Seeking advice about amalgam filling removal

February 4, 2013 1:43 AM

Should I go to my regular dentist or seek a holistic/biological dentist? Does anyone in Vancouver, BC, have a recommendation?

I have one amalgam filling left and am considering getting it removed. I actually had several more (I like sweets :( ) for most of my adolescence, but four years ago, a dentist replaced them all with the white composite. I didn't do it because I was worried about the amalgam -- this dentist claimed I had like, 13 cavities or something insane (when no dentist had told me that before).

I know people will either say there is no harm in keeping this filling (my current dentist says the mercury is 'not active' and not a problem unless the filling is breaking down, etc.), and people who say the mercury is certainly leeching. I personally prefer the composite replacement for aesthetic reasons, and would rather not worry at all about any potential risks.

Now my problem... I am feeling more anxious about the removal of the amalgam. My current dentist is great and I trust him. He does work for many members of my family and has been around a very long time. After a bit of research, I've learned amalgam fillings should be removed with a strict protocol and performed by a dentist specially trained in removal, as the procedure means a peak exposure, particularly from vapors. I asked my dentist's office what they would do, and they say they will use a rubber dam, have high-power suction, and use lots of water (to not heat up the filling). I've read that the holistic/biological dentists will use the full-on alternate oxygen supply for the patient and use masks for themselves, and offer information on chelating any mercury afterwards.

I have an appointment with my regular dentist this week for this filling and feel torn. Do I go to my dentist and just try not to worry about the oxygen/vapor part? I know he has a lot of experience and would be careful otherwise. I already read taking chlorella will help with chelating. Plus, it is just one surface filling.

Or, should I seek the biological dentist for this one filling replacement? I would probably feel a bit more confident, but there are the other factors... Cost, for one. The biological dentists seem much more expensive. I am not even sure that they would just do the one job, without saying "We need to do full X-Rays, etc., etc." And plus, is doing one job with another dentist seen as 'switching' (do not want to do!) and risking my relationship with my current dentist? On top of it all, I have looked at the directory for dentists in my area that do the special removal, and had to check some reviews... just to kind of balance a decision. They weren't great reviews. If you recommend this route, and have used a dentist who uses this protocol and live in the Vancouver, BC, area, could you please let me know which dentist you used? (Please don't tell me how awful mercury is -- I know.)

Added note: I'm pretty sure that other dentist, who replaced my other amalgam fillings, didn't use any ventilation equipment and while perhaps not ideal, I don't recall any negative effects afterwards (I hope?!) I think that was at least 5 fillings replaced.

Thank you very much in advance for reading all the above and for any advice!

posted by branparsons to health & fitness (5 answers total)

What is a "holistic/biological dentist"? People working in the healthcare industry who prefix their job titles with vague feel-good words are generally peddling expensive bullshit.

Also, a dentist should not be performing or advising on chelation therapy, which you almost certainly do not need and wll never need. Chelation is a real medical tool used in actual cases of clinically significant heavy metal poisoning. Unfortunately, the word has been adopted as another offering in the suitcase of the bullshit alternative "medicine" community, where improper and reckless "treatment" protocols have repeatedly killed people. Chlorella will no more "help" with a nonexistent chelation protocol than holding two quartz crystals and chanting will help with a hemorrhoid. You've been sold a bill of goods by people who feel the need to establish their status in the community as a healer without any sort of training with a grounding in reality; more cynically, you've been noted as an open wallet.

Thinking about the above two points in conjunction, it is obvious to me that your choice is between one dentist (or any other non-bullshit dentist you would care to see for a second opinion) and one scam artist.
posted by Inspector.Gadget at 3:21 AM on February 4 [12 favorites]

I did a cursory google search for "best practices amalgam filling removal" and came up with these links

http://www.epa.gov/hg/dentalamalgam.html
http://www.quackwatch.org/01QuackeryRelatedTopics/mercury.html
http://www.ncahf.org/pp/amalgampp.html

along with a website maintained by the "holisitic" dentistry crowd.

After a very quick skim, my gut (and physics B.S.) is telling me that the holistic dentistry crowd are pushing a line of bullshit.

Modern chemistry lab techniques are ridiculously sensitive and careful these days, which means that research doctors and dentists know how much mercury you've got in your body and how much you're getting from various processes (of eating, breathing air near a coal plant, having a filling removed, etc.). And then there's pushback, from these labs back to practicing dentists, which helps regulate the profession.

and people who say the mercury is certainly leeching.
I would completely discount any information from the holistic dentistry crowd, and go with information ultimately traceable to medical journals used by the mainstream profession. And that is what has set the work practices of your current dentist.

I suspect the best way to not expose yourself to a further dose of mercury would be to leave the filling in place, and to disregard your aesthetic concerns.

and would rather not worry at all about any potential risks.
A good way to avoid a potential risk would be to avoid subjecting yourself to an unnecessary medical procedure. There's a lot of small stuff, not just mercury, that's a mild concern with any dental procedure.

