One goal of the dental-patient interaction is education. Any area of concern is discussed with the patient so they can come on board to aid in their own health. This could incorporate diet advice to reduce the risk of a cavity growing, to improve or alter cleaning techniques to better access the areas of concern where a cavity is forming, or tools and products to try to protect the gums from advancing gum disease.

There are patients who are worried about what may develop so they are open to early intervention, fill the cavity now rather than wait and watch. This is fine, but the point to emphasize is that this is discussed between the dentist and patient and it is discussed and a mutually decided treatment is arranged.

Gum disease is more complicated because the ability to clean under the gums varies between patients. Most practitioners recommend more frequent cleanings but to try and control gum disease the home care/maintenance regimen is more critical. Sometimes gum surgery is the recommend treatment by the dentist or gum specialist. If the patient is not interested in the surgery then there could be a risk for continued deterioration of the gum health. Some patients want to hold off on surgery and try and stabilize their gum health with the idea that if there is deterioration, they can still elect to have surgery in the future.

The option to wait and watch is a very real alternative, but for success the patient must be part of the solution. If success is not achieved, then a more aggressive approach may be necessary, but it will be done with the knowledge that all avenues have been addressed.

All the best,
Gary

The remedy is taken as one pellet per dose (ignore the instructions on the vial/bottle). The first dose can be taken just before the procedure (there is no need to start hours before the appointment), but if forgotten then the more important time to start taking the remedy is as close as possible to the trauma itself. As soon as the tooth comes out, a pellet can be placed under the tongue while the dentist continues the procedure cleaning out the socket. The remedy should be taken every hour until the freezing is gone (which usually can be 2-4 hours), and then evaluate how you feel. It is normal to feel soreness in the area after the extraction. As long as the discomfort is tolerable there is no need to repeat the remedy, unless the discomfort returns indicating that the time has come for another dose of Arnica to be taken. If there is concern that the pain level is too strong then continue on the remedy every hour. If the pain level is not abating after repeating the remedy over another 3 hours, then another remedy may be indicated (what other possible remedies are indicated after extraction is beyond the scope of this article) and one should consult their local homeopath. Some individuals want to take painkillers (Advil, Motrin, Tylenol) at the same time, and this is fine. With the correct remedy, when the painkiller wears off the pain level stays low and there may not be a need to repeat the pharmaceutical. Regardless of how you feel, take a dose of the remedy before bed and on waking in order to keep the healing process moving forward. The remedy may be repeated the following day up to four times per day, if needed. Most people do not repeat the remedy the following day because they do not feel there is a need.

Homeopathy is so simple to use and without side effects. It is time more people took advantage of its benefits during their dental treatment.

Homeopathically yours,
Gary

In this blog, I hope to highlight various dental issues and interesting cases that present themselves to me with a hope to open your mind to issues you, or a loved one, could face in the future. None of what I write about should be misconstrued as advice in regards to a specific dental issue because the full history, clinical exam and possible X-ray is always required to best understand any dental issues.

Your feedback is always welcome and I will try to answer any queries as best as possible without making a diagnosis.

The 5-part series, Unconventional Dentistry, by Dr. Burton Goldstein ^1-5 that began in the June 2000 issue of the JCDA is specious at best as his arguments are based on a flawed understanding of complementary modalities, their development and application.The term complementary dentistry (CD) is preferable and more logical than “unconventional dentistry,” because CD meshes very well with conventional clinical practice.

Dr. Goldstein does not describe the philosophy of CD or what he terms “unconventional dentistry,” and so has left the unbiased reader unequipped to compare the traditional and CD systems fairly. Understanding the philosophy behind any health system is important because this determines the direction and the methods of treatment. Thus, denigrating CD without proper insight into its philosophy is unjust. It is easy to arrive at predetermined conclusions by selectively choosing evidence that supports and promotes preconceived notions. This is what Dr. Goldstein has done.

Dr. Goldstein says that traditional dentistry and medicine are science-based. However, he does not define science per se, but rather the scientific method. ¹ How does this comment stand up to the 1991 article in the British Medical journal⁶ which states that “only about 15% of medical interventions are supported by a solid scientific evidence? .. This is partly because only 1 % of the articles in medical journals are scientifically sound and partly because many treatments have never been assessed at all.”

In the May 2000 issue of the JCDA, Dr. Sutherland⁷ writes about the need for “evidence-based care …. It represents a philosophical shift in the approach to practice – a shift that emphasizes evidence over opinion and, at the same time, judgment over blind adherence to rules.”

To claim that a treatment is illogical or that it defies science⁴ implies that science, at present, completely understands how nature works. Because a treatment does not follow established practice does not make it wrong. Such an approach emphasizes a lack of understanding of scientific principles and demonstrates that other phenomena have been ignored altogether.

Research exists to expand our understanding of phenomena. Dr. Goldstein states that homeopathy⁴ violates a basic law of chemistry, while, in the next paragraph, he quotes research⁸ (involving a meta-analysis of 89 placebo controlled trials) which states that the clinical effects of homeopathy cannot be accounted for by placebo. Why not simply say that something new is happening here that needs further investigation. To call it irrational health care is extremely counterproductive.

Considering the above, in Dr. Goldstein’s opinion does the existence of licensure really demonstrate adequate scientific training and practice? Does the lack of licensure necessarily demonstrate a lack of such training? Is it not prejudicial and unscientific to call someone who practises complementary methods a charlatan (within every profession there are unethical individuals) if one knows nothing about complementary practices? For example, how often have we questioned an idea before finally understanding it? One does not necessarily have to adopt a new treatment method, but simply acknowledge that there are different ways of healing.

