Safe Amalgam / Mercury Removal Protocol

BRIEF SUMMARY

INTRO:  Mercury-free for over 35 years, Dr. Veligdan has studied about and removed mercury amalgam fillings safely for his patients since the 1980’s.

CUT and CHUNK:   Making small cuts and picking out large chunks of the amalgam greatly reduces mercury aerosol and exposure to patients.

KEEP IT COOL:  Removing the amalgam slowly with no heat created is of utmost importance.  Using copious amounts of cold water and the right equipment is a must.

SUCTION:   Sucking up the mercury particles and vapor before it gets to our patient is critical.   Dr. Veligdan uses three kinds of suction and a whole room air purifier and filtration.

RUBBER DAM:  We use in the mouth barriers such as a non-latex rubber dam or the Clean-Up device and if possible, both.

COVER UP:   We cover our patient’s eyes, skin, hair and upper clothing with a barrier.

SUPPLEMENTAL AIR:   So that our patients don’t breathe the air around the mouth, we have the equipment to supply clean air or oxygen under positive pressure through a nose piece.

MAINTAIN CLEAN FILTERED AIR in the ROOM:   We use the Dent-Air-Vac for vacuuming the room air with a 3-Filter filtration and purifying unit.

NUTRITION, DETOX, CHELATION:   With the consent of our patients, we give supplements and detox rinse at the time of the procedure and if requested, nutritional counseling for 1-2 weeks before and after the mercury amalgam removal.


EXPANDED VERSION

Introduction

Dr. Veligdan has been mercury-free for over 35 years.   For most of that time, he has been investigating and researching the best ways to protect his patients from mercury exposure during amalgam filling removal.   He has traveled all over the United States attending lectures and taking courses on what has become known as Biological Dentistry.   He was the first dentist in Manhattan, NY to have a “mercury separator” in his office [to protect the environment] in the 1990’s.   He is a member of IAOMT and the Holistic Dental Association and follows their amalgam removal protocol with some of his own added precautions and strategies.  

We have known for quite a while and beyond any doubt that dental amalgam releases mercury.   Even a piece of amalgam sitting on a bench at 37 degrees C [the temperature of your mouth] will release as much as 43 micrograms of mercury vapor per sq. centimeter of surface area each day.  Cutting the amalgam with a dental drill [bur] makes very small particles [besides the vapor] which enormously increases the surface area and therefore greatly increases the chance of mercury exposure and absorption in your body.   This “cloud of particles”, the majority of which are 1 micron or less in size, are so small that they can be fully breathed into the deepest part of your lungs and then later get absorbed into your system, and can lodge in many parts of your body.  And in case you haven’t heard, mercury in any form is poisonous.

The good news is that mercury-free dentists, over many years, have invented many techniques and strategies to protect our patients and ourselves.   OK, so how do we reduce or eliminate exposure to our patients?  

I.              CUT and CHUNK

This is a phrase that most of my Holistic patients have heard of.   It means that instead of grinding away all the amalgam and creating loads of aerosol and mercury vapor, make slices across the old amalgam [for example in the shape of an “X”] and then dislodge the big chunks.   This seems logical and I always try to do this, but in practice, I have found that many times the old filling adheres strongly to the tooth walls, and the walls are many times thin and week.   As you try and dislodge the chunks you may put too much force on the weak tooth walls and they may fracture.   The point of this is, “cut and chunk” is a good idea but the dentist must use GOOD JUDGEMENT and EXPERIENCE when a little more grinding is safer for the tooth than getting a wall broken off.

My patients sometimes do not want to replace defective fillings because they “have heard” that it removes too much good tooth.   My answer to them is, “if the dentist is careful, no good tooth should ever be removed.”   As you are taking out the amalgam, constantly STOP and LOOK, STOP and LOOK, etc.   This way you are careful and don’t take away any unnecessary, healthy tooth structure.

II.            KEEP IT COOL

Reducing heat and therefore vaporization is of utmost importance.   The manner in which a dentist uses his equipment dramatically affects the amount of mercury released; when too high a drill speed and in a dry field, enormous amounts of mercury can be given off.   The drill rotational speed should be no more than 18,000 to 20,000 RPM, which is fairly low for a “high speed” handpiece/drill which can go up to 400,000 RPM.   I only use an Electric Handpiece [dental drill], instead of an “air driven” one, because I believe they have much more ‘control’ and ‘precision’.   Copious amounts of cold water should constantly bathe the filling and particles should be washed and vacuumed away as soon as they are generated.   My assistant and I also frequently rinse the surrounding area with water.  Also, it is important to use new, very sharp burs [drill bits] which reduce friction which reduces heat.   I also like the “cross-cut fissure” burs which have extra grooves 90 degrees to the cutting edge which allow more cold water to get into the cutting surfaces keeping the amalgam and mercury even cooler. 

III.          SUCTION!!!

Even though we have been “chunking it out” and “keeping it cool” there is still some aerosol mist and mercury vapor created.  The first strategy for removing this is to use “high volume evacuation” [HVE].   We also call this the “high-speed suction” with its powerful vacuum at high speeds.   It should be kept, by the assistant, a half inch away from the tooth being worked on, as close as possible and still not interfering with the dentist’s working and sight lines.

An accessory to the HVE is the “Clean-Up” suction tip which connects to the end of the high-speed suction and has a flexible box enclosure that surrounds the tooth and effectively reduces the shower of amalgam particles.   This can sometimes be used together with a “rubber dam” or just by itself.   I will discuss more about the rubber dam [non-latex best] soon.

