Have you ever looked in the mirror, opened your mouth wide, and noticed those dark, silver-colored spots on your back teeth? If you are like many of my patients, you probably have a few of these “silver” fillings. For decades, this material was the standard for treating cavities. However, as we learn more about the connection between oral health and overall wellness, we have to look closer at what those fillings are actually made of and, more importantly, how we handle them when it is time for them to come out.

I am Dr. Bruce Vafa, and in my holistic dental practice, I prioritize not just the look of your smile, but your systemic health. One of the most critical services I offer is the safe removal of these old fillings. You might think taking out a filling is as simple as drilling it away, but when it comes to amalgam, the process requires precision, care, and a very specific safety strategy. This is where the Mercury Removal Protocol comes into play.

Today, I want to walk you through exactly what the SMART protocol is, why safety measures are non-negotiable, and how prioritizing these steps protects you, my dental team, and even the environment.

The Truth About “Silver” Fillings

To understand why we need such strict safety measures, we first have to understand the material we are dealing with. We often call them silver fillings, but that name is a bit misleading. While they do look silver, the material is actually dental amalgam.

It might surprise you to learn that these fillings are not mostly silver. In fact, according to the FDA, dental amalgam is a mixture of metals, consisting of liquid elemental mercury and a powdered alloy composed of silver, tin, and copper. Approximately 50% of dental amalgam is elemental mercury by weight. This is a significant data point because mercury is a heavy metal that can have toxic effects on the body if we are exposed to high levels of it.

In a solid state in your mouth, these fillings release low levels of vapor. However, the real challenge arises when we need to remove them. Whether the filling is cracked, there is decay underneath it, or you simply want to replace them with biocompatible resin for health or aesthetic reasons, the removal process is the moment of highest risk. This is why I never treat amalgam removal like a standard dental procedure.

Why Standard Removal Is Not Enough

Imagine a typical dental visit. The drill spins at high speeds to grind away old material. When a dentist drills into an amalgam filling without special precautions, that friction creates heat. Heat causes the mercury within the filling to turn into invisible vapor and fine particulate matter.

If we were to remove these fillings without a proper safety net, you (the patient) and I (the dentist) would inhale that mercury vapor. It can also be absorbed through the soft tissues of the mouth or swallowed. As a holistic dentist, my goal is to reduce your toxic load, not add to it. This is why standard drilling techniques are simply not acceptable for this material. We need a method that contains the vapor and captures the particles before they can do any harm.

This is where the SMART method shines. SMART stands for Safe Mercury Amalgam Removal Technique. It is a rigorous set of safety standards developed by the International Academy of Oral Medicine and Toxicology (IAOMT). I am proud to implement these standards because they align with my philosophy of biocompatible, whole-body dentistry.

The Mercury Removal Protocol: Step-by-Step

When you sit in my chair for this procedure, you will notice that we prepare differently than we would for a regular cleaning. The Mercury Removal Protocol is comprehensive. I want to explain each step so you know exactly how we keep you safe.

1. Protective Barriers for the Patient

First, we suit you up. We cover your body with an impermeable gown. This ensures that no particles from the drilling process land on your clothes or skin. We also cover your hair and face. It might feel like a bit much for a dental appointment, but preventing heavy metal particles from settling on you is a top priority.

2. External Air Supply

This is perhaps the most important comfort measure for my patients. We place a nasal mask on you that delivers 100% medical-grade oxygen or clean air. Why do we do this? We want to ensure that while the work is happening in your mouth, you are not breathing in the air directly around the operating field. By providing a clean air source through your nose, you bypass any potential mercury vapor that might be released during the removal.

3. The Dental Dam

Before we start working on the tooth, I place a non-latex dental dam (a rubber sheet) inside your mouth. This isolates the tooth we are working on from the rest of your oral cavity. The dam creates a seal so that no debris or water can slide down your throat. It is a physical barrier that prevents you from swallowing amalgam particles.

4. High-Volume Filtration and Suction

In my operatory, air quality is paramount. We use a high-volume evacuator (suction) placed right next to the tooth. This isn’t just a saliva ejector; it is a powerful vacuum designed to capture vapor and particles the instant they are released.

