SMART Mercury Amalgam Removal: Safe Techniques for Healthier Smiles

rocess matters enormously. Done incorrectly, amalgam removal can expose you to more mercury than leaving the fillings in place. Done correctly, using the SMART (Safe Mercury Amalgam Removal Technique) protocol, the process protects both you and your dental team.

At Dakota Dental and Wellness Center in Apple Valley, Minnesota, we follow the strict SMART protocol established by the International Academy of Oral Medicine and Toxicology (IAOMT) for every mercury amalgam removal. This comprehensive approach ensures the safest possible removal process, giving you peace of mind as you transition to healthier dental materials.

Understanding Mercury Amalgam Fillings

Before discussing removal, it’s important to understand what amalgam fillings are and why concerns exist.

What’s in Amalgam Fillings?

Dental amalgam is a mixture of metals including:

  • Approximately 50% mercury
  • 25% silver
  • 15% tin
  • 10% copper
  • Small amounts of zinc and other trace metals

Mercury is used because it binds these metals together and keeps the filling soft enough to pack into the prepared tooth cavity, where it then hardens.

The Mercury Controversy

The safety of dental amalgam has been debated for decades. The dental establishment, including the American Dental Association, maintains that amalgam fillings are safe for most people. However, growing research and patient concerns have led many countries to restrict or ban amalgam use.

The primary concern is mercury vapor. Amalgam fillings constantly release small amounts of mercury vapor, which increases when you chew, grind your teeth, drink hot beverages, or have the fillings drilled during removal or replacement. This vapor is absorbed through your lungs and can accumulate in body tissues over time.

According to the World Health Organization, there is no safe level of mercury exposure, and dental amalgam is the primary source of mercury exposure for most people with fillings.

Research published in NeuroToxicology found measurable levels of mercury in the blood and urine of people with amalgam fillings, with levels correlating to the number and surface area of fillings.

Who Should Consider Amalgam Removal?

Not everyone needs to rush out and have their amalgam fillings removed. However, you might want to consider removal if:

  • Your fillings are failing: Cracked, leaking, or deteriorating fillings need replacement anyway. When that time comes, choosing biocompatible materials makes sense.
  • You’re pregnant or planning pregnancy: Mercury can cross the placental barrier. Many expectant mothers prefer to eliminate unnecessary mercury exposure, though removal should typically wait until after pregnancy.
  • You have health sensitivities: Some people are particularly sensitive to mercury or show signs of metal sensitivity.
  • You’re pursuing a holistic health approach: If you’re working to reduce toxic exposures as part of overall wellness, amalgam removal may align with your health goals.
  • You have many large fillings: Greater filling surface area means more vapor release.

At Dakota Dental, we never pressure patients regarding amalgam removal. We provide information and support whatever decision you make. If you do choose removal, we ensure it’s done with maximum safety precautions.

The Risks of Improper Amalgam Removal

Here’s the critical issue: drilling out amalgam fillings without proper precautions can expose you to mercury levels far higher than you’d experience simply leaving them in place.

When a dental drill contacts amalgam, it creates massive amounts of mercury vapor and tiny particles. Without protective measures, you can inhale this vapor, swallow particles suspended in water and saliva, and absorb mercury through your mucous membranes.

Research has shown that mercury levels in blood and urine can spike significantly after amalgam removal without proper protection. This is why the removal technique matters so much more than whether or not to remove the fillings.

What is the SMART Protocol?

The SMART protocol was developed by the International Academy of Oral Medicine and Toxicology (IAOMT), an organization dedicated to science-based biological dentistry. After extensive research, they created a comprehensive set of recommendations to minimize mercury exposure during amalgam removal.

SMART stands for Safe Mercury Amalgam Removal Technique, and it’s the gold standard for protecting patients, dental staff, and the environment during amalgam removal procedures.

The protocol includes numerous specific steps that work together to minimize exposure from three pathways: inhalation of vapor, ingestion of particles, and absorption through mucous membranes.

