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Responsible And S.M.A.R.T. Amalgam Filling Removal

It makes logical sense to handle heavy metals with care for countless reasons. Lyons Creek Dental Care has been practicing a specific protocol for removing metal fillings for over 30 years, called S.M.A.R.T.–Smart Metal Amalgam Removal Technique. We thought it would be useful to offer our patients the following checklist illustrating the protections we take when patients ask for amalgam filling removal. This protocol was designed by the International Academy of Oral Medicine and Toxicology (IAOMT), of which Dr Chris and Dr Bob are active members. Check out more IAOMT information at https://www.IAOMT.org.

Patient Protection

  • Slurry of charcoal, chlorella, or similar adsorbent for patient to rinse and swallow before the procedure
  • Full body, impermeable barrier, as well as full head/face/neck barrier under/around the dam
  • External air or oxygen delivered via a nasal mask for the patient OR via nasal cannula completely covered with an impermeable barrier
  • Dental dam made with non-latex nitrile material placed and properly sealed in the patient’s mouth
  • Saliva ejector placed under the dental dam
  • At source oral aerosol vacuum in close proximity to patient’s mouth
  • Clean Up device (not essential but preferred)
  • Copious amounts of water to reduce heat and a conventional high speed evacuation device to capture mercury discharges
  • Section amalgam into chunks and remove in as large of pieces as possible, using a small diameter carbide drill
  • After removal, the patient’s mouth should be thoroughly flushed with water and then rinsed out with a slurry of charcoal, chlorella or similar adsorbent

Dentist/Staff Protection

  • Protective gowns and covers for the dentist and dental personnel
  • Non-latex nitrile gloves for the dentist and dental personnel
  • Face shields and hair/head coverings for the dentist and dental personnel o Either a properly-sealed, respiratory grade mask rated to capture mercury or a positive pressure, properly-sealed mask providing air or oxygen for the dentist and dental personnel
  • During the opening and maintenance of suction traps in operatories or on the main suction unit, dental staff should utilize the appropriate personal protection equipment

Office & Environmental Protection

  • An amalgam separator that is properly installed, utilized, and maintained o High-volume air filtration system (such as an at source oral aerosol vacuum)
  • If possible, open windows to reduce the mercury concentration in the air o Compliance with federal, state, and local regulations addressing the proper handling, cleaning, and/or disposal of mercury-contaminated components, clothing, equipment, surfaces of the room, and flooring in the dental office