Safe Mercury Removal (SMART Protocol): Your Essential Guide to Costs and Procedure Safety in Los Angeles

If you have silver-colored fillings in your mouth, there’s a good chance they contain mercury. As a dentist practicing in Los Angeles, I see many patients who are concerned about the mercury in their dental fillings and want to know about safe removal options. Today, I’m going to walk you through everything you need to know about the SMART protocol for mercury amalgam removal, including what it costs and why safety matters so much.

Understanding Mercury Amalgam Fillings

Let me start by explaining what we’re dealing with. Dental amalgam fillings contain approximately 50% mercury, with the rest being a mixture of silver, tin, copper, and sometimes other metals. These silver-colored fillings have been used in dentistry for over a century because they’re durable and inexpensive to place.

However, here’s what concerns many of my Los Angeles patients: mercury vapor is released from dental amalgam fillings at higher rates during brushing, cleaning, clenching of teeth, and chewing. Even more concerning is what happens during removal. When a dentist drills out an old amalgam filling without proper safety measures, significant amounts of mercury vapor and particles can be released into the air.

I want to be clear about something important. The goal isn’t to scare you if you currently have amalgam fillings. Many people have lived with these fillings for years without problems. But if you’ve decided to have them removed, it’s absolutely critical that the removal is done safely using proper protocols.

What Is the SMART Protocol?

SMART is a set of recommendations created by the International Academy of Oral Medicine and Toxicology (IAOMT) based on scientific research. The acronym stands for Safe Mercury Amalgam Removal Technique, and it represents the gold standard for protecting patients and dental teams during amalgam removal procedures.

Here’s a scientific fact that explains why this protocol is so important: Mercury vapor is absorbed rapidly through the lungs and can cross the blood-brain barrier within minutes of exposure. Once mercury enters the body, it can accumulate in organs including the brain, kidneys, and liver. This is why we take mercury exposure so seriously during dental procedures.

At Smile Angels, we follow the SMART protocol because your safety and health are my top priorities. I believe that if we’re going to remove mercury from your mouth, we need to do it in a way that minimizes your exposure during the process.

The Step-by-Step SMART Protocol Process

When you come to my Los Angeles office for safe mercury removal, here’s exactly what happens:

Before the Procedure Begins

The patient will be given a slurry of charcoal, chlorella, or similar adsorbent to rinse and swallow before the procedure. This helps bind to any mercury particles that might accidentally be swallowed during the removal process. Activated charcoal works by attracting and trapping toxins, preventing them from being absorbed into your system.

Protective Equipment and Barriers

Everyone in the room wears protective gear. Protective gowns and covers for the dentist, dental personnel, and the patient must be in place. We also provide you with a protective drape to cover your body, face shields, and head coverings. This might seem excessive, but research shows that mercury particles can settle on clothing and skin during removal.

One of the most important safety features is the rubber dam. This is a flexible barrier made of latex-free material that we place around the tooth being treated. It isolates the tooth completely from the rest of your mouth, preventing you from swallowing or being exposed to mercury particles during the removal.

Clean Air Supply

During the entire procedure, you’ll breathe clean, filtered air through a nasal mask. This is crucial because it prevents you from inhaling any mercury vapors that are released when we remove the filling. You’ll be instructed to breathe through your nose and avoid breathing through your mouth during the procedure.

Specialized Removal Technique

We don’t just drill out the filling in one piece. The amalgam needs to be sectioned into chunks and removed in as large of pieces as possible, using a small diameter carbide drill. This “chunking” method significantly reduces the amount of mercury vapor released compared to grinding the filling into small particles.

Throughout the removal, we use copious amounts of water to keep the filling cool. Heat causes more mercury vapor to be released, so constant water irrigation is essential.

High-Volume Suction and Air Filtration

Each room where mercury fillings are removed must have adequate filtration in place, which requires a high-volume air filtration system capable of removing mercury vapor and amalgam particles. We use multiple suction devices simultaneously:

• A high-volume evacuator positioned near your mouth to capture particles and vapors immediately
• An external suction system that creates negative pressure to pull vapors away from your breathing zone
• Air purifiers that continuously filter the air in the treatment room

After Removal

Once the removal process is complete, the patient’s mouth should be thoroughly flushed with water and then rinsed out with a slurry of charcoal, chlorella or similar adsorbent. We carefully remove the rubber dam and all protective barriers, and you’ll do a final rinse to ensure any remaining particles are removed from your mouth.

Proper Disposal

All mercury-containing waste is collected using an amalgam separator and disposed of according to EPA regulations. This prevents mercury from entering our water system and environment.

How Much Does SMART Protocol Mercury Removal Cost in Los Angeles?

