Protect Protocol Equipment

The International Academy of Biological Dentistry and Medicine (IABDM) require our member dentists who are certified in the Protect Protocol to show proof they have the specific equipment necessary to meet all the requirements of the Protect Protocol.

IABDM members may use any vendor you’d like to obtain the equipment required to pass the Protect Protocol oral presentations. As a service to our members, we have formed a strategic alliance with Dental Safety Solutions, who can provide all of the safety equipment needed for the Protect Protocol as well as OSHA consulting services and respiratory protection training.

Equipment for Operatory

Visit the link below to purchase the various items required for the Protect protocol that are necessary for your operatory, including oral aerosol vacuums and amalgam separators.

Protect Protocol Patient Equipment

Protecting our dental patients from the hazards of mercury is of the utmost importance. You can purchase all the items required by the Protect Protocol to protect your patients at the button below.

Protect Protocol Practitioner PPE

One can choose from an array of PPE styles when selecting PPE to protect against mercury during the removal of amalgam fillings.

Protect Protocol Practitioner PPE

One can choose from an array of PPE styles when selecting PPE to protect against mercury during the removal of amalgam fillings.

Practitioner Respiratory Protection

OSHA requires employers offer their employees respirators & cartridges to provide protection against hazards such as the mercury vapor and particulate matter generated during the removal of an amalgam filling.

Protect Protocol Practitioner PPE

OSHA requires the employer to develop & implement a written respiratory protection program with worksite-specific procedures & elements for respirator use including medical evaluations, fit testing, training & a qualified administrator to oversee the program.


In each room where mercury fillings are removed, it is MANDATORY to have an appropriate filtration system designed to remove mercury.
Appropriate filtration includes:

  1. a high-volume air filtration system (such as an at source oral aerosol vacuum) outfitted with a charcoal filter that can capture mercury vapor and amalgam particles generated during the removal of mercury fillings.
  2. An oral aerosol vacuum which is directly vented to the outside, with a charcoal filter, to reduce environmental pollution of mercury vapor.

The IABDM suggests checking with your local, state and federal regulations regarding the ventilation of mercury contaminated air.

Filters: (Air filtration and Oral Aerosol Vacuums) MUST be changed based on each manufacturer’s recommendations.
The IABDM suggests a card is kept with the change dates and initials of the employee that changed the filter. The card should be kept where it is easily seen. If possible, windows should be opened to reduce the mercury concentration in the air.

Amalgam Separator: The amalgam separator MUST meet the EPA’s Dental Office Point Source Category Rule. The EPA as well as your state and local authority, mandates that the mercury separator MUST be properly installed, utilized, and maintained to collect mercury amalgam waste so that it is not released into the effluent from the dental office.
The IABDM suggests a log is kept with the maintenance dates, filter change dates and initials of the employee that serviced the mercury separator. The log should be kept where it is easily seen.

  • Removal of amalgam fillings contaminates all dental equipment in the room (both used and unused) with mercury contaminated particulate matter.
  • Use of respirators and PPE are required when decontaminating the dental operatory and any instruments, trays or equipment used that have been moved to a sterilization area.  Anything that was not covered with an impermeable covering, MUST be wiped down with mercury capturing wipes.  ie: counters, equipment, instruments, including flooring.
  • Do not autoclave instruments contaminated with mercury until they have been thoroughly decontaminated with mercury capturing wipes.
  • Dental Staff MUST wear (NIOSH approved respirators, eye protection, gloves, gown) during the opening and maintenance of suction traps or changing of any filters that can expose them to mercury vapors or particulate.
  • Dentists MUST comply with federal, state, and local regulations addressing the proper use of respirators, filter change out schedules as well as the proper handling, cleaning, and/or disposal of mercury-contaminated components, clothing, equipment, surfaces of the room, and flooring in the dental office.

Ideal: A separate operatory that is used ONLY for Amalgam Removal and that the room is isolated and contained, as it would limit exposure to the rest of the office.


PPE and Engineering Controls

  • The patient’s mouth should be thoroughly flushed with charcoal, or similar adsorbent mixed with water for the patient to rinse and spit or swallow before the procedure.
  • To protect the patient’s clothing and hands, a full body (from neck to toe), impermeable barrier/drape MUST be utilized.  Any clothing not covered should be thrown away. Sending the patient home with contaminated clothing will expose their washer/dryer and then their home to mercury vapor.
  • To protect the patient’s head, hair and neck, a full head/neck barrier/hood, MUST be utilized.
  • To protect the patient’s face, the face should be covered with an impermeable barrier/drape under/around the dam, leaving only a hole for the mouth.
  • To protect the patient’s eyes, eye protection shall be provided to the patient to prevent mercury vapor and particles from reaching the eyes. Eye protection should adhere to ANSI Z87.1-2020 and have passed D3 (Droplet and Splash Test), D4 (Dust Test) and D5 (Fine Dust Test).
  • Immediately after the last amalgam is out, all patient drapes and drapes used to cover equipment are removed, bagged, and properly disposed of.
  • A new patient drape is placed on the patient to complete the restoration of the tooth.
  • Contaminated instruments are removed from the operatory and new “Sterile” instruments are brought in to complete the restoration.

Ideal: Each Quadrant undergoes amalgam removal separately. The dam and drapes are removed, and the patient’s mouth is rinsed with an adsorbent. New drapes are placed and the restoration completed. This reduces issues concerning a patient’s bite. Then the next quadrant is addressed.

