Mercury Toxicity

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• Mercury Toxicity

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• Is there poison in your mouth ?

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• Ethical questions related to amalgam removal

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• Ethical questions related to amalgam removal
• Dental amalgam restorations and mercury

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• Ethical questions related to amalgam removal
• Dental amalgam restorations and mercury
• What is really known about amalgam's safety

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• Ethical questions related to amalgam removal
• Dental amalgam restorations and mercury
• What is really known about amalgam's safety
• Scientific studies

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• Ethical questions related to amalgam removal
• Dental amalgam restorations and mercury
• What is really known about amalgam's safety
• Scientific studies
• What "60 Minutes" didn't tell you

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• ADA Principles of Ethics

• Code of Professional Conduct

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• ADA Principles of Ethics

• Code of Professional Conduct
• ... the removal of amalgam restorations from the
  non-allergic patient for the alleged purpose of
  removing toxic substances from the body, when
  such treatment is performed solely at the
  recommendation or suggestion of the dentist, is
  improper and unethical.

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• ADA Principles of Ethics

• Code of Professional Conduct
• ... the removal of amalgam restorations from the
  non-allergic patient for the alleged purpose of
  removing toxic substances from the body, when
  such treatment is performed solely at the
  recommendation or suggestion of the dentist, is
  improper and unethical.
• ... a dentist who represents that dental
  treatment recommended or performed by the dentist
  has the capacity to cure or alleviate diseases,
  infections or other conditions, when such
  representations are not based upon accepted
  scientific knowledge or research, is acting
  unethically.

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• Can a dentist ethically remove amalgam upon
  request from a patient? Yes!

• The dentist who removes amalgam based on a
  request from a patient or a patient's physician
  is not acting unethically.

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• Can a dentist ethically remove amalgam upon
  request from a patient? Yes!

• The dentist who removes amalgam based on a
  request from a patient or a patient's physician
  is not acting unethically.
• The dentist is also not acting unethically if
  he/she decides not to comply with the patient's
  request, assuming there is no valid medical
  reason for removal based on a sound physician
  referral.

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• Explain the science (and lack thereof) to the
  patient

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• Explain to the patient any potential risk of
  damaging tooth structure if the amalgam is removed

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• Discuss the cost of removal and the pros and cons
  of the replacement material

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• Encourage the patient to consult with his/her
  physician before making a decision like this
  this can be particularly critical if the patient
  believes that the removal will improve a medical
  condition, such as multiple sclerosis or arthritis

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• If the patient continues to insist on removal,
  given a complete understanding of the science and
  any risk to tooth structure,and, if applicable,
  having obtained medical consultation, the dentist
  can ethically remove the amalgam

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• ... the dentist's discussions with the patient
  and the dentist's decision should be documented
  in the patient's record, with the dates of all
  discussions and the dentist's signature asking
  the patient to initial or sign the record