This is one of the most common questions I hear from Los Angeles patients, and I want to give you honest, realistic information about costs.

Generally the costs are $500 – $1000 per tooth to remove amalgam fillings using the SMART protocol. This price typically includes:

1. The safe removal procedure itself
2. Protective barriers and disposable equipment
3. The replacement filling material (usually composite resin)

Here’s what affects the cost:

Size and Location of the Filling: Simple removals might start at around $250, but if the filling is large or there’s decay, the price can go up to $900 or even $2,000 for more complicated cases. Larger fillings in molars typically cost more than smaller fillings in front teeth.

Tooth Condition: If the tooth structure under the filling is damaged or decayed, you might need more extensive restoration than just a filling. Sometimes a crown or onlay is necessary, which increases the cost.

Number of Fillings: Most dentists (including myself) recommend removing only 2-3 amalgam fillings per visit to minimize mercury exposure. This means if you have multiple fillings, you’ll need several appointments spaced at least two weeks apart.

Geographic Location: Dental costs in Los Angeles tend to be higher than the national average due to our cost of living and overhead expenses.

Additional Fees: Some practices charge a separate “safe removal fee” for the SMART protocol in addition to the filling replacement cost. At our practice, we include all safety measures in our quoted price because I believe safety shouldn’t be an optional add-on.

What About Insurance Coverage?

Dental insurance normally covers replacement of this type of fillings, whether they are mercury amalgam or white composite fillings if the filling is damaged, decayed, or otherwise needs replacement for dental health reasons.

However, here’s the reality: Most insurance companies do not cover the removal of amalgam fillings solely because you want them removed for health or cosmetic reasons. They typically only cover replacement when there’s decay or damage to the existing filling.

Many insurance plans will pay for the composite filling itself but won’t cover the additional cost of the SMART protocol safety measures. You may need to pay the difference between what insurance covers and the actual cost of safe removal.

I always recommend calling your insurance company before scheduling treatment to understand exactly what they’ll cover. At Smile Angels, we’re happy to work with your insurance and help you understand your benefits.

Chart: SMART Protocol Cost Breakdown and Safety Features

Average Cost per Tooth in Los Angeles:

SMART Protocol Safety Features Included:

✓ Rubber dam isolation ✓ High-volume suction systems (2-3 devices) ✓ Clean air supply via nasal mask ✓ Protective barriers for patient and staff ✓ Activated charcoal rinse (pre and post) ✓ Room air filtration system ✓ Proper mercury waste disposal ✓ Chunking removal technique

Data based on Los Angeles dental practice surveys and IAOMT guidelines, 2024

Who Should Consider Mercury Amalgam Removal?

While I offer safe mercury removal, I want to be clear that not everyone needs to have their amalgam fillings removed immediately. Here are situations where removal makes sense:

Medical Reasons: Some patients have sensitivity or allergies to mercury or other metals in amalgam. Others are concerned about potential long-term health effects and prefer mercury-free materials.

Damaged or Leaking Fillings: If your amalgam filling is cracked, chipped, or showing signs of wear, it should be replaced regardless of the material. This is a clear dental health reason for removal.

Cosmetic Preferences: Many of my Los Angeles patients want tooth-colored fillings for aesthetic reasons. Silver fillings can be quite noticeable when you smile or talk.

Pregnancy Planning: The IAOMT does not recommend amalgam filling removal for women who are pregnant or breast-feeding. If you’re planning to become pregnant, you might want to have amalgam removal completed beforehand.

Who Should NOT Have Mercury Removal Right Now?

Safety is always my first concern. There are some situations where I recommend waiting or avoiding mercury removal:

• Pregnant or breastfeeding women
• People with severe chronic illnesses (without medical doctor approval)
• Patients with acute health conditions
• Anyone with extremely compromised immune systems

For these patients, the risk of mercury exposure during removal may outweigh the benefit of having the fillings removed.

The Safer Alternatives: What Replaces Mercury Fillings?

After we safely remove your amalgam fillings, we need to restore your teeth. At Smile Angels, I use biocompatible, mercury-free materials that are both safe and aesthetically pleasing.

Composite Resin Fillings: The cost for a composite filling is generally between $190 and $600. These tooth-colored fillings bond directly to your tooth structure, are durable, and look completely natural. They’re my first choice for most patients.

Ceramic Fillings/Onlays: For larger restorations, ceramic materials offer exceptional durability and aesthetics. They’re more expensive but can last many years.

Zirconia Crowns: If significant tooth structure was lost with the old filling, we might recommend a full crown made from metal-free zirconia.

All of these materials are BPA-free and carefully selected for biocompatibility.

