Amalgam removal for claimed mercury toxicity

1. Introduction

Version followed: the International Academy of Oral Medicine and Toxicology (IAOMT) Safe Mercury Amalgam Removal Technique (SMART: renamed 2016, recommendations last updated July 2019) as IAOMT publishes it. It is set against the US FDA's 2020 patient information on amalgam, the American Dental Association's (ADA) February 2026 statement and, for the harm account, the 1996 Colorado findings against a dentist who promoted amalgam removal.

Dentists carry out amalgam removal. The psychotherapist never performs, sells, prescribes or recommends it. Sections 1 to 3 describe the method as its proponents and regulators publish it. Section 4 covers the psychotherapist's own work with a client who is considering, undergoing or recovering from it.

What it is. Dental amalgam ("silver filling") is a mixture of mercury, silver, copper, tin and zinc. It is about half mercury by weight and can release small amounts of mercury vapour. The release rises briefly when fillings are placed or removed [source: FDA, Information for Patients About Dental Amalgam Fillings]. "Amalgam removal for claimed mercury toxicity" means removing intact, functioning amalgam fillings because a person's symptoms or illness are attributed to mercury from those fillings. The fillings are usually replaced with mercury-free materials. Some practitioners add tests, "detoxification" programmes or extraction of other teeth [source: Quackwatch summary of Colorado ALJ findings, 1996].

Core idea of change, as proponents state it. IAOMT holds that amalgam emits mercury vapour, especially during chewing, brushing, clenching, placement and removal. It holds that this exposes patients, dental staff and fetuses, and that removal must be done with added protections (SMART) to limit the exposure spike [source: IAOMT, The Safe Mercury Amalgam Removal Technique]. IAOMT presents elective removal as a way for patients to reduce their mercury exposure and leaves treatment decisions to the practitioner [source: IAOMT, Safe Amalgam Removal script]. Earlier and more extreme versions, notably that of a Colorado dentist whose licence was revoked in 1996, claimed that removal could relieve serious diseases such as multiple sclerosis and Alzheimer's disease. A Colorado administrative law judge found no scientific basis for these claims (see Harm account) [source: Quackwatch summary of Colorado ALJ findings].

Regulatory status (one line). In the US, FDA regulates amalgam as a medical device. It recommends that certain high-risk groups avoid new amalgam where possible, but it does not recommend removing intact fillings to prevent disease [source: FDA patient information; HPN Online report of the September 2020 FDA recommendations]. The device class is [uncertain: not verified]. In the EU, Regulation (EU) 2024/1849 has prohibited new amalgam use since 1 January 2025, except where a dentist judges it strictly necessary [source: Dental Council of Ireland, Code of Practice regarding Dental Amalgam, 2025].

Evidence status (one line). The ADA states that no properly designed study shows amalgam causes long-term health effects or disease [source: ADA statement, Feb 2026]. In a German controlled trial of people who attributed many symptoms to amalgam, symptoms improved both with removal and with a health-promotion programme without removal (Melchart et al., Journal of Dental Research, 2008) [source: DrBicuspid report of the trial].

2. Framework

2a. The method as its organisations describe it (what a client experiences)

