Amalgam removal

No amalgam fillings are being placed at the Pure North Dental Clinic. We believe that a better material choices exist on the market in this day and age.
There is a considerable controversy surrounding amalgam restorations. Hence it is of utmost importance that patients educate themselves about different, sometimes polarized views on the subject. Education and access to information allow patients to exercise their autonomy, i.e. make an informed independent choice about the treatment.
Note: Health Canada or Canadian Dental Association do not recommend replacing sound amalgam fillings. Be sure to check links below:

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The Health Canada:
 Position Statement on Amalgam


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Canadian Dental Association:
Position on Dental Amalgam

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International Academy of Oral Medicine and Toxicology:
Dental Mercury Facts

If you would like to request amalgam fillings replacement please fill out Amalgam replacement request.

Scenarios

Scenario 1. Existing amalgam filling is faulty either because it is broken, there is caries beside it,  it is worn out or the tooth is cracked/fractured. There is no question treatment needs to be done. Any dentist would recommend one form of treatment or another. The only concern for the patient should be how to minimize one's exposure to mercury as Health Canada advises dentists to use techniques and equipment to minimize the exposure of the patient and the dentist to mercury vapour.
This is non-elective (essential) treatment. No controversy here.

Scenario 2. A patient wants amalgam replaced because it is not tooth-colored and looks unappealing to her.
If the amalgam in question is strong and sound (mechanically speaking) replacing it is viewed as cosmetic. This is example of an elective treatment. Extensive discussion regarding risks and benefits becomes as important as in case of front teeth veneers or teeth whitening.  A written consent is required for this to happen (Amalgam replacement request).

Scenario 3. A patient wants amalgam fillings replaced based on her personal beliefs (philosophical, religious etc) or on recommendations by another healthcare provider or a person.
You have the right to chose what type of treatment you undergo, but also refuse any medical treatment if you are mentally capable. This is called patient autonomy.  During your examination our dentist will assess and inform you of the nature of the condition requiring potential treatment, the treatment and non-treatment options available including the advantages, disadvantages and the potential significant risks and costs of these options.

One needs to be acutely aware that replacing sound amalgam fillings is not recommended by Health Canada or Canadian Dental Association. Dentists are not permitted to recommend procedures that are considered unnecessary by regulatory bodies. Regardless of any dentist's personal beliefs the patient needs to be presented with objectively verifiable facts, which is the only acceptable form of conduct. During discussion you will be familiarized with various views within scientific and dental communities.

Whether you believe that you may be allergic or sensitive to amalgam alloy, or there is a concern about different metals creating galvanism, or an expectation of a future kidney function impairment based on family history etc., you as a patient make the final decision on choice of treatment.  It is your call. Our dentist can replace amalgam only on a direct request from you, providing your choice is informed and  a written consent from is obtained (
Amalgam replacement request).

Amalgam removal

Ok. Amalgam filling/fillings will be drilled based on some of the scenarios described above. Now what?

Health Canada recommends (paragraph 4 here):
"In placing and removing amalgam fillings, dentists should use techniques and equipment to minimize the exposure of the patient and the dentist to mercury vapour".

At Pure North Dental Clinic we are following SMART protocol developed by The International Academy of Oral Medicine and Toxicology to minimize the patient and our staff exposure to mercury vapour. The following steps are taken:
  1. A patient is largely covered/draped so that amalgam particles do not precipitate onto the clothing and are not carried home.
  2. Amalgam is removed exlusively with non-latex rubber dam ( shield).  This is placed over the selected teeth we would be working on and helps prevent you from inhaling or swallowing amalgam pieces or particles.
  3. Dentists use water with our handpieces while drilling the tooth (no dry drilling). This keeps alloy cool and also lowers the mercury evaporation.
  4. High volume suction is used throughout to capture particles that would otherwise fly out.
  5. Once the removal of amalgam is complete drapes and suction tubing are changed.
  6. Charcoal air filtration system (vacuum apparatus) is ran beside the working field to minimize exposure to amalgam particles that may be present in the air close to the site.  Air is being constantly sucked away from the patient's face.
  7. Patient is supplied with oxygen to breathe through nasal canula.

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Drapes to catch flyiing particles, rubber dam to prevent swollowing and a filter to create air flow away from a patient.

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Particles impregnate everything they touch. This is discarded asap.

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Despite high volume suction and air filter small amalgam pieces still precipitate around. We fold and discard drapes once the procedure is finished. The patient will not be taking those particles home.

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Rubber dam (shield) allows to capture amalgam shavings without the patient swallowing it.

SMART certificate is not an indication of superiority, merely a sign that the dentist reviewed and learned to implement best practices aiming to minimize patient's exposure to mercury when dental amalgams are being drilled out.
Please note that it is not necessary to have SMART certification is order to follow Health Canada recommendations and reduce patients and staff exposure, neither these recommendations are mandatory. Each dentist uses his/her clinical judgement as to how to serve their patients best.

Disclaimer: Above are photographs of Dr. Andrew Yegorovykh's  patients and treatment. Photographs are for informational purposes only because individual treatment results will vary from patient to patient. Some patients may not be candidates for treatment. It is important for a prospective candidate to engage in detailed discussions with a dentist about treatment options, realistic outcomes, possible complications, costs, informed consent.
No information presented on this web-site should be construed to imply superiority of Pure North Dental Clinic or its dentist/s.