Face 
Dentistry If you have amalgam fillings and are wondering whether they need replacing, the first step is understanding your individual situation.
Some amalgam restorations remain serviceable for many years and do not automatically need to be removed. Others may eventually need replacing because the filling or surrounding tooth requires further treatment. Some adults may also prefer a tooth-coloured restoration for aesthetic reasons.
At Evolve Dentistry in Portishead, Carol and Maggie can assess your existing restorations, talk you through your options and, where removal is appropriate, when requested, use the SMART protocol to provide additional precautions during the removal process.
Download our guide to SMART amalgam removal
It is very easy to find conflicting information about amalgam fillings online.
You may have read about mercury, SMART removal, white fillings, biological dentistry or different methods of replacing older restorations. Some information can be helpful. Some can be alarming. And it is not always easy to work out what applies to you.
Our aim is to make the subject simpler.
Having an amalgam filling does not automatically mean that it needs to be removed.
Before recommending treatment, we look at the condition of the filling, the surrounding tooth and your individual circumstances. If the restoration is functioning well, monitoring it may be entirely appropriate. If it needs replacing, we can explain why and discuss suitable replacement options.
If you decide to proceed with amalgam removal, we can use the SMART – Safe Mercury Amalgam Removal Technique – protocol when requested.
SMART is about how an amalgam restoration is removed. It does not determine whether it should be removed in the first place
That decision should always come first.
You do not need to read everything at once. Start with the question that feels most relevant to you.
Read: What is SMART amalgam removal?
A straightforward explanation of the protocol, where it comes from and the additional precautions used during treatment.
Read: Should I have my amalgam fillings removed?
Understand the difference between an amalgam filling simply being present and a restoration that genuinely needs further treatment.
Read: Is it safe to remove amalgam fillings?
Learn why amalgam removal involves particular considerations and how additional precautions can be used during the procedure.
Read: What happens during SMART amalgam removal?
Follow the treatment journey from assessment and anaesthetic through to removal, replacement and aftercare.
Read: What can replace an amalgam filling?
Explore tooth-coloured restorative options and why the right choice depends on the tooth rather than simply replacing silver with white.
Read: Does amalgam removal hurt?
Find out what you may feel during and after treatment and how we help make the appointment as comfortable as possible.
Read: How long does amalgam removal take?
Understand why appointment times vary depending on the filling, tooth and restoration required afterwards.
Read: Can several amalgam fillings be removed at the same time?
Learn why some patients have several restorations treated together while others may benefit from treatment being divided between appointments.
Read: How much does SMART amalgam removal cost?
See what influences the overall cost, including the number of fillings being treated and how the teeth need to be restored afterwards.
Read: Can amalgam fillings be removed during pregnancy or breastfeeding?
Read our guidance on elective treatment and why individual dental needs should be discussed with your dentist.
Dental amalgam is a restorative material traditionally used to repair teeth affected by decay or damage.
It is sometimes called a silver filling because of its appearance.
Amalgam is made from a mixture of metals, including mercury combined with metals such as silver, tin and copper. The resulting material has historically been used because it is durable and can withstand the considerable forces placed on back teeth.
Many adults still have amalgam fillings that were placed years – sometimes decades – ago.
The simple fact that a restoration is old does not necessarily mean it needs to be replaced.
Like any dental restoration, amalgam fillings should be checked as part of your regular dental examinations so your dentist can monitor both the filling itself and the tooth around it.
For general information about dental fillings and restorative treatment, you can also read the NHS information on dental treatments:
External resource:
https://www.nhs.uk/live-well/healthy-teeth-and-gums/dental-treatments/
Not routinely.The right question is not simply:
“Do I have an amalgam filling?”
It is:
“What is the condition of this filling and the tooth around it?”
There can be several reasons why replacement may be discussed.
Like other filling materials, amalgam restorations do not last indefinitely.
A filling may eventually become worn, fractured or otherwise require replacement. The surrounding tooth may also develop a problem that means further restorative treatment is needed.
In these circumstances, treatment is being recommended because of the condition of the tooth or restoration – not simply because the filling is amalgam.
Sometimes removing an old restoration reveals that the remaining tooth requires a more substantial repair than another filling.
Depending on how much healthy tooth structure remains, your dentist may discuss options such as a direct tooth-coloured restoration, an inlay, an onlay or a crown.
Some adults dislike the appearance of silver-coloured fillings and ask whether they can be replaced for cosmetic reasons.
That is a reasonable conversation to have.
However, replacing any functioning dental restoration involves removing material from a tooth, so the decision should still be made carefully.
We can examine the restoration, explain the advantages and disadvantages of replacement and help you decide whether changing it is worthwhile for you.