• Who practises it. Licensed dentists. Some describe themselves as "biological", "holistic" or "mercury-free" dentists. IAOMT certifies members in SMART [source: IAOMT, SMART Certification]. In the US, dental licensing and discipline sit with state dental boards; in Ireland, with the Dental Council [source: Quackwatch summary of Colorado Board actions; Dental Council of Ireland Code]. UK: the General Dental Council [uncertain: not verified].
• Training route (for dentists, not the therapist). SMART certification requires active IAOMT membership. Dentists complete three online units with tests (an introduction to IAOMT, mercury and amalgam science, and safe removal), attend an IAOMT conference and a biological dentistry fundamentals course in person, give an oral case presentation and sign a SMART disclaimer. Listing is renewed by attending a conference every three years. The listed enrolment fee is US$500 [source: IAOMT, SMART Certification].
• Stage 1: Attribution and referral. The client links symptoms (commonly fatigue, headache, sleep, mood, memory, skin complaints) to their fillings. The link may come from their own reading, a practitioner, a test result or a community [source: DrBicuspid report of Melchart 2008; FDA patient information lists symptoms of excess mercury but notes that a direct link to amalgam has not been established].
• Stage 2: Dental consultation. The dentist assesses the fillings and the client's history. FDA advises discussing health history, high-risk status, alternative materials and whether any filling actually needs replacing [source: FDA patient information].
• Stage 3: Removal under protective measures. IAOMT calls SMART "a set of recommendations" applied by licensed practitioners using their own judgement. The measures it describes include barriers that keep debris off the patient's airway, mouth and skin, a rubber dam, and engineering controls and protective equipment for staff. An amalgam separator keeps mercury waste out of wastewater. The client typically experiences coverings, a rubber dam and strong suction during the drilling [source: IAOMT SMART page; IAOMT script]. Further patient-side measures in the full SMART document are [uncertain: not verified]. This guide gives no technical parameters.
• Stage 4: Replacement. Fillings are replaced with mercury-free materials such as resin composites or glass ionomers. FDA notes these can wear faster on back teeth [source: FDA patient information].
• Adjuncts some practitioners add. These include testing for "mercury toxicity" (urine, "provoked" urine after a chelating agent, hair) and "detoxification" with supplements, chelation or sauna. The Colorado dentist's clinic also extracted teeth with root canals [source: Quackwatch summary of Colorado ALJ findings; ACMT/AACT Choosing Wisely list]. The IAOMT pages cited here do not prescribe these adjuncts. This guide gives no details of them.
• Pregnancy. IAOMT "does not recommend that pregnant women have their amalgams removed" [source: IAOMT, Safe Amalgam Removal (patients)]. FDA lists pregnant and nursing women, women planning pregnancy, children (especially under six), people with neurological impairment or kidney dysfunction, and people with mercury allergy as high-risk groups for new amalgam [source: FDA patient information].

2b. The psychotherapist's work alongside it [synthesis]

No source sets a format for this work [synthesis].

3. Guiding principles

• The psychotherapist is not the dentist or the doctor. Practical meaning: never advise for or against removal, materials, tests, chelation or supplements. Route those questions to the dentist, physician or pharmacist [synthesis].
• Curiosity without judgement. Practical meaning: ask about amalgam concerns the way you ask about any health choice, so the client does not hide plans [synthesis].
• Attribute claims; state regulators' positions accurately. Practical meaning: say "IAOMT holds…", "FDA states…", "the ADA states…" rather than offering your own verdict on mercury [source: FDA; ADA; IAOMT].
• The client's suffering is real whatever its cause. Practical meaning: validate the symptoms and their impact while keeping the cause an open question for medical assessment [synthesis].
• Irreversibility deserves time. Practical meaning: removing sound tooth structure cannot be undone. FDA notes that removing intact fillings can remove healthy tooth structure and briefly raise vapour exposure, so slowing a rushed decision is legitimate [source: FDA patient information; HPN Online report]. The psychotherapist slows the pace without steering the outcome [synthesis].
• Autonomy with information. Practical meaning: the decision belongs to the client. The psychotherapist's job is to make sure it is informed, unpressured and consistent with the client's values [synthesis].
• Watch for substitution of care. Practical meaning: a new neurological, kidney or other serious symptom needs medical assessment, not only a dental explanation [synthesis; FDA patient information names neurological and kidney conditions as reasons to discuss with a doctor].
• Protect the vulnerable. Practical meaning: pregnancy, children and people with eating disorders or high health anxiety need extra care. FDA and IAOMT both caution about pregnancy [source: FDA; IAOMT].
• No commercial entanglement. Practical meaning: never refer for profit, sell products or endorse a named practitioner. Manage any personal belief about amalgam as a potential bias [synthesis; APA Ethics Code principles on conflicts of interest: [uncertain: not verified]].
• Health anxiety lens without dismissal. Practical meaning: when symptom preoccupation drives repeated testing and procedures, offer established psychological treatment for health anxiety or somatic symptom distress (Domain II), framed as help with distress, not as proof the symptoms are "in the head" [synthesis].

