Safe Mercury Amalgam Removal Technique (SMART) Recommendations

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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).

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.

To read the SMART protocol recommendations with scientific references, click here.
To download a Checklist of the protocol recommendations for patient-dental discussion, click here.

SMART PATIENT – DENTIST CHECKLIST

PATIENT PROTECTION	DENTIST / STAFF PROTECTION
Slurry of charcoal, chlorella, or similar adsorbent for patient to rinse and swallow before the procedure Full body, impermeable barrier, as well as full head/face/neck barrier under/around the dam External air or oxygen delivered via a nasal mask for the patient OR via nasal cannula completely covered with an impermeable barrier Dental dam made with non-latex nitrile material placed and properly sealed in the patient’s mouth Saliva ejector placed under the dental dam At source oral aerosol vacuum in close proximity to patient’s mouth Clean Up device (not essential but preferred) Copious amounts of water to reduce heat and a conventional high speed evacuation device to capture mercury discharges Section amalgam into chunks and remove in as large of pieces as possible, using a small diameter carbide drill After removal, the patient’s mouth should be thoroughly flushed with water and then rinsed out with a slurry of charcoal, chlorella or similar adsorbent	Protective gowns and covers for the dentist and dental personnel Non-latex nitrile gloves for the dentist and dental personnel Face shields and hair/head coverings for the dentist and dental personnel Either a properly-sealed, respiratory grade mask rated to capture mercury or a positive pressure, properly-sealed mask providing air or oxygen for the dentist and dental personnel During the opening and maintenance of suction traps in operatories or on the main suction unit, dental staff should utilize the appropriate personal protection equipment OFFICE & ENVIRONMENTAL PROTECTION An amalgam separator that is properly installed, utilized, and maintained High-volume air filtration system (such as an at source oral aerosol vacuum) If possible, open windows to reduce the mercury concentration in the air Compliance with federal, state, and local regulations addressing the proper handling, cleaning, and/or disposal of mercury-contaminated components, clothing, equipment, surfaces of the room, and flooring in the dental officemn 1 Value

PATIENT PROTECTION

DENTIST / STAFF PROTECTION

Slurry of charcoal, chlorella, or similar adsorbent for patient to rinse and swallow before the procedure
Full body, impermeable barrier, as well as full head/face/neck barrier under/around the dam
External air or oxygen delivered via a nasal mask for the patient OR via nasal cannula completely covered with an impermeable barrier
Dental dam made with non-latex nitrile material placed and properly sealed in the patient’s mouth
Saliva ejector placed under the dental dam
At source oral aerosol vacuum in close proximity to patient’s mouth
Clean Up device (not essential but preferred)
Copious amounts of water to reduce heat and a conventional high speed evacuation device to capture mercury discharges
Section amalgam into chunks and remove in as large of pieces as possible, using a small diameter carbide drill
After removal, the patient’s mouth should be thoroughly flushed with water and then rinsed out with a slurry of charcoal, chlorella or similar adsorbent

Protective gowns and covers for the dentist and dental personnel
Non-latex nitrile gloves for the dentist and dental personnel
Face shields and hair/head coverings for the dentist and dental personnel
Either a properly-sealed, respiratory grade mask rated to capture mercury or a positive pressure, properly-sealed mask providing air or oxygen for the dentist and dental personnel
During the opening and maintenance of suction traps in operatories or on the main suction unit, dental staff should utilize the appropriate personal protection equipment

OFFICE & ENVIRONMENTAL PROTECTION

An amalgam separator that is properly installed, utilized, and maintained
High-volume air filtration system (such as an at source oral aerosol vacuum)
If possible, open windows to reduce the mercury concentration in the air
Compliance with federal, state, and local regulations addressing the proper handling, cleaning, and/or disposal of mercury-contaminated components, clothing, equipment, surfaces of the room, and flooring in the dental officemn 1 Value