You do not need to arrive knowing what treatment you want.
If you have read conflicting information online or simply want to understand the condition of your restorations, Carol or Maggie can assess them and explain what they can see.
Sometimes the outcome of that conversation may be treatment.
Sometimes it may be monitoring.
Both are valid outcomes.
Related Knowledge Hub article: Should I have my amalgam fillings removed?
SMART stands for Safe Mercury Amalgam Removal Technique.
The protocol was developed by the International Academy of Oral Medicine and Toxicology – IAOMT – and sets out a series of precautions designed to reduce exposure to amalgam particles and mercury vapour while an amalgam restoration is being removed.
The removal of amalgam involves drilling the restoration. SMART adds measures intended to control particles, vapour and debris generated during that process.
Depending on the clinical situation, precautions may include measures such as:
SMART should not be interpreted as a guarantee that exposure can be completely eliminated.
It is best understood as a structured precautionary approach to the removal procedure.
You can read more about the protocol directly from the IAOMT:
External resource:
https://iaomt.org/resources/safe-removal-amalgam-fillings/
Related Knowledge Hub article: What is SMART amalgam removal?
This distinction is central to our approach at Evolve.
SMART is a removal protocol.
It is not a diagnosis.
It does not mean every amalgam restoration needs removing, and we do not recommend replacing a sound amalgam restoration on the basis that doing so will improve your general health.
Before treatment is considered, we first assess:
That assessment gives you the information you need to make an informed decision.
Every treatment plan is individual, but the process usually begins well before the filling is removed.
Carol or Maggie will examine the restoration and surrounding tooth.
Where appropriate, this may include dental X-rays or other assessment so that we can understand the condition of the tooth beneath and around the filling as far as possible before treatment.
If the filling appears serviceable, monitoring may be an option.
If treatment is recommended, we will explain why.
If you are considering replacement primarily because you dislike the appearance of the restoration, we will also discuss the implications of removing a functioning filling.
Removing the old filling is only half of the treatment.
We also need to know how the tooth is likely to be restored afterwards.
Depending on the size of the restoration and the condition of the remaining tooth, options may include a tooth-coloured filling or a more substantial restoration such as an onlay or crown.
Local anaesthetic can be used so that the tooth and surrounding area are numb during treatment.
The precise setup depends on the tooth and procedure, but additional precautions are used to help manage amalgam particles, debris and vapour during removal.
Where possible, the existing restoration can be sectioned so that pieces can be lifted from the tooth rather than unnecessarily grinding the whole restoration away.
Water cooling and suction are used during treatment.
Once the old restoration has been removed, Carol or Maggie can see the tooth more clearly.
Occasionally the condition of a tooth can only be fully appreciated once an old filling is out.
If anything unexpected is found, it will be explained to you.
The planned replacement restoration is then provided where appropriate.
The restoration is adjusted so it sits appropriately when you bite together.
You will be given relevant aftercare information, including what you may notice once the local anaesthetic wears off and when you should contact us if you have concerns.
Related Knowledge Hub article: What happens during SMART amalgam removal?
No dental procedure is completely risk-free.
SMART uses additional precautions during amalgam removal, but it should not be described as a guarantee of zero exposure or zero risk.
Removing any existing restoration also involves treating the underlying tooth.
Potential considerations can include:
This is why we assess the tooth first and explain both the reasons for treatment and the alternatives.
Related Knowledge Hub article: Is it safe to remove amalgam fillings?
There is no single material that is automatically right for every tooth.
The choice depends on factors such as:
Composite can be used to restore many teeth and provides a tooth-coloured result.
It is particularly useful where there is sufficient healthy tooth structure to support a direct restoration.
For some larger restorations, an indirect restoration such as an inlay or onlay may be considered.
These are designed outside the mouth before being bonded or cemented to the tooth.
A crown may be considered where a tooth requires greater coverage or support.
A crown is not automatically needed simply because an amalgam filling has been removed. Whether one is appropriate depends on the condition and remaining structure of the tooth.
The most suitable restoration can only be decided after assessment.
Related Knowledge Hub article: What can replace an amalgam filling?
If one of your reasons for replacing amalgam is its appearance, the aesthetic difference can be significant because modern restorative materials can be selected to blend more naturally with the surrounding tooth.
However, cosmetic appearance is only one part of treatment planning.
We still need to choose a restoration that is appropriate for the size, position and condition of the tooth.
Our priority is therefore not simply to turn a silver filling white.
It is to restore the tooth appropriately while taking your aesthetic preferences into account.
The tooth can be numbed using local anaesthetic, so the aim is for you to remain comfortable while treatment is carried out.