Many traditional physicians have discovered the worth of complementary therapies after investing much time and effort. Often using themselves as guinea pigs, they observed phenomena that led them to develop new approaches to treating their patients. They found these therapies to be safe and effective for treatment or prevention.

The article ^₁ states that promoters of CD and complementary medicine (CM) deny the need for scientific testing. A reading of the classic literature on homeopathy, craniosacral therapy or acupuncture, for example, elucidates the painstaking research carried out during their evolution.^9,10 Still, more research is needed to define application. However, I see no need for double-blind studies to discover the existence of a pulse, a heartbeat or cranial bone movement.

For example, science cannot explain why gravity exists. We know it exists because we experience it. We hold someone’s wrist or listen to someone’s chest and we detect a heartbeat. If the so-called skeptics were to spend some time alongside a practitioner who uses complementary modalities, they would experience first-hand phenomena and see the health benefits that “modern science” chooses to ignore. This is due to bias, laziness and apathy. It is far easier to do what one’s colleagues are doing and have their support than leave that comfort zone and delve into the unknown.

It saddens me that the patient, whose needs should take precedence, seems to come last while the ego of the conventional practitioner often appears to come first. The conventional practitioner may say, “If I don’t know about it or understand it, why bother? I am getting results.”

Despite this attitude, more and more patients are seeking out the help they are not getting from traditional care. Part II of Unconventional Dentistry states, “Because the general public lacks scientific training and knowledge, they must trust health care professionals.”² Today’s patients are knowledgeable consumers. They take control of their health and expect intelligent answers to their questions so they can make informed choices. Paternalism no longer works.

Also in Part II the remark, “Explaining why people believe in something that is unscientific, illogical or weird is not easy,”² is insulting and inflammatory. Such a statement has no place in a peer-reviewed, scientific journal. To plead ignorance of a system radically different from one’s own and, therefore, to be suspicious of its authenticity is one thing. However, to dismiss these modalities blatantly, as well as the millions of practitioners and patients who use them, is another. Nowhere does the author state that he has pursued studies in any area of CD or CM. Dr. Goldstein also writes in Part II that ”Although science cannot be denied it can be ignored.” It works both ways.

CM and CD use drugs whose effects have proved beneficial, but how these effects are achieved remains unknown. Still, this does not preclude their widespread use. Should society wait for science to try to explain this? In real life, science often never answers why (at least not yet) and only sometimes how. The laws of physics can often explain how to apply a formula to an event, but cannot explain why the event takes place. Although unconventional practices have proved very effective in treating infants and animals where the placebo effect does not apply, the establishment has shown virtually no interest in investigating this. It is important to note that basic scientific research is the foundation for the advancement of both CM and CD.

The double-blind model of clinical trials (designed for the treatment of populations) is not applicable in all situations. If a different approach to treatment is used (treatment of the individual) using the CD and CM model, it is necessary to design a variation to the testing process to accommodate this different philosophy. As well, many complementary modalities involve hands-on treatment where it would be impossible to use even the single-blind method, as the practitioner must be properly versed in the application of the treatment and the condition being treated.

Researchers in any medical field, conventional or complementary, should have a certain level of expertise in that field. With the appropriate knowledge, a critical mind can conduct proper research. As well, the existing literature should be carefully evaluated as some of it was created by people with inadequate training. We must also question the qualifications of the peer-review body that evaluates unconventional treatments when very few within medicine or dentistry have any knowledge of the various complementary specialties.

All practitioners of complementary treatments have their own organizations and publications where they turn to increase the scope of their knowledge. Conventional practitioners seldom turn to these sources for information. “New techniques” thought to be “scientifically based” are not easily accepted by “professionals.” For example, how many women continued to die after childbirth, even as Dr. Lister urged doctors to wash their hands and observe proper hygiene, before the medical profession changed its ways? As Goethe said, “You see only what you know.”

Conventional and complementary health systems are different, but they truly complement one another when the beneficial modalities of each are properly followed and their limitations realized. I urge the profession to open its collective eyes and realize that other health care modalities, properly used by competent practitioners, can only benefit everyone.

The views expressed are those of the author and do not necessarily reflect the opinions or official policies of the Canadian Dental Association.

Dr. Fortinsky maintains a private practice in North York, Ontario

References:

1. Goldstein BH. Unconventional dentistry: Part I. Introduction. J Can Dent Assoc 2000; 66(6):323-6.

2. Goldstein BH. Unconventional dentistry: Part II. Practitioners and patients.J Can Dent Assoc 2000; 66(7):381-3.

3. Goldstein BH. Unconventional dentistry: Part III. Legal and regulatory issues.J Can Dent Assoc 2000; 66(9):503-6.

4. Goldstein BH, Epstein J. Unconventional dentistry: Part IV. Unconventional dental practices and products. J Can Dent Assoc 2000; 66(10):564-8.

5. Goldstein BH. Unconventional dentistry: Part V. Professional issues, concerns and uses. J Can Dent Assoc 2000; 66(11):608-10.

6.Smith R Where is the wisdom … ? BMJ 1991; 303(6806):798-9.

7. Sutherland SE. The building blocks of evidence-based dentistry. J Can Dent Assoc 2000; 66(5):241-4.

8. Linde K, Clausius N, Ramirez G, Melchart D, Eitel F, Hedges LV. Are the clinical effects of homeopathy placebo effects? A meta-analysis of placebo-controlled trials. Lancet 1997; 350(9021):834-43.

