Safe Mercury Amalgam Removal Technique (SMART) Certified by The International Academy of Oral Medicine & Toxicology
Certified Mercury Amalgam Fillings Removal Dentist
Dr. Buchanan is the only dentist in Birmingham, Alabama certified to safely remove mercury amalgam fillings.
SMART is the Safe Mercury Amalgam Removal Technique, which is a set of safety measures to reduce mercury exposures during dental amalgam filling removal. These safety measures were developed as a result of scientific research collected by the International Academy of Oral Medicine and Toxicology (IAOMT).
Dentists who have obtained SMART certification from the IAOMT have completed coursework related to mercury and the safe removal of amalgam fillings. The educational programming includes learning about the application of the rigorous safety measures, including the utilization of specific equipment. To maintain SMART certification, each dentist enrolls in the program annually to review the safety measures.
Why does SMART matter?
All dental amalgams, also referred to as silver fillings, contain 50% mercury (a neurotoxin) which is constantly released in the form of an invisible vapor. The process of drilling out amalgam fillings releases even higher quantities of mercury vapor and fine particulates that can be inhaled and absorbed through the lungs. This is potentially harmful to patients, dentists, other dental workers, and the fetuses of patients and all dental personnel.
SMART Clinical Protocol:
An amalgam separator is used to collect mercury amalgam waste so that it is not released into the environment from the dental office.
Each room where mercury fillings are removed has adequate filtration in place, which requires a high-volume air filtration system (such as an at source oral aerosol vacuum) capable of removing mercury vapor and amalgam particles generated during the removal of mercury fillings.
The patient is given a slurry of charcoal to rinse and swallow before the procedure (unless the patient declines or there are other contraindications making this clinically inappropriate).
Protective gowns and covers for the dentist, dental personnel, and the patient are worn because substantial quantities of particles generated during the procedure will elude collection by suction devices. It has been demonstrated that these particles can be spread from the patient’s mouth to the patient’s knee, and to the chest, shoulder, and neck of the dentist and dental assistant.
Non-latex nitrile gloves, face shields and hair/head coverings, and respiratory grade masks are utilized by the dentist and all dental personnel in the room.
In order to protect the patient’s skin and clothing, a full body, impermeable barrier, as well as a full head/face/neck barrier under/around the dam, is utilized. External oxygen is delivered via a nasal mask for the patient to assure the patient does not inhale any mercury vapor or amalgam particulate during the procedure.
A dental dam that is made with non-latex nitrile material is placed and properly sealed in the patient’s mouth. A saliva ejector is placed under the dental dam to reduce mercury exposure to the patient. During amalgam filling removal, the dentist utilizes an at source oral aerosol vacuum in close proximity to the operating field (i.e., two to four inches from the patient’s mouth) to mitigate mercury exposure. High speed evacuation is used to capture mercury discharges in the mouth and to reduce ambient mercury levels along with copious amounts of water to reduce heat. The amalgam is sectioned into chunks and removed in as large of pieces as possible. A composite resin filling (tooth colored filling material) is used to replace the amalgam filling.
Once the removal process is complete, the patient’s mouth is thoroughly flushed with water and then rinsed out with a slurry of charcoal.
Mercury Regulations Overview
According to the United States Food and Drug Administration (FDA), “Dental amalgam is a mixture of metals, consisting of liquid (elemental) mercury and a powdered alloy composed of silver, tin, and copper. Approximately 50% of dental amalgam is elemental mercury by weight. The chemical properties of elemental mercury allow it to react with and bind together the silver/copper/tin alloy particles to form an amalgam. Dental amalgam fillings are also known as ‘silver fillings’ because of their silver-like appearance. Despite the name, ‘silver fillings’ do contain elemental mercury.”
Millions of dentists around the world routinely use dental mercury amalgam to repair decayed teeth, but controversy has surrounded the use of mercury in dentistry since the 1800’s, when the neurotoxin was first widely introduced as a filling material. The American Society of Dental Surgeons, the predecessor to the American Dental Association, made its members pledge not to use mercury because of its known toxicity, and in more recent years, government officials, scientists, dentists, consumers, and many others have raised serious concerns about the risks dental mercury poses to humans and to the environment at large.
The United Nations Environment Programme’s Intercessional Negotiating Committee agreed upon the text of a global, legally-binding mercury treaty in 2013, and over 100 nations have since signed the “Minamata Convention on Mercury.” The United States was the first country to give its support for ratification of the international agreement, which entered into force in 2017. – source iaomt.org