You may still be aware of:
Some teeth may feel temporarily different or sensitive after restorative treatment, particularly once the anaesthetic has worn off.
If you are nervous about dental treatment, please tell us.
Knowing what concerns you allows Carol or Maggie and the wider Evolve team to explain the appointment more carefully and help you feel prepared.
Related Knowledge Hub article: Does amalgam removal hurt?
There is no single appointment length that applies to everyone.
Treatment time depends on factors including:
A small restoration requiring a straightforward replacement is very different from several large restorations across multiple teeth.
Once we have assessed your mouth, we can explain the likely treatment plan and appointment schedule.
Related Knowledge Hub article: How long does amalgam removal take?
Potentially, yes.
Some adults have several older amalgam restorations and would prefer to plan treatment across more than one tooth.
Whether that is appropriate in one appointment depends on the individual situation.
We consider:
There is no advantage in rushing treatment simply to remove more restorations in a single visit.
The aim is to create a plan that is appropriate for your teeth and manageable for you.
Related Knowledge Hub article:
Can several amalgam fillings be removed at the same time?
There is not one standard cost for every patient because the removal protocol is only one part of the treatment.
The overall fee is influenced by:
Following assessment, we can provide a treatment plan and explain the associated fees before treatment begins.
You can also view Evolve Dentistry’s current treatment fees on our website.
Related Knowledge Hub article: How much does SMART amalgam removal cost?
Elective amalgam removal deserves particular consideration during pregnancy or breastfeeding.
If treatment is not urgent, it may be appropriate to delay elective removal.
However, pregnancy does not prevent you from seeking dental care if you have toothache, a damaged restoration or another dental problem that needs assessment.
The right approach depends on why treatment is being considered.
Please tell us if you are pregnant, think you may be pregnant or are breastfeeding so that your individual dental needs can be discussed appropriately.
Related Knowledge Hub article: Can amalgam fillings be removed during pregnancy or breastfeeding?
SMART amalgam removal for adult patients at Evolve Dentistry can be carried out by Carol Somerville Roberts or Maggie Nichols.
Your appointment begins with assessment and discussion rather than an assumption that treatment will be needed.
Carol or Maggie can:
You are not unusual.
The combination of online information about amalgam and the prospect of a longer restorative dental appointment can make some patients feel apprehensive.
We find that uncertainty often feels easier once the process is explained properly.
Before treatment you can ask about:
There is no benefit in pretending you are not nervous.
Tell us what concerns you and we can work through it with you.
If you would prefer to understand the subject in your own time, we have created a detailed patient guide:
What to consider before deciding, how the SMART protocol works and what to expect if you choose treatment
The guide covers:
Download – Your-guide-to-SMART-amalgam-removal
People often use the term “silver filling” to describe dental amalgam because of its colour. Amalgam is a mixture of metals, including mercury combined with silver, tin and copper.
No. The presence of an amalgam restoration alone does not mean treatment is required. Its condition and the health of the surrounding tooth need to be assessed.
We do not recommend removing a sound amalgam filling on the basis that doing so will improve your general health. We find that a lot of patients request the removal of their amalgam fillings because they prefer not to have them in their mouths. At Evolve, we do not dictate treatment to patients and respect their autonomy regarding the materials used in their mouths. Treatment recommendations are based on your dental needs, with cosmetic preferences discussed separately where appropriate.
It would probably be a good idea to say that I am a member of the IAOMT and have been for 20 years.
SMART stands for Safe Mercury Amalgam Removal Technique. It is a protocol developed by the IAOMT that uses additional precautions during amalgam removal.
A rubber dam can help isolate the tooth being treated from the rest of the mouth and helps control material and debris during restorative treatment.
High-volume suction close to the treatment area is one of the measures used to manage debris and vapour produced while an amalgam restoration is being removed.
Sometimes, but not always. The best replacement depends on the size and condition of the tooth. A direct tooth-coloured filling may be appropriate for some teeth, while others may require a different type of restoration.
You can certainly discuss this with us. Some adults choose to replace visible silver-coloured restorations for aesthetic reasons. We will first assess the tooth and explain the implications of removing a functioning restoration so you can make an informed decision.
Some sensitivity can occur after restorative dental treatment. The amount and duration vary according to the tooth and treatment provided. We will explain what is expected in your individual situation and when to contact us if you are concerned.
It depends. Multiple restorations can sometimes be treated during the same appointment, while more extensive treatment may be better divided between visits.
This Evolve service and this Knowledge Hub are focused on adult patients.
Elective treatment may be better deferred during pregnancy or breastfeeding. If you have an urgent dental problem, however, you should still seek dental assessment. Your individual circumstances can then be considered.
You can contact Evolve directly to discuss an assessment. If you already have information from another dentist, you are welcome to bring it with you.
