If you have old silver fillings, there is a critical question you should be asking your dentist before they are ever removed: Are you SMART Certified?
Most patients assume that having a dental filling removed is a straightforward procedure. In reality, the way old amalgam fillings are removed makes an enormous difference to your health. Done incorrectly, the process can expose you to levels of mercury vapor that are far more harmful than simply leaving the filling in place. SMART Certification was created to change that.
At Leila Hariri Dental and Sleep Apnea Clinic in Dubai, we believe that exceptional dental care goes beyond treating teeth. It means protecting your whole body, every step of the way. That commitment is why our approach to amalgam removal follows the rigorous safety standards established by the IAOMT's SMART protocol.
What Does SMART Stand For?
SMART stands for Safe Mercury Amalgam Removal Technique. It is a set of evidence-based guidelines developed by the International Academy of Oral Medicine and Toxicology (IAOMT), a leading global organization that promotes mercury-free, mercury-safe, and biologically compatible dentistry.
The IAOMT developed SMART in response to a well-documented risk: drilling out amalgam fillings releases significant quantities of mercury vapor and fine particulates. These particles can be inhaled and absorbed through the lungs, potentially harming patients, dental professionals, and even the fetuses of pregnant women. This is why the IAOMT explicitly advises that pregnant women should not have their amalgam fillings removed.
SMART Certification means a dentist has completed formal coursework on mercury toxicology and the safe removal of amalgam fillings, including three units of scientific readings, instructional videos, and examinations. Certified dentists are then listed in the IAOMT's public directory so that patients can identify and choose a qualified, trained provider.
Why Do Old Amalgam Fillings Raise Concern?
Dental amalgam fillings have been used for over 150 years. While they are durable, they contain approximately 50% mercury by weight. Mercury is one of the most toxic naturally occurring substances on earth. For decades, the dental industry maintained that mercury in amalgam was locked in and therefore safe.
The scientific understanding of this issue has evolved significantly. Research now shows that amalgam fillings release small amounts of mercury vapor continuously, particularly during chewing, teeth grinding, and temperature changes. The concern intensifies during removal, when drilling can generate a surge of mercury vapor that far exceeds safe exposure thresholds if proper precautions are not taken.
Patients who have had fillings removed without SMART protocols may have been unnecessarily exposed to elevated mercury levels without ever knowing it.
What Happens During a SMART-Certified Amalgam Removal?
SMART-certified dentists follow a detailed safety protocol designed to minimize mercury exposure at every stage of the removal process. Key measures include:
Chunking technique: Rather than grinding the filling down slowly, the SMART approach cuts the amalgam into larger chunks to reduce the total amount of mercury vapor generated during removal.
High-volume evacuation: Powerful suction equipment positioned close to the tooth captures mercury vapor and particles before they can be inhaled. Standard suction systems are not sufficient for this purpose.
Rubber dam isolation: A protective barrier is placed around the tooth being treated to prevent mercury particles from being swallowed or spreading throughout the mouth.
Protective coverings: Patients are draped with protective coverings to prevent mercury contact with skin and clothing. Nasal masks may be used to ensure patients are breathing filtered or alternative air during the procedure.
Activated charcoal rinse: Patients may be asked to rinse with activated charcoal before and after the procedure to help bind any mercury that may have been ingested.
Air filtration systems: The treatment room is equipped with filtration systems to maintain air quality throughout the procedure.
Proper disposal: Mercury waste is handled and disposed of responsibly to protect the environment and the wider community, using amalgam separators.
Together, these measures create a significantly safer experience for the patient, the dental team, and the environment compared to conventional amalgam removal.
What Makes SMART Certification Different from General Dental Training?
Standard dental training does not include dedicated instruction on the safe handling and removal of mercury amalgam. A general dentist may be perfectly skilled in many areas of dentistry while having had little to no formal education on mercury toxicology or the specific hazards of amalgam removal.
SMART Certification bridges that gap. It requires dentists to engage with current scientific literature on mercury exposure, complete structured educational modules, pass assessment tests, and demonstrate an understanding of safe case management. To maintain their SMART-certified status in the public directory, dentists must also attend an IAOMT conference in person at least once every three years, ensuring their knowledge remains current as science evolves.
This is not a title awarded automatically with a dental degree. It is earned through deliberate, focused effort.
Who Should Consider Amalgam Removal?
Not everyone with amalgam fillings needs to have them removed. The decision is individual and should always be made in consultation with your dentist. However, there are circumstances where removal may be worth exploring:
- Fillings that are old, cracked, or deteriorating
- Patients with suspected mercury sensitivity or immune concerns
- Those pursuing a more holistic approach to their health
- Individuals transitioning to fully mercury-free dental care
If you do choose to have amalgam fillings removed, the most important thing you can do is ensure your dentist is SMART Certified and follows the full IAOMT protocol.
Our Commitment to Biological Dentistry in Dubai
At Leila Hariri Dental and Sleep Apnea Clinic, our approach to dentistry is rooted in clinical excellence and whole-body health. We recognise that the mouth is not separate from the rest of the body. Everything we do in the dental chair has the potential to impact your systemic health, and we take that responsibility seriously.
SMART-certified amalgam removal is one part of a broader commitment to biologically compatible care that respects your body, your safety, and your long-term wellbeing.
If you have questions about your existing amalgam fillings or would like to discuss safe removal options, our team is here to guide you through every step. Book a consultation at our Dubai clinic today and take the first step toward dentistry that truly puts your health first.
