Protocol for Safe Removal of Amalgam Fillings

Protocol for the Safe Removal of Mercury Fillings

By Mina Levi, DDS, 09/11/2014

Amalgam fillings, or silver colored fillings, are seen every day in many patients’ teeth from prior years’ dental work. Amalgam fillings have mercury in them, which is a toxic chemical when exposed to the body. Finished amalgam emits mercury vapor for extended periods of time, and when it is in someone’s mouth for extended periods of time, it can leak and seep into a patient’s bloodstream. It is a more and more common practice to use metal-free dentistry, like the dental procedures performed by Dentist San Francisco Mina Levi, DDS, and to remove amalgam fillings from patients’ mouths. The practice of removing amalgam fillings needs a strict protocol in order to protect the patient and the dental team from the mercury vapors of amalgam fillings. The protocol outlined by the International Academy of Oral Medicine and Toxicology is as follows:

Cut and chunk, keep it cool

If you remove an old amalgam by slicing across it and dislodging big chunks, you will aerosolize less of the contents than if you grind it all away. If you keep it under a constant water spray while cutting, you will keep the temperature down, and reduce the vapor pressure within the mercury. The dental hand pieces used for mercury removal in the office of Dentist San Francisco Mina Levi, DDS spray water as they cut, and suction is used constantly.

Suction!

The best tool for removing mercury vapor and amalgam particulates from the operating field is high volume evacuation (HVE).  It is kept going next to the patient’s tooth until the dentist is finished with the removal and clean-up process. 

Some dentists hate rubber dams, while others can’t live without them. A rubber dam will help contain the majority of the debris of amalgam grinding, among its many other benefits. Isolite system can also be used in place of a rubber dam, which is what is used at the dental office of Dentist San Francisco Mina Levi, DDS. But you must know that mercury vapor will diffuse right through the dam, and some of the particulates will often sneak past it, too.  So:

• Always use a saliva ejector behind the dam to evacuate air that may contain mercury vapor. Nitrile dams are better vapor barriers than latex.
• Rinse well as you go, especially under the rubber dam clamp, because amalgam particles left on the used dam will emit mercury from your garbage can.  (If you wipe your dirty mirror on a gauze square or the patient’s bib, that gray smear also emits quite a lot of mercury vapor!)
• As soon as the amalgams are out, remove the dam and thoroughly rinse the patient’s mouth before placing the new restorations.  It can take as much as sixty seconds of rinsing to fully remove the mercury vapor.  Search for gray particles.  If there are particles on the back of the tongue, have the patient sit up and gargle them out.
• Post-removal rinses can be used to scavenge mercury from the patient’s saliva. Some of the substances that can be suspended in water and used for this purpose are activated charcoal, chlorella, or n-acetyl cysteine.

If you don’t use a rubber dam, you must be vigilant with the HVE, and take frequent breaks to thoroughly rinse the field.  Either way, the “Clean-Up” suction tip reduces the  dispersion of particulates in the area.

Supplemental air

Upon request, the patient can be provided with piped–in air, so they do not have to breathe the air directly over the mouth during amalgam removal.  A positive pressure respiration device such as a nitrous oxide nose hood, or a similar ventilation device, is probably the best way to provide clean air.

If you have any questions about mercury removal or metal-free dentistry, visit Dentist San Francisco Mina Levi, DDS on the web at www.minalevidds.com or give us a call at (415) 513-5066.

Topics: Dentist San Francisco, san Francisco metal free dentist, metal free dentistry, mercury free dentistry, mercury free dentist, mercury free dentist San Francisco, mercury removal, amalgam removal, amalgam filling removal, amalgam filling removal 94108, mercury filling removal san Francisco, San Francisco filling replacement

Sleep Apnea

Sleep Apnea

Snoring has always been associated as more of an annoyance rather than a medical concern for most people. However, frequent and loud snoring can be a sign of a disorder called sleep apnea. Sleep apnea is a disorder in which breathing stops periodically throughout sleep. Sleep apnea is treatable, but can easily go without being identified or diagnosed. In this article, we discuss symptoms, causes, and treatment of sleep apnea.

What is sleep apnea?

Sleep apnea is a breathing disorder in which breathing periodically pauses for about 10-20 seconds throughout the night and can occur hundreds of times while you sleep. This irregular breathing pattern interrupts your natural sleeping pattern, even if you do not fully “wake up” from the breathing pauses. This causes you to spend more time in a lighter stage of sleep and less time in the deeper stages of sleep such as REM sleep, depriving you of energy and mental acuity. This chronic deep sleep deprivation can cause daytime sleepiness, slowed reflexes and poor concentration. Over time, sleep apnea can cause serious health issues including heart disease, heart attacks, stroke, weight gain, high blood pressure, and diabetes.

There are three main types of sleep apnea: obstructive, central, and complex. Obstructive sleep apnea is the most common type, and occurs when the tissues in the back of your throat relax as you sleep and block the airway. This usually causes loud snoring. Central sleep apnea is much less common and involves the central nervous system. Central sleep apnea occurs when the brain fails to send signals to the respiratory muscles that control breathing and so breathing ceases until other systems notice a decrease in oxygen. People with central sleep apnea do not usually snore, but have longer periods in which they are completely silent and breathing does not occur. Complex sleep apnea is a combination of both obstructive and central sleep apneas.

