SMART stands for Safe Mercury Amalgam Removal Technique. It is a written protocol published by the International Academy of Oral Medicine and Toxicology, and it sets out how an old silver filling should be taken out of a tooth.
Any dentist can drill out an amalgam filling. That isn't the difficult part.The difficult part is containment. Cutting into amalgam generates vapour and fine particles, and the whole point of the protocol is that they go into the suction rather than anywhere else. That is what the equipment is for, and it is why the appointment takes longer than you might expect.
What the protocol involves
-A rubber dam. A sheet sealed around the tooth so the mouth is isolated from the work.
-High-volume suction at the tooth, plus a second extraoral suction hood sitting outside the mouth, catching what rises.
-Copious water throughout, to keep the filling cool and cut down on vapour.
-A separate air supply for you to breathe through the nose, so you are not breathing the air immediately above the tooth.
-The filling sectioned and lifted out in pieces wherever the tooth allows, rather than ground away.
-Protection for us too. The team is covered as carefully as the patient, which is a reasonable way to judge whether a practice means it.
-The room itself. A dedicated air purification system changes the air in the surgery around 25 times an hour. More about the surgery.
-What goes back in. BPA-free white composite, or ceramic where the tooth needs more support than a filling can give.
Where I fit in
I qualified from the University of Manchester in 2004 and I have removed more than 10,000 amalgam fillings. I joined the International Academy of Oral Medicine and Toxicology in 2015, became Accredited in 2023, and in September 2026 I was made a Fellow of the Academy. I am the only active Fellow in the United Kingdom, and the only IAOMT SMART Protocol Mentor in the United Kingdom, which means I teach the protocol to other dentists.
I mention that for one reason. Patients ring us and ask, in these exact words, "is he SMART certified?" It is a fair question and you should ask it of anyone.
What it costs
A first appointment is £169, x-rays included, my Signature 18-Point Biological & Wellness Discovery. Replacing an amalgam filling with white composite is £199 for a small filling, £299 medium and £329 large, and that price includes removing the old one. The full cost page is here.
If you are nowhere near London
Most of my amalgam patients aren't Londoners. Send x-rays and photographs first and we can talk sensibly about what is involved before you book a train, and everything is confirmed at a clinical assessment when you arrive. How we plan around your journey.
Common questions
SMART stands for Safe Mercury Amalgam Removal Technique. It is a set of safety steps published by the International Academy of Oral Medicine and Toxicology. Its purpose is to keep mercury vapour and particles away from you, from me and from my team while an old silver filling is taken out.
Yes. I'm a Fellow of the International Academy of Oral Medicine and Toxicology and the only IAOMT SMART Protocol Mentor in the United Kingdom, so I train other dentists in the protocol. You can check any dentist's status for yourself on the Academy's own directory at iaomt.org.
Your mouth is isolated with a rubber dam, and you breathe clean air through a nasal mask. High-volume suction sits right next to the tooth, and the filling is cut out in chunks under a steady water spray rather than drilled away. The room air is filtered throughout, and your skin and clothing are covered. It feels much like any other filling appointment, just with more kit around you.
A first examination is £169. Replacing a filling is £199 for a small one, £299 for a medium one and £329 for a large one, and that price includes removing the amalgam under the full protocol. Larger teeth sometimes need a ceramic inlay or onlay, which is £895.
Usually up to five or six, depending on their size and where they sit in your mouth. We plan the order together at your examination.
Not always, and that's what the first examination is for. Some people want them replaced because they are worn or cracked, some for appearance, and some simply for peace of mind. If your fillings are sound, I will tell you so, and the choice is then yours to make with all the information in front of you.
Talk to us
Message us on WhatsApp or call 020 7099 6651. 28 Harley Place, London W1G 8LZ. Dr Daniel Sutcliffe BDS, AIAOMT, FIAOMT.
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