9. Sutherland WG. Teachings in the science of osteoparhy. Portland, Ore. : Rudra Press; 1990.

10. Hahnemann S. The organon of medicine. 6th ed. Blayne, Wash. : Cooper Publishing; 1982.

Medicine has created a separate field for the treatment of the oral condi­tion (dentistry). Currently, medical education gives minimal training to its students on the art of oral diagno­sis and homeopathic education is no different. There is so much to learn about health that the oral states of disease are not studied in detail. To allow for a competent oral diagnosis, the use of instruments such as an explorer, mirror, excellent lighting, and a radiograph (an X-ray is required to show the hard tissue changes e.g. cavities, abscesses, wis­dom teeth) are required. Without the above tools and the information they provide, the work of a homeopath in treating a dental problem is much more difficult.  

Complexities of dental treatment  

If an assumption is made regarding a patient’s tooth problem, certain reme­dy choices may be eliminated and the case missed altogether. More impor­tantly, there is the concern that if a “correct” remedy is given with an associated alleviation of symptoms ­such as pain – then the patient may not pursue dental treatment. For instance, if a homeopath thought the pain experienced was connected to the eruption of a wisdom tooth when, in fact, it was due to a cavity, if the cavity was left untreated, then the decay process would continue. A moderate cavity in time turns into a large cavity that encroaches on the dental pulp and creates the risk of endodontic (root canal) involvement, its associated discomforts and costs of treatment. As well, even if root canal treatment is unnecessary, a larg­er cavity, with time, means a larger filling and a weaker tooth structure. This in the future can lead to break­age and subsequent loss of the tooth.  

That is why a working relationship between different disciplines is essen­tial; we all have expertise to bring to the table and sometimes another’s knowledge about the pathology makes our homeopathic prescribing more accurate.

Advantages of homeopathy in dentistry  

Homeopathy can still be beneficial to the patient before, during, and after dental treatment. Certain remedies are indicated for specific tissue types or specific pathological processes. For example, in the case of an abscess, Hepar sulph or Silica should be con­sidered whereas, if there is an inflammatory process, Hypericum or Belladona would be indicated. Many dental complaints are self-limiting, meaning that the problem passes on its own. The goal of homeopathic dentistry is to allow the process to pass quickly and more comfortably; the main concern is the morbidity of a condition and its influence on the patient’s daily life. 

To return to the above example of wis­dom teeth, there are not many dental options for treatment other than antibiotics and/or painkillers, to allow the discomfort to resolve, followed by extraction. Alternatively, a well chosen homeopathic remedy will, in a short time, allow full recovery from discom­fort, and provide time for the tooth to erupt further into the mouth, follow­ing which a decision can be made as to whether extraction is required, (which it often is). Even if the tooth still does require removal, the further it has erupted into the mouth, the less inva­sive or traumatic the extraction will be. There is also the possibility, albeit uncommon, that the tooth may erupt fully into the mouth and not require extraction.

Homeopathy for extractions and tissue traumas  

After an extraction, there are a num­ber of remedies that are possibly indi­cated to stimulate healing. Non­homeopathic choices for the patient are to either take painkillers, or to grin and bear the pain. The beauty of homeopathy is that, with the correct remedy, not only is healing stimulated but also pain control is part and par­cel of the healing process.

There are a number of tissue traumas that can lead to discomfort after a fill­ing. The gums may be traumatized by the procedure, either by use of the drill if the cavity was below the gum line, or the rubber dam clamp (a ring that goes around a tooth) which can pinch the gums. The pulp of the tooth also can become irritated by the process of drilling because whenever a tooth is drilled, inflammation is caused. As a general rule, this process settles on its own for most patients within a day and in other patients between two to three days. In rarer circumstances, the area remains irritated or inflamed for longer and in this case homeopathy proves very effective. (Homeopathy is also useful insofar as a remedy can always be tried prophylactically, before treatment, to prevent the prob­lem from occurring in the first place). In patients where the inflammation persists, the nerve tissue just does not want to heal and the body needs assis­tance to direct the healing process. (Note that this example assumes the patient’s bite will first be examined to ascertain whether the filling is high, perhaps by a only fraction of a mil­limetre, which also can cause inflam­mation but can be alleviated by the dentist making an adjustment.)  

Another example is the discomfort experienced by certain individuals after receiving a needle for freezing. In this case, a homeopathic remedy can be given prophylactically or given post-injection if discomfort arises. Remedies can also playa role in help­ing the anxious patient. When a rem­edy is to be used in a prophylactic manner, it is always best to take the remedy a few hours before the sched­uled dental appointment and to repeat the remedy once in the office or dental chair as it takes time for a remedy’s influence to stimulate the change in the body.

Use of homeopathy in more severe oral conditions 

All of the above oral discomforts tend to be self-limiting. However, infec­tions due to a dying tooth and its abscess, or a gum abscess, can be much more debilitating, accompanied by severe pain and/or swelling and will not settle so readily without some intervention. Prescribing for this sce­nario requires much more precision and expertise with respect to history taking, materia medica, and follow­up. We are all familiar with the phrase “it’s like pulling teeth”. Taking an acute homeopathic history on a toothache is much more difficult and challenging, as a rule, than pulling a tooth. Most patients have no awareness about their experience or may have had the discomfort for only a few hours so they have not had the opportunity to experience the dis­ease process. Many people take pain killers during a toothache and as such have not experienced much more than a nondescript discomfort. As homeopaths, we are always searching for the strange, rare, and peculiar symptoms within a disease and, in the toothache situation, it may be elusive at first. When a remedy is first prescribed, it is helpful if the patient stops taking the painkillers so that more symptoms can manifest and thereby a determination can be made upon follow-up whether the healing process is occurring or if a different remedy is indicated. If the correct remedy is prescribed, the patient often may still experience discomfort as the problem starts to resolve but the intensity or frequency of the dis­comfort lessens. Thus it is important to ask the patient to rate the discom­fort from one to ten at the initial interview and also on follow-up. Some people will report that they were able to sleep after taking the remedy whereas, before treatment, they were awoken by the pain. For serious infections it can take two to seven days for resolution.  

