SMART – Safe Mercury Amalgam Removal Technique

We take great pride in being the only office in Costa Rica with certified SMART doctors designated by the IAOMT (International Academy of Oral Medicine and Toxicology). Dental amalgam restorations, commonly referred to as silver fillings, contain a significant amount of mercury, approximately 50%. These fillings release mercury vapor more readily during activities such as brushing, cleaning, chewing, and teeth clenching. Mercury is stored in various parts of the body including the liver, kidneys, brain, central nervous system, large intestine, and thyroid gland. It is worth noting that the half-life of mercury in the brain is between 16 to 30 years. Proper amalgam removal is crucial as an unsafe removal process can release harmful mercury vapor and particles that pose risks to the patient, dentist, staff, and the environment.

There are several advantages associated with the removal of amalgam fillings due to the potential risks posed by the metallic components found in amalgam. These benefits include:

1. Installing an amalgam separator to collect mercury waste.
2. Using filtration systems, such as oral aerosol vacuums, to remove mercury vapor and particles.
3. Providing patients with an absorbent rinse, such as charcoal or Chlorella, before the procedure.
4. Ensuring that dentists, dental personnel, and patients wear protective gowns and covers.
5. Utilizing non-latex nitrile gloves.
6. Using face shields and head coverings.
7. Dentists and personnel should wear properly sealed, respiratory-grade masks or positive pressure masks with air or oxygen supply.
8. Covering the patient’s skin and clothing with a full-body impermeable barrier.
9. Using external air or oxygen delivered via a nasal mask to prevent the inhalation of mercury vapor or particles by the patient.
10. Placing a dental dam made of non-latex nitrile material and properly sealing it.
11. Placing a saliva ejector under the dental dam and using an oral aerosol vacuum near the patient’s mouth during amalgam filling removal.
12. Using high-speed evacuation with a clean-up device.
13. Using copious amounts of water to reduce heat.
14. Sectioning the amalgam into large chunks for removal.
15. After removal, thoroughly flushing the patient’s mouth with water and rinsing with an absorbent slurry like charcoal or Chlorella.