Protocol for the Safe Extraction of Amalgams


Patient Protection
The first thing in the mind of every conscious doctor is the protection of the patient against additional exposure to mercury. This is especially carefully in patients with mercury poisoning. According to Dr. Hulda Clark, the mercury intoxicated patient may have been exposed to varying amounts of mercury in the diet, in the environment, in his workplace or by mercury or silver amalgams. All forms are cumulative and can contribute to the mercury load on the organism.

Dr. Hulda Clark advises this procedure to minimize any additional exposure of the patient, ourselves or our team to mercury. The chewing is exposed to the patient at intraoral levels that are several times more the concentration of mercury in air allowed by the EPA (Environmental Protection Agency or United States Agency for Environmental Protection).

During the removal or placement of the amalgam, the patient may be exposed to amounts that are a thousand times greater than the concentration allowed by the EPA. Once the drill touches the amalgam, the temperature is immediately increased by vaporizing the mercury component of the alloy.
There are 8 steps that can highly reduce the exposure of all people:

1. Keep cold amalgams.
All the elimination must be done under a spray of cold water with copious amounts of water. Once the elimination has begun, the mercury vapor will be continuously expelled from the tooth.

2. Use a high volume sniffer.
A tip of the high-volume suction device should be placed near the tooth (less than 1 cm and a half) at all times to evacuate the vapor from this area of the patient. Polishing the amalgam can create very dangerous levels of mercury and should be avoided especially for the patient intoxicated by mercury.

3. Provide an alternative source of air.

All patients who have an amalgam removed or placed, must be provided with an alternative source of air and instructed not to breathe through their mouth during treatment. A nasal mask such as the one used with nitrous oxide anesthesia equipment is excellent. The air is better and oxygen is more acceptable although it is not required. If only air is used, it should be clean and free of mercury vapor, preferably taken from outside the dental clinic.

4. Immediate elimination of the mercury alloy.
The particles of the mercury alloy must be washed and vacuumed as soon as they are generated. The stuffing should be sectioned and removed in large pieces to reduce exposure. Currently, the International Academy of Oral Medicine and Toxicology (IAOMT) has approved the elimination with and without the use of a rubber dam.
There is some evidence to support both opinions since high levels of mercury and amalgam particles can be found beneath the dike. All members agree that whether or not an oral rubber dam is used, they should be instructed not to breathe through their mouths and not swallow amalgam particles. Some experts feel that it is better to remove the amalgam first and then apply the dam if it is necessary to perform restorative procedures.

5. Washing and change of gloves.

After the fillings have been removed, remove the rubber dam if it was used and wash the patient’s mouth for at least 30 seconds with cold water and suction. Take off your gloves and replace them with a new pair. If you are going to perform a restorative procedure then reapply a new dam and proceed.

6. Clean the patient immediately.

Immediately change the patient’s protective clothing and clean your face.

7. Consider the intake of supplements to detoxify.

You must ingest them before, during and after the elimination.

8. Keep the air in the room pure.

Install air purifiers or ionizers and fans for the well-being of everyone. PERSONAL PROTECTION OSHA (Occupational Safety & Health Administration, equivalent to the Spanish Ministry of Labor and Social Affairs) requires that employees give written consent informs before the use of any toxic chemical, which mercury is one those. Elemental mercury vapor is one of the most toxic forms of mercury and should not be breathed.

Women in childbearing age should not be exposed to more than 10% of OSHA MAC (MAC= Mexican-American Commission, or Mexican-North American Commission). Women who are pregnant should NOT be exposed to mercury. If you use mercury or remove mercury in any form, the National Institute for Occupational Safety and Health (NIOSH) has recommended that you supervise your employees medically annually.

ANY EXPOSURE TO MERCURY REQUIRES THE EMPLOYEE TO WEAR AN APPROVED MASK WITH MERCURY FILTER. An approved mask is appropriate for use during all dental procedures that expose you or your staff to mercury, a way which dentists use their equipment dramatically affects the amount of mercury expelled. Never drill the mercury dry.

It is dangerous for you, for your staff, and for your patient. Levels of up to 4000mg/m3 have been measured at half a meter of the drill when it is used dry. Levels above 1000μg/m3 have been measured by opening an amalgam mixing capsule. Of every 7 California dental clinics tested by OSHA, mercury contamination of 50mg/m3 was found. In 100% of clinics, the aspirator extractor gave levels above 100mg/m3.

Any clinic in which mercury is used should be monitored regularly and personnel exposure monitored. Testing services are available and a mercury sensor is available for staff supervision. It should be checked inside the stores and along the surfaces where the mercury may have fallen. Spills in the clinic can go unnoticed for years and are extremely dangerous.

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