Face 
Dentistry The short answer: SMART amalgam removal is a protocol that uses additional precautions designed to reduce exposure to amalgam particles and mercury vapour while an amalgam restoration is being removed.
SMART stands for Safe Mercury Amalgam Removal Technique.
It was developed by the International Academy of Oral Medicine and Toxicology – IAOMT – and sets out a series of measures relating to isolation, suction, air management, water cooling, protective barriers and the way an amalgam restoration is removed.
There is one important distinction to understand from the outset:
SMART explains how an amalgam filling can be removed. It does not tell us whether the filling needs to be removed.
At Evolve Dentistry, that decision always comes first.
Dental amalgam is a restorative material that has been used in dentistry for many years.
It is often described as a silver filling because of its appearance and is made from a mixture of metals, including mercury combined with metals such as silver, tin and copper.
Many adults have amalgam restorations that have been in their mouths for years.
Having one does not automatically mean anything needs to be done.
Like any dental restoration, an amalgam filling should be assessed as part of your routine dental care. If it remains serviceable and the surrounding tooth is healthy, continuing to monitor it may be appropriate.
If the restoration or tooth needs further treatment, removal may form part of that treatment.
Some adults may also ask about replacing a silver-coloured restoration because they would prefer a tooth-coloured alternative.
SMART stands for:
Safe Mercury Amalgam Removal Technique
The protocol was developed specifically for the removal of dental amalgam.
Removing an existing filling usually involves using dental instruments to separate the restoration from the tooth. During amalgam removal, this can produce particles, debris and vapour.
SMART brings together additional precautions designed to manage that treatment environment.
The full protocol is published by the IAOMT.
The precise clinical setup depends on the tooth and individual treatment plan, but SMART includes measures relating to several areas.
A rubber dam can be placed around the tooth being treated.
This creates a barrier between the treatment area and the rest of the mouth and helps control debris during the procedure.
If you have never experienced a rubber dam before, it can initially feel unusual. You remain able to breathe normally through your nose and communicate with the dental team.
High-volume suction is positioned close to the treatment area.
This helps collect water, debris and material generated during removal.
Water is used while the restoration is being removed.
Among other purposes, this helps control heat generated during the use of dental instruments.
Where clinically appropriate, the amalgam restoration can be divided into sections.
This allows pieces of the restoration to be removed rather than unnecessarily grinding away the entire filling.
SMART also includes additional protective measures for the patient and dental team and measures relating to air management in the treatment room.
No clinical protocol should be described as guaranteeing zero exposure.
SMART uses additional precautions designed to reduce exposure to particles and vapour during amalgam removal.
We deliberately avoid describing the technique as completely risk-free or claiming that it eliminates exposure altogether.
This is an important part of giving patients balanced information rather than overstating what a particular protocol can achieve.
No.
Using additional precautions during a removal procedure does not mean that every amalgam restoration needs to be removed.
These are two different questions:
Question one: Does this tooth or restoration need treatment?
Question two: If it is going to be removed, how will the removal be carried out?
SMART relates to the second question.
At Evolve, Carol or Maggie will first assess your existing restoration and the tooth around it.
If a filling is functioning appropriately, monitoring it may be a perfectly reasonable option.
There are several possible reasons.
Like any restoration, an amalgam filling may eventually require further treatment.
There may be a problem with the tooth itself that means the existing restoration needs to be removed.
Depending on the amount of healthy tooth remaining, a tooth may require a different restorative approach.
Some adults dislike seeing silver-coloured restorations and would prefer a tooth-coloured alternative.
That is something you can discuss with us, but removing a functioning restoration still involves further treatment of the tooth, so the advantages and disadvantages should be understood first.
This is perhaps the most important part of understanding SMART amalgam removal.
The existence of the protocol does not mean that amalgam fillings should routinely be removed.
At Evolve Dentistry, we do not recommend removing a sound amalgam restoration on the basis that doing so will improve your general health.
Instead, treatment decisions are based on the condition of your teeth and restorations, alongside your informed preferences.
If removal is appropriate and you choose to proceed, SMART can then form part of how that treatment is provided.
Reality: SMART is a removal protocol. It does not determine whether a restoration requires treatment.
Reality: The protocol uses additional precautions designed to reduce exposure. It would not be appropriate to promise that exposure can be completely eliminated.
Reality: SMART describes the removal process. The tooth still needs to be restored afterwards using an appropriate restorative material.
Reality: Patients may require amalgam removal for ordinary restorative dental reasons or may choose replacement for aesthetic reasons. SMART relates to the procedure itself.
SMART amalgam removal for adult patients at Evolve Dentistry can be carried out by Carol Somerville Roberts or Maggie Nichols.
