Autism Research Institute

Recommendations for Safe Dental Care

On June 12th, 2008, the FDA finally admitted on its website that silver fillings in our teeth are toxic and harmful to our health, and that they "may have neuro-toxic effects on the nervous systems of developing children and fetuses." 

ARI asked Dr. Donald Robbins for his recommendations for safe dentistry.

THE NEED FOR SAFE, BIOCOMPATIBLE DENTAL CARE
Dr. Donald Robbins, DMD

Bryan is six years old, and autistic.  The clinically observed statistics cited by authorities claim one in 120 to 150 children have an autism spectrum disorder (ASD). In point of fact, how many “normal” children have a cognitive disorder that either has not yet been expressed, or is thought minor enough to be overlooked by the conventional medical community?  The number of children estimated to have a cognitive disorder has been put at three times the ASD figures--that is a huge number!  The percentage cited by “experts” depends on the study, and who is collecting and tabulating data.  Either way, we know these disorders can be caused by a significant toxic exposure to mercury.

Bryan developed autistic symptoms two weeks after being injected with a vaccine containing thimerosal, which is 49% mercury.  Why was he cognitively affected, when so many other children show no effects from a single exposure to mercury?  And why do some children need two or more vaccinations to be negatively affected?  There are many causes, but there are clues that have become apparent in my biologic dental practice.

Bryan’s parents sought out my practice because they both had “silver” (mercury amalgam) fillings in their teeth.  Through their own reading and Internet research once their son was affected, they realized the risk of mercury exposure people have from these old-fashioned fillings.  (All silver-colored fillings in teeth are 50% elemental mercury, and all off-gas mercury vapor into the mouth nonstop).  They also understood that simply removing mercury fillings without precautions was dangerous. They wanted the mercury removed as safely as possible, according to the biologic protocols that exist to protect patients from the incidental mercury vapor and particles released during removal of mercury dental fillings.

The parents’ oral-vapor mercury levels, both at rest and after chewing, were measured and recorded before treatment.  Their pretreatment levels unsafely exceeded maximum permissible exposure levels set by the Environmental Protection Agency (EPA): 9 micrograms mercury per cubic meter, established after evaluating health and industry data and observing toxic health effects.  Yet as Bryan’s parents and many of my patients find out, their oral levels are above those toxic limits.

Bryan’s parents’ treatment was performed and completed in several visits.  They were protected as much as possible with biologic protocols, including oral supplementation and physical barriers specifically designed to minimize mercury absorption during the procedures.  Usually this is successful, and no immediate or long-term health effects are noted.  However, with both these patients, post-treatment mercury exposure symptoms appeared during the two weeks after each visit:

These symptoms disappeared during the ensuing two weeks.

My evaluation of the parents’ responses indicated that BOTH parents had difficulty excreting mercury.  Even with hygienic and nutritionally supportive help during the removal process of their dental fillings, they experienced toxic symptoms.  In my opinion, Bryan had little chance of avoiding mercury toxicity and its health effects because he inherited a lack of efficient excretion of the toxic mercury from both parents.  That may be why he only needed a little mercury exposure to react so badly.

Men and women of childbearing age do themselves and their future children a service by having mercury fillings removed safely before conceiving a child.  Women with many of these in their mouths pass the vapor absorbed from the fillings to the child they are carrying at a relative rate of ten times what the mother is exposed to.  Add to that the extreme vaccination protocol followed for newborns and young children in this country, and you understand how mercury exposures and absorption add up.
 
To protect yourself and your family from exposure to mercury and its associated potential risks and side effects, make sure that neither you nor your children have mercury “silver” fillings.  You should also confirm that the dental office you want to use observes strict protocols to prevent mercury contamination from all sources.

TOXIC EXPOSURES IN A TYPICAL DENTAL OFFICE
While most of us are aware of mercury exposure from dental amalgam fillings, many are not aware that about half the dentists in the United States still use them.  For most people, concern ends there, because most people are not aware of exposure to other toxins caused by simply walking into an average dental office.

Let’s explore what kinds of chemicals are used--and not controlled--in these offices.  For instance, a dental office might advertise proudly that they do not use mercury dental fillings, but instead replace old silver fillings with the newest white bonded ones, while they in fact are exposing their patients, their staff, and themselves to mercury vapor in their office every minute.  Mercury vapor is released in extremely high concentrations when the silver filling is heated incidentally during the drilling procedure.  Unless specific precautions are taken to control the mercury vapor released every time an old “silver” filling is drilled out, that vapor is contaminating everything in the office.  In addition to the vapor, minute toxic particles are sprayed into the air during filling removal.

Many office buildings now are “closed” systems where windows cannot be opened and external air is not brought in.  Any chemicals released into the office air recirculate through the heating/air conditioning systems until they are either inhaled or deposited on surfaces in the office environment.  Specific precautions and equipment are needed to capture and contain toxic chemicals used every day in these offices.  Every person in the office is at risk; the condition of children with ASDs, whose immune and detoxification systems are already compromised, can be seriously threatened from even minimal exposure.

