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Removal of Amalgam Filling

If you are getting an amalgam filling or having one removed, your dentist will use high-powered suction to remove any excess amalgam from your mouth.

The IAOMT protocol recommendations for amalgam removal are known as the Safe Mercury Amalgam Removal Technique (SMART). These recommendations include the following measures, which are listed here with scientific research:

 An amalgam separator should be properly installed, utilized, and maintained to collect mercury amalgam waste so that it is not released into the effluent from the dental office.

 Each room where mercury fillings are removed should have adequate filtration in place, which requires a high-volume air filtration system (such as an at source oral aerosol vacuum) capable of removing mercury vapor and amalgam particles generated during the removal of one or more mercury fillings

 If possible, windows should be opened to reduce the mercury concentration in the air

 The patient should be given a slurry of charcoal, chlorella, or similar adsorbent to rinse and swallow before the procedure (unless the patient declines or there are other contraindications making this clinically inappropriate)

 Protective gowns and covers for the dentist, dental personnel, and the patient should be in place. All present in the room should be protected because substantial quantities of particles generated during the procedure will elude collection by suction devices. It has been demonstrated that these particles can be spread from the patient’s mouth to the patient’s knee, and to the chest, shoulder, and neck of the dentist and dental assistant

 Non-latex nitrile gloves should be utilized by the dentist and all dental personnel in the room

 Face shields and hair/head coverings are to be utilized by the dentist and all dental personnel in the room

 Either a properly-sealed, respiratory grade mask rated to capture mercury or a positive pressure, properly-sealed mask providing air or oxygen should be worn by the dentist and all dental personnel in the room

 In order to protect the patient’s skin and clothing, a full body, impermeable barrier, as well as a full head/face/neck barrier under/around the dam, should be utilized

 External air or oxygen delivered via a nasal mask for the patient also should be utilized to assure the patient does not inhale any mercury vapor or amalgam particulate during the procedure. A nasal cannula is an acceptable alternative for this purpose as long as the patient’s nose is completely covered with an impermeable barrier

 A dental dam that is made with non-latex nitrile material should be placed and properly sealed in the patient’s mouth

 A saliva ejector should be placed under the dental dam to reduce mercury exposure to the patient

 During amalgam filling removal, the dentist should utilize an at source oral aerosol vacuum in close proximity to the operating field to mitigate mercury exposure

 The amalgam should be sectioned into chunks and removed in as large of pieces as possible, using a small diameter carbide drill

 Copious amounts of water to reduce heat and a conventional high speed evacuation device to capture mercury discharges should be used to reduce ambient mercury levels.

 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

 Dentists must comply with federal, state, and local regulations addressing the proper handling, cleaning, and/or disposal of mercury-contaminated components, clothing, equipment, surfaces of the room, and flooring in the dental office

It is important to note that as a safety precaution, the IAOMT does not recommend amalgam filling removal for women who are pregnant or breast-feeding and that the IAOMT does not recommend that dental personnel who are pregnant or breast-feeding conduct work that disrupts amalgam fillings (including their removal)