What is Dental Amalgam?

Dental amalgam restorations — often called “silver fillings” — are composed of a mixture of metals, including elemental mercury combined with silver, copper, tin, and zinc. Amalgam has been used in dentistry for decades and is still an accepted restorative material in many practices.

When removal of amalgam restorations is clinically indicated, it is important that the procedure is performed using standardized safety protocols to minimize exposure to mercury vapor and particulate matter.

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Why Use SMART Protocols?

The Safe Mercury Amalgam Removal Technique (SMART) was developed by the International Academy of Oral Medicine and Toxicology (IAOMT) to provide a structured, evidence‑informed approach for removing amalgam restorations while minimizing potential exposure during the procedure. SMART certification indicates that a clinician has completed specific training in these protocols.

SMART protocols include:

• Use of high‑volume evacuation and supplemental air filtration

• Separation and isolation techniques

• Protective barriers and oxygen supplementation

• Careful instrumentation to limit vapor release

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What Does the Research Say?

Some peer‑reviewed studies indexed on PubMed have investigated aspects of mercury exposure related to dental amalgam:

• A long‑term clinical study found that urinary mercury levels were higher in individuals with amalgam restorations compared with those without; differences diminished after amalgam removal.

• A systematic review of mercury exposure from dental amalgam concluded that while amalgam contributes to low‑level mercury exposure, the clinical significance of this exposure remains under investigation, and existing evidence does not establish that amalgam fillings cause systemic disease.

• In vitro studies have documented the release of mercury vapor when amalgam is mechanically manipulated, which underscores the importance of protective protocols during removal.

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These findings reflect ongoing research and scientific discussion within oral health and toxicology literature but do not confirm that amalgam fillings by themselves directly cause specific health conditions.

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Our Approach to Amalgam Removal

At Biological Dentistry of Southern California, all amalgam removal procedures are performed by SMART‑certified clinicians using standardized safety protocols. Our process is designed to protect patients, clinical staff, and the practice environment during treatment.

We provide individualized evaluation and treatment planning, and removal is recommended only when clinically indicated. Patients are informed of the rationale for removal, potential risks and benefits, and alternative restorative options, such as metal‑free composite or ceramic restorations.