Welcome to my practice. If you are reading this, you are likely looking for answers about your dental health, specifically regarding those dark, silver-colored fillings in your mouth. As Dr. Bruce Vafa, I have spent years helping patients achieve healthier, brighter smiles through holistic and biological dentistry. Today, I want to have an honest conversation with you about a topic that is very close to my heart: the Safe Mercury Removal Protocol, often referred to as SMART.
You might have heard the term “Amalgam Removal” floating around the internet or mentioned by health-conscious friends. It sounds technical, but it is actually quite straightforward when you break it down. It is all about taking old fillings out of your teeth in a way that keeps you, my staff, and the environment safe from mercury exposure. In this guide, I am going to walk you through exactly what this protocol is, why it is necessary, and how I ensure your safety every step of the way.
Understanding the “Silver” Filling
Before we dive into the removal process, we need to understand what we are removing. For decades, “silver” fillings were the standard in dentistry. However, the name is a bit misleading. While they look silver, these fillings are actually a mixture of metals, scientifically known as dental amalgam.
Here is a fact that surprises many of my patients: Dental amalgam is composed of approximately 50% elemental mercury by weight. The other half is a mix of silver, tin, and copper. Mercury is used because it binds the metals together to create a hard, durable material. However, we now know much more about mercury than we did a hundred years ago.
Mercury is classified as a heavy metal. While the dental community has debated its safety for years, my philosophy as a holistic dentist is simple: if there is a safer, non-toxic alternative, why risk it? Many people choose to have these fillings replaced because they are concerned about the potential release of mercury vapor, especially when they grind their teeth or chew gum. Furthermore, old amalgam fillings can expand and contract with temperature changes, which often leads to cracks in the natural tooth structure over time.
What is the SMART Protocol?
SMART stands for Safe Mercury Amalgam Removal Technique. It is a set of rigorous safety recommendations developed by the International Academy of Oral Medicine and Toxicology (IAOMT). It isn’t just a suggestion; it is a science-based standard that I follow strictly in my office.
When a dentist drills out an old amalgam filling without safety measures, friction creates heat. This heat can cause the mercury in the filling to vaporize. Without protection, the patient (that’s you) and the dental team can inhale these invisible vapors. Standard suction is often not enough to capture all of it.
The SMART protocol is designed to drastically reduce that exposure. It is about creating a controlled environment where the filling is removed efficiently without spreading mercury particles or vapor into the air or your body.
The Danger of Unsafe Removal
I cannot stress this enough: simply drilling out a silver filling is not the same as safe Amalgam Removal. In fact, removing a filling unsafely can be more dangerous than leaving it alone in the short term. During an unsafe removal, the amount of mercury vapor released can be significantly higher than daily background exposure.
Data Point: According to scientific reviews regarding dental amalgam, significant amounts of mercury vapor can be released during the placement and removal of fillings, with some studies suggesting that without high-volume suction, particulate matter and vapor can linger in the operatory air for some time.
This is why you need a biological dentist who is certified and trained in these specific protocols. We don’t just “drill and fill.” We protect and heal.
My Step-by-Step Guide to Safe Amalgam Removal
When you come to me for Amalgam Removal, you will notice that the appointment looks a little different than a standard dental cleaning. We gear up—literally. Here is a detailed look at the procedure I use to keep you safe.
1. Pre-Rinse with Activated Charcoal
Before we even start, I will have you rinse your mouth with a charcoal or chlorella mixture. Why? Activated charcoal is excellent at binding to toxins. If any microscopic particles do happen to slip by our defenses (which is rare), the charcoal is there to catch them in your mouth before they can be absorbed.
2. Protective Barriers for Your Body
We treat the removal process like a minor surgery regarding sterility and protection. We will cover your upper body with an impermeable gown. This prevents any tiny particles of the filling material from landing on your clothes or skin. We also cover your hair and face. It might feel like a lot of wrapping, but it is purely for your protection.
3. External Oxygen Supply
This is one of the most critical steps. I will place a nasal mask on you that delivers pure oxygen. You will not be breathing the air right in front of your mouth where we are working. By providing you with an external air source, we ensure that you do not inhale any mercury vapor or amalgam dust that is generated during the drilling process.
4. The Dental Dam
I will place a non-latex dental dam in your mouth. This is a rubber sheet that isolates the tooth we are working on. It acts as a physical barrier, preventing chips of the old filling from falling to the back of your throat or being swallowed. It also keeps the working area dry, which is essential for placing the new, white filling later.
We also seal the edges of the dam with a special liquid dam material to make it airtight. We want to be absolutely certain that nothing gets underneath that barrier.
5. High-Volume Evacuation (HVE)
Standard saliva ejectors (the little straw that hangs in the corner of your mouth) are not strong enough for this. We use a powerful High-Volume Evacuator. This suction device is placed right next to the tooth.
