This publication is not to promote amalgam removal. Since some patients may request removal of their amalgams with the hope of improving their overall health, some safety tips are warranted in the event the patient and the dentist select to remove the restorations. The following are suggestions to consider when a decision to remove amalgam has been made by the dental professional and the patient. Removal of the amalgam, emits a vapor of elemental mercury that can be absorbed through the lungs. High levels are associated with adverse effects in the brain and kidneys. So, in the event of removal, safety issues should be in place. These safety issues have evolved over time. As we have learned more, additional regulations and suggestions have been added. One such finding is the inclusion of amalgam separators that is mandated by the EPA.
Amalgam Separators and Legislation: EPA Mandate
David Mendlik with DDShgSolutions makes the following recommendations:
Chairside amalgam separator for the ease and efficacy of the EPA mandate: When old fillings are drilled, spent amalgam enters the chairside cuspidor and drains into municipal sewer and septic systems. The EPA's reinstated final rule on amalgam separators has mandated that all existing dental practices have amalgam separators installed on dental engines by July 14, 2020. This will reduce the impact of amalgam used and will reduce waste amalgam and its environmental impact.
Dental offices must use either an ISO 11143:2008 certified amalgam separator or an ANSI/ADA Standard No. 108 for amalgam separator at a separation rate of 95% or greater. Dental offices must employ the use of an amalgam waste bucket for the proper recycling of dry amalgam waste. Line cleaners must be between a pH of 6-8.
Chairside unit vs. central system: Keep in mind what kind of vacuum your dental office uses, wet or dry. Some amalgam separators are unsuited for “wet” evacuation systems. The best ones will work with either kind of vacuum. Some amalgam separators require the services of a plumber and/or electrician to get up and running. Many of the best units can be a DIY project and are designed with the simple concept of connecting to the dental engine by the dentists themselves.
The Following Organizations Appear to be Cohesive in Their Overall Recommendations
The FDA does not suggest amalgam removal when the restorations are not cracked, leaking or there is no evident decay under the amalgam.
The American Dental Association states in a position paper:
Based on the results of a comprehensive review, the Council reaffirmed at its July 2009 meeting that the scientific evidence supports the position that amalgam is a valuable, viable and safe choice for dental patients.
Statement adopted by the ADA Council on Scientific Affairs, August 2009
The Canadian Dental Association in its position paper states the following:
“It is considered unnecessary and ill - advised to replace functional or serviceable dental amalgam fillings (restorations) for safety concerns or perceived health needs. A conservative approach to filling replacement, combined with effective decay prevention, is strongly advised to help maintain the dentition over a lifetime."