ROLE OF

ACTIVATED CARBON

IN SAFE AMALGAM-

REMOVALDr. EHSAN SANJABI

Dental amalgam Dental amalgam is the end result of mixing

approximately equal parts of elemental liquid mercury (43 to 54 %) and an alloy powder (57 to 46 %) composed of silver, tin, copper, and sometimes smaller amounts of zinc, palladium, or indium. It has been widely used since the mid 1800s.

We know beyond any doubt that amalgam emits mercury, as elaborated in the related article, “The Scientific Case Against Amalgam.” Finished amalgam on the bench at 37˚C will emit as much as 43.5μg of mercury vapor per square centimeter of surface area per day, for extended periods of time. Cutting the amalgam with a dental bur produces very small particles with vastly increased surface area, and vastly increased potential for subjecting the people present to a mercury exposure.

The safety of amalgam fillings represents an increasingly controversial topic in world dentistry. Sweden, Austria, Denmark, and Norway have

banned amalgam use, and the United States' FDA revoked its previously pro-amalgam stance

in a landmark decision June 4, 2008.

Metallic mercury vapors or organic mercury may affect many different areas of the brain and their associated functions, resulting in a variety of symptoms

The kidneys are also sensitive to the effects of mercury, because mercury accumulates in the kidneys and causes higher exposures to these tissues, and thus more damage.

MERCURY TOXICITY

In addition to effects on the kidneys, inorganic mercury can damage the stomach and intestines, producing symptoms of nausea, diarrhea, or severe ulcers if swallowed in large amounts. Effects on the heart have also been observed in children after they accidentally swallowed mercuric chloride. Symptoms included rapid heart rate and increased blood pressure

MERCURY TOXICITY

Although the American Dental Association continues to promote amalgam fillings as standard of care dentistry, the FDA's website now warns "Dental amalgams contain mercury, which may have neurotoxic effects on the nervous systems of developing children and fetuses"

Activated carbon, also called activated charcoal, activated coal, or carbo activatus, is a form of carbon processed to be riddled with small, low-volume pores that increase the surface area available for adsorption or chemical reactions

Activated charcoal itself is a fine, black powder that is odorless, tasteless, and nontoxic and usually derived from charcoal.

Activated carbon

Due to its high degree of microporosity, just one gram of activated carbon has a surface area in excess of 500 m2, as determined by adsorption isotherms of carbon dioxide gas at room or 0.0 °C temperature. An activation level sufficient for useful application may be attained solely from high surface area; however, further chemical treatment often enhances adsorption properties.

Medical applications

Activated carbon is used to treat poisonings and overdoses following oral ingestion.Activated charcoal exerts its effects by adsorbing a wide variety of drugs and chemicals. Adsorption is a process in which atoms and molecules move from a bulk phase (such as a solid, liquid, or gas) onto a solid or liquid surface.

In other words, the toxic substance attaches to the surface of the charcoal. Because charcoal is not "digested," it stays inside the GI tract and eliminates the toxin when the person has a bowel movementActivated charcoal is estimated to reduce adsorption of poisonous substances up to 60%.

Mercury vaporizes at room temperature. As soon as the dentist touches the filling with a drill, the temperature soars and the mercury vapor comes pouring off the fillings. These can be inhaled or swallowed which can lead to unacceptably high levels of exposure.

So when removing mercury amalgam dental fillings, it becomes very important to follow safety protocols and assess each individual patient to protect them from toxic exposure; reduce any mercury vapor during the procedure; and aid them in eliminating this toxic element from the body.

Ingested activated charcoal capsules have been suggested to prevent absorption of non-suctioned mercury from amalgam particles from the digestive tract. This procedure enhances the prevention of mercury absorption through all oral soft tissues as well. It is inexpensive, simple, fast and tasteless.

Approximately 15-30 minutes before amalgam removal, the patient should take a charcoal caplet. Thissupplement will bind some of the minute amalgam particles that may be inadvertently swallowed during the drilling procedure. A second caplet should be taken at the end of the appointment. Thereafter, activated charcoalshould be avoided because it can also absorb certain good nutrients and medications

1. In a small disposable cup, dissolve 1 teaspoon of activated charcoal powder in 1 ounce of water.2. Before removing amalgam, before anesthetic, have the patient briefly rinse then swallow the slurry.3. The oral mucosa and tongue will be coated with the black powder to prevent the absorption of non suctioned mercuryand amalgam particles and the digestive tract will benefit from better protection as well.4. As soon as all amalgam has been drilled out, thoroughly rinse the visible black powder from all accessible mucosawith water spray and suction for at least 45 seconds.

slurry of activated charcoal powder and water

Contraindications

Activated charcoal will absorb all drugs taken two hours prior or two hours after ingestion. Ensure patient has not taken or will not take any important medication (birth control pills, antibiotics, chronic disease medication, etc) in the two hours before or two hours after ingesting the charcoal. If the patient has taken medication in the critical time period, have him/her rinse and spit out the charcoal back in the cup to protect the oral mucosa only at this time but not swallow the mixture. Prescribe charcoal to be ingested later if deemed appropriate. Activated charcoal does not absorb vitamin or mineral supplements.

Of course using the activated charcoal is only one part of amalgam safe removal procedure. here is the safe Amalgam Filling Removal guidelines:

SA

FE

1.Keep the fillings cool during removal. 2.Use a high-volume evacuator. 3.Use additional air purification4.Provide the patient with an alternative source of air. 5.Use a rubber dam.6.Immediately dispose of filling particles. 7.Remove gloves and clean the patient’s mouth. 8.Immediately clean up. 9.Keep room air as pure as possible. 10.Use activated charcoal.

Guidelines for Dentist and Staff based on that of the International Academy of Oral Medicine and Toxicology (IAOMT)