4. Intervention inventory

All interventions below are the psychotherapist's own work alongside a dental procedure. They are [synthesis] unless a source tag says otherwise. Factual content about amalgam comes from the regulators and organisations cited.

4.1 Routine, non-judgemental inquiry and recording

• Purpose: Find out whether the client is considering, undergoing or has had amalgam removal, "mercury" testing or detoxification, so that risks and meanings are visible. Use at intake, at reviews, and whenever the client mentions unexplained symptoms, "toxins", "heavy metals" or a new practitioner.
• Steps: (1) Ask about complementary health approaches in the same tone as other health questions. (2) If amalgam comes up, record: what is planned or done, by whom (dentist, other practitioner), any tests and who interpreted them, any adjuncts (supplements, chelation, sauna, diets, tooth extractions), cost, timeline, and whether the client's doctor knows. (3) Record the client's own words for the problem, e.g. "mercury poisoning". (4) Do not comment on merit at this stage.
• Example language (illustrative): "Many people use dental or complementary approaches alongside their medical care. Is there anything like that going on for you at the moment?" "You mentioned your fillings. Could you tell me more about what you are planning and who is helping you with it?"
• Watch for: Shame or defensiveness, which suggests the client expects to be dismissed. Plans already under way with large prepayments. Tests from non-medical laboratories. Mention of extractions, chelation or restrictive detox diets (flag for 4.6). Working: the client tells you about changes in the plan without being asked.

4.2 Exploring meaning, hopes and the explanatory model

• Purpose: Understand why removal matters to this client: hope of relief, a sense of control, an explanation for unexplained suffering, distrust of medicine after feeling dismissed, belonging to a community, or identity as someone who lives "clean". Use before any decision talk.
• Steps: (1) Ask for the story: when the symptoms began, how the mercury idea arrived, what it explained. (2) Ask what they expect to change after removal, how much and how soon. (3) Ask what it would mean if things did not change. (4) Ask what medical care has been like for them. (5) Reflect the model back in their words and check you have it right. (6) Note certainty level: a firm conviction needs a different approach from an open hypothesis.
• Example language (illustrative): "What made the connection with your fillings click for you?" "If the removal goes the way you hope, what would be different in six months?" "And if it helped less than you hope, what would that mean to you?" "It sounds like you have spent a long time feeling that no one was taking this seriously."
• Watch for: All-or-nothing expectations ("this will fix everything"). Expectations that removal will cure a diagnosed disease such as MS: such claims were found to have no scientific basis in the Colorado case [source: Quackwatch summary of Colorado ALJ findings]. Anger at doctors, which may be a rupture risk if you seem to side with them. Working: the client can hold both hope and uncertainty, and names what matters most to them beyond symptom relief.

4.3 Supporting an informed, values-based decision (without recommending)

• Purpose: Help the client make a choice that is informed, unpressured and their own. The psychotherapist never advises for or against removal.
• Steps: (1) Ask what information they already have and what they would like to know. (2) Offer to look together at what the organisations say, attributed: FDA does not recommend removing intact fillings in good condition, or removing them to prevent disease, unless a health professional considers it medically necessary. FDA notes removal briefly raises vapour exposure and can remove healthy tooth structure. FDA lists high-risk groups for new amalgam. IAOMT recommends SMART for any removal and advises against removal in pregnancy. The ADA considers removal of serviceable fillings solely to replace them with mercury-free material unwarranted and contrary to its ethics code [source: FDA patient information; HPN Online; IAOMT; ADA statement]. (3) Help the client write the questions they want to ask the dentist (see below). (4) Explore values: irreversibility, cost, time, what they are willing to risk, what would count as "worth it". (5) Check for pressure from a practitioner, partner, group or deadline. (6) Respect the decision, whatever it is, and keep the door open.
• Questions a client might take to the dentist (illustrative, drawn from FDA's suggested topics): Is any filling failing or decayed underneath? What are the alternatives and how long do they last on back teeth? What is the plan if I am pregnant or planning pregnancy? What tooth structure will be lost? What will it cost in total, including any tests or programmes? Are you recommending anything else alongside, and what is the evidence for it?
• Example language (illustrative): "I'm not the right person to tell you whether to have it done. That is between you and your dentist and doctor. What I can do is help you get clear on what you want to know and what matters to you." "Here is what the FDA and the dental association say, and here is what IAOMT says. How do you make sense of the difference?"
• Watch for: Your own pull to persuade either way (a rupture risk and outside scope). Decisions made under deadline or discount pressure. Large irreversible packages, e.g. extractions of healthy or root-filled teeth (see Harm account). Working: the client can explain the choice and its trade-offs in their own words and feels it is theirs.