Why Choose a SMART-Certified Dentist in Los Angeles?

Not all dentists follow the SMART protocol, and this matters greatly for your safety. When a dentist simply drills out an amalgam filling using standard techniques, studies show that mercury levels in the air can spike dramatically during the procedure.

I invested in SMART certification through the IAOMT because I believe in protecting my patients and my team. This training taught me the specific techniques, equipment, and protocols necessary to minimize mercury exposure during removal.

When you’re looking for a dentist to remove your mercury fillings in Los Angeles, ask these questions:

1. Are you SMART-certified through the IAOMT?
2. What specific safety measures do you use during amalgam removal?
3. Do you use rubber dam isolation for every amalgam removal?
4. What type of air filtration system do you have in your treatment rooms?
5. How do you dispose of mercury waste?

A dentist who follows the SMART protocol should be able to answer all these questions in detail.

The Long-Term Benefits of Safe Mercury Removal

When my patients complete their mercury removal treatment, they often tell me they feel a sense of relief knowing the mercury is out of their mouths. Many report these benefits:

Peace of Mind: Knowing you’ve eliminated a potential source of mercury exposure can reduce anxiety about your dental health.

Improved Aesthetics: Tooth-colored fillings blend seamlessly with your natural teeth, making your smile look better.

Better Tooth Structure: Modern composite materials bond to your teeth and can actually strengthen them, unlike amalgam which can expand and contract, potentially cracking teeth over time.

Environmental Consciousness: By choosing mercury-free dentistry, you’re also helping protect our environment and water systems from mercury contamination.

Finding the Right Mercury-Safe Dentist in Los Angeles

Los Angeles has many dentists who offer amalgam removal, but not all follow the SMART protocol. Here’s how to find a qualified provider:

Check the IAOMT website for certified dentists in your area. The International Academy of Oral Medicine and Toxicology maintains a directory of dentists who have completed SMART certification training.

Read reviews and ask questions during your consultation. Pay attention to how thoroughly the dentist explains their safety protocols.

Visit the office if possible before scheduling treatment. You can see their equipment and ask to observe their treatment room setup.

At Smile Angels, we’re proud to be a mercury-free and mercury-safe practice. We don’t place new amalgam fillings, and we follow strict SMART protocols for removal.

What to Expect During Recovery

Recovery from mercury amalgam removal is usually straightforward. Most patients experience:

• Mild sensitivity to temperature for a few days (normal with any filling replacement)
• Slight tenderness in the gums around the treated tooth
• Temporary numbness from the anesthetic (wears off within a few hours)

I recommend that patients:

• Avoid chewing on the treated tooth for 24 hours
• Continue taking activated charcoal supplements for a few days if desired
• Maintain excellent oral hygiene
• Stay hydrated to help your body naturally eliminate any mercury
• Eat a nutrient-rich diet to support your body’s detoxification systems

The Bottom Line on SMART Protocol Mercury Removal

Safe mercury amalgam removal using the SMART protocol is an investment in your health and peace of mind. While it costs more than standard filling replacement, the protection it provides is invaluable.

The typical cost in Los Angeles ranges from $500 to $1,000 per tooth, depending on the size and complexity of the filling. This includes all safety measures and the replacement filling material.

If you have concerns about the mercury in your dental fillings, I encourage you to schedule a consultation with a SMART-certified dentist. We can examine your fillings, discuss your specific situation, and create a treatment plan that prioritizes your safety.

Remember these key points:

• Mercury amalgam fillings contain 50% mercury by weight
• Safe removal requires specialized protocols to protect you from mercury exposure
• The SMART protocol is the gold standard for safe amalgam removal
• Not everyone needs to have their amalgam fillings removed immediately
• Pregnant and breastfeeding women should wait for amalgam removal
• Cost ranges from $500-$1,000 per tooth in Los Angeles
• Choose a SMART-certified dentist for your protection

Your oral health affects your overall health. Making informed decisions about your dental care is one of the best things you can do for yourself.

If you’re in the Los Angeles area and considering mercury amalgam removal, I invite you to visit us at Smile Angels. We’ll answer all your questions, show you our safety protocols, and help you decide if mercury removal is right for you. Your health and safety will always be our top priority.

Additional Resources

For more information about mercury amalgam fillings and safe removal:

• International Academy of Oral Medicine and Toxicology: https://www.iaomt.org
• American Dental Association – Patient Information: https://www.ada.org

Dr. Bruce Vafa practices holistic and biological dentistry in Beverly Hills, serving patients throughout Los Angeles. For more information about safe mercury amalgam removal using the SMART protocol and other mercury-free dental treatments, visit SmileAngels.com.