In the case of abscesses even after the correct homeopathic prescription, the patient usually still needs dental treat­ment to address the cause of the prob­lem, for example, cavities. Full recov­ery or comfort may not be possible with a homeopathic remedy alone until the mechanical or physical issues are dealt with dentally. The purpose of the remedy is to stimulate the healing process, and to encourage the body to start dealing effectively with the infec­tion so that when dental treatment is initiated, it is a less traumatic experi­ence, both during and after. The array of remedies that are possibly indicated in infection is much larger due to the varied possible personal experiences the patient can encounter, and there­fore an accurate description of the experience by the patient is paramount in finding the simillimum.  

Dr. Gary Fortinsky, DDS, practises dentistry in North York, ON and can be reached at 416-225-1352. 

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Suggested dental remedies

The following is from an information sheet I give patients describing how to take a remedy in an acute situation with examples of some commonly used remedies.

All remedies can be taken in the 30C or 200C potency. If the symptoms are strong, then the remedy may be repeated every half hour up to two to four hours. If symptoms do not improve or worsen, a more appropriate remedy needs to be chosen and you should consult with a health care practitioner who can further evaluate the oral complaint. In terms of application of ice, it may make one feel better but does not indicate a remedy because it anaesthetizes the nerve.

Aconite – one of the main remedies for apprehension and fear before an event e.g. dental appointment, acting, presentation. Associated with this nervousness is restlessness. Also may be useful if gag reflex is strong.

Arnica Montana – used in cases of trauma to tissues which leads to bruising e.g. tooth pain after filling, extraction.

Calendula – for abrasions in the mouth, can use tincture in glycerin e.g. gum treatments, ulcers, burns rinse 60 seconds ]-5 times per day.

Chamomilla – for severe toothache that feels better with cold, wisdom tooth eruption, fussy baby cutting teeth. In all cases you would expect to find irritability.

Gelsemium – another remedy for apprehension but here you find heaviness or lethargy of the body and stomachache often with diarrhea.

Hypericum – another trauma remedy but here it is indicated in tissues rich in nerves such as teeth or fingers. Consider after injury and Arnica does not seem to be helping.

Ledum – indicated after injuries by sharp pointed instruments or punctures e.g. after injection for freezing.

“Oral Mines Uncovered” 

– Adapted from an article regarding dental mercury in “Common Ground Magazine” – Winter 1995-96 

BY DR. GARY FORTINSKY, D.D.S. 

The use of amalgams in dental fillings is a controversy awaiting resolution. It is also a source of confusion to dental patients — even the dentist – primarily due to conflicting data, which makes a clear understanding of amalgam use difficult to interpret. When the dentist doesn’t have a definitive answer to a patient’s question, then the patient feels the dentist is being either evasive or uninformed or both. As a result, misconceptions are created regarding this issue. 

The result of scientific research into the use of dental amalgams involves the art of interpretation. Every piece of information is understood differently by people as a result of their knowledge, research, even personal experiences. Although a degree is not a pre-requisite for holding an opinion, it is necessary to be well-versed and well-informed to derive informative conclusions. Clinical experience is also an invaluable tool, because it allows the results of theory to be seen in practice. With this in mind, it is crucial to point out that every dentist has a personal opinion regarding any issue in dentistry. 

My intention is not to speak for all dentists, but to relay my opinion and, where possible, to provide understanding and the scientific rationale. 

The Controversy 

The amalgam controversy is comprised of two central aspects. The first issue concerns the basic constituents comprising silver/amalgam dental fillings, which are 50% mercury, 27% silver, 10% tin, 12% copper, and 1-2% zinc—-percentages may vary between manufacturers. The second issue is the corrosion of the amalgams and the sub- sequent generation of electricity in the mouth. 

The general public is most familiar with the first issue of the controversy: Is mercury toxic? The answer is a resounding and definite yes. It is even more toxic than lead, cadmium, or arsenic. There are no safe levels of mercury. In fact, no government agency has established a safe level of mercury to which people can be exposed. Even the pharmaceutical establishment has removed mercury from a number of preparations. 

The History 

Historically, the pro-amalgamists have said that once a silver/mercury amalgam was placed in the mouth, it took on an inert or stable state, thereby making it safe as a filling material. This state of stability eliminated any chance of the filling constituents being ingested by the patient. Recent scientific research has, however, proven beyond a doubt that mercury vapours are constantly being released from the fillings. This rate of mercury release increases up to fifteen fold every time food is eaten, teeth are brushed and hot liquids drunk.  

The amount of mercury vapours released however, is still a topic of debate between scientific researchers. When confronted with the scientific data showing mercury vapour release, pro-amalgamists maintain that only inconsequential amounts are released from mercury fillings and that more mercury is ingested from the food than from amalgam. 

Recent research has also shown that mercury affected the bacteria of the gut by causing it to produce antibiotic resistance, which disappeared when the amalgam fillings were removed.

