Safe Amalgam Removal

Amalgam, which has been used in dental filling materials for years, consists of silver, mercury, and various metals. Amalgam is not a stable alloy. It is an alloy that works as a bond between metals and turns into a gas at room temperature. %50 of amalgam is mercury.

All dental amalgam restorations contain approximately 50% mercury, and studies have agreed that these fillings emit dangerous mercury vapor. Scientific research on dental mercury amalgam shows that dentists and dentistry workers expose their patients to mercury vapor or mercury-containing particles. Mercury can accumulate in our vital organs like the brain, kidney, large intestine, liver, thyroid gland, central nervous system, and adipose tissue. If mercury accumulates in the brain, its average half-life varies between 16 and 30 years.

It is also known that mercury vapor is released from fillings during brushing, cleaning, clenching, and chewing. Additionally, mercury is released during the making, replacement, and removal of amalgam teeth fillings. Amalgam fillers are still being used in developing countries, and there are many middle-aged and older patients with these fillings all around the world.

Mercury vapor and particles generated during dental amalgam removal can cause serious health problems for healthcare professionals and patients. For this reason, it is recommended to take special precautions during the removal of the amalgam filling. As Dentram Dental Clinics, we apply the Safe Mercury Amalgam Removal Technique accepted by the International Academy of Oral Diseases and Toxicology (IAOMT) in 2019 ( The Safe Mercury Amalgam Removal Technique, SMART).

Safe Mercury Amalgam Removal Technique (SMART)

The safe amalgam extraction technique was officially recommended by the International Academy of Oral Diseases and Toxicology (IAOMT) in 2016. It was last updated on July 19, 2019. In 2019, it was renamed Safe Mercury Amalgam Removal Technique (SMART), and dentists were informed by IAOMT to be certified as SMART. At Dentram Dental Clinics, we recommend this technique to our patients during amalgam filling removal.

Using the available scientific evidence, IAOMT has developed a wide range of safety recommendations for removing existing mercury amalgam fillings, including detailed preventive measures to be used for the procedure.

IAOMT’s proposals build on traditional safe amalgam extraction techniques such as mask use, water wash, high volume suction. These conventional strategies have only recently been identified in scientific research and supplemented with several additional protective measures.

• An amalgam separator should be installed, used, and stored so that it does not mix the mercury waste to wastewater discharged from dental clinics. For this, using amalgam separators might be a better idea.
• In the room where mercury fillings are removed, high-volume vacuum devices that can absorb mercury vapor and amalgam particles that may occur during the removal of one or more mercury fillings should be used.
• In the room where mercury fillings are removed, high-volume vacuum devices that can absorb mercury vapor and amalgam particles should be used.
• If possible, windows should be opened to reduce the concentration of mercury in the air.
• A charcoal slurry, chlorella, or similar absorbent should be given to the patient to rinse and swallow before the procedure.
• Protective gowns should be used for the dentist, dental worker, and the patient. All that is present in the room must be protected. Because particles occurring in large quantities during the procedure may not be absorbed by the suction devices. It has been proven that these particles can spread from the patient’s mouth to his hands, arms, face, chest, and other parts of the dentist and patient’s body.
• Non-latex nitrile gloves should be used.
• Masks and hair caps should be used by the dentist and any dental worker in the room.
• A properly sealed respirator-grade mask or a properly sealed mask that supplies air or oxygen to capture mercury or positive pressure should be used by the dentist and any dental worker in the room.
• To protect the patient’s skin and clothing, a barrier covering the body should be used under or around the dental isolation rubber, as well as a barrier that will cover the head/face/neck completely.
• External air or oxygen delivered to the patient through a nasal mask should also be used so that the patient does not inhale any mercury vapor or amalgam particles during the procedure. (The patient can get oxygen by wearing a nasal mask.)
• A dental isolation rubber made of non-latex nitrile material should be placed in the patient’s mouth so that it cannot be opened.
• A saliva ejector should be placed under the rubber dam to reduce the patient’s exposure to mercury.
• During the removal of the amalgam filling, the dentist should use the oral aerosol vacuum at the source very close to the work area to reduce mercury exposure.
• The heat generated during the removal of amalgam increases the release of mercury. Therefore, during the dismantling of amalgam, excessive irrigation should be done to prevent heat increase.
• Amalgam should be cut into pieces and removed as large amounts as possible using a small diameter carbide bur.
• After the removal is complete, the patient’s mouth should be thoroughly rinsed with water and then rinsed with a charcoal powder, chlorella, or similar absorbent material.
• Proper disposal of mercury-contaminated components, clothing, equipment, room surfaces, and the dentist chair is required.
• While cleaning the filters in the dental chair or suction unit, the dental worker should also wear the appropriate personal protection equipment described above.
• As a safety precaution, the IAOMT does not recommend removing amalgam fillings in pregnant or breastfeeding women. IAOMT also does not suggest that pregnant or breastfeeding women perform tasks that would disrupt the structure of amalgam fillings (including their removal).