Sleep apnea symptoms

It is relatively difficult to identify sleep apnea alone, since the most prominent symptoms occur during sleep. A solution is to record yourself during sleep, ask a bed partner to monitor your sleep, or participate in a sleep study at a local hospital. The major symptoms of sleep apnea are as follows:

• Pausing when snoring followed by choking or gasping after the pauses
• Consistent sleepiness throughout the day
• Headaches or dry mouth upon waking up
• Inability to concentrate, including learning and memory issues
• Waking up frequently to urinate
• Mood swings, irritability, or depression

Not everyone who snores has sleep apnea, and not everyone who has sleep apnea snores during the night. The biggest sign to test if you have sleep apnea or you just snore is how you feel throughout the day. Normal snoring should not interfere with sleeping patterns, so you shouldn’t feel exhausted during the daytime.

Sleep apnea causes and risk factors

Any person can have sleep apnea, but there are certain risk factors that are associated with sleep apnea that put people at a higher risk. You have a higher risk for obstructive sleep apnea if you are:

• Overweight
• Male
• Over 65 years old
• A smoker
• Related to someone with sleep apnea

You have a higher risk for central sleep apnea if you are:

• Male
• Over 65 years old

Central sleep apnea is often associated with serious illness such as heart disease, stroke, neurological disorder or brainstem injury.

Treatments for sleep apnea

Sleep apnea is a treatable condition and there are multiple treatments that can be done at home such as lifestyle changes or medically. Treatment options include:

• Lose weight. People who are overweight have extra tissue in the back of their throat, which can block the airway.
• Quit smoking. Smoking contributes to sleep apnea by increasing inflammation in the throat and airway.
• Avoid alcohol and sedatives. These drugs will relax the muscles of the throat and can cause difficulty breathing or worsen sleep apnea symptoms.
• Sleep on your side. Avoid sleeping on your back where gravity is working against you.
• Use a nasal dilator. Nasal dilators are helpful to open up nasal passages during sleep.
• Medical treatment with CPAP. A Continuous Positive Airflow Pressure (CPAP) is used commonly for moderate to severe sleep apnea. The CPAP device has a mask that provides a constant stream of air that keeps your airway passages open when you sleep.
• Medical treatment with BPAP. Bilevel Positive Airway Pressure (BPAP) devices are used for those who cannot adapt to using CPAP. This device automatically adjusts pressure while you’re sleeping, providing more on the inhale and less on the exhale.
• Mandibular repositioning or tongue retaining device. These two common oral devices open the airway by bringing the jaw lower or moving the tongue forward during sleep.
• Surgical options. Surgery to increase the size of the airway can reduce sleep apnea episodes.

 

If you suffer from symptoms of sleep apnea or have more questions regarding sleep apnea symptoms or treatment, visit San Francisco Dentist Mina Levi, DDS on the web at www.minalevidds.com or give us a call at (415) 513-5066.

Topics: Sleep apnea, sleep apnea treatments, snoring, sleep apnea symptoms, San Francisco dentist

 

Four Ways to Improve Your Smile

Improvements in dental techniques and new cosmetic products and procedures give you many options for improvement if you are unhappy with the appearance of your smile. Depending upon your goals, your oral health, and your budget, you can opt for cosmetic dentistry, veneers, Invisalign® alignment devices, or even an instant “Snap on Smile.”

Cosmetic Dentistry

Cosmetic dentistry is concerned with the aesthetics of your smile, not just your oral health. Cosmetic dentists use state-of-the-art tools, materials, and techniques to realize your vision of a beautiful smile. Often, Cosmetic Dentistry includes removal or movement of teeth to improve the symmetry of a patient’s smile, but some dental problems that detract from a smile’s appearance are easier to fix. You may opt for custom whitening with an oxidizing agent, laser-reshaping of gum tissue, or correction of broken or chipped teeth with epoxies or veneers.

Veneers

Dental Veneers are thin coverings of ceramic or porcelain – or sometimes a composite resin. This covering is permanently bonded to the fronts of patients’ teeth, and can be used on one or two, or the entire visible smile. Fitting and adhering Veneers does not usually require anesthesia, and is ideal for those who want to improve the look of their most visible front teeth but do not require movement or removal of teeth. You can hide stains, fill gaps between teeth, create a brighter smile, and make slight changes to the shape of teeth with Veneers. Results can last for many years.

Snap on Smile

Snap-On-Smile is a great option for patients who are not sure they want to commit to more permanent or expensive improvements to their smiles. Some patients use Snap on Smile temporarily, to mask damaged teeth until a permanent fix can be achieved. These thin, strong, custom-fitted coverings for the visible teeth provides better bite function as well as a more pleasing appearance, and can be created and fitted without anesthesia or any change in tooth structure. They are available for upper and lower teeth.

Invisalign

Invisalign® tooth aligners are clear, comfortable nearly invisible customized devices that work similarly to regular braces, without the pain, mouth sores, tooth decay or discoloration, plaque buildup, and difficulty eating that regular braces often cause. Invisalign® helps to gradually move a patient’s teeth into the proper alignment, creating a symmetrical smile and helping the gums fit more securely around the teeth to help prevent gum disease.

 

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