Consider this too: When a treatment room is cleaned up and made ready for the next patient, disinfectant sprays and sterilant chemicals are used on all surfaces in the room.  Some are allowed to remain on surfaces until they evaporate, and some must be wiped dry after a period of time.  Either way, these chemical vapors find their way into office air.  Some of them are not kind to our bodies.  Topical antiseptic agents used on the skin and in the mouth include:

Although used topically, these antiseptics have the potential to be absorbed through skin or mucosa contact.

Consider what these disinfectant agents can do:

We need to protect our treatment and operating rooms by killing or removing as many pathogens as possible.  So how can dentists keep from exposing themselves, their staffs, and their patients to the same fate?

One of the major requirements for precautions that must be taken in all dental offices is the use of high-efficiency medical-grade air cleaners.  These are not readily available like the home-use air cleaners that remove some bacteria or viruses from the air.  Professional air cleaners are needed, like the IQAir units (SMARTAir Solutions 800-9779-AIR), which are sophisticated Swiss-made units; different models are available to remove specific chemical vapors, metals, toxins, or pathogens from the office air.  Their unit for removal of mercury vapor in the dental treatment room is used chair-side, while the mercury fillings are drilled out.  It is the best unit made, because it removes 99.6% of the mercury in the air the first time the air moves through the unit (first pass).  Read on in articles to follow for more information about these remarkable IQAir cleaner units.

IS IT SAFER TO LEAVE MERCURY DENTAL FILLINGS IN, OR TO REMOVE THEM?
I am frequently asked this question by my patients and at conferences.  Available information indicates that when a mercury amalgam filling is being placed or removed (drilled out), the oral mercury vapor levels rise significantly, sometimes reaching levels fifty times the resting level.  Mercury vapor in the mouth is inhaled and absorbed from the lungs into the bloodstream in a matter of minutes.  Even the American Dental Association, which stonewalls the overwhelming scientific literature establishing that these fillings are toxic, agrees that mercury vapor levels are their highest during placement and removal.  But why not “let sleeping dogs lie”?  The answer is not simple.

The average mercury exposure for a person with a typical number of amalgam fillings is 17 micrograms of mercury per day (World Health Organization 1991).  The average mercury (ethyl mercury) from thimerosal in one vaccination is 20 to 25 micrograms, injected into the body tissues.  Thimerosal is the preservative used in multi-dose vials, for injectable vaccines.  These exposures carry significant health risks; they should of course be avoided when possible.  Those of you familiar with vaccinations know that not all vaccines available in the United States are listed on the FDA website.  The FDA website currently lists all pediatric vaccines as NOT containing thimerosal, overlooking that more than half of the flu vaccines still contain mercury. 

Because of the large mercury exposure that occurs while drilling out mercury amalgam fillings, I avoid removing them from female patients who are pregnant or nursing.  In fact, whether female or male, if the patient is of childbearing years or trying to get pregnant, I advise safe removal of amalgam dental restorations as soon as possible.  So why remove these fillings in a child or adolescent with an autistic spectrum disorder (ASD), when conception is not an issue?
For the last five years I have measured the oral mercury-vapor levels in all my new patients and in patients in for their routine checkups.  I use a very accurate atomic spectrometer (used in high-tech diagnostic laboratories), which records mercury vapor readings directly, in the mouth.  Patients receive a record of their oral mercury-vapor levels, comparison with government regulations, and a list of websites that provide information about mercury levels.  All patients with more than a few fillings show mercury vapor levels above the maximum level permitted by the Environmental Protection Agency (EPA) and the Occupational Safety and Health Administration (OSHA).  By definition, these high oral mercury-vapor levels mean that these individuals are chronically toxic.

All mercury dental fillings give off (“off-gas”) mercury vapor twenty-four hours per day, seven days a week. Allowing this constant toxic exposure in ASD children is unacceptable.  The long-term absorption of mercury from their fillings can only add to their dysfunction.  I recommend removal of any mercury dental fillings as soon a possible, but with precautions.  You don’t want to make the child’s condition worse by exposing them, unprotected, to a “cloud” of toxic vapor.  My office protocols minimize the patient’s toxic exposure during removal.  These precautions also limit mercury exposure for me and my staff. 
I advise a consultation with a physician well versed in chelation procedures; keep in mind that most physicians are not aware of the effective protocols.  A knowledgeable practitioner will place the child on transdermal or sublingual supplements such as reduced glutathione, oral supplementation with vitamin C, and perhaps intravenous chelation immediately following the dental procedure.  Informed practitioners recommend the best protection for the patient (both adult and child) to minimize absorption of the toxic metals.

