The SMART Choice

Safe Mercury Amalgam Removal Technique

Make the SMART choice to protect your health by learning more about
the Safe Mercury Amalgam Removal Technique (SMART).

Why should I care?

All silver-colored dental fillings, also called amalgams, contain approximately 50% mercury.

Mercury is harmful to human health and the environment. Mercury is continuously released from amalgam fillings, and it is absorbed and retained in the body, particularly in the brain, kidney, liver, lung, and gastrointestinal tract. Although a number of other countries have banned or limited the use of silver amalgam fillings, dental mercury is currently used on about 45% of direct dental restorations worldwide, including in the USA.

How much mercury is released
from silver amalgam fillings?

Removal of silver amalgam fillings without safety measures can potentially result in everyone in the dental room exceeding the safety limit of mercury exposure.

The amount of mercury released from fillings depends on the number of fillings a patient has and other circumstances, such as chewing, teeth-grinding, and the consumption of hot liquids. Mercury is also known to be released at higher levels during the placement, replacement, and removal of dental mercury amalgam fillings.

Some patients require the removal of silver amalgam fillings due to device failure, while others opt for the removal of silver amalgam fillings because of cosmetic purposes (white-colored fillings match the teeth better) or because they prefer to have dental fillings that do not contain mercury. However, removal of silver amalgam fillings without safety measures can potentially result in everyone in the dental room exceeding the safety limit of mercury exposure. Obviously, the danger to the patient is the greatest since mercury is being released directly into the mouth. Also, dentists and dental staff not applying safety techniques can be routinely exposed to these mercury releases.

What is the Safe Mercury Amalgam Removal Technique (SMART)?

SMART Certified, “mercury-safe” dentists apply special techniques to remove mercury fillings.

While “mercury-free” dentists no longer place amalgam fillings and use available mercury-free alternatives, “mercury-safe” dentists apply special techniques to remove existing amalgam fillings. Based on up-to-date scientific research, the IAOMT has developed rigorous recommendations for removing existing dental mercury amalgam fillings to assist in reducing the potential negative outcomes of mercury exposure to patients, dental professionals, dental students, office staff, and others. The IAOMT’s recommendations are known as the Safe Mercury Amalgam Removal Technique (SMART).

To read the SMART protocol recommendations with scientific references, click here.

Note that due to mercury releases, polishing, placement, removal, or any disruption of a dental mercury amalgam filling should not be should not be conducted upon patients who are pregnant or lactating and should not be done by dental personnel who are pregnant or lactating.

What are the mercury-free alternatives
for dental fillings?

Obviously, once amalgams have been removed, they must be replaced with a different dental filling material. Most consumers choose direct composite fillings because the white coloring matches the tooth better and the cost is considered affordable.

In the past, a common argument against composite fillings was that they were not as durable as amalgam. However, recent studies have debunked this claim. Composite fillings have also been criticized because some of them contain the controversial material bisphenol-A (BPA). Dentists have a variety of opinions about the safety of BPA and other types of bisphenol, such as Bis-GMA and Bis-DMA; however, there are new types of composites that do not contain these ingredients.

There has likewise been concern about glass ionomers, many of which contain fluoride.

Patients who are concerned about the material in their dental fillings often choose to speak with their dentists about using a material that does not contain the ingredient.

Another option for dental patients concerned about which mercury-free alternative to use as a filling material is to do their own research and/or take a dental biocompatibility test. Indeed, the IAOMT suggests that composites and all replacement materials should also be assessed for safety and biocompatibility with special consideration for all populations and all known risk factors.

                    Mercury Amalgam Fillings

                    Mercury-Free Composite Filling

How do I make the SMART choice to protect my health?

  1. Watch the videos and read all the information on this webpage.
  2. Download our checklist for dentists and patients to discuss safe mercury amalgam filling removal here.
  3. If you are a patient: Share the SMART choice page with your dentist, doctor, family, and friends: www.thesmartchoice.com
  4. If you are a dentist: Learn more about becoming certified in the Safe Mercury Amalgam Removal Technique (SMART) by clicking here.
  5. Search for an IAOMT SMART-certified dentist by clicking here.
  6. Note that due to mercury releases, polishing, placement, removal, or any disruption of a dental mercury amalgam filling should not be should not be conducted upon patients who are pregnant or lactating and should not be done by dental personnel who are pregnant or lactating.  

Disclaimer: The IAOMT makes no representation as to the quality or scope of a member’s medical or dental practice, or as to how closely the member adheres to the principles and practices advocated by the Academy. You must use your own best judgment when using the services of any health care practitioner.