The IAOMT protocol recommendations for amalgam removal are known as the Safe Mercury Amalgam Removal Technique (SMART). Note that SMART is presented as a set of recommendations. Licensed practitioners must exercise their own judgment concerning the specific treatment options to utilize in their practices. The SMART protocol recommendations include the following measures, which are listed here with scientific research: 

Griffin Cole, DDS performing the Safe Mercury Amalgam Removal Technique

The IAOMT safe amalgam removal protocol recommendations were most recently updated on July 19, 2019. Also, on July 1, 2016, the IAOMT protocol recommendations were officially renamed as the Safe Mercury Amalgam Removal Technique (SMART), and a training course for IAOMT dentists to become certified in SMART was initiated.

All dental amalgam restorations contain approximately 50% mercury,1 and reports and research are consistent that these fillings emit mercury vapors.2-16

Scientific research demonstrates that dental mercury amalgam exposes dental professionals, dental staff, dental patients, and/or fetuses to releases of mercury vapor, mercury-containing particulate, and/or other forms of mercury contamination.4-48

Furthermore, mercury vapor is known to be released from dental mercury amalgam fillings at higher rates during brushing, cleaning, clenching of teeth, chewing, etc.,5, 14, 15, 24, 30, 49-54 and mercury is also known to be released during the placement, replacement, and removal of dental mercury amalgam fillings.2, 25, 28, 29, 32, 36, 41, 45, 46, 55-60

Utilizing the available scientific evidence, the IAOMT has developed extensive safety recommendations for removal of existing dental mercury amalgam fillings, including detailed protective measures that are to be utilized for the procedure. The IAOMT’s recommendations build upon traditional safe amalgam removal techniques such as the use of masks, water irrigation, and high volume suction by supplementing these conventional strategies with a number of additional protective measures, the need for which have only recently been identified in scientific research.

  • An amalgam separator must be properly installed, utilized, and maintained to collect mercury amalgam waste so that it is not released into the effluent from the dental office.25, 61-73</