Dr. Darryl Nabors, a Clyde, North Carolina dentist whose practice has been amalgam-free since 1982, places ultimate importance on precautions during amalgam removal to reduce mercury exposure for his patients, his staff, and himself. The first and most important step is to use a rubber dam, which is a thin piece of latex that the dentist installs in the back of the patient's mouth to keep material from going down their throat. "A study that I saw said that if a dentist takes out an amalgam filling without a rubber dam, the patient can swallow anywhere from 40-60% of the old filling," Nabors stated. "It's taken out in the form of a powder, pulverized, and then it hits the inner lining of the tongue, the cheeks and everything, and when the patient swallows, they ingest that. A rubber dam is absolutely essential." He and his staff members also use masks when they remove amalgam fillings, and the dental assistant uses a high-speed suction device. They use large amounts of water to cool the amalgam so less vapor will be released, and they cut the amalgam out in large chunks, to reduce the powdery cloud of minute mercury particles that is generated when amalgam is drilled out. Nabors also uses a new high-velocity suction device that he places in front of the patient to pull mercury vapor and powder away during the procedure. According to Dr. Nabors, if you decide to have your amalgams removed, the first thing you should ask a dentist is whether or not they use amalgam at all in their practice. "There are a number of dentists out there who say, 'I'll take your amalgams out for you and I'll put something other than amalgam in', but they still do amalgams. The best idea is to choose a dentist who is committed to mercury-free dentistry." Nabors has shown a great deal of commitment to healthful dentistry. In cooperation with the doctors he works with, M.D.s, chiropractors, and other practitioners, he has researched and found metal-free replacements for dental materials containing heavy metals.