Is Amalgam-Removal Dangerous
Michael C. Goldman, DDS
Of all the "holistic type" questions I am asked, one group of questions is by far the most frequent. People want to know about the dangers of removing silver-mercury fillings.
What I hope to demonstrate in this article are the following facts, which may really surprise many readers. It is different from what you have probably read many other places. I will back up what I say with science, not just opinions that sound right at first glance!
1. The temporary increase in blood mercury level after amalgam removal is actually a GOOD thing, even if it is temporarily bad.
2. The increase in blood levels of mercury after amalgam removal is NOT from drilling out the amalgams incorrectly, or even from the drilling itself at all!
Many of you have read something about how mercury levels increase following the drilling out of old silver fillings. The "logical" conclusion is, and has been, that there must be a lot of mercury released in the process of grinding out the old fillings and that the increased blood levels of mercury is from that mercury that was released from the old fillings during the process of grinding them out. Seems logical, right? Well, it's not quite as simple as that.
We do know that if you take an amalgam filling which is normally a full 50% - or even more - mercury, and grind on it, mercury vapor will be given off as a result of heating the mixture of mercury and silver and tin etc, that makes up what is called amalgam. Any dentist in his right mind would take measures to prevent it from being heated up if he had to grind on amalgam. For his or her own safety, the dentist would not want to create more mercury vapor than necessary. So, normally water and air would be spraying on the amalgam during the drilling process and powerful suction would be held close by to remove pieces and vapors away from the room. Even a dentist that thinks this mercury stuff is all baloney would probably do that much. That's pretty basic.
If the dentist uses just basic traditional common sense and uses water spray and lots of vacuuming, there should be no significant problem with the mercury. If mercury vapor is produced inadvertently, the vacuuming of the air around the drilling area should remove it effectively. But even if that is done very well - perfectly, in fact - there will still be an increase in blood and plasma mercury observed within 48 hours. So where does it come from?
We need to backtrack. When the fillings are sitting there in your mouth year after year, mercury vapor is given off constantly. Not very much, but some... Even the conventional dental community accepts that much. They even acknowledge that some of the mercury given off is absorbed into body tissues. They just go on to state: yes, but we don't believe enough of it is given off and absorbed to be a significant health hazard... But that's a whole other debate.
So, mercury is given off over a long time and some is absorbed into various body tissues. The brain and kidneys appear to be favorite places, but it can vary for different people.
As the mercury coming out of amalgam fillings is gradually given off and absorbed by body tissues, there is a kind of pressure, pushing the mercury out into as even a distribution as possible.
You must understand this part to get what I'm talking about... Sort of like if you gently put a spoonful of salt in one side of a bucket of water and just left it alone, what happens to the salt? It diffuses out into the bucketful of water and keeps diffusing out until it reaches a balance - an equilibrium. Somewhat similarly, the mercury in the mouth (fillings) and the mercury out in the body tissues repel each other and push against each other like similar poles of two magnets brought near each other, until a kind of equilibrium is achieved. No magic here, or rocket-science, just basic chemistry and physics.
Well, if in the hypothetical bucket of salt-water, you had a way to take out the salt from, let's say, the left half of the water, what would happen? I think you probably guessed it - the salt that was diffused throughout the right half would begin to spread out, to diffuse, throughout both sides of the bucket until the salt concentration was again the same on both sides.
So it is with the mercury. Take out a filling - or several - and the mercury that had been in equilibrium out in the body tissues suddenly has less pressure repelling it (less amalgam in the mouth). Now there is actually too much mercury out in the tissues to be held in balance by the amalgams in the mouth remaining if any. So the tissue mercury - or some fraction of it - actually comes out of the cells and into the intracellular fluid and into the bloodstream where it is carried around the body. If it comes to a place where there is pressure pushing it to stay there, it does just that. So it may get pulled out of brain tissue and redeposited in muscle tissue - not the hips, please.. not the hips!
