Mercury Safe Dentistry: Continued from Page One
What You Can Say About Mercury Amalgam Fillings
You don't even have to say anything to patients about how you personally feel about amalgam fillings if you don't want to. The way around this is to provide patients with factual information about mercury amalgam fillings from a credible third-party source - which takes you off the hook. However, you should be clear that if a patient asks you how you feel about amalgams you can express your opinion.
Why is this? The boards are concerned about you giving your opinion about amalgam fillings without being asked. For example, if you tell patients that you think they should have their amalgams removed because you feel the mercury exposure from them is detrimental to their health - and the patient agrees to have them removed and replaced with another filling material - you could be charged with malpractice. This is because the ADA considers amalgam to be a good and safe filling material. Thus, if you get patients to remove amalgams and have them replaced with a more expensive filling material, you would - according to Code-of-Ethics - have done so to make a profit. And that, in their opinion, is a no - no.
Marketing and Promoting Your Mercury Safe Practice
I consider Mercury Safe Dentistry to be the new growth area in dentistry. This is also discussed on the New Directions Dentistry website but it is a very important aspect of becoming Mercury Safe. There is nothing wrong with generating revenues by doing the right thing. It also means that by cost-effectively marketing our practice, you will be able to quickly pay back the capital investment it takes to make your practice Mercury Safe. Is essence, it is a profitable investment in your dental practice.
By maximizing your Internet exposure and learning how to effectively promote your Mercury Safe practice in your community - particularly in getting health practitioners to refer patients to your practice - you will generate a steady flow of new patients and significantly increase revenues. This is not a theory - it works - and a segment of the New Directions Dentistry DVD Course is devoted to this subject.
What and How to Make Your Practice as Mercury Safe as Possible
While becoming Mercury Free only involves making a decision to do so, becoming Mercury Safe is more involved. Hopefully you have already committed to becoming a Mercury Safe practice and the next step is learning How to make that happen - and What you need to fully implement the Safe Removal Protocols.
There are two ways to go about this. Start from scratch and devote hundreds of hours to researching it - or eliminate that extra time and go to the source. That source is the DVD Course: How to Make Your Practice Mercury Safe: Minimizing Occupational Exposure to Mercury in the Dental Office.
This unique DVD is the only one of its kind available to dentists and includes everything you need to know to minimize occupational mercury exposure and to easily and quickly become a Mercury Safe Practice. It is a 4.5 hour course and presents the information in a logical and step-by-step format. This includes demonstrations, presentation of the very best equipment and products, visuals of how you implement the protocols, staff education, and much more. It also offers 6 Hours of CE credit.
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The DVD was taken from a live Seminar and will explain;
- The safe amalgam removal protocols, equipment and products needed to make your practice Mercury Safe;
- Where to purchase the equipment and products (selected exhibitors demonstrate their products in the DVD Course);
- How to help ensure your practice is protected from potential lawsuits;
- The most cost-effective way to educate your staff and patients about the value and benefits of Mercury Safe Dentistry;
- How to add new patients and increase revenues by cost-effectively promoting your Mercury Safe practice;
- How to create a powerful Internet presence needed to access the 80% of those searching the Internet to find a Mercury Safe practice;
- How to educate your patients about the value and importance of Mercury Safe Dentistry and why you choose to add it to your practice.
Because it is in a DVD format the course is by far the easiest, quickest, and most cost-effective way to provide the information presented at the seminar to dentists who want to make their practices Mercury Safe as quickly - and as quickly as possible. One of the key benefits of the DVD format is that it makes the entire seminar available to you and your staff immediately - without the expensive of travel and down time at the office to attend a seminar. It also allows you and your staff to view it at your leisure and to be able to refer back to it at any time.
Educating Your Patients about Mercury Safe Dentistry
There are a number of ways to do this. You or your staff can take valuable office time explaining this to patients and answering their questions. Or you can provide them with other sources of information and have them learn about it - away from the dental office. I learned a long time ago that while you have to treat the patient at the dental office you don't have to teach them there. We make the following patient handouts available.
