It’s one thing for a dental office to be “mercury-free,” which means that they don’t place “silver” amalgam fillings. Those fillings are actually 50% mercury, and mercury is extremely toxic. Creating them can expose both the patient and the dental team to very high levels of this heavy metal. Take a look:
The great news is that more and more conventional dentists are stepping away from amalgam, largely due to patient demand, as well as the better aesthetics that tooth-colored composites offer. It also helps that today’s resins are extremely strong and durable compared to earlier generations of the material.
Being mercury-free is important. But it’s not enough on its own. A practice needs to be mercury-SAFE, as well – for the health of patients, practitioners, and our planet. This means taking special precautions to minimize exposure to mercury, especially mercury vapor. Inhaling it gives mercury an easy path into the bloodstream via the lungs, to be deposited throughout the body, particularly in organs such as the kidneys, liver, and, most importantly, the brain.
Even something as simple as polishing an amalgam filling during a routine cleaning can generate dangerous amounts of mercury vapor, as you can see in this next video:
Drilling generates even more mercury vapor, which has been shown to linger for a long time afterwards. What’s more, ”The levels of mercury vapor created by this procedure,” according to a 2019 study, “frequently exceed the safety thresholds of several jurisdictions and agencies.”
This is exactly why the International Academy of Oral Medicine & Toxicology developed the Safe Mercury Amalgam Removal Technique, or SMART. It’s the protocol we follow whenever an old amalgam filling needs to be removed or a patient chooses to have their amalgams replaced with biocompatible restorations.
Here are the basics of what SMART involves:
- Amalgam separators are properly installed and maintained to collect mercury waste, keeping it from being released into the environment via wastewater.
- High-volume air filters and aerosol vacuums are used in each room to remove mercury vapor and particulate that’s generated during the procedure.
- Unless the patient declines or there are contraindications, the patient is given a slurry of charcoal, chlorella, or a similar adsorbent to rinse with and swallow before the procedure.
- The patient is fully covered in protective gowns and drapes, including covering for the neck and head.
- The dentist and team members likewise wear protective gowns, along with non-latex, nitrile gloves, face shields, and head coverings. They also wear properly sealed, respiratory grade masks rated to capture mercury or positive pressure, properly sealed masks providing air/oxygen.
- To prevent nasal inhalation of mercury vapor or particulate, the patient wears a nasal mask or cannula through which oxygen is delivered.
- A non-latex, nitrile dental dam is placed and properly sealed in the patient’s mouth. A saliva ejector is placed under the dam to further reduce mercury exposure.
- An oral aerosol vacuum is placed close to the patient during the amalgam removal to capture mercury vapor and particulate.
- The amalgam is sectioned into chunks with a small diameter carbide drill and removed in the largest pieces possible.
- Great amounts of water are used to reduce heat. A conventional high-speed evacuation device is used to capture mercury discharges.
- Once removal is complete, the patient rinses their mouth thoroughly, first with water, then with a slurry of charcoal, chlorella, or a similar adsorbent.
Here’s a great demonstration of just how big of a difference SMART makes:
For an even more detailed description of the protocol and scientific references supporting these safety measures, check out this article by the IAOMT.