During the time when the mercury is pulled out of the body tissues where it has been stored in equilibrium, and begins circulating in the bloodstream trying to find a new place to be stored in a new equilibrium, that mercury shows up as increased mercury in the blood.
That increased blood level of mercury indicates an actual decrease of mercury in the non-liquid tissues of the body. It's really a good thing happening!!!
The bad news is that if you suffer from mercury toxicity symptoms, then you may very well suffer a little or a lot more for a short time while the blood mercury level is up..
So the point of the above is that the increased blood mercury level, while temporarily not so good, is actually an indication that your body tissues are GETTING RID of stored mercury. The whole idea of mercury removal is to get it out of the tissues. When it's in the brain, liver, kidneys, etc. that's when it's a problem for your long term health. When it's in your blood, it can make you feel like you have the flu - if you feel anything different at all - but it's your body trying to GET RID OF IT! So it's a good thing happening! Detoxing during that time helps your blood dump it rather than having it re-absorbed. After all, if you didn't have stored mercury in your tissues, there wouldn't be any significant increase in it in your blood!
This brings us to #2 above.....
The increased mercury blood level usually occurs after about 48 hours and then declines "exponentially" (faster at first and then more and more slowly) over about 3 months.
You have no doubt read lots of stuff saying that drilling or grinding out old amalgam fillings releases lots of mercury and it shows up in your body.... and therefore, the many different dentists say, lots of special precautions need to be taken like gas masks, oxygen to breathe, rubber dams, even special rooms with special air cleaning systems, and so on. Some suggest the timing should be dictated by the electrical measurements of the amalgam fillings!
A very big deal is made about the "correct way" to remove amalgams, almost to the point of suggesting that if it is done wrong you and the dentist will likely drop dead then and there! Well, while there is a grain of truth to that whole idea, I would like to give you a different set of facts to think about.
For a long time I thought this whole idea about mercury from drilling causing a mercury increase was just not right, but I didn't have any proof.
Then I found an obscure article titled "Kinetics of Mercury in Blood and Urine after Brief Occupational Exposure" This is a study reported in May-June 1992 in the Archives of Environmental Health. This was not a "dental" study. The study was to find out just how long it took for a mercury exposure to show up in the blood. An example of mercury exposure can exposure to the mercury vapor produced by a dentist drilling on an old amalgam filling to remove it.
Well, I was very pleased to see that they found the mercury showed up almost right away. ..... A lot less than the 48 hours cited in other holistic dentistry articles on the internet. They found that after about TEN MINUTES, the red blood cells showed increased mercury levels and the blood plasma showed it after TEN HOURS.
Why am I excited? What does that mean? It means that the theory that drilling on the amalgams in the mouth causes a release in mercury which is absorbed into the body resulting in an increase in mercury in the blood after 48 hours ...... is not scientifically valid! The mercury increase after 48 hours is from a different source - the release of mercury from body tissues as discussed above. If it came from the dentist drilling out the amalgams "wrong" it would show up within the first TEN MINUTES or so!
So this means that the specific protocol of how the fillings are removed is not so big a deal as we were all led to think!!!
Does this mean that how it's done doesn't matter? No, of course not . If a dentist is stupid about it, he or she exposes himself and you to more mercury vapor than necessary and that's not a good thing. We DO know that more mercury is released from amalgam when it is drilled on. But with this information it seems to me that basic simple precautions like lots of water spraying to keep the amalgam from getting hot and using lots of suction to pull particles and vapors away during the drilling should be all that is needed. If it makes you feel good and you want to pay extra for oxygen or gas masks, special rooms etc, that's fine...I just don't think it will make a difference or make you any safer. Even if a dentist is "old school" and still thinks mercury is fine, his dental school training taught him not to drill on amalgam "dry" so normal good dental procedure should really be enough ... if it is properly followed. The only problem is that a dentist that thinks mercury is ok, may not be so vigilant to do even the basics of what he was taught regarding mercury toxicity.