Why My Practice is Mercury Safe
One of the first things you can do is let All of your patients know why you are practicing Mercury Free and Mercury Safe Dentistry. After all you may have patients for whom you placed amalgam fillings and new patients who didn't come to your office to have their amalgams removed.
Providing this information will not only educate your patients about this subject but serve as a way to promote your Mercury Safe practice. We have prepared a patient handout that will serve this purpose for you and you can order it from us by calling toll free, 800-335-7755. Just ask for the Patient Handout: Why My Practice is Mercury Safe.
The Difference Between Mercury Free and Mercury Safe Dentists
This patient handout explains the difference between Mercury Free and Mercury Safe dentists. Once you become Mercury Safe you will want all of your patients to know what that difference is. As with the above handout, it will serve to promote your Mercury Safe practice. You can access it by calling the number above.
What the Patient Needs to Know about Amalgam Fillings
The second level of patient education is informing them about mercury amalgam fillings. As I mentioned earlier, the most effective way to minimize any possible risk factor of educating your patients about the health hazards of mercury amalgam fillings is by providing them with information - in a way they can understand - from a credible, third-party, source. I recommend utilizing my book, The Poison in Your Teeth: Mercury Amalgam (Silver) Fillings: Hazardous to Your Health as that primary source. You can access it at www.mercurysafedentists.com.
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The Patient's Guide to Safe Amalgam Removal Protocols
There is a lot of information out there for the patient about what constitutes the safest way to remove amalgam fillings. Some of them aren't true, or no longer true. Some are incomplete and confusing. Some just aren't accurate.
For example, for a long time it was believed that a latex rubber dam was the most effective protection against mercury vapor for the patient when an amalgam is being removed. This is no longer true and Dr. Paul Rubin does an excellent demonstration as to why in the DVD Course. A rubber dam will help protect against amalgam particles (particulate) being swallowed but mercury vapor easily passes through a latex dam. However, many patients erroneously think you aren't really protecting them unless you use a rubber dam.
Once your practice is fully Mercury Safe it is in your best interests - and your patients - to provide them with the list of Safe Removal Guidelines. You can personalize this list to reflect the protocols you choose to use. You can add it to your website or provide it as a patient handout. This will provide a number of benefits for you and the patient.
- They will know exactly what you do regarding safely removing mercury amalgam fillings;
- It will allow them to see how you may differ from dental offices who aren't fully Mercury Safe;
- It will be a great marketing tool.
What I'm providing here is a model, or template, that you can utilize to provide this information to your patients. I realize there is no standard, State Board, or legal requirement, for you to make your practice Mercury Safe. Some dentists will maximize the protocols and others less - this is solely up to you . In addition, I wanted to make it clear to patients about the different protocols and how they affect them.
Keep in mind that there is a difference between what you need to know, and do, to make your practice mercury safe and what you want the patient to know. The DVD Course will explain that to you.
Safe Removal Guidelines for Amalgam Fillings: For the Patient
The purpose of the safe amalgam filling removal protocol is to protect the patient from excessive and unnecessary exposure to the mercury vapor released during their removal. The protocols listed below are designed to protect the patient, the environment, and the dentist and staff.
What you need to know. Fifty-percent of an amalgam filling is mercury. The amount of mercury vapor released from an amalgam filling is directly proportional to the temperature. Thus, the higher the temperature the more mercury vapor is released.
The purpose behind our safe removal protocols is to not only lower the temperature of an amalgam during its removal but to capture whatever mercury vapor escapes during that process.
1. Keep the fillings cool during removal
Drilling out an amalgam filling generates a tremendous amount of heat, which causes a significant increase in the release of mercury, both as a vapor and as amalgam particles, during the entire removal process. Cooling the filling with water and air while drilling substantially reduces the amount of mercury vapor the filling releases.
2. Cutting the Amalgam into Chunks
Mercury Safe dentists use a removal process that’s commonly referred to as chunking. This involves less drilling because the dentist only drills enough to cut the filling into chunks/sections, which can then be easily removed by a hand instrument or suction. Both chunking and keeping the filling cool during removal are very important and Mercury Safe dentists follow this procedure.
