Many people have old amalgam fillings that have broken down and need replacement. In other cases, advice from naturopathic doctors or other medical personnel acts as a catalyst for patients to ask for amalgam removal.
Sometimes they are replaced because a patient does not like the aesthetics of the metal. These filings are still considered safe according to the Canadian and American Dental Associations, and St. Lawrence Dentistry does not recommend removing them just on the basis that they are metal fillings. St. Lawrence Dentistry has not placed amalgam fillings in many years; however, Dr. Hawryluk Jr. routinely removes them. There are a few key steps that are followed at our clinic to ensure these fillings are removed safely and without precipitating injury to the tooth nerve.
Dental amalgam fillings have been around for over 150 years and historically were considered the dental material of choice. There use has significantly declined in North America and Europe, and St. Lawrence Dentistry phased out, placing these fillings years ago. However, there are still millions of people in Canada who have amalgam fillings in their teeth. Dental amalgam is a mixture of metals, consisting of liquid (elemental) mercury and a powdered alloy composed of silver, tin, and copper. Approximately 50% of dental amalgam is elemental mercury by weight. The chemical properties of elemental mercury allow it to react with and bind together the silver/copper/tin alloy particles to form an amalgam. (FDA.gov).
Dr. Hawryluk Jr. uses a Global Dental Microscope to remove deep amalgam fillings and believes simple dental loupes do not offer enough acuity in certain situations such as deep fillings in the very back molars. A global dental microscope is superior in both magnification and resolution in these situations over simple magnifying glasses. Magnification is the ability to make small objects seem larger. Resolution is the ability to distinguish two objects from each other. When you have proper magnification and resolution, the dentist can avoid ‘micro gouging’ the underlying tooth, which can injure the dental pulp.
For the health and safety of our patients, Dr. Hawryluk Jr. uses a dental dam when removing amalgam fillings. This barrier will act as a ‘safety net’ to ensure no inadvertent swallowing of the metal while being removed from your tooth. It also increases the dentist’s view of the tooth, further improving the accuracy of the procedure. They are easy to place, and most patients find them very comfortable and are at ease, knowing no metal bits are going into their mouths. All in all, proper magnification and dental dam use are the two fundamental keys to safe amalgam removal.
The removal of the amalgam ideally accomplished by the dentist using only very light pressure. If the dentist tries to speed up the process by pushing harder on the amalgam, the underlying tooth can be overheated. The metal pieces really should just be flaked of ‘little by little’. A brand new sterilized carbide bur must be used (as opposed to a bur previously used and sterilized). A sharp bur means less pressure needs to be applied by the dentist. Sometimes multiple new carbide burs need to be used per patient if the patient has several amalgam fillings to be removed. In addition to the efficacy of using brand new burs, it is also more hygienic and safer (than re-sterilized burs).
Dr. Hawryluk Jr. uses two high volume suction tips in the removal process. He has found that just having one suction tip next to the amalgam is not necessarily enough to ensure all pieces and vapor from the removal process are successfully collected. At St. Lawrence Dentistry, we use one large suction and one smaller tip. The smaller tip can be placed right next to the tooth and bur without inhibiting the view of the dentist. Using two suctions at once also means the offices suction motor must be strong enough to accommodate the increased suction power needed to operate in this scenario while supporting the other operatories in use.
After the amalgam removal, it is time to place a new composite resin filling. A few extra steps here can ensure your tooth is not left sensitive from the process. A copious amount of bonding agent is critical, and it must be judiciously burnished into the tooth (as opposed to just scantly applied). At St. Lawrence Dentistry, we use G-Premio BOND, which is a universal, 8th generation bonding agent from GC Corporation. This patented formula reduces sensitivity issues when placing fillings and ensures a strong bond of the new composite filling to your tooth. Finally, the new composite filling must be packed appropriately in small increments and cured the ideal amount to ensure a solid composite filling.
As you can see, there are several steps to consider for safely removing old metal fillings and obtaining a long-lasting and sensitive free new fillings.
If you live in the Mississauga/Toronto area and would like to discuss removing amalgam fillings, please contact St. Lawrence Dentistry.