A guiding principal for any dental office should be to minimize patient exposure to toxic chemicals and materials. Unfortunately, in the case of dentists who look only to the ADA for guidance and information, most have little appreciation of the dangers of chronic exposure to mercury vapor and do very little to protect themselves or you the patient, from unnecessary exposure. . Conversely, mercury-free dentists are critically aware of the potential health effects of chronic exposure to mercury vapor and most go to extraordinary lengths to protect themselves, their patients and staff from all unnecessary exposure to this insidious poison. Remember, you cannot smell, taste or see mercury vapor, consequently without special instruments to measure its presence, there is no way of knowing how contaminated a dental office may be.

Chemically sensitive individuals walking into a mercury contaminated dental office will in all likelihood react immediately, without ever realizing what they are reacting to. That is another reason why dentists who practice mercury-free usually have various types of specialized mercury vapor filtering devices and systems, designed to reduce office background levels of mercury vapor.

There are also special techniques utilized to properly remove mercury amalgam fillings. If done properly, there is minimum exposure to increased levels of mercury vapor caused by the removal procedure. However, we feel it important that you should be aware of certain aspects related to removing mercury from the oral environment:

• The office and operatory should be well-ventilated.
• The dentist should have an assistant present to assist in minimizing their exposure, and yours, to any mercury vapor. The correct protocol requires the use of high volumes of cold water both from the drill and separate irrigation by the assistant, who should also be simultaneously using high volume suction evacuation of the vapor and particles resulting from the removal procedure. The requirement for copious amounts of cold water during amalgam removal is well documented and cannot be overly emphasized. Even dentists who are not mercury-free should know this. Failure of a dentist to be aware of this should be considered a sign of a lack of knowledge on the subject. Sadly, some dentists still drill out old amalgam with very little or even no water spray or may even do it without an assistant helping. Should you encounter a dentist who is unaware or inattentive to this, you would be well advised to seek treatment elsewhere.
• It is the volatility of mercury that necessitates all the precautions and correct techniques. Mercury vapor pressure doubles with every ten degree centigrade rise in temperature. Once acceptable procedure that minimizes extensive grinding (which generates great temperature increases) involves sectioning the amalgam into chunks versus just grinding it out.
• In some dental offices the dentist may ask you to breathe through a nose piece that will permit you to draw air from another area of the operatory or office. If the dentist has nitrous oxide\oxygen available and you have elected to use it, this will accomplish the same thing.
• The use of the rubber dam during the amalgam removal procedure is still controversial at this time. Some believe it to be essential, while others maintain that it results in amalgam particles and mercury vapor being trapped under the dam during the entire procedure. Those believing the latter contend that careful attention to removal and evacuation results in lower mercury exposure to the patient.
• Clean Up™ is a recently developed new type of oral aspirator/evacuator product from Sweden that is now available in the United States and Canada. The Clean Up device fits over the tooth being worked on and applies a constant high speed suction to the immediate work area, thereby greatly reducing extra-oral aerosol spray and possible infectious particulate.
• During amalgam removal, the dentist and his or her assistant are at greater risk to mercury vapor exposure than the patient. To protect themselves, they will putting on specially mercury trapping masks and rubber gloves to protect them during repeated removal operations.
• There are several different types of chair side mercury vapor filtering devices available. Some are specialized vacuum systems, that exhaust the mercury vapor from the patient's head area into activated carbon filters, that trap and bind the mercury preventing its recirculation in the operatory. Hopefully, the dentist you select to do your work will have one or more of these specialized filters available in the operatory.
• Don't be in a hurry. Current information indicates that it is better to replace only a few amalgams at a time, with several weeks in between appointments.

Also make sure to read these books: Poison in Your Teeth: Mercury Amalgam (Silver) Fillings...Hazardous to Your Health! and Mercury Detoxification by Tom McGuire