Vapour Reactions 

The vapours which are released from silver/mercury fillings enter the body in a number of ways. Over the last five years it has been discovered that mercury is absorbed through the mouth’s tissues. Or it can be breathed into the lungs where 80% is absorbed directly into the blood stream. Within a very short time, inhaled mercury vapours have access to every organ within the body. 

However, blood and urine levels may not show increased levels of mercury in people with numerous amalgam fillings. In fact, people with few or no amalgam fillings may have higher levels of mercury in their urine. However, if the mercury is absorbed directly into the blood stream and whisked away to all corners of the body, the chances are that these tissues have absorbed the mercury, therefore blood mercury levels drop. 

There are no research findings that can correlate blood levels to body burden, so therefore blood levels do not give any information regarding chronic exposure. To complicate things further, one of the main targets of mercury is the kidneys. Mercury will hamper renal function causing mercury excretion to be reduced. 

In summary: with chronic mercury exposure, kidney excretion of mercury drops, so the concentration of mercury in our urine will drop as well. This would explain why people with many amalgams excrete little mercury. But when the source of the mercury (amalgam fillings) is removed, the body is now more able to excrete mercury. As a result, the organs can begin to function to capacity and urine levels of mercury increase. 

The pro-amalgamists state that only minute quantities are released from fillings over time. The problem with this statement is that it disregards the rate of excretion of mercury. The excretion is based on the concept of half-life, which is defined as the time in which half the absorbed dose is excreted. The half-life of mercury varies between tissues from days to years. The significance of this is that the excretion is not on the total body content, but on the daily intake. So, therefore, what is absorbed and excreted yesterday has no effect on what is absorbed and excreted tomorrow. Each days absorption is independent. This means that the rate of accumulation of mercury far exceeds the rate of excretion. 

Therefore, over years, your body’s store of mercury can enlarge to the point that disease may occur. 

There is information that says the levels of mercury released do not come close to the levels required to produce toxic symptoms. 

The response to this can be answered on a couple of levels. Firstly, remember that it takes time for toxicity to occur. In the majority of individuals, illness does not influence a person’s life immediately. Most chronic illnesses are insidious (creeping up on us), and by the time we realize something is seriously wrong, the disease is well entrenched, or we have tried to adapt to the changes it has thrown at us. It could take years for these changes to occur, and the relationship to the teeth is never as direct as we would like. Further, in some people the time lapse between amalgam placement and illness is not as great. 

Secondly, the individual constitution dictates how much their body can handle and, when it reaches this point, overt disease manifests. Just because someone is not obviously sick does not mean that there aren’t any subtler effects. It is easier and faster to treat an individual in an earlier state of illness. Once obvious signs of disease occur, it takes longer and is harder on the client to recover completely, especially if illness has developed. 

Electrical Discharge 

Electrical interference as a result of amalgam fillings has not received the attention accorded to mercury. Personally I feel it’s just as important if not more so. Frequently, I ask clients if they have ever bitten down on a piece of foil and felt a shock. The usual response is yes — with a cringe! That shock is due to the discharge of electricity from within the filling. This is an indicator of corrosion or rusting. 

There is no dispute whatsoever within dentistry about the corrosion or rusting of amalgam. In fact, it is encouraged, as the by-products of this breakdown are suppose to fill in any gaps that exist between the filling and between the filling and the tooth. Whenever there is corrosion, there is always electricity. Why be concerned? 

Our body, more specifically its nervous system, function via electricity. The nervous system also functions at a specific current. Amalgams can generate currents stronger than the natural ones, and in my opinion this can over-ride the natural current and interfere with proper function. This leads to systemic or body effects. 

Symptoms of Toxicity 

So, how can people find out whether or not their amalgams (or the mercury from them) is affecting their health? Symptoms for mercury toxicity can be vague and diverse. Mercury can interact with almost every protein in the body and alter its function. The initial signs of poisoning may include: 1) neurological (relates to the nervous system and brain) e.g. inability to concentrate, loss of memory, drowsiness, 2) immunological effects (relates to the body’s protection system) e.g. infections, chronic fatigue, auto-immune diseases, and 3) systemic effects e.g. headaches, kidney disease, cardiovascular disease. 

The other difficulty is the insidious nature of toxicity. The body adapts to its slow progression. The definition of health should be the absence of disease, but should disease be identified only when the body is compromised and no longer adapting? Should disease be recognized in its earlier stages? If so, how? 

Vegatesting & Remedies 

In my practice I refer patients to one of a number of practitioners who is trained in using a machine based on electro-acupuncture. The test basically “asks” the body if various substances are detrimental to its health – i.e. amalgam, mercury, etc. It can also ask if this is the key issue. If the answer is “Yes”, then we recommend removal, but not every amalgam necessarily requires removal. If the answer is “No”, the amalgams and/or mercury are not affecting health, then removal is not recommended. However, there are some clients who feel uncomfortable having these materials in their body and elect to have them removed anyway. It should be borne in mind that if a health problem exists and is unrelated to mercury and amalgam, and amalgams are removed, the health problem will not change. 

We have patients who, on discovering that amalgam is not a health risk for them, are devastated. They have health problems that have not been effectively treated and the test was their last resort. In these situations, and actually, I feel in all cases of patients who want to improve their overall health, consultation with an alternative health care practitioner is the best route to unravel and treat systemic problems. 

Amalgam removal does not always mean that health will improve completely. I have had clients whose amalgams were removed but are still having health difficulties. On testing, it shows that mercury is still a problem. The reason is that the body still retains mercury, or the effects of the mercury, in which case other treatments may be is necessary. 