SMART Protocol Steps We Follow at Dakota Dental

At Dakota Dental, we’ve implemented every element of the SMART protocol. Here’s what happens during your safe amalgam removal:

Pre-Removal Preparation

Before we even begin the removal process, we take important preparatory steps:

Nutritional Support: We may recommend antioxidant supplementation in the days before your appointment. Vitamins C and E, selenium, and other antioxidants can help your body process any mercury exposure. We’ll discuss specific recommendations based on your individual needs.

Timing Considerations: We schedule adequate time for your appointment so we’re never rushed. Careful, methodical removal is essential.

Patient Education: We thoroughly explain what will happen during your procedure so you feel informed and comfortable.

Protective Equipment for Patients

On the day of your removal, we ensure you’re fully protected:

Rubber Dam Isolation: We place a rubber dam (a latex or non-latex sheet) that isolates the teeth being worked on from the rest of your mouth. This prevents you from swallowing mercury particles or having them contact your mucous membranes.

Oxygen Nasal Mask: You’ll breathe pure oxygen through a nasal mask throughout the procedure. This prevents you from breathing any mercury vapor that might escape into the room.

Protective Draping: We cover your clothing, hair, and exposed skin to prevent any particle contact.

Eye Protection: Safety glasses protect your eyes from particles and the high-volume water spray we use.

Advanced Equipment

We use specialized equipment designed for safe amalgam removal:

High-Volume Evacuator: This powerful suction device (separate from the standard dental suction) captures mercury vapor and particles right at the source before they can spread. We position it just millimeters from the filling being removed.

Copious Water Irrigation: We flood the work area with cool water throughout the drilling process. This dramatically reduces vapor formation (mercury vaporizes at higher temperatures) and helps flush particles away.

External Air Filtration: Our office uses mercury vapor filters in the ventilation system to clean the room air during and after amalgam removal.

Specialized Drill Technique: We use specific drilling patterns and chunking techniques designed to remove amalgam in the largest possible pieces, minimizing the creation of particles and vapor.

During Removal

As we remove your amalgam filling, we employ precise techniques:

Sectioning the Amalgam: Rather than grinding the entire filling into dust, we carefully section it and remove it in large chunks whenever possible. This dramatically reduces vapor and particle creation.

Continuous Irrigation and Suction: The work area is constantly flooded with cool water while high-volume suction captures everything.

Minimizing Heat: We use minimal drilling speed and pressure to reduce heat generation, as heat increases mercury vaporization.

Immediate Disposal: Removed amalgam pieces are immediately placed in a sealed container for proper medical waste disposal, never into regular trash.

Protective Equipment for Staff

Our team’s safety is equally important:

Respiratory Protection: Our staff wear specialized respirators that filter mercury vapor.

Protective Clothing: Gowns, gloves, and face shields protect our team from exposure.

Environmental Monitoring: We monitor room air quality to ensure safe working conditions.

Post-Removal Care

After the amalgam is completely removed:

Thorough Rinsing: We carefully rinse your mouth multiple times to remove any residual particles.

Air Suction: Before removing the rubber dam, we use high-volume suction around it to capture any vapor or particles.

Patient Oxygen Continuation: We keep you on oxygen for a few minutes after the dam is removed.

Charcoal Rinse: We may have you rinse with activated charcoal, which can bind to mercury particles.

Post-Procedure Recommendations: We provide guidance on nutrition and supplements that support mercury detoxification.

Biocompatible Replacement Materials

Once your amalgam filling is safely removed, we replace it with biocompatible, tooth-colored materials that are free of mercury and other toxic metals.

Composite Resins

For most fillings, we use high-quality composite resins that:

  • Match your natural tooth color
  • Bond directly to tooth structure, providing excellent seal and strength
  • Contain no mercury or metals
  • Can be placed in a minimally invasive manner, preserving maximum tooth structure

We carefully select BPA-free composite materials to avoid replacing one concern with another.