4.4 Coordination with the dentist, doctor and pharmacist (with consent)

• Purpose: Make sure someone with medical responsibility knows about symptoms, plans, tests and any chelating agents or supplements. Use when symptoms are new or serious, a neurological or kidney condition is present, pregnancy is possible, chelation or supplements are planned, or medicines are involved.
• Steps: (1) Ask whether the GP or physician knows. (2) Explain why coordination helps: a single picture, safety with medicines. (3) Obtain specific written consent: what will be shared, with whom, and for what. (4) Share only what is needed: the client's plan, symptom distress, and your observations (e.g. health anxiety features). Do not give your opinion on amalgam. (5) Route all medicine, supplement and chelation questions to the prescriber or pharmacist. (6) Record contacts.
• Example language (illustrative): "Would it be all right if I let your GP know you're planning this and how much these symptoms are affecting you? I wouldn't be giving an opinion on the dental side, just making sure your care is joined up." "That's a question about a medicine, so your pharmacist is the right person. Shall we write it down for them?"
• Watch for: Refusal because the doctor was dismissive before. Explore that rather than override it. FDA names neurological conditions, kidney impairment and mercury allergy as reasons to discuss removal with a dentist or doctor [source: FDA patient information]. Working: the client has a named clinician holding medical responsibility.

4.5 Conversations about "mercury toxicity" tests

• Purpose: Help a client understand that how a test is done and who interprets it matters, and route interpretation to a physician. Use when the client brings hair, nail or "provoked" urine results, or a long questionnaire "diagnosis".
• Steps: (1) Ask what test was done, by whom, and what they were told. (2) Share, attributed, what medical toxicology societies state: the American College of Medical Toxicology and American Academy of Clinical Toxicology advise against "provoked" urine testing after a chelating agent. Chelators raise urinary metals even in healthy people. They also advise against hair or nail testing for metal poisoning in people with non-specific symptoms, and against chelation except for documented metal poisoning [source: AACT/ACMT Choosing Wisely recommendations]. (3) Suggest the client asks their physician to review the result. (4) Explore what a "positive" result meant emotionally: relief at an explanation is common.
• Example language (illustrative): "It sounds like that result felt like the first real answer you'd had. Would you be willing to have your doctor look at it with you, so you know what it can and can't tell you?"
• Watch for: Tests leading straight to costly chelation or supplement programmes. Repeated testing as reassurance-seeking, a health anxiety feature (see 4.7). Working: test results are interpreted inside medical care, and testing does not escalate.