Testing for Mercury Levels in Your Body
Various tests, blood, urine, hair analysis have been used to test for mercury and other heavy metals. I think the most reliable test is done with a fecal sample. Not the most esthetic approach, but hey, there are no needles and you don't have to cut off lumps of hair close to the scalp... Every cloud has a silver lining, they say. Anyway, it's a take home thing (you probably don't want your dentist helping you with it anyway, right?) that you can put a sample in and mail it away to the lab. Or you can mail it to someone you don't like very much ... it's up to you. The results come back with literature to help interpret them. For info on where to get the test done if you are not near my office call:
Doctors Data Inc. 800-323-2784
PO Box 111 Fax 630-587-7860
Chicago Illinois 60186-9986
Here are some thoughts regarding other methods of testing
Intra-oral Vapor Testing An interesting test to demonstrate the fact that mercury is present in your mouth from your mercury fillings. It's a motivator and can be a scare tactic but it doesn't show you how much mercury your body tissues are storing. Blood and Urine Testing Again, interesting, but both high and low urine mercury levels could be a problem. It won't necessarily tell you the level of stored mercury. It only shows you what is presently being excreted. Blood levels can indicate recent exposure, recent excretion, or high levels. DMPS Challenge Test A urine mercury test before and after a chelation "challenge" with DMPS that liberates mercury stored in body tissues. This is much more accurate and meaningful than plain blood or urine testing. Hair Testing Indicates levels of mercury and other metals stored by your body over a period of time. hair closest to the scalp [newer, more recent growth] gives the most recent indication. Apparently there are many variables with hair - possibly including the kind of shampoos and conditioners etc. used - so that the alternative "experts" mostly seem to have little faith in hair analysis. I trust them since they are closer to the scientific research that checks these things out. Skin Patch Testing - Hypersensitivity This is controversial. There are concerns that it could "sensitize" a person and make things worse. It should only be done by a medically trained professional like a dermatologist or medical allergist and should be done with ammoniated mercury [not mercury chloride]. Electrical Galvanic Testing Interesting in that it shows how the amalgam fillings have created a "battery" in your mouth and actually produces an electrical current that can speed the release of mercury and maybe even create havoc with acupuncture meridians. But it does not tell you how much of a problem you have with mercury toxicity or stored mercury levels. Also the specific "readings" will vary from one time to another so the readings are nothing more than relative general indications and don't mean a whole lot specifically. As far as I have seen most holistic dentists - even those that used to swear by electrical "galvanic" testing - have abandoned it altogether except perhaps as a way of occasionally demonstrating the electrical effect to a skeptical patient.
During the time when the mercury has been "pulled" out of tissue and into the bloodstream, we have a wonderful "window of opportunity" to use nutritional supplements which are able to chemically combine with - bind with - the blood-borne mercury. The good thing about that is that once bound to one of these scavenging supplements, the mercury is no longer able to get back into other body tissues. It is excreted from the body! Mostly supplements high in large molecules containing sulfur are used because the mercury will combine pretty strongly with sulfur and the resulting large molecule is then too large to be re-absorbed and gets to be excreted from the body in the form of urine, sweat, or feces.
Under "Topics" there are two different Detoxification regimens outlined if you want more info on that.
A Great Research Abstract!!! J Dent Res., 77(4):615-24, Apr 1998
I was excited to read this abstract because it was so simple, clear and straight-forward. The researchers took 12 healthy subjects (people..) that had an average of 18 surfaces of amalgam fillings each (if the top and side of a tooth is filled with a single amalgam filling wrapping over from top to side, that is 2 surfaces). The range was 13 to 34 surfaces of amalgams.
In each case all the patient's amalgams were removed in a single dental appointment (must have been quite an appointment!). A high speed drill with water spray was used. Vacuum evacuation ( high speed suction) and without rubber dam.
