You have been doing some reading online. You have silver amalgam fillings and you are starting to worry. You have heard that removing them releases mercury vapour. Some sources say it is safer to leave them in. Others say removal is essential. What is the truth?

Dental amalgam contains mercury. This is a fact. Mercury is a metal that, in certain forms, can be toxic. The concern is that mercury could be released from fillings as vapour, which you then inhale or swallow. Over time, this could potentially cause health problems.

This concern has been studied extensively for decades. Major health organisations, including the World Health Organization, the FDA, and the British Dental Association, have all concluded that dental amalgam is safe for most people. The amount of mercury released from intact fillings is extremely small and not considered harmful.

Here is where the concern about removal comes in. When an amalgam filling is drilled out, mercury is indeed released. The drilling process creates heat and friction, which can vaporise mercury from the filling surface. This means that during the removal process, you are exposed to more mercury than you would be from simply leaving a healthy filling in place.

This is why some critics argue that removal is riskier than leaving intact fillings. If the fillings are not causing problems, exposing yourself to mercury during removal may offer no health benefit.

However, if you do decide to have your amalgam fillings removed, there is a way to do it safely. The International Academy of Oral Medicine and Toxicology has developed a specific protocol for mercury-free removal. This approach includes several precautions that minimise mercury exposure during the procedure.

Your dentist should use a rubber dam to isolate the tooth and prevent you from swallowing any debris. They should use high-volume suction to capture mercury vapour and particles. Cool water should be used to reduce heat. The filling should be removed in large pieces rather than drilled down, which reduces vapour release.

Despite the concerns, there are situations where removal is genuinely advisable. If a filling is cracked, leaking, or decayed underneath, it needs to come out regardless of the material. If you have an actual allergy or sensitivity to amalgam, removal is clearly indicated. Some patients have psychological distress about having mercury in their mouths that affects their quality of life.

In these cases, the benefit of removal outweighs the temporary exposure risk. Your dentist can discuss material options for replacement, such as composite resin or ceramic fillings.

The decision should be made based on your individual circumstances and honest conversation with your dentist, not on fear or internet misinformation.