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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Dental Health Plan
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At Evolve Dentistry, our Patient Care Advisors are at the heart of everything we do. From the first friendly hello to helping patients feel comfortable and cared for, you’ll play a huge part in creating the experience we’re so proud of.
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Sound like you? We’d love to meet you!
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If you’re considering replacing an amalgam filling, you may have come across the term SMART.
SMART stands for Safe Mercury Amalgam Removal Technique. It is a protocol designed to reduce exposure to mercury vapour and particles while an amalgam filling is being removed.
At Evolve, SMART amalgam removal is available for adults who have made an informed decision to replace their amalgam fillings.
Importantly, we don’t suggest that everyone should have their amalgam fillings removed, and we don’t make claims that removing them will improve your general health.
Swipe through for a simple explanation of what the SMART approach involves.
#SMARTAmalgamRemoval #AmalgamFillings #DentalCare #EvolveDentistry
If you’ve never visited Evolve before, here’s a little look around.
We know that walking into a new dental practice can feel daunting, particularly if it’s been a while since your last appointment.
We’ve designed Evolve to feel calm, welcoming and a little different from what you might expect from a dental practice.
But the most important part isn’t the building. It’s how you’re made to feel when you’re here.
Come in, make yourself comfortable in our patient lounge and let us look after you.
#EvolveDentistry #Portishead #PortisheadDentist #DentalCare
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
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