Amalgam, a metal mixture of mercury, silver, copper, tin, and zinc, has been used in dental work since the early 19th century. It became one of the most popular dental restorative materials because of its strength and low cost.
Amalgam has a very high mercury concentration of 50% by weight.
Removal of amalgam fillings (also called silver fillings) and crowns can release mercury vapor, which is known to cause health issues. In January 2024, the European Parliament banned amalgam fillings due to health concerns.
Amalgam fillings are still used in the United States, but many dentists have stopped. They often recommend their patients replace amalgam with composite (made of ceramic particles) for fillings and other dental work – and the American Dental Association has expressed environmental concerns about mercury amalgam.
Health Centered Dentistry has adopted the SMART protocols for amalgam filling removal to ensure the safety and health of their patients.
Dr. Amanda Waddle, DDS at Health Centered Dentistry in Anchorage talks about the concerns when removing amalgam dental work, and discusses the details of the SMART protocol, what it involves, and how it helps protect their patients’ health.
Want to replace your amalgam fillings? Contact Health Centered Dentistry today for a free consultation.
Safely Removing Mercury Amalgam Fillings
What are the potential health risks of amalgam dental work?
Amalgam fillings and crowns can crack or be damaged during removal. That damage can release harmful mercury vapor into the air, which can be inhaled. Inhaling mercury vapors can lead to difficulty breathing, chest pains, or headaches, and there’s also the risk of ingesting small bits of amalgam, which can break off during the removal process. Ingesting these can lead to rashes, kidney distress, and diarrhea.
But that’s just a short-term issue that occurs during the removal process. The longer-term effects of leaving amalgam dental in place are more concerning.
Dr. Waddle says, “We do the amalgam removal in the first place to remove the longer-term effects because those can happen for as long as we have amalgam fillings in our mouth.”
Long-term exposure to amalgam, especially if it develops cracks, may result in mercury toxicity. Effects of mercury toxicity include memory loss, headaches, sleeplessness, brain fog, and possibly even personality changes.
How does the “SMART” protocol protect patients during mercury amalgam removal?
SMART stands for “Safe Mercury Amalgam Removal Technique”. It involves several safety measures that include:
- Protective gowns for both the dental staff and the patient.
- Equipping rooms with specialized air filtering to reduce mercury exposure.
- Have patients rinse with an activated charcoal solution to remove traces of mercury.
- Using an amalgam separator to collect the mercury amalgam waste for environmentally safe disposal.
- Providing patients with an external air supply during the procedure.
- Isolating the affected teeth with a rubber dam, using a high-speed vacuum to remove dental amalgam fragments, and using a large volume of water to flush away any amalgam particles.
“We have high-volume suction in the area to minimize any amalgam aerialization,” says Dr. Waddle. “We also have what we call our ‘Snuffleupagus’, that gets wheeled in, and placed right under the patient’s chin. It has charcoal filters to remove the mercury vapors.”
What role does IV vitamin C play in the smart protocol? And how does it benefit patients undergoing amalgam removal?
Health Centered Dentistry adds an extra safety measure not required by the SMART protocols: intravenously administered Vitamin C.
Mercury is a powerful oxidant that can find its way into vital tissues. Vitamin C is a powerful antioxidant that helps remove mercury from the body. With intravenous delivery, vitamin C becomes rapidly available to the body. It disperses faster than orally delivered vitamin C and avoids any potential digestive issues patients might experience from higher doses of vitamin C.
According to Dr. Waddle, intravenous vitamin C “…helps our cells with oxidative stress and reduces the risk of damage to vital tissues.”
“It helps tissue healing by increasing collagen production and iron absorption,” says Dr. Waddle, “and also helps the removal of free radicals from vital tissues, including mercury.”
IV Vitamin C requires a prescription. Health Centered Dentistry cannot prescribe this for you. Patients should consult with their primary care provider before amalgam removal to obtain that prescription. Health Centered Dentistry can coordinate with your primary care provider to expedite that process.
Does the SMART protocol involve any pretreatment steps for patients?
The SMART protocols don’t require any specific pretreatment steps. It’s always a good idea to inform your primary care provider that you’re undergoing an amalgam removal procedure, to see if they recommend any pretreatment steps for your level of physical health.
Health Centered Dentistry provides three other pretreatment supplements.
- Selenium: a powerful antioxidant that helps boost our immune systems.
- Glutathione: An antioxidant that helps the body eliminate toxins by binding to them and making them water-soluble.
- A charcoal-water solution to remove any microparticles of amalgam and prevent potential mercury poisoning. The charcoal binds to them before they can be absorbed into the gastrointestinal tract.
“We’ll put a little bit of lemon just in it, so it tastes better than just charcoal water,” says Dr. Waddle. “Glutathione is like the mother of antioxidants. Glutathione and selenium both promote mercury removal.”
Should patients be concerned about safety or discomfort during amalgam removal?
According to Dr. Waddle, amalgam removal is a very common process. “Comfort is very similar, if not the same, as any other routine dental filling appointment.”
Adhering to the SMART protocols means dentists like Dr. Waddle take multiple precautions to remove mercury vapor and particles and ensure your safety.
If you have questions, “Go do your research. Bring resources. Talk to your medical provider, or talk to me,” says Dr. Waddle. “I like people being informed.”
If you’d like to learn more about the SMART removal protocols, visit the website of the International Academy of Oral Medicine and Toxicology (IAOMT).
How long does the procedure take?
Despite the extra equipment and safety protocols, the procedure doesn’t take too long.
“Not that much longer than a regular filling appointment,” says Dr. Waddle. “Usually it’s an additional 10 minutes at the beginning of an appointment.”
The procedure itself involves using a very sharp, very small diameter carbide drill to remove the existing amalgam fillings. They’re removed in single pieces, rather than cutting them into sections or grinding them into small pieces.
“It’s just like a mercury disk,” says Dr. Waddle.
If extra decay is found during the procedure, extra time may be needed to prepare the tooth structure for a new composite filling.
“Sometimes we find cracks underneath that require potentially more expensive restorations,” says Dr. Waddle.
Prior to your amalgam removal, extra time is needed for supplements and the IV vitamin C.
Health Centered Dentistry in Anchorage is Certified for the SMART Amalgam Filling Removal Process by The IAOMT
At Health Centered Dentistry, our Anchorage office provides SMART amalgam filling removal, family dentistry, restorative dentistry, and aesthetic dentistry.
We’ve been Alaska’s destination for holistic dentistry for over 20 years. We ensure comfortable dental care — and we love spoiling our patients with a luxe menu of amenities that will have you looking forward to visiting us. We love our Alaska Community!
We provide comprehensive dental services to Anchorage, and we use the latest dental technologies to make sure you get the best dental care possible.
Need fillings, crowns, or other restorative dental work? Contact Health Centered Dentistry today.