Amalgam Removal

What is dental amalgam?

Dental amalgam is a filling material that has been used in dentistry for over 165 years. It is made from a mixture of powdered silver, tin and other metals mixed with liquid mercury in a ratio of 1:1. Once combined together as amalgam and placed in teeth, the mercury was thought to be bound within the filling material. However, research has since shown that the mercury is released as vapour during chewing, grinding and from consuming hot foods and drinks. Mercury has been shown to accumulate over time in tissues of the body such as thyroid, kidneys, uterus and foetus, and the brain. (Vimy, Lorsceider)

Mercury is known to be an extremely toxic heavy metal and can reduce kidney, liver and thyroid function, be related to depression and mood swings, can interfere with immune system function and is implicated in many nervous system disorders.

Long-term exposure to mercury from dental amalgam can change the gut microbiome – bacteria that live in the digestive system, in a way that mimics frequent antibiotic use. The World Health Organization (2017) states that mercury is toxic in small amounts, especially to the developing foetus and recommends that its use should be phased down over time within industry, medicine and dentistry. (

Amalgam Removal Protocol

Whenever an amalgam filling is drilled or replaced mercury vapour is released which you would normally inhale and absorb into your body without special measures. Amalgam removal without following the correct protocol is more dangerous than leaving it in the mouth and increases your mercury poising risk dramatically. The rate at which amalgams are replaced depends on the individual and should be carefully discerned. Amalgam removal involves the careful drilling out of silver fillings that contain mercury.

We follow the Safe Mercury Amalgam Removal Technique (SMART) protocol, recommended by the International Academy of Oral Medicine and Toxicity (IAOMT). This includes but is not limited to, the use of a rubber dam, air filtration and nasal medical air to minimize exposure to mercury vapour and particulates that are released during drilling.

Rubber dam

This is a sheet of rubber or latex-free stretchy material that is stretched around the teeth being treated during amalgam removal. Holes are punched in the sheet allowing only the teeth being worked on to be exposed. It is stretched over a frame to form a physical barrier that prevents you inhaling mercury vapour through your mouth. A rubber dam also acts as a shield stopping amalgam particles, water and dental decay contacting your mouth tissues thus preventing ingestion and absorption of particles. We place the latex free dam in such a way as to protect the nasal passages from inhaling the vapour.

The use of rubber dam is one of the most important parts of the amalgam removal protocol. It also allows for more-rapid amalgam removal. Most patients feel more comfortable with rubber dam as they do not end up with a mouth full of amalgam particles and water.

Air Filtration

This involves the use of a mercury filtration machine (IQAIR) with a flexible vacuum arm or suction duct that captures the aerosol and vapours from the drilling process. Our treatment rooms are purpose built for amalgam removal and are fitted with a unique ducted high velocity air-exchange system that removes contaminated air from the room and replaces it with fresh air every three and a half minutes during amalgam removal.

Nasal Medical Air

We use nasal masks to deliver medical air during safe amalgam removal to assure that patients do not inhale any mercury vapor or amalgam particulate during the procedure.

Amalgam Waste Disposal

In our practice, we have installed a Durr amalgam separator that filters the waste-water from amalgam removal. The waste is trapped in a sealed cassette and is recycled by an environmentally responsible waste collection company.

For any further questions, please contact our friendly staff on 07 3871 3035.