Certain foods aid in the detoxification of mercury from tissues: garlic, lentils and pectins (found in fruits, especially bruised apples) help the body clear the digestive tract which is retaining toxins. 

The Vegatest will also determine whether the body is exhausted and can tolerate change. If so, the amalgam fillings are removed at a slower rate. For some clients, changing a filling can exacerbate existing health problems, or cause a relapse, which is generally temporary until the body readapts. 

Nor does it follow that the larger the filling the greater the current. The problem could be the smallest filling. There is a complex interaction between all the fillings, the saliva and factors we may not even know about which determines the corrosion and current. The higher the current, the greater the breakdown of the filling and release of its components and also the greater the electrical interferences. 

This is the reason I feel the electrical component of amalgam is important. When a number of amalgam fillings are present, the order of their removal is based on the detected current within the fillings. The fillings with the highest current in a quadrant – the mouth is divided into four quadrants – are removed first. By removing the highest current the client can get the greatest change with the least amount of treatment. 

I feel it is important for the client to understand what is actually happening in their mouth. The easiest way to do this is to save a piece of the amalgam during removal. What they see is a chunk of metal with a shiny surface on one side. This is where the drill did the cutting. On the other surfaces are various shades of grey to black, indicating corrosion or tarnishing. What this means is that the ingredients of the filling have broken down, which also leads to electricity production. 

There is a difference between the surface representing the biting surface and all other surfaces. The surface which is used for chewing is rarely as dark as the other surfaces. This is due to the grinding of the teeth during chewing and swallowing. When we go through these motions we are essentially polishing the surface of the fillings. When this occurs a very thin layer of the filling is removed and consequentially swallowed (we should also remember that this increases vapour production for about an hour and a half). This is a major problem for people who grind and clench because both usually occur over long periods of time. With the increase in vapour, the ingestion of mercury is increased many times (some people grind or clench all night, it’s mind bog-gling to think how much more vapour would be produced and inhaled). 

Once the filling is removed, the body must adapt to a new electrical current, or lack of it, and this stresses the body and can alter health. If the body is exhausted, it may not have the strength to adapt, and gets sicker before it over-comes the stress. If the body is not exhausted it usually can adapt, but if the person is getting his fillings changed too rapidly he/she can still get sick. If this occurs, I stop removal until the individual feels better. In the exhausted group we recommend removal at a rate of one filling per month. For many people it may take one to two years to have all their fillings changed. But you must remember that the purpose of changing them is to improve health. If treatment is under- taken too rapidly, the patient may become even more ill, and in some cases even incapacitated. 

After one quadrant of amalgam is removed, the electrical readings are redone to determine how to proceed. The readings on every filling could change. There are patients who get discouraged when readings show an increase. This does not mean that treatment is not progressing. We do not understand the inter-relationship between the fillings and the current, the readings are just guiding us to the best route to take. 

Time to Heal 

Many patients ask how long it will take to see an improvement. That is difficult to say because everyone is different. Think of our bodies as a pail with a hole in it. The mercury or toxins are being poured into the pail and a hole in the bottom is allowing the mercury to flow out (be excreted). If more toxin is being poured in than excreted we start accumulating a surplus. When we change an amalgam, we are altering the flow into the pail. At some point it will be reduced to a level less than that being excreted. At that point we have the potential to start healing. It may take a while for enough to exit the hole so that we feel better. For people with 15-20 amalgams they may not start feeling results until more than 1/2 or 3/4 of the fillings are removed, which can take over a year. Patience is vital to success. Most people do feel some changes before that though. 

Alternative Dental Materials 

With all this in mind how should we proceed? Do I get all my teeth extract- ed to remove the amalgam and improve my health? There are a variety of materials and techniques that have been developed: l)gold alloy 2) composite (white fillings)-light cured 3) composite-heat and/or pressure cure 4) porcelain 5) glass ionomer). I won’t go into the details of each material because the choice of material may depend on your particular situation. No one material is perfect, each has its strengths and weaknesses. The important thing to remember is that it should not be deleterious to your health. 

Also different dentists are more comfortable with one technique or material over another. This does not necessarily mean that one is better over the other. What must be emphasized is that many of the new materials are “technique sensitive”, i.e. they are more difficult to use. That was one reason why dentists loved amalgam. If the tooth preparation (cavity) was wet with a little saliva, the amalgam stayed and the filling succeeded. With the above materials the tooth cannot get contaminated or else the filling will fall out or decay underneath. The reason is that the new materials are glued to the tooth and if saliva gets on the tooth it creates a barrier between the filling and the tooth. The way around this problem is to devote enough time to properly isolate the tooth so the filling can be placed. 

This is the reason many people come in saying, for instance: “I was told if I get white fillings placed I will need root canals on all these teeth.” That is 100% wrong if the filling is placed properly. That does not mean that the teeth will not develop a new cavity or the filling will last forever! The filling only fills a hole, the process that causes cavities are independent and a new cavity may develop with time, but it should not happen because of the filling. 

It’s also good to remember that just because an alternative material is not silver/mercury amalgam an individual can tolerate it. You must decide for yourself how this issue fits into your other priorities and affects your life. If it’s important to you, ask some questions at your next dental visit. The important thing is that you are aware of these potential concerns. 

