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Make the SMART Choice to Protect Your Teeth!

Updated: Nov 20, 2019

What is SMART?

SMART is the Safe Mercury Amalgam Removal Technique, which is a set of safety measures to reduce mercury exposures during dental amalgam filling removal. These safety measures were developed as a result of scientific research collected by the International Academy of Oral Medicine and Toxicology (IAOMT).

Why does SMART matter?

All dental amalgams, also referred to as silver fillings, contain 50% mercury (a neurotoxin) which is constantly released in the form of an invisible vapor. This mercury is absorbed and retained in the body, particularly in the brain, kidney, liver, lung, and gastrointestinal tract. The process of drilling out amalgam filings releases even higher quantities of mercury vapor and fine particulates that can be inhaled and taken into the body. This is potentially harmful to patients, dentists, dental workers, and the fetuses of patients and all dental personnel.

The process of removing amalgam fillings can release dangerous levels of mercury..........

SMART safety measures for patient protection:

  • Slurry of charcoal, chlorella, or similar adsorbent

  • Full body, impermeable barrier

  • Full head/face/neck barrier

  • External air or oxygen delivered via nasal mask

  • Dental dam made with non-latex nitrile material

  • Saliva ejector

  • At source oral aerosol vacuum

  • Clean Up device (non essential but preferred)

  • Copious amounts of water spray

  • Conventional high speed evacuation device

  • Section amalgam into chunks and remove in large pieces

SMART safety measures for dentist and dental staff protection:

  • Protective gowns and covers

  • Non-latex nitrile gloves

  • Face shields and hair/head coverings

  • Either a properly-sealed, respiratory grade mask related to capture mercury or a positive pressure, properly-sealed mask providing air or oxygen

  • During the opening and maintenance of suction traps, dental staff should utilize the appropriate personal protection equipment

SMART safety measures for office and environmental protection:

  • An amalgam separator

  • High-volume air filtration system

  • If possible, open windows

  • Compliance with regulations addressing the proper handling, cleaning, and/or disposal of mercury-contaminated items

How can a dentist become SMART certified?

To obtain SMART certification, the dentist must complete IAOMT coursework related to mercury and the removal of amalgam fillings. The educational programming includes learning about the implementation of the rigorous safety measures, including the utilization of specific equipment. To maintain SMART certification, the dentist enrolls in the IAOMT program annually to review the safety measures. The dentist must also be a member of the IAOMT, which is an organization that promotes awareness of the biocompatibility of dental products and the concepts of biological dentistry.

Where can you learn more about SMART?

To learned more about the International Academy of Oral Medicine and Toxicology (IAOMT)'s Safe Mercury Amalgam Removal Technique, visit

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