If you’re like many of our patients, you probably didn’t get interested in the mercury issue out of any kind of passion for dental materials. Rather, it might have been because something about the way you’d been feeling just wasn’t adding up.
Maybe you’d been dealing with health issues that weren’t resolving the way you had hoped, even though you did all the “right” things. You consulted different physicians and therapists, and tried different approaches, all to no avail.
Then – maybe it was a podcast you heard or a video you saw that turned your attention to the possibility that your “silver” fillings might be playing a role.
Or maybe your path here was more straightforward than that. You already understood why mercury isn’t something you want stored up in your body, so the idea of mercury-free dentistry just makes sense.
Regardless, it’s important to recognize that once you make the decision to have those so-called “silver” fillings removed, HOW it’s done matters. A lot.
For mercury doesn’t just quietly disappear once an amalgam is out. It has to go somewhere. Without proper controls, that somewhere could be our environment. For instance, one 2025 systematic review of dental wastewater studies “confirmed that dental clinics contribute substantially to mercury loads in wastewater, with a single chair releasing as much as 4.5 g/day.
That’s the equivalent of six to nine whole amalgam fillings each day, with enough mercury in it to fill a small teaspoon.
Even more concerning is the mercury vapor that gets released into the air when amalgams are cut or drilled in the standard way. Studies like this one have shown that
drilling dental amalgam generates particulate that volatilizes significant amounts of mercury vapor generally for more than an hour after removal. The levels of mercury vapor created by this procedure frequently exceed the safety thresholds of several jurisdictions and agencies.
This clip from the documentary film Evidence of Harm provides a powerful visual demonstration of this:
The thing to keep in mind is that dental work is an intervention. It changes conditions in the mouth, and – for a short time – it changes what the body is exposed to. The goal of removal, then, isn’t just to get the fillings out but to do so cleanly and deliberately, without extra mercury exposure along the way.
That’s why it’s not enough for dentistry to be mercury-free. It must also be mercury-SAFE. Mercury-free dentistry focuses on materials that are used going forward. Mercury-safe dentistry focuses on how existing mercury is handled, especially when it’s being removed.
When it comes to mercury removal here in our own office, we follow the protocols of the Safe Mercury Amalgam Removal Technique (SMART). SMART is a science-based protocol that was developed by the International Academy of Oral Medicine & Toxicology (IAOMT) to minimize exposure through the process of replacing old mercury fillings with biocompatible restorations.
SMART brings together a set of practical measures that work together to protect patients, the dental team, and the environment at the same time. The protocol includes
- Isolation of the teeth to be worked on with a non-latex rubber dam to limit contact or ingestion of mercury amalgam.
- High-volume suction set close to the tooth to capture mercury vapor and particulate at the source.
- Supplemental air or oxygen for the patient, to limit inhaling vapor and airborne particulate.
- Protective coverings for the patient’s skin, hair, and clothes.
- Appropriate protective equipment for the dental team, including properly sealed, respiratory grade masks rated to capture mercury or properly sealed positive pressure masks delivering oxygen.
- Removal techniques that minimize heat, friction, and aerosolization.
- Amalgam separators and proper waste handling to limit environmental release.
A detailed version of the protocol, along with scientific references, is available here.
Of course SMART addresses only the matter of amalgam removal. It doesn’t address what those fillings will be replaced with, nor clearing the body’s tissues of all the mercury that’s built up over the years. Both of these are things your dentist will discuss and plan with you ahead of time. Biocompatibility testing may be done to determine which materials are safest to use with respect to your unique biochemistry. A custom plan will be made to support your body’s natural detoxing abilities both around the time of removal and afterwards.
Ultimately, the goal is to remove amalgam carefully and replace it thoughtfully, so each tooth can continue to function as it should once the procedure is complete. Each of us has individual health considerations and recovery needs, after all.
Getting mercury out of the mouth is important. Doing so carefully, with attention to people, process, and impact beyond the dental chair, matters just as much. That includes our patients, our team, and the environment we all share.
This is what it means, to us, to practice dentistry with intention.