One of the most controversial areas within dentistry is the concern surrounding mercury-amalgam fillings.¹¹ Amalgam was first introduced in 1830, to wide acclaim, as it was inexpensive and easily placed in the mouth. The previous choices had been gold or extractions and eventually dentures. In 1845, The American Society of Dental Surgeons asked its members to sign a document stating that they would no longer use amalgam because of concerns regarding its possible toxicity. However, the public demand for amalgam caused most dentists to abandon their pledge, and the American Dental Society eventually disbanded. In 1859 the American Dental Association (ADA) was founded by a group of pro-amalgamists.^{1, 2, 3}

The basic components of amalgams are mercury 50%, silver 35%, copper 6% and tin 9%–along with traces of zinc. The toxicity of mercury was well known by the time amalgam was developed, and initially the dental profession stated that, once set, the mercury did not leach out of the amalgam. However, evidence has proved that amalgam vapourizes mercury 24 hours a day from the moment it is placed in the mouth.^{4, 5} 

The ADA web site states: “Silver, copper and tin, in addition to mercury, bind these components into a hard, stable and safe substance.”⁶ The ADA still does not acknowledge the constant release of mercury vapour. In fact, the amount of mercury released increases after drinking hot liquids, chewing, or brushing the teeth, and takes approximately 90 minutes to settle back to the pre-stimulated rate.⁷ “The Smoking Tooth” video clearly illustrates this phenomenon.⁸

The amount of mercury an individual with amalgams absorbs is widely debated.^{9, 10} Upon release, mercury is inhaled; 80% of it is absorbed through the lungs into the bloodstream.⁷ The mercury vapour that is absorbed from the fillings is in the form of elemental mercury, Hg⁰. This form has high lipid solubility and therefore can cross cell membranes readily including the blood-brain barrier.  Intracellularly catalase oxidation converts Hg⁰ to Hg²⁺ and this ionic form is responsible for the adverse effects of mercury.⁷ Mercury clings to sulphur molecules (protein cysteine groups), and sulphur exists in almost every protein in the body, so the effects of mercury toxicity can manifest in any bodily system.⁷ Concern also exists regarding mercury in conjunction with all the other toxins the body absorbs through food, water and air.

Dentists must recognize the hazards of mercury when working with amalgam. The Ontario Dental Association guide to workplace hazards states¹¹:  Dentists working with amalgam should not touch mixed amalgam with their hands. Amalgam that has been mixed but remains unused cannot be thrown into the trash as it is considered toxic waste; it must be stored in a container with a solution that prevents its vapours from contaminating the environment—nevertheless, it is safe to place in one’s mouth. 

Should amalgam be banned? Amalgam is a long-lasting, effective filling material that is inexpensive and easy to work with.¹² On the other hand, since mercury is the most toxic non-radioactive material on earth, and since it is constantly being released from amalgam, its use should be abandoned.¹³  

One must therefore choose: the dentist must decide if amalgam is to be placed in patients’ mouths, and the patient must decide if they want amalgam in their own mouth or if they have them, that they be removed. 

The study of toxicology generally focuses on acute poisoning, not on low, chronic dosing.¹⁴ In and of itself, the dose may seem innocuous, but, over time, that dose can take on a whole new effect on the body. Diagnosis of mercury toxicity is difficult as it can mirror many other diseases.^{7, 14}   There is not enough room to mention all the conditions found due to inhalation of mercury vapour based on human studies (animal studies have found numerous additional effects) but the following are just a sample; chest pains, cough, elevated blood pressure, palpitations, inflammation of the oral mucosa occasionally accompanied by excessive salivation, decreased haemoglobin and hematocrit, tremors, muscle pains, excretion of urinary proteins, erythematous and pruritic skin rashes, and may cause either a decrease in immune activity or an autoimmune response depending on the genetic predisposition of the individual.²³

Some dentists do not advocate elective removal of amalgam fillings because mercury is released during the removal process. If an amalgam is placed or removed without protective measures (to be discussed below), there is an increase in blood mercury levels for approximately three to four days.^{15, 16}  Elective amalgam removal, therefore, is contraindicated during pregnancy or lactation, since mercury crosses the placental barrier and is expressed in breast milk. The American Dental Association web site states: “To pregnant women who may be concerned about receiving amalgam fillings, Dr. Hujoel says they should know there is little reason for anxiety.”¹⁷

If the decision to remove amalgams is taken, precautions are in order. To protect the patient, the tooth to be drilled is isolated with a rubber dam. Some dentists do not use a dam, but try to suction all liquid and debris during the drilling process so that the rest of the mouth is protected. When drilling out the amalgam, copious water spray is used to cool the tip of the drill to minimize vapour production, and a high-volume suction tip removes the water and the debris that is generated. The amalgam should be sectioned so large pieces of the filling can be removed as chunks. Also, a saliva ejector is placed behind the rubber dam to remove vapours and liquids from behind the dam.

Another major concern is the vapour and particulate (sawdust-like particles) ejected at high velocity by the rapidly turning drill that fill the breathing zone.¹⁸ During the removal, the patient is protected by an external source of oxygen through a nose piece. For the dentist/dental assistant, either oxygen or a mask fitted with a filter rated for mercury is utilized. Most conscientious dentists have a room filter that constantly cleans the air to ensure that the mercury vapour in the office air is removed.¹⁹

The majority of patients do not experience any immediate negative or positive changes after amalgam removal since removal of the filling has not changed the body stores of mercury; rather, the reservoir of mercury has been removed, and chelation/detox is required as the next phase of treatment.

Based on clinical experience some patients feel ill after amalgam removal but it is usually a short lived event. There are rare cases, however, where ill effects have lasted for a number of weeks. Other patients report an improvement almost immediately. This is often explained as being due to the placebo effect but another phenomenon, galvanic reaction, may be occurring.²⁰ Metals in a liquid environment will corrode or rust setting up an electrical current. This can manifest in a metallic taste or a shock in the mouth due to thedischarge of a filling. Some people’s bodies are sensitive to electricity, and this, therefore, affects their physiologic functioning.²¹ After the fillings are removed, so is the disruptive current, so certain symptoms can disappear.

