When replacing amalgam fillings with white fillings what might you have to consider?
The amalgam (metal) fillings might have been in place for many years and some might be very large. The amalgam might be holding the structure of the tooth together and removing the amalgam might destabilise the tooth, so great care is needed when considering what to put in place of the amalgam. It might not be as simple as just replacing the amalgam with a white filling. Sometimes an inlay or onlay is needed, sometimes a crown. It depends on the patient and the particular tooth.
To protect the patient during amalgam removal it is important to minimise the mercury vapour a patient is exposed to. During the preparation of the tooth an exhaust system should be used and the suction should be increased to minimise vapour uptake. To prevent damage to the tooth lots of water should be in the immediate area to keep the tooth cool. A drill causes heat and it is important to keep the tooth as cool as possible to avoid damaging the internal structure of the tooth.
Other precautions that can be taken when removing amalgam fillings are a nose mask for breathing oxygen and a rubber dam. A rubber dam isolates the tooth being worked on. It is believed that the rubber dam can protect the patient from breathing mercury vapor in through the mouth.
A nasal hood can be provided through which a patient can breathe an alternative air source. The patient should be instructed to breathe through the nose and avoid breathing through the mouth while amalgam fillings are being removed.
To decrease the amount of vapor, fillings are cut out in chunks as opposed to grinding them out.
The consensus is not to remove mercury amalgam fillings during a pregnancy or during nursing.