Up” suction tip is attached to the HVE hose. The “Clean-Up” suction tip has an enclosure at the end that surrounds the tooth. It also dramatically reduces the splatter or particles and vapor. As with the rubber dam, upon removal and clean-up of the amalgam the mouth is rinsed.

Cover the Skin

Covering your face with a barrier will prevent spattered amalgam particles from landing on the skin, or the eyes. Dr. Ward uses a fresh towel to cover the patient from platter. Dr. Ward does prefer to use protective eyewear to cover the patient’s eyes. He finds that patients become uncomfortable under the rubber dam and a towel over their face.

Supplemental Air

Dr. Ward’s staff provides the patient with piped-in air, so they don’t have to breathe the air directly over the mouth during the amalgam removal. A nasal cannula is placed on the patient to provide pure medical grade oxygen directly to the patient, greatly reducing the mercury vapors the patient breathes.

Controlling the Breathing Space

Although the HVE that we use is very efficient, the air surrounding the operative filed will fill up with a mercury vapor and amalgam particulate aerosol. It is a priority to Dr. Ward that the patient, staff and himself are free of contamination. Dr. Ward has installed a negative ion generator to enhance the removal of the metallic vapors and sub-micron floating particles. This system removes the vapor and particulates in the operatory air and the rest of the office.

Respirators for the Staff

Dr. Ward and staff will wear a respirator. Although this might look strange to the patient, Dr. Ward believes in protecting himself and staff from mercury vapors. It has been found that the paper mask has no benefit for removing either amalgam particulates or mercury vapor from the air we breathe.