If you are considering amalgam removal, you do not need to decide anything before you come to see us.
The first step is simply understanding:
If the right option is treatment, we can plan it with you.
If the right option is to leave a sound filling alone and continue monitoring it, that is equally useful to know.
If you would like your existing amalgam fillings assessed, Carol or Maggie can discuss your concerns and help you understand your options.
Book a new patient consultation
Or, if you are still at the research stage download our guide:
Evolve Dentistry is a private dental practice in Portishead, near Bristol, providing personalised adult dental care in a calm and supportive environment.
We believe patients should be given enough information to understand their choices without feeling pressured into treatment.
You can learn more about our practice and team through our website.
Read our CQC report:
https://www.cqc.org.uk/location/1-1802248769
Gum disease can be surprisingly easy to overlook.
Bleeding when you brush, red or swollen gums, persistent bad breath or gums that seem to be receding are all things worth paying attention to.
The important thing is not to wait until something hurts. Gum disease can develop without causing pain, which is one reason regular dental and hygiene appointments matter.
In this short video, Yasmin explains some of the signs to look out for.
If you’ve noticed a change in your gums, mention it at your next appointment or get in touch with the team.
#GumHealth #DentalHealth #PreventiveDentistry #EvolveDentistry
🦷 Day one, first clinic!
Carol has sent us the first photos from her trip — and what a first day it’s been!
Working alongside five other dentists, the team saw an incredible 197 patients in just one day. ❤️
In Carol’s words:
“I’ve taken out more teeth today than I have in the past year!”
A very different day in dentistry from the ones Carol is used to back home at Evolve, and a reminder of just how much need there is for the care the team is providing.
We’re so proud of her — and we’ll be sharing more updates and photos from Carol’s trip as they come in. 🌍🦷
#EvolveDentistry #DentalOutreach #Dentistry #MakingADifference
Ever run your tongue over your teeth and wonder why they suddenly feel rough?
There are a few possible reasons, from plaque build-up to changes in the surface of a tooth.
In this short video, Yasmin explains some of the common causes and when it’s worth mentioning it to your dentist.
Noticing small changes in your mouth is useful. You don’t need to diagnose them yourself, but do tell us if something feels different.
#DentalHealth #OralHealth #Portishead #EvolveDentistry
Good dental care starts with listening.
That’s why some of our clinicians use Heidi, a secure AI note-taking tool, during appointments.
Heidi helps create accurate clinical notes from the conversation, which means your clinician can spend less time typing and more time looking at you, listening to what matters and focusing on your care.
Before using Heidi, we’ll always check that you’re happy for it to be used. And if you’d prefer us not to use it during your appointment, that’s absolutely fine. Just let your clinician or a member of the Evolve team know. It won’t affect your care in any way.
Technology should never get in the way of the human side of dentistry. Used well, we think it can help us protect it.
#EvolveDentistry #PatientCare #PortisheadDentist
Electric or manual toothbrush - which is better?
It`s one of those dental questions where almost everyone has an opinion.
But does buying an electric toothbrush automatically mean you`re doing a better job?
Richard tackles the question.
Whichever toothbrush you use, how you brush matters enormously - so don`t panic if there`s nothing rechargeable sitting beside your bathroom sink.
Now we`re curious...
Clear aligners or fixed braces - which is better?
Which is better - clear aligners or fixed braces?
Neither.
At least, not until we know more about you.
The right orthodontic treatment depends on your teeth, what you`d like to change, your lifestyle and a number of clinical considerations.
For some people, clear aligners can be a great option. For others, fixed braces may be more appropriate.
So rather than starting with:
“Which braces do you want?”
We`d much rather start with:
“What would you like to change about your smile?”
Swipe through to understand some of the differences.
💚 £338 raised for Macmillan Cancer Support! 💚
We had such a lovely time at our Macmillan Coffee Morning last week. ☕🍰
A huge thank you to everyone who popped into the practice, enjoyed a slice of cake, had a chat and made a donation. It was wonderful to see so many of our patients, friends and members of the local community getting involved, and we were genuinely touched by everyone’s generosity.
Together, you helped us raise an amazing £169.
And we’re delighted to share that Carol has very generously matched every pound raised, bringing our final total to…
🥁 £338 for Macmillan Cancer Support! 💚
Thank you to our brilliant team for baking, organising and keeping the cake table well stocked, and to every single person who helped make the day such an enjoyable one.
Days like this remind us just how lovely the community around Evolve really is. 💚
#MacmillanCoffeeMorning #MacmillanCancerSupport #Portishead #EvolveDentistry #PortisheadCommunity
BannerText_Seraphinite Accelerator