Everyone must decide if removal is right for him or her as no treatment is without risk. Whenever a tooth is worked on, it experiences trauma. Generally, the tooth recovers quickly, but sometimes the tooth or nerve dies, leading to abscess formation. If this situation arises there are only two possible treatments: root canal or extraction. Leaving an infected tooth in the body is not an option because, 24 hours a day, the immune system must expend energy to try to control the infection. If immune function drops, for whatever reason, flare-ups can occur. Taking homeopathic Arnica or Hypericum after each appointment can stimulate healing and reduce inflammation. Tooth sensitivity to hot or cold may also occur after removal.

Naturopathic doctors use various approaches to detox/chelate metals in the body, often through professional products at their disposal. The focus is the need to get into the tissues and cells and draw out the mercury so the body can eliminate it. If no active treatment is pursued, the mercury can persist in certain tissues for years.⁷ Mercury is excreted through the urine and stool via the bile.⁷ Certain practitioners prefer to start treatment aimed at improving liver and kidney function before demanding from these organs the added labour of excreting the mercury through the various detox protocols. Once these organs are stronger, the demands placed on them will not be too onerous. The concern is that, by drawing out the mercury and the toxins that the detox protocol acts on, without the body’s ability to eliminate them we inadvertently re-poison ourselves as the tissues reabsorb the circulating substances. Excreting the mercury through a program can be slow; many months may be required for success as certain tissues have retention half-lives that can last days to years⁷ and certain chelation protocols are more aggressive than others. Clinical experience reveals that sensitive patients may become ill, so it is prudent to start slowly. If patients can handle the regimen, then the naturopathic doctor can alter the protocol. 

According to Health Canada, “Dental amalgam is the single largest source of mercury exposure for average Canadians”; however, the Health Ministry believes that there is not enough evidence to indicate that amalgam is causing illness in the general population.²² A wise individual once said, “I do not need to prove the toxicity of mercury; we have known this for hundreds of years. Rather, you need to prove that mercury amalgam is safe.” (author unknown)

References:

1)      http://en.wikipedia.org/wiki/American_Society_of_Dental_Surgeons

2)      www.ada.org/public/resources/history/timeline_19cent.asp

3)      http://en.wikipedia.org/wiki/Dental_amalgam_controversy#The_American_Dental_Association_.28ADA.29

4)      Svare,CW; Peterson,LC; Reinhardt,JW; Boyer,DB; Frank,CW; Gay,DD; and Cox,RD. The Effects of Dental Amalgams on Mercury Levels in Expired Air. J Dent Res, 60, 1668-1671, (1981)

5)      Patterson,JE;et al. “Mercury In Human Breath From Dental Amalgams.” Bull Environ Contam Toxicol. 34: 459-68, (1985)

6)      www.ada.org/prof/resources/topics/amalgam.asp

7)      Fritz,LL; Vimy,MJ; and Summers,AO. “Mercury Exposure From “Silver” Tooth Fillings: Emerging Evidence Questions A Traditional Dental Paradigm.” FASEB J. 9, 504-508, (1995)

8)      Smoking Tooth Video. www.youtube.com/watch?v=9ylnQ-T7o1A

9)      Vimy,MJ; Lorscheider,FL. “Serial Measurements of Intra-oral Air Mercury: Estimation of Daily Dose From Dental Amalgam.” J Dent Res, 64: 1072-1075, (1985)

10)  Mackert,JR. Factors Affecting Estimation of Dental Amalgam Mercury Exposure From Measurements of Mercury Vapour Levels in Intra-oral and Expired Air. J Dent Res, 66: 1775-1780 (1987)

11)  Ontario Dental Association Health Hazard Manual pages 24-28, Revised Fall 1995

12)  Canadian Dental Association. www.cda-adc.ca/en/oral_health/faqs_resources/faqs/dental_amalgam_faqs.asp#7

13)  DAMS (Dental Amalgam Mercury Solutions) www.dams.cc and www.amalgam.org

14)  International Academy of Oral Medicine and Toxicology (IAOMT)   www.iaomt.org/articles/files/files193/The%20Cases%20Against%20amalgam.pdf

15)  Berglund,A; Molin,M. “Mercury Levels in Plasma and Urine After Removal of All Amalgam Restorations; The Effect of Using Rubber Dams.” Dent Mater 13: 297-304 (1997)

16)  Snapp,KR et al. “The Contribution of Dental Amalgam to Hg in Blood.” J Dent Res 68(5): 780-5 (1989)

17)  The American Dental Association Posted April 1, 2005. www.ada.org/prof/resources/pubs/adanews/adanewsarticle.asp?articleid=1334

18)  Richardson,GM. “Inhalation of Hg-Contaminated Particulate Matter By Dentists: An Overlooked Occupational Risk. Hum Ecol Risk Assess.” 9:1519-1531 (2003)

19)  www.iaomt.org/articles/files/files288/safe%20Removal%20of%20Amalgam%20fillings.pdf

20)  Anderson’s Applied Dental Materials Sixth Edition. John F. McCabe. Blackwell Scientific Publications

21)  www.flcv.com/galv.html

22)  www.hc-sc.gc.ca/dhp-mps/md-im/applic-demande/pubs/dent_amalgam-eng.php

23)  Center For Disease Control- www.atsdr.cdc.gov/toxprofiles/tp46.pdf  (pages 264-283)