No supplements or other intervention was given. Frequent blood sampling and 24 hour urine collections were performed up to 115 days after amalgam removal. In 8 subjects additional samples of plasma and urine were collected up to 3 years !!!
The object was to obtain data on the changes in mercury levels in blood, plasma, and urine following removal of all amalgam fillings.
A transient increase of mercury in the blood and plasma was seen after 48 hours, as expected. Blood plasma mercury peaked to about 130% of what they were when compared to before amalgam removal. Urine levels were about the same as before removal.
Sixty days after removal of amalgams, the mercury levels of blood, plasma, and urine had dropped to about 60% of what they were before removal.
The mercury levels continued to gradually decline to approach the levels of patients that never had any mercury fillings.
For practical purposes, it is my impression from this and other articles that within 3 to 6 months to a year the body will normally have returned to levels comparable to people with no history of amalgam fillings even with no special detoxification or other intervention...other than removing the amalgams, of course!
Using detoxification can potentially speed the process and minimize toxicity reactions and symptoms experienced during this time, however.
* I found this research abstract in Bio-Probe Newsletter Vol 14, May 1998 and I recommend Bio-Probe if you want information based on science rather than fad or fancy! See Resources, in "Topics" section.
Acute or other diagnosed cases of mercury toxicity are treated by a physician/toxicologist by using FDA approved metal binding drugs and that is beyond the scope of this pamphlet, but information is available!
There is a lot of information about mercury and possible problems with it and a lot of controversy also. You need to be the judge of what you think is important to you. It does appear that some people are very much affected by mercury while others seem not affected in any way that is obvious. Organized dentistry in the US would have you believe that those that are significantly affected comprise only a minute fraction of the population. Others feel up to 90% or more of us are affected adversely. If you feel you could be adversely affected by the mercury in your fillings now, and by the mercury which would likely be temporarily increased during replacement of your fillings with non-mercury materials, these are things you can consider to help take back some control in your own health and well-being. Done carefully and especially with guidance, it can do no harm and just might turn around symptoms that have been a problem for a long time...or prevent the appearance of new ones.
This pamphlet was written in the hope that it will increase understanding about a topic that seems important from time to time. Obviously it is only part of the whole story, so if you have questions after reading this please do not hesitate to ask or call. Also, if there is a topic that you think would be helpful, please suggest it.
Michael C. Goldman, DDS
General and Cosmetic Dentistry
3815 East-West Highway
Chevy Chase, Maryland 20815 Phone (301) 656-6171
Holistic dentistry is an approach to dental treatment, primarily caring for patients' health and safety from both a conventional as well as "alternative healthcare" point of view. It is sometimes called "biological" dentistry or "biocompatible" dentistry. In it's fullest sense, I believe it acknowledges and deals with the mind, body and spirit of the patient, not just his or her "teeth". See Topics / Info.....
Cosmetic dentistry is about doing quality , esthetic dentistry in a way that looks natural to begin with, and furthermore, can even improve one's attractiveness through techniques such as bonding, bleaching, veneers, caps, implants and more. It can be like "instant orthodontics" in correcting crooked, twisted or misplaced teeth in many instances. Dark or misshapen teeth can be restored. Smiles that lack youthful vigor or beauty can be revitalized! See Topics / Info..
In holistic dentistry there is an effort to find biocompatible materials to use to reduce toxicity for everyone, especially the chemically sensitive. Amalgam use is avoided in holistic dentistry (" amalgam free" or "mercury free") due to concern about possible toxicity problems. Amalgam removal and replacement with natural-looking bonded materials is a common holistic dentistry treatment as well as a common cosmetic dentistry treatment. Detoxification, especially of residual mercury deposits in body tissues from amalgams is often done. Root canals are controversial in holistic dentistry and are discussed under topics. And much more....
Bleaching, veneers, bonding, caps, bridges, and implants are cosmetic dentistry treatments that are also discussed in Cosmetic Dentistry, and more...