The U.S. Food and Drug Administration (FDA) reports that while mercury amalgam has been in use for decades to fill the teeth, there are risks associated with it and therefore, the utmost care must be taken while filling and removing it from the teeth. 

Safe Mercury Amalgam Removal Technique (SMART) is a safety protocol from IAOMT (International Academy of Oral Medicine and Toxicology).

This page discusses how a dentist removes mercury according to the SMART protocol. Continue reading to know the benefits, cost, procedure, risks, and more about it.

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Understanding Silver or Mercury Amalgam

Tooth decay is likely to occur to anyone at any time. A dentist can replace the decayed portion with a long-lasting material to avoid further tooth damage.

According to Colgate’s website, dental amalgam (also known as silver fillings) is thought to be composed of mercury amalgam. But in actuality, tin, mercury, copper, and silver are used to make these fillings,

National Health Services (UK) mentions that cast gold, silver amalgam, and composite fillings are utilized for dental fillings.

Avoiding Risks of Mercury Amalgam Filling Removal

Research studies have explained how mercury can release during replacement, placement, and removal of dental amalgam fillings. For this reason, mercury-based fillings are best avoided. It is also why extreme care is required to avoid the proliferation of mercury particles or vapors inside the mouth or in the room where the procedure is underway.

SMART for Patient and Other Stakeholders’ Safety

Though filling a tooth with amalgams is a practical solution, its risks have long been a subject of debate. People with this type of fillings should consider a replacement.

Mercury-based amalgam filing(s) should be replaced with the composite dental filling because it is safer and it can be colour-matched to the tooth.

This process should be performed with great care as mercury particles can spread into the mouth, nose, and other areas of the patient and other people in the room.

To deal with the risks posed by this sensitive procedure, different standards exist and SMART is one of the leading protocols to avoid possible risks.


The safety of the patient, doctor, and people around is at the heart of this meticulous process. Some notable advantages have been enlisted below:

  • Your health is no longer at risk due to the presence of mercury in the mouth.
  • The presence of an alternative filling material gives peace of mind to the patient. 
  • There are filling materials that have teeth-like color and that look totally natural. 


Though anyone who wants to remove dental amalgam can have it, there are some rules that must be considered. You can be a good candidate for SMART if the following apply to you: 

  • You have mercury amalgam dental filling.
  • You do not want to compromise your safety. 
  • You know the risks that exist during the procedure. 


Our professionals follow all SMART guidelines from IAOMT to remove amalgam from the tooth or teeth. We have all the necessary machines, equipment, and tools to perform this procedure.

To reduce the concentration of mercury in the air, windows stay open during the procedure. The patient will give charcoal or another absorbent before the treatment.

Though this technique requires careful planning and arrangements, it comprises of many small steps. We can divide the treatment into three parts:

Part 1: Initial Preparation: Initial preparation is an important part and we try to ensure the following precautionary measures before we get started:

  • The dentist, dental staff, and the patient cover themselves with protective gowns. 
  • The dentist and dental staff wear non-latex nitrile gloves to avoid mercury contamination.
  • The dentist and dental staff will also wear activated charcoal masks, head coverings, and face shields.
  • The patient’s face and all other body parts will be covered with an impermeable barrier. 
  • To avoid inhalation of mercury particles, a nasal mask is used to deliver external oxygen to the patient. Alternatively, a nasal cannula can be used. 
  • The patient’s mouth will be properly sealed using a non-latex nitrile dental dam. 
  • To avoid inconvenience, saliva ejectors will be inserted under the dental dam. 

Part 2: Amalgam Removal: It is important to use thin drills during the procedure to remove mercury as a single large piece. This goal can be achieved by trying to separate amalgam from the tooth. By doing so, the risk of dividing mercury into small pieced reduces. Moreover, a vast amount of water will be used to reduce the level of heat produced during the procedure. Furthermore, a conventional high-speed evacuation device will be used to gather mercury particles to reduce mercury levels in the surroundings.

Part 3: Final Teeth Cleaning: After complete removal of amalgam, the doctor will flush the mouth thoroughly with water followed by rinsing out with charcoal. All items that have been contaminated with mercury will be properly disposed of; this includes instruments, containers, clothing, and equipment. The items that were not directly exposed to mercury will be cleaned toughly.

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Pre-Op Care

The patient does not have to make many preparations before having this treatment. It is required to check all details about the treatment and risks involved during and after having it.


The patient will stay safe during the treatment and there is not much care required afterward. The new filling will require the patient not to chew hard items for one to two days.
Each person has distinct concerns and goals which means different treatment scope for different patients. Furthermore, the following factors also influence the SMART’s cost:

  • The size of each mercury filling(s)
  • The location of the metal filling(s)
  • The number of fillings to be removed 

We can share pricing details if you visit us for a short consultation.

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SMART – Dental Amalgam Removal FAQ’s

Is it safe to have amalgam fillings removed?

Removal involves risks but there are safer ways using which one can reduce possible risks. Safe protocols have been designed to remove dental fillings that can harm the mouth and other areas. Make sure your dentist use the safest protocols for filling removal.

Which dental filling is the safest?

Amalgam dental fillings or silver fillings are among the safest options. Researchers have elaborated that these fillings are durable and safe. In general, copper, silver, mercury, tin, and other metals can be used to make this type of dental fillings.

Is dental amalgam safe?

Yes, it is a safe and long-lasting option because the metals used to make amalgam dental fillings are safe to be used inside the mouth. Copper, silver, mercury, tin and other metals can be used to make them.

How are fillings removed?

A specific method of dental filling removal should be used based on the type of dental filling that needs to be removed. If you want to have your dental fillings removed, make sure your dentist uses safe protocols to do that.

Consult an Expert

In essence, SMART is the smart choice when it comes to removing mercury fillings. You can speak to one of our dentists who performs SMART at Euromed Clinic Dubai. Scheduling an appointment has become easy. Just call us or fill our online form before you pay us a visit.

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