In summary, it appears that when amalgams do need to be replaced, selecting a dental professional who is cognizant and informed about mercury vapor potential is important in patient safety and the safety of the staff. The consensus appears to be that replacement is only recommended when there is breakage, leakage and decay involved. In certain instances, when determined, removal of an amalgam may be conducted because of sensitivity to the materials in the alloy. Removal of the amalgam allows the release of mercury vapors into the operatory and inhalation into the lungs of the patient. Current research documents the fact that mercury can cross the blood brain barrier and mercury vapors are of a prime concern. When specific protocol is not followed, the entire team may be unnecessarily exposed to mercury vapors. This is especially of concern to staff members who may be pregnant and others who are exposed long-term to materials and vapors in the work environment. Patients who are informed about the amalgam removal process will certainly have a better outcome and be able to plan for their needs at the time. Some states are required to provide brochures that address the restoration advantages and disadvantages. A dermatologist will be able to determine if metal sensitivity may be a factor in patients with possible lichenoid-type reactions such as those associated with oral lichen planus. Discussing these concerns and issues with your patient is a positive step in making good decisions involving any removal process and choices for replacement materials.
Even though most states do not require that patients be given material describing advantages/disadvantages of restorative materials, an ethical practice would see the benefit of providing this information to the patient and educating the staff about safe environmental practices. With new regulations requiring amalgam separators, the topic of amalgam toxicity and environmental concerns will continue to increase with both professional and public concerns. The knowledgeable dental professional will be key in addressing all of these issues with the patient and staff.
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