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Consent for Elective Removal of Amalgam Fillings

Amalgam is the commonly used "silver" filling material. Its actual composition is approximately 50% silver alloy (containing silver, copper, tin zinc and other metals), and 50% liquid mercury. Most of the controversy surrounding amalgam concerns the mercury content.

When existing fillings are mechanically intact, it must be the patient's exclusive, personal choice to have them replaced with other materials. A dentist is not legally entitled to suggest or diagnose a connection between the presence of these fillings and any medical condition or symptoms.

Nevertheless, mercury is one of the most toxic substances known, and its presence in dental fillings has been said to cause toxic illnesses in some people. Many people have reported improvements in their health when their fillings have been removed and replaced, although many other people have not experienced such results. It is not possible to predict, given our present knowledge, who would noticeably benefit from having existing amalgams replaced. There is a large body of scientific information on the subject, and an equally large body of unscientific, anecdotal information. This paper will describe what we know about mercury and amalgam, what we don't know, and what we surmise.

Amalgam has been dentistry's main filling material since the early 19th century, and many dentists still use it routinely, although its use has been declining as the reliability of newer materials has become accepted. It is very effective for restoring teeth, and the dental establishment strongly proclaims its record of safety and effectiveness. However, there has never been any positive proof of safety, and surprisingly little scientific research to investigate the level of risk posed by the mercury content. The American Dental Association and allied authorities have consistently claimed that mercury is stable within amalgam, and if it is released at all, it is in quantities too small to cause any harm. The dental establishment condemns the practice of removing intact fillings to reduce a person's exposure to mercury, in order to affect their overall health. Other researchers have shown that mercury is, in fact, released in significant amounts.

The whole field is full of contradictions. Despite all the claims of safety, the ADA recommends that dentists' and assistants' bare hands never touch the freshly mixed amalgam, and scraps must be kept in tightly sealed containers to prevent the escape of mercury vapor. Dental amalgam has never been formally approved by the FDA, and the Environmental Protection Agency considers discarded amalgam to be toxic waste. In our office, we have decided that there is no longer any justification for using amalgam fillings.

Risks of Replacing Amalgam Fillings

Removing and replacing any filling material, for whatever reason, involves drilling it out, washing, drying, and placing new materials. All of this can be traumatic to a tooth. It is possible that a tooth that starts out comfortable can be rendered sensitive, or even painful, by this process. Occasionally, root canal therapy is necessary to relieve such pain. Rarely, a tooth must ultimately be extracted as a result of the trauma from replacing a filling.

Removing amalgam fillings will produce a transient increase in the person's exposure to mercury. Although we take great care with physical barriers to reduce this exposure for patients and dental staff, a person who is mercury toxic or sensitive may experience an increase in their symptoms (both physical and emotional) for some time following an amalgam removal procedure. Other nutritional and metabolic precautions can be taken to minimize this effect.

Treatment Options

It is always your option to do nothing, to undergo no treatment. Replacement of amalgam fillings can be performed as they break down in the normal course of events, as a matter of routine dentistry.

A treatment program to deliberately remove and replace amalgam fillings can be designed for you. This includes a comprehensive examination and treatment plan to assure the best dental outcome, and an effort to determine which new dental materials would be the most biologically compatible for you.

Consent For Treatment

I having read and understood this entire two page document, and understanding the risks involved, give permission to Dr. Freedman and his staff to remove and replace my existing amalgam fillings, according to a treatment plan I have reviewed and approved. I declare that the purpose of this treatment is my voluntary and exclusive decision to eliminate a potential health hazard from my mouth, in the form of amalgam fillings. For actual diagnosis and treatment of mercury or other heavy metal toxicity and other systemic conditions, Dr. Freedman has advised me to consult the physician of my choice. I acknowledge that no claims of general or specific health benefits for this procedure have been made by Dr. Freedman. I understand that I always have the option not to undergo treatment, and that I may stop treatment and withdraw this consent at any time. I understand that the fee for this service is 33% above the Ontario Dental Association's suggested fee guide.

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