Whether your dentist is a member of the IAOMT or not, it is very important that you know your dentist!  Knowing your dentist means that you have a clear understanding of any treatment plans for you and how these treatments will be performed.  The IAOMT advocates and promotes such patient-doctor dialogue, as it establishes a collaborative effort, reasonable expectations, mutual respect, and in the best case scenario, improved health.

Note also that just as every patient is unique, so is every dentist.  Even within the membership of the IAOMT, each dentist has preferences for which treatments are performed and how they are performed.  While we offer educational programs and resources to all of our members, it is up to the individual dentist as to which educational resources are utilized and how practices are implemented.  This same concept can basically be applied to all doctors:  In the end, each doctor makes decisions pertaining to practices and patients based on their own knowledge, experience, and professional judgement.

That being said, taking that time to know your dentist can be very helpful to you as patient. You might consider asking questions such as the following:

What is your position on the mercury issue? How much knowledge do you possess about dental mercury?

If a dentist is knowledgeable about the mercury issue and understands mercury biochemistry, it is likely they will take biological dentistry or the amalgam filling removal process seriously. Be concerned if you hear, “I don’t think the mercury in fillings is a big deal, but I’ll take it out if you like.” This is probably a dentist that isn’t very concerned about recommendations for safety measures.
Familiarize yourself with the terminology of dental practices associated with measures to reduce mercury exposures.  There are a variety of methods dentists employ to address the harms of mercury, so it is essential to acknowledge the specific aims of each of these types of dentistry.

• “Mercury-free” is a term with a wide-range of implications, but it typically refers to dental practices that do not place dental mercury amalgam fillings.
• “Mercury-safe” typically refers to dental practices that use rigorous safety measures to limit or prevent mercury exposure, such as in the case of removing previously existing dental mercury amalgam fillings and replacing them with non-mercury alternatives.
• “Biological” or “Biocompatible” dentistry typically refers to dental practices that utilize mercury-free and mercury-safe dentistry while also considering the impact of dental conditions, devices, and treatments on oral and systemic health, including the biocompatibility of dental materials and techniques.

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You should also understand that dentists cannot, per the American Dental Association, tell you to have your fillings removed for toxicological reasons.  In fact, some dentists have been disciplined and/or fined for speaking out against dental mercury and encouraging its removal. So, keep in mind that your dentist might not want to discuss mercury removal from a toxicological perspective.

What is your understanding of biocompatibility and biological dentistry?

​Remember that “biological” or “biocompatible” dentistry typically refers to dental practices that utilize mercury-free and mercury-safe dentistry while also considering the impact of dental conditions, devices, and treatments on oral and systemic health, including the biocompatibility of dental materials and techniques.  A dentist knowledgeable about biological dentistry will have an answer in regard to “biocompatibility” which is defined by Merriam-Webster dictionary as “compatibility with living tissue or a living system by not being toxic, injurious, or physiologically reactive and not causing immunological rejection.”  You might also want to ask what types of training the dentist has in biological dentistry and why the dentist has chosen specific treatments and/or practices for you.
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What precautions do you take to safely remove dental amalgam mercury fillings?

Traditional safe amalgam removal techniques include the use of masks, water irrigation, and high volume suction.  However, the IAOMT’s Safe Mercury Amalgam Removal Technique (SMART) supplements these conventional strategies with a number of additional protective measures.  Patients are encouraged to utilize the IAOMT’s SMART Checklist with their dentists to make sure that both parties agree upon which precautions will be used, even if the dentist is SMART-certified by the IAOMT.  The SMART Checklist also helps patients and dentists to establish expectations and understandings prior to the actual amalgam removal procedure.

What is your experience in working with patients who ___________?

This is your opportunity to find out whether the dentist has expertise in whatever area you are concerned about or interested in.  In other words, you can fill-in-the-blank in the question above to relate to your unique patient needs.  Some examples that dentists have heard before include: patients who want fluoride-free options, patients who are pregnant, patients who want to become pregnant, patients who are breastfeeding, patients who are allergic to eugenol, patients who are having an issue with a root canal, patients with periodontal disease, patients with claustrophobia, patients with multiple sclerosis, etc.  Based on the dentist’s previous experiences or willingness to learn, you can make an informed decision about whether or not you feel comfortable with the treatment plan.

How do you utilize patient informed consent?

As a patient, you reserve (and deserve!) the right to be informed about the materials and procedures that will be used during your appointments.  So, it is essential to make sure that your dentist will provide you with informed consent (which is basically patient permission for a health professional to use a certain material or procedure).  Properly designed informed consent forms carefully explain what the potential benefits, potential harms, and alternatives to the material/procedure are.

