What Is SMART?
SMART stands for Safe Mercury Amalgam Removal Technique — a detailed, evidence-based protocol developed by the International Academy of Oral Medicine and Toxicology (IAOMT) to protect patients, dental teams, and the environment during the removal of mercury amalgam fillings.
Here is what most patients are never told: removing amalgam fillings without proper precautions can expose you to significantly more mercury in a single appointment than years of simply leaving the filling in place. When a drill cuts through an amalgam filling without protective measures, it releases mercury vapor and fine particles in quantities that far exceed the slow, ongoing emissions of an intact filling.
This is why the technique matters as much as the decision to remove.
At Dr. Rossinski Dental Health, we are SMART certified. When we remove amalgam, we follow the full protocol — for you, for our team, and for the environment.
What Is Dental Amalgam?
.webp)
Despite being commonly called "silver fillings," dental amalgam is approximately 50% mercury by weight. The remaining composition includes silver, tin, and copper. Mercury is what makes the material workable — but bound does not mean inert.
Amalgam fillings release mercury vapor continuously throughout their lifetime. Exposure increases during chewing, grinding, brushing, and drinking hot liquids. That vapor is absorbed into the body, crosses the blood-brain barrier, and accumulates in tissue over time.
In 1991, the World Health Organization concluded that dental amalgam was the primary source of mercury exposure for people with amalgam fillings — exceeding combined exposure from food, air, and water. The European Union completed a full ban on dental amalgam in 2026. Norway, Sweden, and Denmark had already banned it years earlier.
The conversation has changed. And so has the standard of care.
Mercury is one of the most potent neurotoxins known to science. It does not stay in one place — it crosses the blood-brain barrier, accumulates in the kidneys, liver, and nervous system, and disrupts cellular function at a level that can take years to become visible.
Chronic low-level mercury exposure from amalgam fillings has been associated with a wide range of symptoms that are frequently attributed to other causes or left unexplained entirely:
Neurological symptoms — brain fog, memory difficulties, difficulty concentrating, numbness or tingling in the hands and feet.
Fatigue — persistent, exhaustion that does not improve with rest
Mood and mental health — anxiety, irritability, depression, emotional instability
Hormonal disruption — irregular cycles, thyroid dysfunction, adrenal imbalance
Immune dysregulation — frequent illness, autoimmune conditions, heightened sensitivities and allergies
Digestive issues — nausea, gut inflammation, disrupted microbiome
Cardiovascular effects — elevated blood pressure, irregular heart rhythm
Kidney and liver stress — mercury accumulates in both organs and can impair their function over time
Sleep disturbances — difficulty falling or staying asleep, restless sleep patterns
Joint and muscle pain — unexplained aches, stiffness, or inflammation
Many patients carry these symptoms for years without connecting them to their dental history. Mercury burden is rarely the first thing investigated — and yet for some patients, it is the missing piece.
We recommend consulting with your physician about mercury testing if you suspect metal toxicity or would like to understand your current mercury levels. Two options are currently available: the Quicksilver Mercury Tri-Test and the BioComp Labs Test.
What Mercury Does to the Body
How We Protect You: The SMART Protocol
Every SMART procedure at our practice includes a carefully coordinated set of protective measures:
Air filtration
high-volume systems capture mercury vapor at the source throughout the procedure
Dental dam
the dam prevents particles from entering the throat
Clean air supply
the patient breathes through a nasal mask delivering clean air or oxygen, so no vapor is inhaled
Full protective
coverings
gowns, face shields, and gloves for the patient and the entire dental team
Chunking
technique
the amalgam is sectioned into large pieces rather than drilled into fine particles, dramatically reducing vapor generation
Pre- and post-procedure rinse
charcoal or chlorella to bind and clear any residual mercury from the oral cavity
Mercury waste collection
disposed of through an amalgam separator in compliance with federal, state, and local regulations
Who Should Consider Amalgam Removal?
The decision to remove amalgam fillings is personal and should never be made in a rush. Our team approaches each patient individually. Removal may be worth discussing if you:
Important: The IAOMT does not recommend amalgam removal for women who are pregnant or
breastfeeding. Timing and individual health circumstances always matter, and our team will
guide you accordingly.
Have old silver fillings and are moving toward a mercury-free mouth as part of a broader health commitment
Experience unexplained chronic symptoms — fatigue, neurological issues, hormonal disruption, or autoimmune conditions — and suspect your fillings may be a contributingfactor
Have known sensitivities or allergies to metals
Are replacing old, failing, or cracked restorations and want to take the opportunity to go mercury-free
Have systemic conditions with known connections to heavy metal burden
What Replaces the Amalgam?
We use biocompatible, tooth-colored composite resin — materials that are free of mercury and heavy metals, bonded directly to the tooth structure, and matched to your individual tooth shade. Beyond being a safer choice, they are also considerably more beautiful. For patients with known sensitivities or complex health histories, we can discuss biocompatibility testing before selecting replacement materials to ensure the best possible match for your individual biology.
