Littleton, CO dentist Dr. Guy Grabiak and team celebrate case study award for long-term healthy results with their patient.

Mercury Removal (Smart Protocol)

Mercury Removal

What is Safe Mercury Removal?

New research about the dangers of mercury filling removal has brought to light some alarming facts about the process and its effects on patients, dentists, dental workers, and the environment. In order to minimize the risks of mercury vapor and particulate inhalation during treatment the International Academy of Oral Medicine and Toxicology (IAOMT) created the SMART (Safe Mercury Amalgam Removal Technique) protocol.

SMART is a specific set of safety measures used to reduce mercury exposures during dental amalgam filling removal. Once the mercury restoration is safely removed, we can then replace it with a more biocompatible material to restore the tooth. The SMART protocol uses detailed scientifically proven protective measures to safely remove amalgam fillings while capturing mercury vapors, and reducing exposure to toxins in the air and particle matter significantly. If you are looking for ways to reduce risks during your dental care, it is essential to find out if your dentist uses SMART mercury removal in their office. Did you know that less than 1% of dentists have this certification?

Why is Safe Mercury Removal needed?

Dental amalgam fillings are made with a mixture of mercury, silver, copper, tin, and sometimes zinc. Often called “silver fillings,” all dental amalgams are 45-55% elemental mercury. Mercury is toxic, and this poison is recognized by the World Health Organization as one of the top ten chemicals or groups of chemicals of major public health concern. Mercury accumulates in the body, and any amount of mercury taken into the body should be considered hazardous.

This mercury can leak over time with regular brushing, flossing, clenching or even eating and drinking. Mercury vapor that is caused by these activities can be harmful to the patient, and can even be detrimental to the health of the fetus of pregnant patients. For this reason, we often recommend to our patients that they have their old amalgam fillings removed and replaced as soon as possible.

Who is a candidate for Safe Mercury Removal?

If you have amalgam fillings in your mouth right now, you’re already a good candidate to have them removed. We believe mercury (a neurotoxin) is not safe for any individual. The FDA states amalgam fillings may pose a greater health risk to certain populations.

The typical removal method involves drilling out each filling, piece by piece—meaning that large amounts of mercury vapor are expelled into the immediate area around you during the procedure. This not only puts you at risk; it also poses a significant risk to Dr. Grabiak and his staff. Exposure to mercury may pose a greater health risk in certain groups of people, who may be more susceptible to potential adverse effects generally associated with mercury. These high-risk populations include:

  • Pregnant women and their developing fetuses;
  • Women who are planning to become pregnant;
  • Nursing women and their newborns and infants;
  • Children, especially those younger than six years of age;
  • People with pre-existing neurological disease;
  • People with impaired kidney function;
  • People with known heightened sensitivity (allergy) to mercury or other components (silver, copper, tin) of dental amalgam.

What happens during the Safe Mercury Removal process?

Prior to the removal process Dr. Grabiak will discuss with you a one week, two-step protocol designed to support the body in detoxifying and removing mercury and other heavy metals during the removal of dental amalgams. The appointment begins with a charcoal rinse and vitals. In order to protect our patient’s skin and clothing from potential exposure, a full body, impermeable barrier, as well as a full head/face/neck barrier and non-latex dental dam will be utilized. Medical grade oxygen delivered by a nasal mask will be utilized to assure the patient does not inhale any mercury vapor or amalgam debri during the procedure. A saliva ejector will be placed under the dental dam to reduce mercury exposure to the patient.

During the amalgam filling removal, Dr. Grabaik will utilize 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. Copious amounts of ozone water to reduce heat along with a high speed evacuation device to capture mercury discharges are required to reduce ambient mercury levels.

The amalgam will be sectioned into chunks and removed in as large of pieces as possible. This practice minimizes excess potential for mercury exposure. Once the removal process is complete, the patient’s mouth is thoroughly flushed with water and then rinsed out with a slurry of charcoal, chlorella or similar adsorbent.

To ensure safe disposal of mercury for our environment an amalgam separator is properly installed, utilized, and maintained to collect mercury amalgam waste so that it is not released into the effluent from the dental office. Additionally each room where mercury fillings are removed adequate filtration is in place, which requires a high-volume air filtration system capable of removing mercury vapor and amalgam particles generated during the removal of one or more mercury fillings.

