Level 17, 111 Elizabeth Street, Sydney NSW 2000
Level 17, 111 Elizabeth Street, Sydney NSW 2000
Holistic Treatment · SMART Certified
The SMART protocol, the Safe Mercury Amalgam Removal Technique, is a set of 19 evidence-informed safety measures published by the International Academy of Oral Medicine and Toxicology (IAOMT). Its purpose is to minimise exposure to mercury vapour and particles for the patient and the dental team during the removal of a mercury amalgam filling. Sydney Holistic Dental Centre has been IAOMT SMART certified and applies the protocol to every amalgam removal we perform.
Image of SMART Protocol Equipment
An intact amalgam filling releases small amounts of mercury vapour through daily use. Drilling one out without precautions releases far more, in vapour and in fine particles, in a few concentrated minutes. The entire logic of SMART is to manage that window: isolate the tooth, capture what is released at the source, keep the patient breathing separate air, and protect the team who do this work every week. The IAOMT consolidated these measures into a named, teachable protocol in 2016 and last updated it in 2019.
Phase 1 — The room
An amalgam separator captures waste amalgam, so mercury never enters Sydney's wastewater (ISO 11143, as required by NSW Health guideline GL2020_015).
High-volume air filtration runs in the treatment room, and our supplementary at-source capture unit, the one patients nickname 'the elephant', sits within centimetres of the mouth throughout the procedure.
Where the room allows, fresh airflow is maximised for the duration.
Phase 2 — You, the patient
A charcoal or chlorella slurry rinse before we begin, which binds particulate matter.
A full-body impermeable drape and head, face and neck barriers, so no particle reaches skin or clothing.
A separate medical air supply via a nasal mask, so the air you breathe never passes over the work site.
A nitrile (non-latex) rubber dam sealing the tooth off from the rest of your mouth, with a saliva ejector placed beneath it.
Phase 3 — The team
Nitrile gloves, face shields, hair covering and respiratory-grade masks rated for mercury vapour for every person in the room.
The team's protection matters to you directly: a practice that protects its own people at this standard is a practice taking exposure seriously, every time, not only when asked.
Phase 4 — The removal itself
The amalgam is sectioned into large chunks with a tungsten carbide bur rather than ground away, which reduces vapour and particle generation.
Copious water irrigation keeps the filling cool, because heat increases vapour release.
High-volume mercury-rated suction and the at-source aerosol capture unit run continuously, 2–4 centimetres from the tooth.
Phase 5 — After removal
A thorough water flush of the whole mouth, followed by a final charcoal or chlorella rinse.
Suction traps and equipment are cleaned under protective procedures.
Every gram of removed amalgam leaves the practice as regulated toxic waste to a licensed mercury processing facility. The law treats removed amalgam as hazardous; the same material sat in a tooth for decades, which is a thought worth sitting with.
"People sometimes ask whether all of this is necessary for one small filling. My answer is that we do this procedure every week, our team is in the room every time, and the protocol protects them as much as the patient in the chair. When you protect your own people at that standard, patients can trust the standard."
DR CRAIG WILSON — PRINCIPAL DENTIST
Image of Craig
Australia's baseline requirements, rubber dam, additional suction and amalgam waste separation, trace back to NHMRC recommendations from 2002 and are now embedded in NSW Health guideline GL2020_015. SMART goes further, adding the separate air supply, at-source aerosol capture, barrier protection and binding rinses. In short: the law sets the floor, SMART is the ceiling, and SHDC works at the ceiling.
Image of Treatment Room Setup
Honestly: a slightly theatrical version of a normal filling appointment. More equipment, more draping, a nasal mask, and a rinse that tastes of charcoal. The removal itself is usually quicker than patients expect because sectioning is faster than grinding. Appointments run from about 60 minutes for a single filling to longer staged visits for quadrant work, and normal eating and drinking resume the same day, guided by your dentist's advice about the new restoration.
The IAOMT itself does not recommend amalgam removal during pregnancy or breastfeeding except where clinically necessary, and the FDA and ADA concur. If you are planning a family and considering removal, the timing conversation belongs with your dentist and your GP together, before conception. We raise this unprompted because it is the most important safety boundary in this field.
Why don't all dentists use SMART?
Every Australian dentist must meet the regulatory baseline for amalgam removal and waste. SMART is a voluntary certification that goes beyond it, requiring specific training and equipment. Practices make their own judgement; ours is that when a known neurotoxin is being aerosolised centimetres from a patient's airway, the ceiling beats the floor.
Is SMART certification checked?
SMART certification is issued by the IAOMT after completion of its training program. Our certification is current and our protocol equipment is maintained and documented as part of practice accreditation.
Can I take chlorella or charcoal beforehand myself?
The procedure-day rinses are part of the protocol and we supply them. If you are considering broader nutritional support around removal, see the Mercury Detox Support page and speak with your practitioner; bring anything you are taking to your consultation so we can coordinate.
Every amalgam removal at SHDC follows the full SMART protocol. Book a comprehensive new patient consultation to discuss your situation and plan your removal safely.
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Dr Craig Wilson
Principal Dentist — FIAOMT, SMART-Certified
Dr Craig Wilson has practised at Sydney Holistic Dental Centre since its founding and holds IAOMT SMART certification. He leads the practice's amalgam removal programme and has overseen more than 32,000 amalgam replacements.