4.6 Risk recognition and response

• Purpose: Notice and respond to risks that sit around amalgam removal: delayed or replaced medical care, harmful adjuncts, pregnancy, children, eating restriction, financial exploitation and group pressure.
• Steps: (1) Delayed care: if new neurological, kidney, cognitive or other serious symptoms are being explained only as mercury, encourage prompt medical assessment and offer to coordinate (4.4). (2) Adjuncts: if chelation, high-dose supplements, sauna "detox" or extraction of healthy or root-filled teeth is planned, make sure a physician or dentist outside the selling practice reviews it. The ACMT/AACT advise chelation only for documented metal poisoning [source: AACT/ACMT Choosing Wisely]. The Colorado judge found that the Colorado clinic's routine extraction of root-filled teeth and its sauna-detox claims lacked scientific support [source: Quackwatch summary of ALJ findings]. (3) Pregnancy and breastfeeding: note that IAOMT advises against removal in pregnancy and that FDA lists pregnant and nursing women among high-risk groups. Route to the dentist and obstetric care [source: IAOMT; FDA]. (4) Children: see safeguarding in 4.9 and the Harm account. Parents decide dental care with the dentist. Escalate only where a child is subjected to harmful procedures or deprived of needed medical care [synthesis]. (5) Eating restriction: "detox" diets attached to removal can mask or trigger restrictive or orthorexic eating. Screen for restriction, weight change, rigid food rules and distress when rules are broken, and refer to eating-disorder services where indicated. Medical risks of severe restriction, such as electrolyte disturbance and refeeding syndrome, need medical monitoring [synthesis; eating-disorder clinical guidance: [uncertain: not verified]]. (6) Money: ask about total costs, prepayment, loans and pressure tactics. (7) Group pressure: online or in-person communities may frame doubt as betrayal. Explore the client's freedom to disagree.
• Example language (illustrative): "These new numbness symptoms sound important to get checked by a doctor as well, whatever is going on with your fillings. Could we look at how to get that appointment?" "How much has this cost so far, and how is that sitting with you?" "What happens in that group when someone has doubts?"
• Watch for: Abandoning medical treatment. Extraction plans. Chelation from non-physicians. Financial strain or debt. Rigid food rules. Pregnancy. Working: medical review is in place for serious symptoms, and the client can name risks without feeling judged.

4.7 Health anxiety, somatic symptom distress and idiopathic environmental intolerance (cross-ref Domain II)

• Purpose: Offer established psychological treatment where symptom preoccupation, checking, reassurance-seeking, avoidance or repeated procedures are causing distress. Use when the pattern persists across practitioners or after removal. In the German trial of people who attributed many symptoms to amalgam, a health-promotion programme without removal produced improvement comparable to removal. The authors raised reduced "amalgam anxiety" and expectation as possible contributors [source: DrBicuspid report of Melchart et al., 2008].
• Steps: (1) Assess with a standard health anxiety or somatic symptom assessment, without reproducing proprietary items here (see Domain II). (2) Agree a shared, non-dismissive formulation: symptoms are real; attention, worry, checking and avoidance can amplify them, whatever their origin. (3) Offer a CBT-based or other evidence-based protocol for health anxiety or somatic symptom distress (Domain II): monitoring, reducing checking and reassurance-seeking, behavioural experiments, graded return to valued activity, sleep and activity pacing. (4) For idiopathic environmental intolerance (multiple attributed exposures), use the same approach and avoid debating causes. (5) Keep medical care coordinated so that new symptoms are still assessed.
• Example language (illustrative): "We don't need to settle what caused this to work on how much room it takes up in your life." "Let's look at what happens to the symptoms and the worry when you check, and when you don't."
• Watch for: The client hearing "it's all in your head" (repair at once, see 5). Escalating search for new causes after removal. Working: less time spent on checking and researching, more valued activity, less distress, whatever happens to the symptoms themselves.

4.8 Working with the aftermath of removal

• Purpose: Help clients integrate outcomes: improvement, no change, worsening, damaged or lost teeth, costs, regret, or anger at practitioners or at doctors who disagreed.
• Steps: (1) Invite an open account of what happened and how they feel about it now. (2) Normalise mixed outcomes and attributions. (3) For regret, separate the decision made with the information available then from the outcome. Work on self-compassion. (4) For loss of teeth or ongoing dental problems, link to an independent dentist. (5) For anger or a sense of being misled, consider complaint options (4.9) and support the client's choice. (6) Watch for a search for the "next cause".
• Example language (illustrative): "You made that choice hoping to get your life back. It makes sense that it hurts that it didn't turn out the way you hoped." "Would it help to talk through whether you want to raise this with anyone?"
• Watch for: Self-blame, depression, suicidal thinking (assess using standard practice), or a new, more invasive procedure. Working: the client describes the episode with less shame or anger and makes forward plans.

