Amalgam Filling and Removal

What is Amalgam?

Amalgam is a special mixture of metal powders such as silver (Ag), copper (Cu), zinc (Zn) and tin (Sn) mixed with mercury (Hg). The reaction that occurs by wetting the amalgam powder with mercury is called amalgamation.

Amalgam Filling

Amalgam is a filling material used in dentistry since ancient times. However, today, the mercury contained in amalgam has been replaced by resin-based filling materials both locally, systemically and aesthetically. We can say that composite filling materials, also known as white filling among the people, have replaced amalgam in the long term.

Broken, coloured, secondary caries amalgam fillings should not be left in the mouth of the person and must be replaced. Various systemic disorders (tachycardia, GIS diseases, etc.) have been observed in people with too many amalgam fillings in their mouths, and it has also been reported that these diseases disappeared when amalgam fillings were replaced. This may be due to the amount of free mercury in the amalgam filling and the passage of this mercury into the oral environment.

Among the factors that provide this situation;

1. Frequency of eating
2. Gum chewing habits
3. Frequent intake of hot food and drinks
4. The acidity of the food (acidity in the food can increase the abrasion of the filling)
5. The habit of grinding teeth especially at night can be counted.

In people who are allergic to amalgam, amalgam fillings should be removed once, but not more than twice, the cavity should be closed with a healing paste (ZNO2) and the cavity should be closed with a healing paste (ZNO2) and waited for 4 weeks, and after the complaints are reduced, they should be filled with a non-allergenic filling material.

A second local effect of amalgam is “Galvanic Current” which may occur due to another metal or amalgam in the mouth. Galvanic current is defined as the emergence of an electric current between two different metals with the effect of saliva. Galvanic current causes a metallic taste in the patient’s mouth and a flash-like pain due to sudden electrical discharge. It also causes the formation of white lesions on the oral mucosa (such as lichen.) No maximal or minimal value is given for these symptoms. These findings vary from patient to patient, according to the personal perception of the patients and the degree of flow.

How Should Amalgam Filling Removal Be?

• Before the amalgam filling is removed, the patient should be given vitamin C in tablet form at the dose recommended by the physician or intravenous vitamin C should be administered. Because the desire of mercury to bind to vitamin c in the blood is greater than the desire to bind to body tissues.
• A closed room should be selected before amalgam filling removal.
• Before the amalgam fillings are removed, a rubber dam, which reveals only the tooth where the amalgam filling will be removed and which we use to isolate the whole mouth, should be applied to the tooth and the tooth should be isolated from the oral tissues.
• A saliva absorber should be placed under the rubber dam and any fluids that may leak under the rubber dam should be removed.
• An alternative respiratory source should be provided for the patient, such as an O2 tube).
• A highly absorbent surgical aspirator should be used by the assistant.
• An ioniser should be available in the environment to isolate the mercury vapour released during amalgam filling removal, and a strong suction aspirator should be available to prevent the spread of mercury vapour to the environment during the procedure.
• The physician, patient and assistant should wear protective aprons, cap and goggles, in addition, the physician and assistant should use carbon fibre masks specially provided for amalgam filling removal.
• After the amalgam filling is removed from the cavity, the rubber dam should be carefully removed.
• After the amalgam filling is removed, the patient should be rinsed with metal-binding mouth solutions, and if necessary, the physician should clean the inside of the mouth with special solutions. The remaining small metal residues may cause heavy metal accumulation in the body and cause systemic disorders in the future.

More than 2 amalgam fillings should not be removed at a time because the toxicity of mercury vapour produced during amalgam filling removal is very high. If a large number of amalgams are to be removed, at least one month should be left between appointments.

Amalgam Filling Removal in Pregnant Women

Due to the high toxic effect of mercury released during amalgam filling removal, amalgam filling removal is not preferred in pregnant women unless there is a very urgent situation (acute pain, abscess, etc.).

The information contained in the content of the website is for informing visitors to our website. This information does not replace the physician’s examination or diagnosis of the patient for medical purposes.

Kaynak: http://dergipark.ulakbim.gov.tr/sdutfd/article/download/1089001206/1089001330