Q&A With Dr Emma
Hi Dr Emma. Can you please explain the best way to remove mercury fillings? I ask this because I am told there is a specific and safe procedure for doing this, which may not always be followed? Recommendations on who to see are much appreciated. Thank you for your guidance. Marie - Morley (WA)
If you want to minimise the amount of mercury absorbed when removing an old amalgam restoration, the best way is through the use of rubber dam and high speed suction. This isn't anything groundbreaking or new, as these are the ideal conditions under which to remove and replace any restoration. I try to use rubber dam whenever possible, but there are circumstances under which it's just not possible. There's more information on this in my article about rubber dam.
There's a lot of talk about chelating agents, vitamin supplements, and all sorts of other pre- and post-removal treatments to mop up the mercury in your body. I am yet to see any good evidence that this is effective or necessary, so any practitioner who guarantees success from these methods is either knowingly trying to take your money, or doesn't understand science properly.
I urge you to think carefully about the pros and cons of replacing amalgam fillings. Yes, the evidence shows that after removal the levels of mercury in your body will reduce. It is yet to be seen whether or not there are long-term health benefits from these lowered levels, and one study which showed quality of life was not at all improved in people who had all their amalgam fillings removed and replaced. The exception to this is people who have local reactions, (a bit like dermatitis in the mouth), because of an allergy to amalgam, and their symptoms improved after new non-amalgam fillings were put in.
On a tooth level, removing amalgams is not a risk-free procedure. Every time a filling is replaced it puts the tooth under stress, which can result in sensitivity, pain, and possibly the need for root canal therapy or loss of the tooth. You need to weigh up the perceived benefits with the potential risks, and make sure your dentist has taken the time to explain everything so you can be sure you're doing the right thing for your body.