4.9 Reporting routes and safeguarding

• Purpose: Know where clients can report and where the psychotherapist may have duties.
• Steps / routes: (1) Adverse reactions to amalgam (US): FDA's MedWatch programme, which FDA itself lists for reactions thought to be caused by amalgam [source: FDA patient information]. (2) Dentist conduct (US): the state board of dental examiners. The Colorado Board's hearings and revocation in the Colorado case show the route [source: Quackwatch summary]. Ireland: the Dental Council, whose Code of Practice governs amalgam [source: Dental Council of Ireland Code]. UK: the General Dental Council [uncertain: not verified]. (3) Misleading advertising: the Colorado findings included deceptive advertising [source: Quackwatch summary]. Advertising regulators include the US Federal Trade Commission and the UK Advertising Standards Authority [uncertain: not verified]. (4) Children: where a child is subjected to harmful procedures or deprived of needed medical care, follow local safeguarding procedures [synthesis]. (5) Your own duties: follow your professional code on confidentiality limits. Reporting a dentist is normally the client's choice unless safeguarding applies [synthesis].
• Example language (illustrative): "If you want to raise a concern about the dentist, the dental board is the body that looks at that. We can go through what that would involve, and it's entirely your decision."
• Watch for: Fear of retaliation, shame about having paid, or wanting the psychotherapist to report on their behalf. Working: the client knows the options and chooses freely.

4.10 Managing the psychotherapist's own stance and conflicts of interest

• Purpose: Prevent your beliefs about mercury, or ties to practitioners, from steering the client.
• Steps: (1) Notice your own view (sceptical or sympathetic) and keep it out of the decision. (2) Never refer to a named "mercury-free" or "biological" dentist for benefit, sell supplements or tests, or co-market services. (3) If you have a personal or financial tie to such a practice, disclose it and consider referral. (4) Use supervision when you feel pulled to persuade.
• Example language (illustrative): "I want to be careful that my own views don't get in the way here. My job is to help you think it through, not to decide for you."
• Watch for: Collusion ("we both know doctors don't listen") or contempt ("that's quackery"); either damages the alliance and autonomy. Working: the client experiences you as neutral on the procedure and firm on safety [synthesis; ethics code text: [uncertain: not verified]].

5. Handling problems

None of the sources covers the psychotherapist's role. All guidance in this section is [synthesis] unless tagged.

• Client is certain and wants agreement, not exploration. Do not argue about mercury. Acknowledge the certainty, ask what support they want from you, and keep to safety and coordination. (Illustrative) "I can hear how sure you are. I'm not going to try to change your mind. Can we make sure the rest of your health is looked after too?"
• Client experiences you as "one of the doctors who dismissed me" (rupture). Name it, take responsibility for anything you said that sounded dismissive, and restate your stance: neutral on the procedure, focused on their wellbeing and choice. (Illustrative) "I think I just sounded like I was brushing this off. That's not what I want. Can you tell me what that felt like?"
• Client wants you to say whether to have it done. Decline the dental judgement warmly and offer decision help (4.3). Do not hint.
• Overwhelm from conflicting information. Slow down. Narrow to the client's top two questions. Write them down for the dentist and doctor. Reduce research time with a contained "worry and research period" from health-anxiety work (Domain II).
• Rushed decision (discount deadline, practitioner pressure, partner pressure). Explore the pressure. Point out that the client can ask for time. Irreversible tooth removal justifies a pause, per FDA's note on loss of healthy tooth structure [source: FDA patient information].
• Non-engagement with medical review. Explore past experiences with doctors. Offer choice of clinician. Keep the topic open without making therapy conditional on it, unless there is acute risk.
• Symptoms continue or worsen after removal. Watch for despair and for escalation to chelation, extractions or other procedures. Revisit 4.7 and 4.8. Check suicidal ideation in line with standard risk assessment practice.
• Client improves and attributes it to removal. Accept their account. Support the gains and healthy habits. Monitor for over-generalising to other procedures. In the German trial, improvement also occurred without removal, so improvement after removal does not settle the cause [source: DrBicuspid report of Melchart 2008].
• Financial harm or debt. Problem-solve, link to debt advice, and explore complaint and refund options (4.9).
• Pregnancy discovered during planning. Prompt the client to tell the dentist and obstetric team. FDA and IAOMT both caution about pregnancy [source: FDA; IAOMT].
• A child's teeth or a child's "detox" is planned. Explore with the parent, encourage dentist and paediatric review, and follow safeguarding procedures if a child is exposed to harmful procedures or denied needed care.
• Eating restriction emerges. Screen (4.6), share concern, and refer to eating-disorder services with medical monitoring if indicated.
• Group pressure. Explore the costs of dissent within the group. Support the client's other relationships. Watch for high-control dynamics such as isolation, shaming and escalating payments.
• Your own frustration or advocacy. Take it to supervision. Restate scope (4.10).

