In This Article

What is the SMART Protocol?

SMART stands for Safe Mercury Amalgam Removal Technique. It is a set of protective procedures designed to minimize mercury exposure for the patient, dental staff, and the environment during the removal of amalgam (silver) fillings.

The core idea is straightforward: while all amalgam removal carries some procedural mercury exposure, careful technique can significantly reduce the amount of mercury vapor and particles that are released and potentially inhaled or absorbed during the procedure.

📋 Key Point
SMART is not a single thing — it's a collection of techniques used together. A dentist may use some SMART elements without being formally SMART-certified. When evaluating a provider, ask about each specific protective measure.

Who developed the SMART Protocol?

The SMART protocol was developed and is promoted by the International Academy of Oral Medicine and Toxicology (IAOMT), a nonprofit organization of dental, medical, and research professionals who focus on evidence-based approaches to the impact of dental materials on human health.

The IAOMT offers training and a certification program for dentists who want to demonstrate proficiency in SMART procedures. However, IAOMT membership and SMART certification are not the only ways a dentist can practice these techniques — many dentists follow similar protocols without formal certification.

The 5 core SMART protective steps

01
Rubber dam isolation
A rubber or non-latex sheet is placed in your mouth and secured around the tooth being worked on. This acts as a physical barrier, preventing mercury particles, debris, and vapor from entering the rest of your mouth and throat. This is considered the single most important protective step for patients.
02
Sectioning (chunking) the filling
Instead of grinding the amalgam down (which creates a fine mercury-laden dust and large amounts of vapor), the SMART technique involves cutting the filling into large sections and removing them as whole pieces. This dramatically reduces the surface area of mercury exposed during removal.
03
High-volume evacuation (HVE)
A high-powered suction device is positioned directly adjacent to the tooth throughout the procedure. This captures mercury vapor, particles, and coolant water before they can spread into the treatment room air or be inhaled. Standard dental saliva ejectors are insufficient — HVE is a specific, high-capacity suction system.
04
Copious water irrigation and cooling
Continuous water spray cools the drill and amalgam during sectioning, which reduces mercury vapor production. Heat significantly increases mercury volatilization, so keeping temperatures low during cutting is a meaningful protective measure.
05
Room air filtration
HEPA air filtration units with activated carbon are used in the treatment room during SMART procedures. Some practices also use an additional external suction device near the patient's face. This protects both the patient and the dental team from ambient mercury vapor in the room.

Additional SMART elements

Beyond the five core steps, many SMART-trained practitioners also incorporate:

  • Supplemental oxygen for the patient through a nasal cannula during the procedure
  • Pre-and post-procedure nutritional protocols (often including chlorella, vitamin C, or other supplements)
  • Protective covering for the patient to prevent skin contact with mercury particles
  • Immediate removal and proper disposal of amalgam waste
  • Thorough rinsing of the patient's mouth after removal

Who offers SMART removal?

SMART removal is offered primarily by biological dentists, holistic dentists, and dentists who have completed IAOMT training. Some conventional dentists also use SMART-like protocols without formal certification.

Not all dentists who describe themselves as "mercury-free" (meaning they no longer place new amalgam fillings) necessarily follow SMART procedures for removing existing amalgam fillings. These are distinct practices — see our guide on Mercury-Free vs. Mercury-Safe Dentistry.

Does SMART removal cost more?

Yes, in most cases. The additional equipment, time, and protective materials involved in SMART procedures typically add $50–$200 per filling above standard removal rates. This cost is generally not covered by dental insurance. See our Cost Calculator for estimates based on your situation.

Questions to ask your dentist about SMART

  • Do you use a rubber dam for amalgam removal?
  • Do you section the amalgam or grind it out?
  • Do you use high-volume evacuation (not just saliva ejectors)?
  • Do you have air filtration in the treatment room?
  • Are you IAOMT-trained or certified in SMART?
  • Do you provide oxygen during the procedure?

Use our full 20-Question Appointment Checklist to prepare for your consultation.