Ceramic Restorations

For larger fillings or when maximum biocompatibility is desired, we offer ceramic options:

Porcelain Inlays and Onlays: These are crafted in a dental laboratory from pure ceramic. They’re extremely biocompatible, very durable, and beautifully aesthetic.

Same-Day Ceramic Restorations: In some cases, we can create and place ceramic restorations in a single visit.

All our replacement materials are tested for biocompatibility and chosen for their track record of safety and longevity.

The Benefits of Mercury-Free Dentistry

Patients who have their amalgam fillings safely removed often report various benefits:

Peace of Mind

Simply knowing you’ve eliminated a source of mercury exposure provides psychological comfort. Many patients feel they’ve taken an important step in protecting their long-term health.

Improved Aesthetics

Tooth-colored restorations look completely natural. Your smile will show white teeth, not dark metal fillings. Many patients are surprised by how much better their smile looks without the silver filling

s visible when they laugh or talk.

Better Fit and Seal

Modern bonded restorations actually seal and protect teeth better than amalgam. Composite materials bond to tooth structure, creating a tight seal that helps prevent future decay.

Amalgam, by contrast, doesn’t bond to teeth. It’s held in place by mechanical retention, which requires removing healthy tooth structure to create undercuts. Over time, amalgam expands and contracts differently than natural tooth structure, which can cause cracks.

Preservation of Tooth Structure

Because composite bonds to teeth, we can be much more conservative in our tooth preparation. We remove only decayed tooth structure, preserving as much healthy tooth as possible. This contributes to better long-term tooth survival.

Potential Health Improvements

While results vary individually, some patients report health improvements after mercury amalgam removal. These might include:

  • Reduced headaches
  • Improved energy levels
  • Better concentration
  • Decreased sensitivity or metallic taste
  • Resolution of certain chronic symptoms

It’s important to note that scientific studies on these outcomes show mixed results. We never promise specific health improvements, but we support your right to make informed choices about your dental materials.

Environmental Responsibility

Mercury amalgam doesn’t just affect patient health. It’s also an environmental concern.

Dental offices are the largest source of mercury entering municipal wastewater systems. When amalgam enters sewage systems, mercury can eventually contaminate waterways and accumulate in fish and wildlife.

At Dakota Dental, we’re committed to environmental responsibility:

Amalgam Separators: We use certified amalgam separator systems that capture mercury waste before it enters the sewer system.

Proper Waste Disposal: All amalgam waste is collected and sent to certified medical waste facilities for proper disposal or recycling.

SMART Protocol Compliance: By minimizing vapor release, we also minimize environmental contamination.

Mercury-Free Practice: We haven’t placed new amalgam fillings in years. We’ve committed to being a mercury-free practice, using only biocompatible materials for new restorations.

By choosing safe amalgam removal, you’re not only protecting your own health but also contributing to environmental protection.

What to Expect: The Removal Process

If you decide to have your amalgam fillings removed, here’s what you can expect at Dakota Dental:

Initial Consultation

We’ll start with a comprehensive examination and discussion. We’ll:

  • Evaluate the condition of your existing fillings
  • Discuss your health history and any sensitivities
  • Explain the SMART protocol in detail
  • Answer all your questions
  • Create a treatment plan that works for you

If you have multiple amalgam fillings, we’ll determine the best sequence for removal. We typically don’t remove all fillings in one appointment, as this could create excessive mercury exposure despite our precautions.

Appointment Day

On the day of your removal:

  • Plan for a slightly longer appointment than a typical filling
  • Wear comfortable clothing (we’ll provide protective draping)
  • Consider having someone drive you if you’re receiving sedation (we offer sedation options for patient comfort)

The actual removal process is comfortable and straightforward. With local anesthesia, you won’t feel any discomfort. The oxygen nasal mask makes breathing easy and pleasant.