If you have amalgam (metal) fillings and would like to have them removed, call our office today so that we can help schedule you with an appointment.

The foundation of providing safe and personalized holistic care begins by getting to know you and your goals for your oral health and overall health, both short term and long term. Dr. Grabiak will then learn about your family’s dental and medical history, along with your dental and medical history. Afterwards, we begin your exam by taking a sample of your saliva (Sillha), checking for seven different biomarkers. That same day, we will send you home with a report showing how you scored in those different biomarker categories.

The head and neck examination is often overlooked by busy clinicians but it is as crucial as an element of the oral cancer examination. Dr. Grabiak begins his exam outside of the mouth by starting with a soft tissue check of the neck and the jaw. A thorough head and neck examination is essential for detecting early skin cancers, any overdeveloped jaw muscles that may be contributing towards bruxism, and enlarged lymph nodes that may indicate an active virus or infection.

After the extraoral exam, Dr. Grabiak begins his extensive intraoral exam. During Dr. Grabiak’s exam he is evaluating the teeth, uvula, mucosal tissues, tongue, floor of the mouth, hard and soft palate, and the oropharynx. Part of this exam includes taking high-definition photos of the mouth, all at different angles so you can see exactly what he is seeing. Our hygienist will then come in and complete a comprehensive periodontal assessment. In some cases, Dr. Grabiak and your hygienist may recommend additional testing to get to the root cause of the evidence of symptoms they are seeing in your mouth. This entire process takes roughly an hour. In some cases, depending on what Dr. Grabiak and your hygienist had found during their exam we will invite you back for a follow-up appointment called review of findings.

In preparation for the review of findings, Dr. Grabiak and your hygienist will take the time to evaluate all of the data that was collected from your examination and testing to determine your specific needs. At your review of findings appointment Dr. Grabiak will sit down with you one on one to review the data that was collected from your appointment, along with any recommendations. This allows you the time to ask Dr. Grabiak any questions that you may have about your treatment recommendations and expectations from treatment.

Jeromy Mulkey

Jeromy Mulkey

Operations Manager

Jeromy received his Bachelors of Science in Finance from New Mexico State University in Las Cruces, New Mexico. He moved to Colorado in 2015 from Hannibal, New York (a small town outside of Syracuse) and that is when his career in the dental field began. Jeromy started in corporate dental as a patient coordinator and quickly progressed to office manager and then running multiple specialty practices over the next 5 years. Holistic dentistry was an exciting new challenge and Jeromy couldn't be happier with his family at Denver Dentistry. Holistic dentistry was a breath of fresh air and gave a new excitement and passion for learning of all the new sciences and technologies the Denver Dentistry team has integrated into their practice. Jeromy currently lives in Sheridan and enjoys living close to the mountains. In his free time he enjoys spending time with family, snowboarding, playing soccer and basketball, camping, and hiking. Jeromy is passionate about delivering excellent customer service and assisting the team in bringing more smiles to satisfied patients.
Chelsea White

Jazmin Contreras

Dental Hygiene Assistant

In 2020 Jazmin graduated from Colorado Mesa University at the top of her class with a degree in Kinesiology. From a young age Jazmin knew she had a passion and interest in the medical field which led her to gain various experiences in the medical field. However, when she first came to Denver Dentistry, she fell in love with dentistry and knew this was her passion. Dr. Grabiak and his team offered a unique holistic approach to the field; something Jazmin has always been highly interested in. She quickly realized this is where she was meant to be and Denver Dentistry instantly felt like home. In her free time she and her fiance enjoy traveling and participating in outdoor activities like hiking, camping, and kayaking.
Chelsea White

Chelsea White


Chelsea is a born and raised Florida girl and has now been a Colorado resident for 5 years. She has loved dentistry for a long time, and couldn’t see herself in any other profession. Knowing her career path, she went to school at Central Florida Institute to become a dental assistant with an extended program. Graduated in 2012 as a Dental Assistant and as an EDDA, she looks forward to esthetics and happiness with patients. As someone who has been in the field for almost 10 years, she strives to work as a team to meet all expectations with the patient. In her free time she loves to hike, and explore the beautiful places Colorado has to offer.

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