Harm account

What was actually done

The best-documented case of harm is the practice of a Colorado dentist, as found by a state administrative law judge in a case brought before the Colorado State Board of Dental Examiners on behalf of eight complaining patients, after hearings that began on 27 November 1995 [source: Westword; Quackwatch summary of the Administrative Law Judge's Initial Decision].

• Practice focus. For about 22 years the dentist limited his practice to diagnosing and treating what he believed was mercury toxicity from amalgam. He said his life's goal was exposing mercury's harm. He claimed amalgam causes conditions including multiple sclerosis and Alzheimer's disease.
• Intake and "diagnosis". His centre accepted patients with almost any symptoms, diagnosed mercury toxicity, and treated the mercury alongside the disease instead of referring patients to physicians. A questionnaire of about 500 largely general questions was used. The judge found it had no diagnostic value. He advertised an 85% success rate with no scientific basis. He described "retention toxicity", which the judge also found had no valid basis. He told patients he had had MS and been cured, though he never had the disease.
• Dental work. Amalgam fillings were removed. The standard protocol also extracted all root-canal-treated teeth, even when they caused no symptoms.
• "Detoxification". Programmes included an in-office programme of roughly US$6,000 plus dental charges, taken by about 250 patients a year, and a cheaper remote "assist" programme with serum tests and dental work for out-of-state patients, milder cases and "prevention". The dentist claimed sauna sweating removes mercury, while admitting there was no scientific evidence for this. Removal temporarily raised urine mercury through grinding and displacement, and this was presented as evidence of "retention". The judge rejected that interpretation.
• Decision. On 29 February 1996, the administrative law judge recommended revocation, finding the dentist's diagnostic methods and treatments scientifically unsupported, without clinical justification and outside the practice of dentistry; he did not appeal her conclusions [source: Westword]. The Initial Decision followed 12 days of hearings and contained 235 findings of fact, and his licence was revoked in 1996 [source: Quackwatch summary]. In 2007 the Board concluded he was unlawfully practising dentistry at a clinic he owned. He signed a stipulated cease-and-desist order, without admitting the allegations, and agreed not to use "D.D.S." in Colorado without disclosing he was unlicensed there [source: Quackwatch summary; uncertain: secondary, primary Board record not cited].

How it caused harm

• Loss of sound tooth structure and teeth. Removing intact amalgam can remove healthy tooth structure and briefly raise mercury vapour exposure. FDA states intact fillings should not be removed to prevent disease [source: FDA patient information; HPN Online]. Extraction of asymptomatic root-filled teeth was part of the Colorado dentist's protocol [source: Quackwatch summary]. Damage to one patient's mouth and gums was found [source: Quackwatch summary].
• Financial loss. The judge found all eight patients in the case lost money [source: Quackwatch summary].
• Emotional harm. Emotional distress was found for at least one patient [source: Quackwatch summary]. False hope, a fixed illness identity and disappointment are likely sequelae [synthesis].
• Missed or delayed medical care. Patients with serious diseases were treated for "mercury" rather than referred, and some were abandoned without referrals [source: Quackwatch summary].
• False diagnosis through testing. Provoked urine testing after a chelating agent raises urinary metals even in healthy people. Hair and nail testing is often unreliable. Both can lead to false diagnoses and inappropriate treatment. Chelation can cause serious side effects and is advised only for documented metal poisoning [source: AACT/ACMT Choosing Wisely].
• Who was most at risk. People with serious or progressive diseases (the Colorado clinic's claims included MS, Alzheimer's, ALS and leukaemia patients in the in-office programme), people with chronic unexplained symptoms and high health anxiety, and those with limited money [source: Quackwatch summary; synthesis for the health-anxiety point].