Your first appointment is about understanding the current condition of your teeth and your reasons for considering treatment.
If removal is appropriate, Carol or Maggie can explain:
The underlying dental objective is still to remove the existing restoration and restore the tooth appropriately. SMART adds a structured series of additional precautions specifically relating to amalgam removal.
Rubber dam isolation forms part of the SMART approach. Carol or Maggie can explain the exact clinical setup planned for your individual treatment.
Potentially. If several restorations require treatment, we will first assess each tooth and decide whether treatment is best provided together or divided between appointments.
No. SMART relates to the dental procedure used to remove an amalgam restoration. At Evolve we do not position amalgam removal as a treatment for general medical symptoms or as a form of detoxification.
Some adults ask about replacing visible silver-coloured restorations with tooth-coloured alternatives. We can assess whether this is clinically appropriate and discuss the implications before you decide.
If you are wondering whether your own fillings actually need treatment, read:
Should I have my amalgam fillings removed?
If your main concern is the removal procedure itself, read:
Is it safe to remove amalgam fillings?
For a step-by-step explanation of the appointment, read:
What happens during SMART amalgam removal?
Or return to our complete cornerstone resource:
Amalgam removal using the SMART protocol
Prefer to read everything in one place?
Download: Your guide to SMART amalgam removal
It explains how to decide whether treatment may be appropriate, what SMART involves, replacement options and what to expect if you choose treatment.
You do not need to decide on removal before making an appointment.
Carol or Maggie can assess your existing restorations, explain what they can see and discuss whether treatment or continued monitoring may be appropriate.
Book an amalgam consultation
Read the IAOMT’s explanation of the SMART protocol
Read our CQC report
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Book An Introduction Call Why is my dentist taking photographs of my teeth?
“Why are you taking photographs of my teeth?”
A perfectly reasonable question.
Dental photographs aren`t just for before-and-afters.
They can help us record what we`re seeing, monitor changes, explain things more clearly and involve you in conversations about your own teeth.
Richard explains why you might see a camera appear during an appointment at Evolve.
Because when we`re talking about your mouth, we think it`s rather useful if you can see what we`re talking about too.
There`s more to a smile transformation than two photographs
A before-and-after shows you two moments.
What it doesn`t show is everything that happened between them.
The conversations. The planning. What the patient wanted to change. The different options considered. And the decisions about what not to change.
That`s why we think the story behind a smile is every bit as interesting as the finished result.
Every patient is different - and every treatment plan should be too.
Here`s one of the lovely transformations we`ve had the privilege of being part of at Evolve. 💚
What actually happens during a dental examination?
If it’s been a while since your last dental examination, not knowing what to expect can sometimes make booking that appointment feel like a much bigger deal.
So what actually happens when you come in?
Richard explains what your dentist is looking for during a dental examination - and why it involves much more than simply checking whether you need a filling.
Regular examinations give us an opportunity to keep an eye on your teeth, gums and mouth, talk about anything that has changed and identify anything that may need our attention.
And if you haven’t been for a while? Please don’t feel embarrassed.
We’re simply pleased you’ve decided to come and see us.
🦷 We’re hiring - Dental Nurse | Portishead
We’re looking for a lovely new person to join our award-winning team at Evolve Dentistry.
You could be an experienced or newly qualified Dental Nurse, already in training, or looking for a completely new career - we’re genuinely open to all three. Finding the right person matters most.
If you’re new to dental nursing, we’ll fund and support you through your qualification.
💚 Permanent | Approx. 36 hours per week
💷 Trainee: £13.50-£14.50 per hour
💷 Qualified: £14.50-£16.55 per hour
📍 Portishead
📅 Monday, Thursday, Friday + alternate Saturdays
You’ll join a friendly, supportive team with great benefits, funded training and plenty of opportunities to develop.
Interested? Send your CV and a short covering note to hello@evolve-dentistry.co.uk.
Know someone who might be perfect for Evolve? Please tag them or share this with them. 💚
https://evolve-dentistry.co.uk/recruitment/
A little Evolve refresh 💚
You may have noticed something new if you’ve passed us recently…
Our new external signage is up!
We’ve given the outside of Evolve a refresh, making it even easier to spot us when you’re visiting the practice.
It’s been lovely seeing everything come together, and we think it looks rather smart. 😊
Have you spotted it yet?
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Starting orthodontic treatment can feel like a big step.
But once you know what to expect, the whole journey often feels much less daunting.
From your first appointment to the day your braces come off, every stage is carefully planned to help you achieve a healthy, confident smile.
Swipe through our step-by-step guide to see what happens during orthodontic treatment - and how we’ll support you every step of the way.
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