How do you stay current on new research and developments related to dentistry, oral health, and overall health?

​You probably want to make sure that your dentist is actively involved in learning about the latest developments in dentistry, medicine, and health care.  This means that the dentist reads a variety of research articles, attends professional conferences and meetings, is a member of professional groups, and/or communicates with other dental and medical professionals on a regular basis.

COURTESY: IAOMT at www.iaomt.org/for-patients/know-your-dentist/

Every dentist has his/her own opinions about mercury based on education, experiences, and sources of trade and scientific information. Some dentists do not use mercury because it is known to be harmful, while others defend it because they were taught in the past to believe it is not dangerous.

For those dentists who do recognize the risks of mercury, there are a variety of practice philosophies that exist. That’s why it is essential to acknowledge the specific aims of each of these types of dentistry:
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• “Mercury-free” is a term with a wide-range of implications, but it typically refers to dental practices that do not place dental mercury amalgam fillings.
• “Mercury-safe” typically refers to dental practices that use rigorous safety measures to limit or prevent mercury exposure, such as in the case of removing previously existing dental mercury amalgam fillings and replacing them with non-mercury alternatives.
• “Biological” or “Biocompatible” dentistry typically refers to dental practices that utilize mercury-free and mercury-safe dentistry while also considering the impact of dental conditions, devices, and treatments on oral and systemic health, including the biocompatibility of dental materials and techniques.

While positions on mercury vary widely within the field of dentistry, these talking points should assist you in discussing the topic with your dentist.

1. Remember your rights as a patient at all times.

As a patient, you have the right to know what is being put in your mouth. You also have the right to express concerns about any treatment offered to you, including the use of mercury/amalgam/silver fillings, all of which contain approximately 50% mercury. As part of your patient rights, you can ask to see the “Safety Data Sheet” (formerly called an “MSDS”) for mercury fillings and other dental materials. These descriptive sheets explain health hazards of chemical products. Additionally, some states, such as California, Connecticut, Maine, and Vermont, have fact sheets about dental fillings which dentists are supposed to give to their patients. Share what you have already learned, and ask your dentist about the procedure and materials used.

2. If you are having your amalgam fillings removed, read about precautions that can be taken to protect you and your dentist from additional mercury exposures.

Familiarize yourself with the information about the Safe Mercury Amalgam Removal Technique (SMART) on this website. You might also want to consider searching for a SMART-certified dentist. No matter what, be sure to utilize our SMART Checklist for Patients and Dentists so that you and your dentist can be sure that you agree on which safety measures will be applied.

3. Bring copies of any documents of interest you have already found with you to your dental visit.

It is one thing to tell your dentist about something you read, but it quite another to have a copy with you. This means doing your own research before your appointment. In addition to learning about SMART and using the SMART Checklist for Patients and Dentists, you should explore potential health risks of amalgam fillings that directly relate to you and your family. For example, the International Academy of Oral Medicine and Toxicology (IAOMT) has dental mercury fact sheets and webpages designed to help you learn more.

4. Understand that dentists cannot, per the American Dental Association, tell you to have your fillings removed for toxicological reasons.

The ADA states that “removal of amalgam restorations from the non- allergic patient solely for the alleged purpose of removing toxic substances from the body, when such treatment is performed at the recommendation or suggestion of the dentist, is improper and unethical.” Indeed, some dentists have been disciplined and/or fined for speaking out against dental mercury and encouraging its removal. Keep in mind that your dentist might not want to discuss mercury removal from a toxicological perspective.

5. Find out about regulations to phase down and end the use of mercury due to health and environmental concerns.

For example, Norway, Sweden, Japan, and Switzerland have all restricted or banned amalgam. France has recommended that alternative mercury-free dental materials be used for pregnant women, and Germany, Finland, Austria, and Canada have reduced the use of dental mercury amalgam fillings for pregnant women, children, and patients with kidney problems. Additionally, over 100 countries, including the U.S., have agreed on the United Nations Environment Programme (UNEP)’s “Minamata Convention on Mercury,” which is a global treaty that calls for phasing down the use of mercury, including the mercury in dental amalgam. The U.S. Environmental Protection Agency (EPA) recently passed a guideline that prevents dentists from releasing amalgam/mercury waste down the drain. Keep up to date on the regulations by visiting this website and the IAOMT website so that you can share this information with your dentist, other health practitioners, family, and friends!

COURTESY: The Smart Choice at www.thesmartchoice.com/share-your-concerns-about-dental-mercury-with-your-dentist/