Safe Mercury Amalgam Removal Technique
(SMART Dentistry)
We offer Safe Mercury Amalgam Removal Technique (SMART) for patients who need to replace old or failing silver fillings and want added safety measures during the process.
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Dental amalgam fillings contain mercury, which can release vapor—particularly during removal. The Safe Mercury Amalgam Removal Technique (SMART) is a protocol developed by the International Academy of Oral Medicine and Toxicology (IAOMT) to reduce mercury exposure for patients, dental staff, and the environment.
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SMART dentistry uses multiple layers of protection that go beyond standard filling removal, focusing on airway protection, isolation, vapor capture, and safe waste management.
What Is SMART Dentistry?
SMART dentistry refers to the use of IAOMT-recommended protocols when removing mercury amalgam fillings. These protocols are designed to minimize exposure to mercury vapor and particles by using:
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A dental dam to isolate the tooth
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High-volume suction positioned near the mouth
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Additional air filtration and ventilation
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Continuous water cooling during removal
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Sectioning the amalgam into large pieces instead of grinding
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Protective barriers for the patient and dental team
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Proper disposal using EPA-approved amalgam separators​
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When appropriate, amalgam fillings are replaced with mercury-free, biocompatible dental materials, such as composite resin or ceramic restorations.
Our approach to amalgam removal is conservative, evidence-informed, and patient-centered. We recommend removal only when clinically necessary and tailor each treatment plan to your individual oral health needs.
FAQs
What is Safe Mercury Amalgam Removal Technique (SMART)?
Safe Mercury Amalgam Removal Technique (SMART) is a set of clinical guidelines developed by the IAOMT to reduce mercury exposure during dental amalgam removal. It focuses on safety for patients, dental professionals, and the environment.
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Why is mercury a concern in silver fillings?
Dental amalgam fillings are made with approximately 50% mercury combined with other metals. During drilling and removal, mercury vapor and particles can be released. SMART protocols are designed to minimize inhalation and ingestion of mercury during this process.
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Is SMART amalgam removal safer than traditional removal?
SMART uses additional protective measures beyond conventional removal techniques, including enhanced suction, isolation, and air filtration. While no method eliminates exposure entirely, SMART significantly reduces it.
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Is SMART required by law?
No. SMART is not a government mandate, but a voluntary best-practice protocol followed by dentists who prioritize mercury exposure reduction during amalgam removal.
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Who should consider SMART amalgam removal?
Patients may consider SMART removal if they:
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Have failing or cracked amalgam fillings
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Have decay under an existing silver filling
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Need replacement for structural or functional reasons
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Prefer mercury-free dentistry
We do not recommend removing intact, healthy amalgam fillings without a clinical reason.
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Is SMART removal safe during pregnancy?
As a precaution, amalgam removal is generally avoided during pregnancy or breastfeeding unless absolutely necessary. Timing and alternatives are discussed on an individual basis.
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What replaces mercury amalgam fillings?
After removal, fillings are typically replaced with mercury-free dental materials, such as:
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Composite resin (tooth-colored fillings)
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Ceramic or porcelain restorations
Material choice depends on tooth location, bite forces, esthetics, and long-term durability.
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Does SMART completely eliminate mercury exposure?
No dental procedure can guarantee zero exposure. However, SMART protocols are designed to significantly reduce mercury vapor and particulate exposure compared to unmanaged removal.
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Is SMART part of biological or holistic dentistry?
SMART is often used in biological, holistic, or integrative dental practices, but it can be performed independently. It specifically addresses safe amalgam removal, not other treatment philosophies.
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How do I know if a dentist follows SMART protocols?
Dentists trained in SMART may complete IAOMT education and certification. Patients are encouraged to ask their dentist what safety measures are used during amalgam removal and why.