The second kind of suction we use is the “slow speed suction.”   It usually rests next to the “Clean-Up” or behind the non-latex rubber dam, pulling away any mercury vapors that may have gotten past the dam.

The third kind of suction, which also cleans, filters and purifies the whole room, is the Dent-Air-Vac.   It is a large vacuum device with 3 separate filters: the Pre-filter, the HEPA filter, and the “blended carbon filter.”   It has a long vacuum extension [that I call the “elephant trunk”] that is also placed as close to the working area as possible.   It is also left on between procedures to purify the room air further.

IV.          RUBBER DAM

My preference is to use a rubber dam, though many dentists don’t like using it.   Some studies have shown, Berglund and Molin and IAOMT among others, that a rubber dam has a protective benefit for patients to mercury exposure.  It is important to use a non-latex rubber dam as mercury vapors do not penetrate this nearly as much.    Also important is to use the saliva ejector [slow speed suction] behind the dam to catch any stray vapors.   We constantly rinse on and around the dam as we go since this washes the particles so they can be better suctioned, reduces mercury vapor and generally has a cooling effect.  

Immediately after the amalgams are removed, we take off the rubber dam and have our patient thoroughly rinse their mouth.   If many amalgams are removed I also have my patient rinse with Zeolite [ACZ Nano brand] suspension, an excellent detoxifier that clings to any mercury left in the mouth and then washes out with the final rinsing.

V.            COVER UP

Covering our patient’s eyes, skin and hair are very important.   The eyes are protected with “blue blocking” glasses/goggles.   We actually protect our patients’ eyes for all procedures, but for amalgam removal, it is even more important.  The “blue blocker” glasses are colored orange and block [actually absorb] the high energy, excitatory blue wavelengths of light thereby make our patients more relaxed at the same time.  The hair and skin are usually covered with a moist cloth towel.   Even for their clothes, we offer our patients a full-length plastic drape.

VI.          SUPPLEMENTAL AIR

So that our patient doesn’t have to breathe the air around the mouth, we can provide supplemental air through a nitrous oxide type nose hood.   We will provide positive pressure clean air or oxygen through this nose piece.   Just a note: for patients that are too claustrophobic with all this paraphernalia and apparatus on their face, we can also just cover their nose area with a moist cloth towel, which does a good job considering all the other precautions we take.

VII.         MAINTAIN CLEAN AIR in the OPERATORY

As I previously mentioned, we use the Dent-Air-Vac for additional suction and filtration with three separate and different filters, all for mercury removal and capture.   To maintain the clean air we leave the Dent-Air-Vac on for a long time even after the procedure.  Fortunately, we are able to open the windows in our office which we always do during amalgam removal.  

VIII.       DETOX, CHELATION, and NUTRITION

Just to be extra safe, we have additional Detox protocols.  With the consent of our patients, before and after the procedure we give 3 types of supplements for the chelation and absorption of any minuscule pieces of mercury.   They are activated charcoal, super chlorella and N-acetyl-cysteine [NAC].   As I’ve already mentioned, immediately after amalgam mercury removal we have our patient rinse with a nanoparticle suspension of Zeolite and spit it out, removing any residual micro-particles.

I advise to keep taking the 3 supplements for 2 weeks after the work, but this is up to the individual patient.  The herb Cilantro is also beneficial as a weak to the moderate chelator.  You can either take Glutathione capsules or boost Glutathione production by eating cysteine-rich foods like whey protein or organic milk.   NAC will also conserve Glutathione in the body, build up cysteine and other Sulfhydryl antioxidants.   As with any foods or supplements that you are not used to taking, be careful and start with the help of a medical practitioner so as not to elicit any untoward reactions.

For about 2 weeks before the procedure, I recommend optimizing their body’s strength and defenses.   It is best to remove all inflammatory and allergenic foods such as sugar [fructose], processed, packaged, fast foods and most starch and grain.   I advise a moderate to high protein diet high in sulfur-bearing amino acids – organic eggs are a good source.

Sulfur in sulfur-containing foods will attach to the mercury and help to mobilize it into the bloodstream.   Eggs, as already said, and onions and garlic are good sources.   Be careful as it is possible to over-do “mobilizing” all this mercury in the bloodstream; you have to make sure to wash and push it out.   Otherwise, it is “all dressed up with no place to go” and you may feel sick as all this mercury that was previously buried in your tissues [what the body does to protect itself] is “out in the open” possibly creating havoc.   Make sure to drink loads of pure water and do what you need to have good bowel elimination.

In years past I would prescribe the strong, prescription sulfur containing medications DMSA or DMPS.   What I found is that patients had uneven reactions and sometimes became ill because of what I explained above; too much mercury was mobilized all at once and was not eliminated fast enough.   I believe that DMPS and DMSA do work but if a patient wants to go through this detox I always send them to a Holistic doctor.

And what about the doctor and his assistants?    Don’t worry; we take measures to protect ourselves like special gloves and masks.  And some of the same things that protect you [like the high-speed suction and the Dent-Air-Vac suction/filter] also protect us.

Location
Robert Veligdan, DMD
343 W 58th Street, Suite 5
Columbus Circle, Midtown West, Hell's Kitchen

New York, NY 10019
Phone: 212-257-0838
Fax: (212) 832-3682
Office Hours

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212-257-0838