Protocol in Amalgam Removal

When removing amalgam, consider the following in your discussion:

  • The dental facility should discuss the steps involved in the removal of the amalgam restorative material with the patient.
  • Determine if any of the amalgams are cracked, leaking or if there is decay under the “filling” material (Figures 2‑4).
  • If removal is suggested because of a defective restoration, the following questions/actions are suggested as the most appropriate protocol to consider. Other sites mentioned in this course contain more detail and suggestions to limit mercury exposure and specific questions or answers for both the patient and the provider.
    • Is high speed evacuation with water used?
    • Will a rubber dam be used to limit swallowing of the material?
Figure 5.
Figure 5 shows a rubber dam around tooth for amalgam removal
Courtesy of Carol Perkins, BA, AS, RDH.
    • Is some barrier protective device used over the nose of the patient to limit inhaled materials such as mercury vapor and particles? Some dentists have the patient breath in oxygen during this removal process. Special masks are available for the patient to wear during the procedure.
    • Will clothing be covered so that amalgam materials are not carried home to those contacts of the patient or to those out in the general community?
    • Is eye wear used to limit debris and particles contaminating the eyes of the patient? Eye wear worn by the patient and practitioner is standard in most offices.
    • Does the dental professional believe he/she is equipped to handle amalgam removal? Some clinicians may prefer to send the patient to another facility that handles amalgam/mercury removal and maintains proper disposal more frequently.
    • Is there high filtration in the operatory that is used for removing the amalgam? Some dental professionals will open the window as well, so that fresh air comes into the operatory. Again, depending upon location and the season, this is sometimes not the most conducive option.
    • What material will be placed in the tooth after removal of the amalgam? Most offices in the United States have opted for non-amalgam restorations at this point. But, since the regulations still permit amalgam, this is something that should be discussed with the patient as well as any alternative restorative materials.
Figure 6.
Figure 6 depicts a defective composite restoration
Depicts a defective composite restoration that should have had a crown originally.
Courtesy of Carol Perkins, BA, AS, RDH.
  • The International Academy of Oral Medicine and Toxicology21 has specific guidelines that were updated in December 2016 for the removal of amalgam restorations. These guidelines can be found at www.thesmartchoice.com.
  • The California Dental Association has specific recommendations and statements related to Best Management Practices for Amalgam Waste that have been updated in 2016.22
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