After Your Appointment

Following amalgam removal:

  • Your mouth may feel numb for a few hours from the local anesthetic
  • We’ll provide specific aftercare instructions
  • We may recommend nutritional supplements to support your body’s natural detoxification processes
  • We’ll schedule your next appointment if you have additional fillings to replace

Most patients report that the process was much easier than they anticipated and appreciate the thoroughness of our safety protocols.

Frequently Asked Questions

Is SMART amalgam removal covered by insurance?

Most dental insurance plans cover the replacement of defective or failing fillings. If your amalgam fillings need replacement due to decay, cracks, or deterioration, insurance typically covers the replacement filling at standard rates. The additional safety protocols may not be separately covered, but the overall cost is comparable to standard filling replacement.

We’ll help you understand your benefits and can also discuss our Kleer membership plan for patients without traditional insurance.

How many fillings can be removed at once?

While it’s technically possible to remove multiple fillings in one visit, we typically recommend removing no more than 1-3 fillings per appointment. This minimizes total mercury exposure and makes the appointment more comfortable. The exact number depends on the size and location of the fillings.

Should I remove amalgam fillings if they’re not causing problems?

This is a personal decision. If your fillings are in good condition and you have no sensitivities or health concerns, there’s no emergency to remove them. However, if you’re already planning to have them replaced (due to age, cracks, or decay), using the SMART protocol for removal makes sense.

Many patients choose to gradually replace their amalgam fillings over time as they need replacement anyway, taking the opportunity to upgrade to biocompatible materials.

What about mercury detoxification?

Despite our extensive safety protocols, your body may process small amounts of mercury during removal. We can discuss nutritional support strategies to help your body’s natural detoxification pathways function optimally. This might include specific supplements, dietary recommendations, and adequate hydration.

However, we don’t make medical detoxification recommendations beyond nutritional support. If you have significant health concerns related to mercury, we recommend working with a physician who specializes in environmental medicine.

Can pregnant women have amalgam removed?

We strongly recommend waiting until after pregnancy and breastfeeding to remove amalgam fillings unless they require emergency replacement. Even with perfect safety protocols, it’s best to avoid any elective mercury exposure during pregnancy.

If an amalgam filling breaks or develops severe decay during pregnancy and requires emergency replacement, we can safely replace it using SMART protocols. We’ll work closely with your obstetrician in these situations.

SMART Removal as Part of Holistic Care

Safe mercury amalgam removal is one component of our comprehensive holistic dental approach at Dakota Dental. We believe your dental materials should support, not compromise, your overall wellness.

This philosophy extends to all our services. We offer natural healing options like ozone therapy, metal-free ceramic implants, and comprehensive wellness services because we’re committed to providing dental care that honors your whole body.

When you choose Dakota Dental, you’re choosing a practice that:

  • Prioritizes safety in every procedure
  • Uses biocompatible materials
  • Respects your concerns and choices
  • Stays current with the latest research and protocols
  • Views dentistry as an integral part of overall health

Learn more about how we connect oral health to total body wellness and discover the difference a holistic approach makes.

Take the Next Step Toward Mercury-Free Dentistry

If you have amalgam fillings and you’re ready to explore safer, more biocompatible alternatives, we’re here to help. At Dakota Dental and Wellness Center, we’ve made the commitment to provide the safest possible amalgam removal process, giving you peace of mind during your transition to mercury-free dentistry.

Our experienced team has the training, equipment, and dedication to follow every element of the SMART protocol. We’ll never rush through the process or cut corners with your safety. Your health and the health of our team are our top priorities.

Whether you have one filling to replace or a mouth full of amalgam, we’ll create a personalized plan that works for your schedule, budget, and health goals.

Ready to schedule your SMART mercury amalgam removal consultation?

Call Dakota Dental today at 952-431-5774 or book your appointment online. We’re located at 14682 Pennock Avenue in Apple Valley, MN, proudly serving families throughout the Twin Cities area.

Let’s work together to replace those old mercury fillings with beautiful, biocompatible restorations that support your long-term health. Your journey to mercury-free dentistry starts here.