Level 17, 111 Elizabeth Street, Sydney NSW 2000
Level 17, 111 Elizabeth Street, Sydney NSW 2000
Safe Amalgam Removal · Frequently Asked Questions
Every question below is asked in our consultation rooms weekly, answered here the same way we answer in the chair: directly, with the evidence, and with the decision left where it belongs, with you. Five groups: safety and precaution, the procedure, cost and appointments, after the procedure, and materials.
Is removing my amalgam fillings safe?
With a proper protocol, yes. The SMART protocol exists to reduce mercury vapour and particle exposure during removal to the practical minimum for you and the dental team. Unprotected removal is where exposure spikes, which is why the protocol matters more than reassurance.
Isn't drilling amalgam out worse than leaving it in?
Unprotected, yes, briefly: drilling produces the highest vapour exposure of a filling's life. That is the entire argument for SMART, which isolates the tooth, captures aerosol at the source and keeps you breathing separate air. A sound filling you choose to keep is also a legitimate answer.
Should I remove amalgams while pregnant or breastfeeding?
No, except where clinically necessary. The FDA, the IAOMT and the Australian Dental Association all advise against elective removal during pregnancy and breastfeeding. This is the clearest boundary in the field and we hold it firmly.
I'm planning a pregnancy. When should removal happen?
Before conception, with timing agreed between your dentist and GP. The FDA's 2020 guidance lists women planning pregnancy among the groups who should discuss amalgam alternatives with their dentist; planning the calendar is exactly what that discussion is for.
Is anyone unsuited to amalgam removal?
Pregnancy and breastfeeding aside: severe kidney impairment, some neurological conditions and complex medical pictures warrant coordination with your treating doctor first, and occasionally a decision to stage or defer. Your medical history genuinely changes the plan, which is why we take a proper one.
What is the SMART protocol in one paragraph?
A set of 19 IAOMT safety measures: sealed nitrile rubber dam, separate medical air for you, charcoal or chlorella rinses before and after, full barrier protection, sectioning the filling into chunks under copious water, high-volume mercury-rated suction with at-source aerosol capture, and disposal of every gram as regulated toxic waste. The full walkthrough is on our SMART Protocol page.
How long does removal take?
About 60 minutes for a single filling including the protocol set-up; multiple fillings are usually staged quadrant by quadrant across separate visits rather than marathon appointments.
Will I feel anything?
Local anaesthetic, warmed and delivered slowly, does its usual job; most patients report the appointment feels like a well-organised filling visit with more equipment. The charcoal rinse tastes exactly as expected.
Can you remove all my amalgams in one appointment?
We generally advise against it: staging respects the protocol, your jaw's tolerance and the quality of each replacement restoration. A heavy amalgam load is a planned campaign, not a single battle.
What if you find decay under the old filling?
Common, and one of the main clinical reasons amalgams are replaced. The decay is removed as part of the same procedure; if it proves deep enough to involve the nerve, we pause, show you the imaging, and discuss options before proceeding. No mid-procedure surprises billed afterwards.
Do you charge for the removal itself?
No. There is no separate fee for the SMART removal; your investment is in the replacement restoration plus consultation and any imaging. The protocol is simply how we remove amalgam.
What does the whole treatment cost?
It depends on how many fillings, their size, and the replacement material (composite versus ceramic). Indicative ranges are published on the cost page and your written plan gives exact figures before anything begins.
Do private health funds rebate this?
Funds rebate the restoration item numbers according to your cover; HICAPS on site gives you the rebate on the spot. We supply item numbers in advance so you can check with your fund.
Will I need to detox afterwards?
Need is the wrong frame: removal itself eliminates the main ongoing exposure source. Some patients choose a nutritional support programme around removal, which we coordinate with your practitioner or clinic nutritionist. It is optional, supportive care, never a condition of treatment. See Mercury Detox Support.
Why the chlorella or charcoal rinse?
Both bind particulate matter, one before the procedure as a precaution and one after as a final sweep. They are part of the protocol's belt-and-braces logic.
Are there side effects after removal?
The ordinary post-filling experience: possible short-lived temperature sensitivity and anaesthetic wear-off. Report anything beyond that; bite adjustments after large restorations are quick and normal.
When can I eat and drink normally?
Composite restorations set immediately; ceramic work follows the same-day guidance we give at the visit. Practically: once the anaesthetic wears off, normal life resumes.
What do you replace amalgam with?
BPA-free composite resin for smaller restorations; ceramic inlays, onlays or crowns where size and bite forces demand strength, usually milled on site with CEREC in a single visit.
Is composite resin BPA-free?
The materials we use are selected for it, and material choice is part of the biocompatibility conversation at your consultation, including for patients with specific sensitivities.
What is a ceramic inlay or onlay?
A precision-milled ceramic piece bonded into (inlay) or over (onlay) the prepared tooth, stronger than composite for large restorations and kinder to the tooth than a full crown when a full crown is not needed.
Are ceramic restorations dearer than composite?
Yes, reflecting material and fabrication; they also carry different longevity and strength. The comparison, with figures, is part of your written plan.
Do you use zirconia?
Yes, where its strength suits the site, and zirconia is also our metal-free implant material; the materials story continues on the Dental Implants pillar.
A comprehensive consultation with imaging gives you a written plan with your options and all-inclusive costs before you commit to anything.
Lewis image
Dr Lewis Ehrlich
Principal Dentist — Sydney Holistic Dental Centre
Dr Lewis Ehrlich has led Sydney Holistic Dental Centre since its founding and has overseen the practice's SMART-certified amalgam removal programme for over two decades. Technical answers reviewed by Dr Craig Wilson.