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3. Use a high-volume evacuator
Mercury Safe dentists use a powerful high-volume evacuator/suction system. This is an important tool in minimizing the patient’s exposure to mercury vapor and amalgam particles. The evacuator tip should be kept close to the filling during the entire time the filling is being removed. This helps capture more of the mercury vapor and particles. All mercury safe dentists will follow this procedure.
4. Provide the patient with an alternative source of air
All patient should be provided with an alternative air source - delivered through a nasal hood that covers the nostrils - while their amalgam fillings are being removed. This nasal hood provides compressed air from a tank, air from a source outside the office, or oxygen from a tank. Patients should breathe through their nose/nostrils and make every effort to avoid breathing through the mouth while mercury amalgam silver fillings are being removed. If this is strictly followed it will maximize the patient's protection - regardless if all of the other protective protocols are utilized.
An alternative source of air isn’t necessary after the removal process is completed and the tooth is being prepared for the new filling and while the new filling is placed but some dentists may still utilize it.
****Some Mercury Safe dentists do not feel mercury amalgam fillings should be removed during pregnancy or during nursing. Others feel it may be better if they are safely removed. But if a patient decides they should be removed, an alternative source of air should absolutely be provided when removing amalgam fillings from the teeth of pregnant and nursing mothers, patients who have multiple allergies and sensitivities, immune system problems, or any other health issues that could be related to chronic mercury poisoning.
5. Using a rubber dam
A rubber dam isolates the tooth or teeth being worked on. It was believed that the rubber dam would protect the patient from breathing mercury vapor in through the mouth. We now know that mercury vapor can readily pass through a rubber dam made out of latex, the most commonly used rubber dam material. In addition, if the patient breathes through the mouth during the removal process - mercury vapor will not only pass through the rubber dam - but will also pass over and around the rubber dam.
Many patients have heard that the rubber dam offers a great deal of protection and should absolutely be included as part of the safe removal protocol. Some people will even insist on its use to protect them from mercury vapor. Because the rubber dam does not protect you from inhaling mercury vapor through the mouth during the removal process, it does not absolutely have to be used when removing amalgam fillings.
If a composite filling is used to replace a mercury amalgam filling, the rubber dam offers an isolated and dry field for placing the composite filling. The dentist will decide when it is or isn't necessary. It does take some time to place and remove the rubber dam, it can be a little uncomfortable, and some patients simply cannot tolerate its use. There are other exceptions to its use, including the position or location of some teeth, particularly 3rd molars or so-called wisdom teeth, may make it impossible to place a rubber dam.
Incorporating the first 4 steps listed above will provide the greatest source of protection from mercury vapor for the patient. But while the rubber dam offers little protection against mercury vapor I believe that it does make it easier to evacuate the filling material and prevent amalgam particles from being swallowed.
A Note to the Patient
Whether your dentist uses a rubber dam or not you should always focus on breathing through your nose/nostrils during the entire time the amalgam fillings are being removed. I can't emphasize the importance of this enough!
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6. Remove gloves and clean the patient’s mouth
Once an amalgam filling(s) has been removed and replaced, the dentist and the assistant should remove and dispose of their gloves and the rubber dam, and thoroughly rinse and vacuum the patient’s entire mouth for at least 15 seconds. This will help remove amalgam particles and residual mercury vapor from the mouth. The patient should make every effort not to swallow during the rinsing procedure.
I also suggest that after the rinsing procedure, the patient use a small amount of water and gargle as far back into his throat as possible. Again, the patient should not swallow this watery residue! Instead, he or she should spit it into a sink or cup. All mercury free dentists should follow this procedure but it won't hurt to remind him or her. (Some dentists offer a mouth rinse that can capture mercury and, if used, the same rinsing and gargling procedures as explained above should be followed.)
7. Immediately clean up
After the fillings have been removed and replaced, the dentist or dental assistant should immediately remove and dispose of the patient’s protective covering and thoroughly clean the patient's face and neck. All mercury safe dentists should routinely do this but remind the assistant if she forgets.