The HVE captures the vapor and particles at the source. Think of it like a very strong vacuum cleaner designed specifically for aerosols. It pulls the air away from you and sends it through a filtration system.
6. The IQAir Dental Hg FlexVac
In addition to the suction in your mouth, I use an extraoral suction system. This is a large vacuum arm with a clear hood that sits close to your chin. It acts as a second layer of defense, pulling away any air around your face and filtering it through high-grade HEPA and charcoal filters to capture mercury vapor.
7. Sectioning the Filling
When I actually remove the filling, I do not just grind it all away. Grinding creates heat and vapor. Instead, I use a specific drill bit to cut the filling into large chunks. I “section” it, like slicing a pie.
By cutting it into chunks, I can pop the pieces out whole. This drastically reduces the amount of drilling required and, consequently, minimizes the release of mercury vapor.
8. Thorough Cleaning and Flushing
Once the chunks are out, I thoroughly flush the area with water and suction everything away. I check to make sure every microscopic speck of the metal is gone. Only then do we remove the dental dam. After the dam is off, I will have you rinse and spit again to ensure your mouth is completely clean.
Why Choose a Biological Dentist?
You might be wondering if your regular family dentist can do this. While many dentists are excellent at restoring teeth, not all of them have the equipment or the training for the SMART protocol. Biological dentistry is a mindset that looks at the mouth as an integral part of the whole body.
I believe that what you put in your mouth affects your overall health. Therefore, removing toxic materials requires a holistic approach. It is not just about the tooth; it is about your immune system, your respiratory system, and your peace of mind.
For more information on the strict standards regarding mercury safety, you can read this article from the International Academy of Oral Medicine and Toxicology (IAOMT), which details the science behind these protocols.
The Benefits of Replacing Amalgam
Replacing these old fillings isn’t just about avoiding mercury. There are significant dental and aesthetic benefits to Amalgam Removal as well.
- Restored Strength: Amalgam fillings do not bond to the tooth; they are packed in. This acts like a wedge. Over time, biting forces can cause the tooth to crack around the filling. The composite (white) fillings I use bond directly to the tooth structure, actually pulling the tooth together and strengthening it.
- Aesthetics: Let’s be honest, nobody loves the look of dark grey metal in their mouth. Modern composite materials can be color-matched perfectly to your natural enamel. When you laugh or yawn, all people will see are white, healthy-looking teeth.
- Less Sensitivity: Metal is a conductor of heat and cold. This is why some people with large metal fillings experience sensitivity when drinking hot coffee or eating ice cream. Composite materials are insulators, much like natural tooth structure, which often reduces this sensitivity.
Environmental Responsibility
My commitment to safety extends beyond the dental chair. We have to consider where that mercury goes once it leaves your tooth. We cannot simply wash it down the drain, as it would contaminate our water supply.
Data Point: According to the EPA, dental offices have historically been responsible for a significant percentage of the mercury discharged into publicly owned treatment works (wastewater systems). To combat this, strict regulations now require the use of amalgam separators.
In my office, we use an advanced amalgam separator. This device filters the wastewater from our suction lines and separates the mercury particles. We then collect this waste and send it to a specialized recycling facility for safe disposal. When you choose our practice for your Amalgam Removal, you are also making an environmentally responsible choice.
What Happens After the Appointment?
Patients often ask me if they will feel different after the procedure. While I cannot make medical claims about curing systemic diseases, many patients report feeling a sense of relief knowing the metal is gone. The procedure itself is done under local anesthesia, so it is painless.
After the appointment, some sensitivity is normal, as it is with any dental filling. This usually subsides within a few days. I often recommend that patients support their bodies with good nutrition, plenty of hydration, and perhaps antioxidants like Vitamin C to help their natural detox pathways, though you should always consult with your primary care physician regarding supplements.
Is Amalgam Removal Right for You?
This is a personal decision, but it is one we can make together. During a consultation, I examine the condition of your current fillings. If they are old, leaking, cracking the tooth, or if you simply want them out for health concerns, then you are a candidate for SMART.
I understand that dental anxiety is real. The equipment I described—the masks, the drapes, the vacuums—might sound intimidating. But please know that the atmosphere in my office is calm, caring, and positive. We explain everything before we do it. My goal is to empower you to take control of your health.
Moving Forward with Confidence
Your smile is one of your most valuable assets, and your health is priceless. By choosing to remove your silver fillings using the SMART protocol, you are prioritizing both. You are ensuring that the removal process is handled with the highest degree of care, precision, and safety available in modern dentistry.
I am proud to offer this service because I have seen the difference it makes. It allows me to sleep well at night knowing I have done no harm, and it allows my patients to smile with confidence, free from the worry of mercury exposure. If you have questions about Amalgam Removal or want to inspect the condition of your current fillings, I am here to help guide you toward a healthier, toxin-free future.