If you chose to undergo an unnecessary medical procedure, you should make sure it is reasonably safe. "Doc, I've heard that some dentists supply an oxygen line and so on for removing amalgum mercury. Is there a point to this? Do reputable dentists in research labs do blood tests and find mercury in the blood after this if they don't supply oxygen?"

Also, "Doc, setting aside the aesthetics, if this was your filling in your mouth, would you remove it?"

That last one is the important one.

Added note: I'm pretty sure that other dentist, who replaced my other amalgam fillings, didn't use any ventilation equipment and while perhaps not ideal, I don't recall any negative effects afterwards (I hope?!) I think that was at least 5 fillings replaced.

I imagine the grinding turns the amalgam to chunks and powder, which is flushed out with water. There's not enough vapor to be a concern.

I already read taking chlorella will help with chelating.
huh. You should check that on google scholar. (That's a polite way of suggesting this feels like a bit of nonsense.) In the meantime, tell your pharmacist you're taking the stuff in case it triggers an autoimmune disorder or screws up your meds.

What is a "holistic/biological dentist"? People working in the healthcare industry who prefix their job titles with vague feel-good words are generally peddling expensive bullshit.

I think there's a market for persuading people to have their fillings drilled out and replaced. I mean, there's no proof that charkras exist, but there's good money realigning them.

I'll try to put this gently: if you're that concerned about mercury, go have your blood tested, by a real lab. Then go see your dentist.

If you don't have significant levels, don't worry about it.

And spend your money on your health, buy a cream tart or a bike or something else that's good for you. Instead of having a working filling ground out of your tooth.
posted by sebastienbailard at 3:32 AM on February 4 [4 favorites]

There are a lot of huge red flags in your question that indicate that you are being lied to so that someone can hurt you to make a buck. Mercury is honestly not that awful unless its handled improperly.

"Do I go to my dentist and just try not to worry about the oxygen/vapor part?"

Really the vapor part is the only one worth worrying about. Mercury toxicity is a really interesting thing that has a lot of bullshit peddled about it, but while it is not simple it is very very well characterized. Mercury, for the most part, is only adsorbed through our lungs as a vapor, and then only very poorly unless it has chemical groups bonded to it. The mercury in fish is a problem primarily because of the vapors we breathe in while eating and because it is generally methyl mercury. By now you've probably been shown toxicity data for either methyl or worse dimethyl mercury which are dangerous and super dangerous respectively and really difficult to handle properly, but what you've got in your mouth is elemental mercury, which is quite straightforward to handle properly.

"I already read taking chlorella will help with chelating. Plus, it is just one surface filling."

This is completely unnecessary for the kinds of exposure one would get from a filling by orders of magnitude and I imagine quite expensive.

"...and they say they will use a rubber dam, have high-power suction, and use lots of water (to not heat up the filling)"

If you do end up needing to have fillings removed, this is the standard procedure endorsed by the good folks at the ADA who know what they're doing. There are genuine concerns that it might be insufficiently protective of dentists, particularly if they do it quite a bit, but not really for ordinary people with one filling that is a concern.
posted by Blasdelb at 3:48 AM on February 4 [5 favorites]

Yes. Do not worry about it even a little bit. Elemental mercury is not particularly harmful. Where it gets harmful is when it combines with other elements to create mercury compounds. That's what is in fish that purportedly causes mercury toxicity. But the mercury in dental amalgam is pure mercury, mixed (alloyed) with silver and tin so that it isn't liquid at room temperature.

(Analogy: carbon and nitrogen are perfectly fine. We breathe them all day. But combine them chemically and you get cyanide.)

Even if you happen to swallow some accidentally, most of it will just run right through you.
posted by gjc at 5:21 AM on February 4

Thanks so much everyone for your input. I've never actually contacted any of these holistic dentists -- the 'extra safe' removal procedure was just something new discovered online and I did some additional Googling. Needless to say, information on the Internet can be overwhelming and crazy-making. It helped to get some balance from you folks (who may have related expertise/degrees in this stuff -- I don't!) I really do appreciate it. Especially the reassurance about the type of mercury for if I do decide to still remove the filling. I didn't know about any of that.

sebastienballard - Thank you for those links! I should have done more research into the background of holistic dentistry and its credibility. I'll read those shortly. The chlorella thing seems to be consistent everywhere, about it binding with mercury. No concerns about mercury levels in my body right now -- just spooked by the thought of unleashing a whopping amount from the filling removal. But everyone seems in agreement that it is not as harmful as I think.

My dentist did say that he would never advise me to replace the filling, as nothing is currently wrong with it, but would be fine with doing it if requested for aesthetic purposes, which he's had patients do. I guess I just need to decide if it's really that important to me!
posted by branparsons at 2:13 PM on February 4