Additionally, we use an external oral aerosol vacuum. You will see a large suction arm positioned close to your mouth. This device pulls the air away from the procedure area and filters it, acting as a second layer of defense against mercury vapor.

5. Chunking, Not Grinding

The technique I use with the drill is very specific. Instead of grinding the filling down into a powder (which creates massive amounts of heat and vapor), I use a thin burr to cut the filling into large chunks. By sectioning the amalgam, I can pop the pieces out whole. This “chunking” method significantly reduces the amount of drilling required, which in turn minimizes the release of mercury vapor.

6. Copious Amounts of Water

During the brief moments when I am drilling, we use large amounts of water spray and air. The water keeps the tooth and the filling cool. Remember, heat is what causes mercury to vaporize. by keeping the temperature down, we keep the mercury in a solid state, making it easier to suction away safely.

Protecting Our Environment

My commitment to safety extends beyond the dental chair. We have to consider where all that removed material goes. If we wash amalgam down the drain, it enters the municipal water supply, where it can harm wildlife and ecosystems.

According to the EPA, dental offices are the single largest source of mercury discharges to sewage treatment plants, contributing roughly 5.1 tons of mercury annually before regulations were tightened.

To combat this, my practice utilizes an amalgam separator. This is a specialized filtration device installed on our plumbing system. It captures the mercury particles from our suction lines so they do not enter the public water system. By adhering to the Mercury Removal Protocol, we are protecting our local waterways and community just as vigorously as we protect our patients.

Why I Advocate for This Approach

You might be wondering, “Dr. Vafa, is all this really necessary?” My answer is a resounding yes. In my career, I have seen that the body has an incredible ability to heal, but it struggles when burdened by toxicity. By removing potential stressors like mercury in the safest way possible, we clear the path for better overall health.

Many of my patients come to me because they are dealing with unexplained health issues, or they simply want to live a cleaner, more holistic lifestyle. They understand that oral health is the gateway to the body. If I were to remove these fillings carelessly, I would be doing a disservice to the trust they place in me.

I view the Mercury Removal Protocol as an insurance policy for your health. It transforms a potentially hazardous procedure into a safe, controlled, and beneficial transition toward a metal-free smile.

The Benefits of Going Metal-Free

Once the amalgam is safely removed, we don’t just leave a hole there. I replace the old filling with biocompatible composite resin or ceramic materials. These modern materials have several advantages:

• Aesthetics: They are color-matched to your natural tooth shade. No more dark spots when you laugh or yawn.
• Bonding: Unlike amalgam, which just sits in a pocket cut into the tooth, composite bonds directly to the tooth structure. This can actually strengthen the remaining tooth.
• Less Sensitivity: Metal conducts heat and cold very well, leading to temperature sensitivity. Composite materials are insulators, generally making them more comfortable.
• Non-Toxic: You get peace of mind knowing your dental restorations are free from mercury and heavy metals.

For more in-depth reading on the science behind these safety recommendations, I highly suggest reviewing the resources provided by the International Academy of Oral Medicine and Toxicology (IAOMT). Their research is the backbone of the safety standards I implement every day.

Taking the Next Step for Your Health

Choosing to replace your amalgam fillings is a personal decision, but it is one that should be made with all the facts in hand. If you have decided that you want these metals out of your mouth, you deserve to have it done right.

I treat every patient as a unique individual. When you come in for a consultation, we will discuss your health history, examine the condition of your current fillings, and determine the best timeline for replacement. We never rush. For patients with many amalgam fillings, we often space out the appointments to ensure your immune system isn’t overwhelmed, even with our strict safety protocols.

A Healthier Smile Awaits

Navigating the world of dental health can be confusing, but it doesn’t have to be. As your holistic dentist, my job is to bridge the gap between advanced dental technology and natural wellness. The Mercury Removal Protocol is just one of the ways I ensure that your visit to the dentist contributes positively to your life.

Your safety is my priority. Your health is my passion. If you have questions about the silver fillings in your mouth or want to learn more about how we can safely restore your smile, I am here to help. Let’s work together to create a smile that is not only beautiful but also supports a healthier, happier you.