Recognising it today

• Phrases and rationales: "mercury toxicity" or "retention toxicity" diagnosed from a long symptom questionnaire. Removal promised to treat MS, Alzheimer's or other diseases. Success-rate claims. "Detox" packages after removal. "Provoked" urine, hair or nail metal tests. Claims that root-filled teeth are toxic and should be extracted. Sauna or supplement "mercury elimination" [source: Quackwatch summary; AACT/ACMT].
• Regulatory news used as a rationale. The EU's 2025 restriction and the 2025 Minamata Convention decision to phase out amalgam manufacture, import and export by 2034 concern new amalgam [source: Dental Council of Ireland Code; ADA News, Feb 2026]. The Irish Code states there is no requirement to replace functioning fillings. FDA's 2020 high-risk-group advice concerns new fillings and does not recommend removing intact ones [source: Dental Council of Ireland; FDA]. Watch for these being presented as reasons to remove sound fillings.
• Red flags in a practice: one cause offered for almost every symptom. Not referring to physicians. Packages bundling testing, removal, extractions and detox. Prepayment and urgency. Testimonials in place of evidence. Advice that conflicts with the client's doctor without any coordination.
• How legitimate care differs: dentists replace fillings that are failing or decayed. Dentists discuss material choice with high-risk groups as FDA describes [source: FDA]. IAOMT presents SMART as protective recommendations for removal, with decisions left to the licensed practitioner, rather than as a disease cure [source: IAOMT]. The ADA regards removing serviceable fillings solely to replace them with mercury-free material as unwarranted [source: ADA statement].

What to do instead and how to help those harmed

• Instead (to discuss, not prescribe): medical assessment of the symptoms. An independent dental opinion on whether any filling needs work. Established psychological treatment for health anxiety or somatic symptom distress (Domain II). Health-promoting routines, given that a non-removal programme also produced improvement in the German trial [source: DrBicuspid report of Melchart 2008; synthesis].
• Assessment of people harmed: explore the dental, financial and emotional losses, current symptoms, ongoing practitioner contact, suicidal thinking, and trust in health care. Link to an independent dentist for restorative needs and to a GP for symptoms [synthesis].
• Treatment: work on regret, shame and anger (4.8). Grief for lost time and money. Rebuild trust in care. Health-anxiety work where symptom preoccupation continues [synthesis].
• Ethical, reporting and legal routes: dental board complaints (as in Colorado), the Dental Council in Ireland, MedWatch for amalgam adverse events in the US, and advertising regulators for deceptive claims (FTC and ASA [uncertain: not verified]). Follow safeguarding procedures for children. Legal advice is the client's own decision [source: Quackwatch summary; FDA; Dental Council of Ireland; synthesis].

Sources

• Information for Patients About Dental Amalgam Fillings (FDA)
• FDA issues recommendations for certain high-risk groups regarding mercury-containing dental fillings (HPN Online, 30 Sept 2020)
• FDA press announcement on high-risk groups (2020): https://www.fda.gov/news-events/press-announcements/fda-issues-recommendations-certain-high-risk-groups-regarding-mercury-containing-dental-amalgam [uncertain: not verified]
• The Safe Mercury Amalgam Removal Technique (SMART) (IAOMT)
• Safe Mercury Amalgam Removal Technique (IAOMT)
• Safe Amalgam Removal, for patients (IAOMT)
• SMART Certification (IAOMT)
• Safe Amalgam Removal Online Learning Activity Script (IAOMT)
• ADA statement on use of dental amalgam in the US (ADA, Feb 2026)
• Indian Health Service to end dental amalgam use by 2027 (ADA News, Feb 2026)
• Code of Practice regarding Dental Amalgam (Dental Council of Ireland, Jan 2025)
• Choosing Wisely Recommendations (AACT and ACMT)
• Colorado State Board of Dental Examiners actions and Initial Decision summary (Quackwatch)
• Tooth Will Tell, Westword (Denver), report on the 1995–96 Colorado dental board hearing and the administrative law judge's recommendation
• Removing amalgam cures ills, but so does healthy living (DrBicuspid, 2008)
• Melchart D, et al. (2008). Controlled trial of amalgam removal, removal plus "biological detoxification", and health promotion without removal. Journal of Dental Research, 87(4), 349 [uncertain: full author list and title not verified].