After the Procedure: Detox and Whole-Body Support
Removing the fillings eliminates the ongoing source of exposure. But mercury that has accumulated in the body's tissues over months or years does not leave on its own. This is where detox begins — and where the work extends beyond the dental chair.
We strongly recommend that patients who have completed amalgam removal work with a functional or integrative medicine physician to support the body's detoxification pathways. A guided detox protocol — which may include targeted supplementation, nutritional support, and in some cases intravenous vitamin C or chelation therapy — helps the body process and clear the mercury burden that has built up over time. This is not an optional afterthought. It is an essential part of the process.
We are proud to work alongside practitioners who specialize in exactly this. The Morrison Center, a leading integrative medicine practice in New York City, is one of our trusted collaborators — their team regularly works with patients undergoing amalgam removal to provide medically supervised detox support before, during, and after the procedure. Patients are often referred between our practices as part of a coordinated, whole-body approach to mercury recovery.
For those who want to understand their mercury burden before or after removal, we offer testing options through the practice — including the Quicksilver Mercury Tri-Test, which analyzes hair, blood, and urine to distinguish between amalgam-related and dietary sources of mercury, and the Blood Metal Test, which measures levels of 15 metals in the body. Our team also uses EAV screening — based on the Reinhold Voll method — to assess mercury exposure and overall tooth health in the context of your broader wellbeing.
Frequently Asked Questions (FAQ)
01
Is amalgam removal safe?
When performed with the full SMART protocol, yes. The protocol was developed specifically to address the risks that unprotected removal creates. Every measure — from air filtration to the chunking technique to protective coverings — is backed by scientific research and designed to minimize exposure for the patient, the dental team, and the environment.
02
How is SMART different from regular amalgam removal?
Standard amalgam removal offers basic protections — water irrigation and suction — but does not address the full scope of mercury vapor and particle generation that occurs when fillings are drilled out. The SMART protocol adds multiple additional layers of protection identified through more recent research. The difference in exposure levels between the two approaches is significant and well- documented.
03
How many fillings can be removed at one appointment?
This depends on the number and location of the fillings, as well as the individual patient's health circumstances. Our team will discuss the most appropriate approach during your consultation — some patients complete removal in a single visit, while others benefit from a staged approach.
04
What do I need to do to prepare?
Our team will walk you through preparation instructions at
your consultation. Generally, patients are advised to eat beforehand, stay well hydrated, and avoid unnecessary exposure to other environmental toxins in the days around the procedure. Specific guidance will be tailored to your situation.
05
Is my body mercury-free after the fillings are removed?
Not immediately. Removing the fillings eliminates the ongoing source of mercury vapor exposure, but mercury that has accumulated in tissues over the years does not clear on its own. A medically supervised detox program — guided by a functional or integrative medicine physician — is an important next step. Testing before and after can help track changes and guide the process. We are happy to connect you with practitioners who specialize in this, including The Morrison Center.
06
How do I test for mercury?
Several options are available through our practice. The Quicksilver Mercury Tri-Test analyzes hair, blood, and urine to assess mercury levels and distinguish between amalgam-related and dietary sources. The Blood Metal Test measures 15 metals in the body, providing a broader picture of overall metal burden. We also use EAV screening in-office to assess mercury exposure in the context of overall tooth and systemic health.
07
Will my insurance cover this?
Coverage varies by plan. Some insurance providers cover amalgam removal when it is associated with a failing or damaged restoration. Elective removal for health or biological reasons is often not covered. Our team is happy to help you understand your options before proceeding.
08
I'm pregnant — can I have my fillings removed?
The IAOMT does not recommend amalgam removal during pregnancy or while breastfeeding, as the procedure itself — even with full SMART protections — carries a level of exposure that is best avoided during this time. We recommend waiting until after pregnancy and nursing, and our team can help you plan accordingly.
09
What if I have no symptoms — should I still consider removal?
That is a personal decision, and one our team is happy to discuss with you. The absence of obvious symptoms does not mean there is no mercury burden — many patients with significant amalgam exposure feel well for years. For those who are proactive about reducing their toxic load or who are planning a pregnancy, removal is worth considering. We never pressure patients in either direction; our role is to give you the information you need to decide what is right for you.
10
How do I know if my fillings contain mercury?
If your fillings are silver-colored and were placed before the mid-2000s, they almost certainly contain amalgam and therefore mercury. If you are unsure, our team can evaluate your existing restorations at a consultation and give you a clear picture of what you have and what your options are. For those who want to go further, we also offer in-office EAV screening — based on the Reinhold Voll method — to assess mercury exposure and its potential influence on overall health, as well as laboratory testing options including the Quicksilver Mercury Tri-Test and the Blood Metal Test.
