Dr. Merkel is committed to having an office that is, in dental terms, “mercury-free”.
Simply put, we do not place amalgam (silver colored) fillings. Dr. Merkel feels that resin-based composite (tooth colored) fillings are a far superior alternative. Listed below are just a few of the many reasons.
In addition, we follow all appropriate protocols for the safe removal of amalgam fillings. The International Academy of Oral Medicine and Toxicology (IAOMT) has specific instructions regarding this and a copy of the protocol is available on this web site.
International Academy of Oral Medicine and Toxicology
Protocol for Mercury/Silver Filling Removal [1]
Patient protection:
First in every concerned doctor’s mind is the protection of the patient from additional exposure to mercury. This is especially true of the mercury toxic patient. The mercury toxic patient may have been exposed to varying amounts of mercury from diet, environment, employment or from mercury/silver dental fillings. All forms are cumulative and can contribute to the body burden. The goal of this preferred procedure is to minimize any additional exposure of the patient, ourselves, or staff to mercury.
During chewing the patient is exposed to intraoral levels which are several times the EPA allowable air concentration. [2] During removal or placement of amalgam the patient can be exposed to amounts which are a thousand times greater than the EPA allowable concentration. [3] Once the drill touches, the filling temperature increases immediately vaporizing the mercury component of the alloy. There are 8 steps to greatly reducing everyone’s exposure.
Step One: Keep the fillings cool
Staff protection
OSHA [4, 5] requires that employees be given written informed consent before the use of any toxic chemicals of which mercury is one. Elemental mercury vapor is one of the most toxic forms of mercury and should not be breathed. Women of child bearing age should be exposed to no more than 10% of the OSHA MAC [6]. Women who are pregnant should be exposed to no mercury. [7] If you use mercury or remove mercury in any form the National Institute of Occupational Safety and Health (NIOSH) has recommended that your employees be medically monitored annually.
9) Any mercury exposure requires that the employee wear an approved mercury filter mask. An approved mask is appropriate for wearing during all dental procedures which will expose you or your staff to mercury. [8]
The manner in which dentists operate their equipment dramatically affects the amount of mercury released. Never drill on mercury high dry. It is hazardous to you, your staff and your patient. Levels as high as 4000 mg/M3 have been measured 18” from the drill when used high dry. Levels over 1000mg/M3 are measurable upon an amalgam mixing capsule.
One out 7 California dental offices tested the OSHA TWA of 50 mg/M3. 100% of the vacuum cleaner exhaust tested over 100 mg/M3. Any office where mercury is used should be tested regularly and staff should be monitored for exposure. Testing services are available and mercury sensor badge is available for personnel monitoring. They should test inside storage areas and along baseboards where mercury might have dropped. Office spills can go undetected for years and are extremely hazardous. The International Academy of Oral Medicine and Toxicology protocol committee is seeking submissions to the Standards of Care/Protocol/Preferred Procedures. We are particularly concerned and interested in detoxification.
In keeping with this protocol:
Will my insurance company pay for resin-based composite restorations?
The simple answer is, some insurance companies will and others will not. Most all insurance companies will pay for resin-based composite restorations on anterior (front) teeth. Many insurance companies will not pay for resin-based composite restorations on posterior (back) teeth, but will pay for an alternate, less expensive treatment. For detailed information on whether your policy covers composite resin restorations, please contact your insurance company or your employer’s benefits coordinator. We also would be happy to help you.