8. Use additional air purification
Some mercury safe dentists use an additional air vacuum/filtering system that’s placed as close to the patient’s mouth as is practical. The more popular ones resemble an elephant’s trunk and have openings about 4 inches in diameter. More and more Mercury Safe dentists are using this type of mercury capturing system and while it’s a positive addition to the removal protocol, it is more important for the dentist and assistant than the patient.
9. Filtering air in the operatory
There are a number of effective ways to filter/capture mercury in the air in the dental office. I’m not making specific recommendations. But many mercury safe dental offices filter the office air, as they work in it all day and it’s to their benefit to do so. This is more important for the dentist and staff than for the patient.
*****Although Mercury Safe offices don’t place amalgam fillings, they certainly are required to remove them. Keep in mind that you will only be at the office for a short period of time but the dentist and his or her staff will be removing these fillings many times throughout the day. I believe all mercury safe dentists would want to take the necessary precautions to protect themselves and their entire staff from excessive exposure to mercury. But keep in mind that the first 4 protocols are the most important for the patient's protection.
10. Use activated charcoal
There’s some evidence that activated charcoal taken 10-15 minutes before amalgam removal can bind smaller particles of swallowed mercury, allowing them to be harmlessly passed out of the intestine via the feces. I consider this to be optional, as very little elemental or inorganic mercury is absorbed through the intestine, but it can’t hurt to add it, especially if you are in the high risk category.
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As you can see, the amalgam removal procedure in a Mercury Safe office is vastly different from what you have experienced at a dental office that is not Mercury Safe. The above protocols are only presented as guidelines for the safe removal of mercury amalgam fillings.
It should be noted that all of the above procedures are not weighted equally in regard to how much protection from mercury vapor and particles they will provide the patient. Some are more important than others but I believe it is absolutely necessary for Steps 1, 2, 3, and 4 to be taken. For example, it is much more important to the patient to breathe an alternative source of air than to take activated charcoal so you wouldn't want to trade taking charcoal for an alternative source of air.
It is also more beneficial to the patient if the dentist keeps the fillings cool, uses a high speed evacuator and a rubber dam, than filtering the dental office air. Again, not all the above procedures are absolutely necessary to safely remove amalgam fillings but the more of them your mercury dentist uses the better. Always ask the dentist if you are unsure about any procedure he or she is using.
If you are new to the concept of Mercury Safe dentistry you should now have a better understanding of this philosophy. You will also have sources of information that you can readily access to help guide you along the path to become a Mercury Safe Practice.
From my many years of experience in this area I can assure you that if you make a commitment to become Mercury Safe you will absolutely be doing the right thing. It is not only the right and ethical thing to do for your patients, your staff, and the environment but the right thing for yourself, your practice, and your health.
I also want to mention the role the IABDM can play in this process. I am a member of that wonderful organization and their purpose is to support its members in every aspect of what I call holistic/healthy dentistry. If you haven't done so, I encourage you to go to its website and learn more about them. It is an organization that will support you in the process of making your practice Mercury Safe, healthy, and offers an environment where you can be in contact with like minded dentists.
About Dr. Tom McGuire
Dr. Tom McGuire is a leading authority on Mercury Safe Dentistry, mercury amalgam fillings, mercury detoxification, holistic dental wellness, and marketing a Mercury Safe Practice. He pioneered the term Mercury Safe and along with Dr. Paul Rubin produced the definitive DVD Course on how to make a practice Mercury Safe.
He has written three bestselling books; The Poison in Your Teeth: Mercury Amalgam (Silver) Fillings: Hazardous to Your Health; Mercury Detoxification: The Natural Way to Remove Mercury from Your Body; and - Healthy Teeth – Healthy Body: How to Improve Your Oral and Overall Health.
Dr. McGuire has the largest and most comprehensive website on these issues, www.mercurysafedentists.com and his Mercury Safe Dentist Internet Directory is the most extensive, informative, and the highest ranked Directory on all Mercury Safe Search engines.
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