Amalgam Removal: To Do or Not to Do?
There is a topic in dentistry that continues to raise doubts among many patients, regarding the need to remove dental amalgams or not.
That’s why I decided to address this issue and clarify all your doubts related to it, as many people still use amalgams, better known as “fillings” or “sealed teeth,” a term that refers not to the presence of lead in this material, but to the color that this metal mixture displays.
What does the Portuguese Dental Association say about this topic?
Based on the recommendation of the Portuguese Dental Association, dental amalgams should not be removed unless they fail, meaning they become damaged and need to be removed to prevent further issues. Otherwise, they do not need to be removed.
Although they may release small amounts of mercury, there is no evidence to suggest that they can cause illness. Therefore, the prophylactic removal of amalgams is unnecessary and could even result in the patient absorbing a greater amount of mercury than if the amalgam had not been touched.
It is also important to note that composite resin restorations may temporarily increase urinary levels of bisphenol-A, the effects of which on health are not fully understood.
What precautions should be taken when removing amalgams?
This is another crucial point in this debate. If the dentist, together with the patient, considers that it is necessary to proceed with the removal of amalgams, it is important to know how to do so safely.
First and foremost, it is important to contextualize, saying that, a few years ago, amalgam restorations were the most common option because they were inexpensive and durable. Nowadays, this is a solution that is increasingly avoided and is even discouraged for pregnant women, breastfeeding mothers, and children under 15 years old.
One of the reasons why this is no longer a commonly used option is due to the fact that it is now known that mercury (present in 50% of the composition of these amalgams) has various risks to the body and that whenever someone with amalgams chews, drinks, or brushes their teeth, they are ingesting mercury vapor.
It is also now known that mercury can be the cause of some pathologies, such as:
- Neurodegenerative diseases
- Autoimmune diseases
- Hypothyroidism
- Congenital malformations
- Antibiotic resistance
- Kidney dysfunction
- Headaches
- Periodontal disease
- Fatigue, depression, and anxiety
- Weakness
- Autism
- Cardiovascular diseases.
Although this is not enough to state that everyone with amalgams should remove them, there are cases where it may be justified, and in such situations, it is important to remove the amalgams, following specific procedures and safety protocols. If this is not guaranteed, the patient may be exposed to elevated, and indeed dangerous, levels of mercury vapor.
One of these protocols is the SMART Protocol (Safe Mercury Amalgam Removal Technique), advocated by the IAOMT (International Academy of Oral Medicine and Toxicology). This protocol sets out several guidelines aimed at protecting the patient, as well as the healthcare professionals involved in the procedure and the environment in which everyone operates.
Among these rules, the following are included:
- Complete protection of the patient with protective fields and protection for the professionals;
- Absolute isolation (latex-free rubber dam);
- External suction to reduce the release of mercury vapor;
- External oxygen source;
- Among others.
At the same time, there is also a protocol aimed at preparing the body for the removal of amalgams, based on three basic principles, namely:
- Detoxifying the Body;
- Heavy Metal Chelation (to help in the elimination of heavy metals);
- Increase of Antioxidant Potential.
In summary, I believe that, as with most cases and topics in oral health, each patient needs to be assessed, considering the advantages and disadvantages that all options carry.
It is also worth adding that, from an aesthetic point of view, amalgams do not provide as pleasing a smile and, sometimes, their removal is a patient request aimed at increasing their self-esteem and self-confidence.
Therefore, it is essential to consult the dentist and evaluate the pros and cons of each decision, always keeping in mind the idea that if you have amalgams, there is no risk, and there is no scientific evidence supporting the mandatory removal of them.
By Marisa Zenha
