SMART-The Safe Mercury Amalgam Removal Technique at Dr-Roze and Associates.

smart-1At Dr. Roze and Associates, the SMART protocol is adopted in order to correspond with international standards of safe replacement of amalgam fillings.

  • Mercury is known to be released during the placement, replacement, and removal of dental mercury amalgam fillings. An unsafe amalgam removal process releases mercury vapor and particles that can be harmful to the patient, the dentist, the dental staff, and the environment.
  • Utilizing the most up-to-date science and research of the IAOMT (International Academy of Oral Medicine and Toxicology), Dr. Roze and Associates dentists follow the safety recommendations for removal of existing dental mercury amalgam fillings, including detailed protective measures that are to be utilized for the procedure.
  • Each room where mercury fillings are removed has adequate filtration in place capable of removing mercury vapor and amalgam particles generated during the removal of one or more mercury fillings.
  • If possible, windows are opened during the procedure to reduce the mercury concentration in the air.
  • The patient will be given an absorbent such as charcoal to be taken before the procedure (unless the patient declines or there are other contraindications making this clinically inappropriate).
  • Protective gowns and covers for the dentist, dental staff, and the patient are put in place. All present in the room are protected because substantial quantities of particles generated during the procedure will elude collection by suction devices.
  • Non-latex nitrile gloves are 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.
  • Activated charcoal masks are worn by the clinic’s personnel during the procedure.
  • 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 is utilized.
  • External air or oxygen delivered via a nasal mask for the patient is 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 is placed and properly sealed in the patient’s mouth.
  • A saliva ejector is placed under the dental dam to reduce mercury exposure to the patient…
  • 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.
  • The amalgam is removed in a single large piece as we use thin drills to separate the tooth from the filling so we don’t actually “drill” the amalgam that reduces the heat and mercury vapor.
  • Once the removal process is complete, the patient’s mouth is thoroughly flushed with water and then rinsed out with a slurry of charcoal.
  • We safely dispose of the mercury and mercury-contaminated components, clothing, equipment and conduct a thorough cleaning of the surfaces of the room and flooring in the dental office.
  • During the opening and maintenance of suction traps in operatory or on the main suction unit, dental staff utilizes the appropriate personal protection equipment described above.
  • It is important to note that as a safety precaution, Dr Roze and Associates, based on the instructions of the IAOMT, does not recommend amalgam filling removal for women who are pregnant or breastfeeding and that the IAOMT does not recommend that dental personnel who are pregnant or breastfeeding conduct work that disrupts amalgam fillings (including their removal).


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