As far as I am aware, there are almost no pedodontists (dentists treating children only) practicing in a complete biologic manner.  Most do not take all the precautions, nor use only the biocompatible materials that are necessary to protect the patient.  Many children with ASDs need to be treated as general anesthesia cases, possibly in hospital operating rooms or outpatient surgical centers.  These facilities have no equipment for capturing mercury released during the removal of fillings, nor do they filter the room air to remove the released vapors from earlier procedures.  If you are faced with this situation and cannot find a biologic pedodontist, protect the child with everything else you can (as outlined above), find a pedodontist who does not use mercury–containing fillings, and trust a knowledgeable physician to help you.

PROTECTING THE PATIENT FROM MERCURY
How to avoid exposure when mercury fillings are removed
We previously reviewed how patients are generally exposed to huge amounts of mercury vapor while their old fillings are being drilled out.  At rest, patients with an average of six “silver” fillings have constant off-gassing of mercury vapor at levels over six times that of an average daily consumption of fish (World Health Organization 1991).  Routine drilling of a mercury amalgam filling with air-and-water spray increases the toxic vapor 10 to 100 times the patient’s resting vapor level.  Not only is the patient at risk of inhaling and absorbing mercury, but the dentist and the office staff are also exposed, and are at increased risk of toxicity.

These are some of the reasons why it’s important to have your “silver” mercury dental fillings removed only by a biologic dentist knowledgeable in the precautions necessary to minimize that toxic exposure.  Simply going to a dentist who claims never to use mercury in the office is NOT safe enough to keep you, your family, or your unborn child safe from vapor exposure and consequent neurologic damage.  Those dentists who place only white bonded fillings may do so very expertly - but their removal procedures still are a great health hazard to the patient, and the dental office staff itself.

What precautions are needed to keep mercury exposure to a minimum during these procedures?  Although they will vary with the overall health and the needs of each patient, certain basic precautions are universally taken to safeguard against metal toxicity.

During the safe removal of mercury fillings, wet drapes are placed over the patient’s exposed skin on head, face and neck, since mercury (released in the aerosol spray) can be absorbed through the skin.  Protective eyeglasses with side shields also keep spray out of the eyes and the sensitive surrounding skin.  Importantly, the high-speed evacuation system used by the office to suck out the debris, water, and particles from the mouth MUST be exhausted to the outside of the building.  This is also true of the suction from the saliva ejector that’s placed in the floor of your mouth, under your tongue, during dental procedures.  Many offices are in buildings where the windows and corridors cannot be opened to the outside.  In these buildings, the air is constantly recirculating.  Unless the mercury that’s removed while a “silver” filling is being drilled out is vented and captured outside the dental office, the contaminated air is recirculated, and represents a threat to everyone involved, as well as others in the building.

To help protect the dentist and staff during the safe removal of mercury fillings, high efficiency mercury air cleaners are used, with a flexible vacuum tube opening right at the patient’s mouth.  The IQAir unit we use is the best mercury-capture air cleaner available, capturing 99.6% of the mercury vapor coming out of the filling area being drilled.  This efficient capture of mercury vapor keeps the patient from having to rebreathe the contaminated air.

In our office we also use a different IQAir unit to filter all volatile organic compounds (VOC’s), formaldehydes, chemical agents and any residual mercury from the office air.  These units run 24 hours, 7 days a week to remove the chemical agents listed above.  These IQAir units also remove odors, pollens and allergens, vapors released (off-gassing) from office machines and equipment, molds, yeast, bacteria, and viruses.  You can tell if an office is clean as soon as you walk into the waiting room, by the lack of any “dental” odors.

Depending on the patient’s general condition and sensitivity to toxic materials, we evaluate each for oral nutritional supplementation.  A short-term supplement recommendation may be prescribed for the general physical wellbeing of the patient, or to support their defenses against the toxic vapor that will be released when fillings are removed.  These supplements are a very important part of protecting the patient from incidental exposure to mercury during the process.  Extremely debilitated patients require a consultation with a physician knowledgeable in heavy metal toxicity and detoxification techniques.  We will occasionally remove the fillings and immediately send the patient to a physician’s office for intravenous administration of detoxifying supplements.

Remember, mercury can have serious negative short-term impact on your health.  People who cannot excrete mercury efficiently (like young children with ASDs from thimerosal in vaccines, or from another source of mercury) are at a higher risk for bad reactions.  But mercury also has insidious long-term effects that progress slowly, such as Alzheimer’s disease or cardiovascular damage.  Children who already have been injured by mercury exposure have demonstrated an inability to adequately excrete this metal.  Any small addition of mercury will have a magnified effect, and may cause a relapse of negative health symptoms.

You must take control of your health decisions.  Know the facts, and know about the treatment practices of any medical or dental office you use.

Donald Robbins, DMD, FAGD, AIAOMT, is a bio-safe dentist protecting patients’ overall health, practicing in Exton, Pennsylvania.

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