Air for the patient to breathe while the removal is being performed is MANDATORY (this will reduce inhalation of mercury vapors & particulate matter). These two ways are considered acceptable.

  • use of an external air source.
  • oxygen delivered by a nasal mask.

A Dental Dam

  • A non-latex nitrile or polyisoprene dental dam MUST be correctly placed and properly sealed around the teeth with the amalgams being removed.
  • We suggest a dam sealer is used if needed.
  • A thin smear of HgX cream may be used on the dam after placement for added protection*.
  • Any exceptions for using a dam should be well documented.

*Note: the dental dam is somewhat permeable and does not prevent 100% of the mercury vapor from passing through. It prevents particulate and larger pieces of amalgam from accidentally being swallowed.

  • A saliva ejector must be placed under the dental dam, inside the patient’s mouth to remove saliva and reduce mercury vapor exposure to the patient.
  • It is MANDATORY to use copious amounts of water, sprayed directly onto the tooth. This will help reduce the heat generated from the drilling process, thus reducing mercury levels created from this process.
  • An additional high-speed suction MUST be used above the dam, in the patient’s mouth to reduce mercury particulate/vapors and help suction the water used during the removal.

At Source Oral Aerosol Vacuum (with charcoal filters to capture mercury)

  • A high-volume air filtration system (such as an at source oral aerosol vacuum) must be placed as close to the mouth as possible during the removal of an amalgam filling, so as to reduce the amount of mercury vapors and particulate matter that patients and dental practitioners will be exposed to.

Removing the amalgam.

  • The amalgam being removed MUST be sectioned into chunks and removed in as large of pieces as possible.
  • This can be accomplished by using a small diameter carbide drill.
  • Removing the amalgam with the least amount of drill time reduces exposure levels.
  • This process is known as “Chunking”.

Once the amalgam removal is complete.

  • The dam is carefully removed and discarded appropriately as contaminated with mercury vapor and particulate.
  • The patient’s mouth should be thoroughly flushed with water.
  • You may choose to use a binder like charcoal, or similar adsorbent mixed with water for the patient to swish and spit.
  • Reminder: Ideal is a quadrant at a time.


Personal Protective Equipment (PPE) and Respiratory Protection for mercury exposure includes the Dr, Staff, Patient, and any other people in the room while amalgam removal is performed.

  • Face shields will accumulate mercury particulate and must either be thoroughly cleaned after EACH use or thrown away.
  • Eye protection should adhere to ANSI Z87.1-2020 and have passed D3: Droplet and Splash Test, D4: Dust Test and D5: Fine Dust Test
  • Hair/head/neck coverings
  • Shoe coverings

The IABDM discourages any non-NIOSH certified respirators (such as charcoal masks)

The use and maintenance of NIOSH certified respirators should adhere to OSHA standard 1910.134(a)(2) on respiratory protection by using:
1. a properly sealed respirator with cartridges and filters rated to capture mercury vapor and particulate matter, (This requires each respirator be fit tested by a certified individual to assure the proper fit) A paper mask may not be worn under this mask as it interferes with the proper seal.
2. a positive pressure, properly sealed respirator providing air or oxygen. These respirators must be worn by the dentist and all dental personnel in the room.

If no face shield is used, respirators and filter cartridges will collect mercury particulate on them during the amalgam removal process and will need to be thoroughly wiped down with mercury capturing wipes after EACH exposure.
Note: some filter manufacturer companies suggest changing the filters after 50 hours of use. You need to document what your manufacturer suggests.


  • 1910.134(c)(1)
    In any workplace where respirators are necessary to protect the health of the employee or whenever respirators are required by the employer, the employer shall establish and implement a written respiratory protection program with worksite-specific procedures. The employer shall include in the program the following provisions of this section, as applicable:
  • 1910.134(c)(1)(ii)
    Medical evaluations of employees required to use respirators;
  • 1910.134(c)(1)(iii)
    Fit testing procedures for tight-fitting respirators;
  • 1910.134(c)(1)(iv)
    Procedures for proper use of respirators in routine and reasonably foreseeable emergency situations;
  • 1910.134(c)(1)(v)
    Procedures and schedules for cleaning, disinfecting, storing, inspecting, repairing, discarding, and otherwise maintaining respirators;
  • 1910.134(c)(1)(vii)
    Training of employees in the respiratory hazards to which they are potentially exposed during routine and emergency situations;
  • 1910.134(c)(1)(viii)
    Training of employees in the proper use of respirators, including putting on and removing them, any limitations on their use, and their maintenance; and
  • 1910.134(c)(1)(ix)
    Procedures for regularly evaluating the effectiveness of the program.


  • Ideally, thick non-latex nitrile gloves should be utilized by the dentist and all dental personnel in the room.
  • Dental gloves thinner than 4 mils are at a higher risk of mercury permeation.
  • The thicker the glove, the more protective they will be at reducing mercury exposure through the skin.
  • Consider double gloving with HgX cream applied between gloves.
  • And/or utilizing thicker nitrile gloves, such as 6mil or higher.
  • All exposed skin (hands, wrists, neck, etc.) and clothing (Scrubs, shoes, or other clothing the person wishes to keep) must be covered. This is in accordance with OSHA 1910.132.
  • Substantial quantities of mercury particles are generated during the procedure and may evade the suction devices.

NOTE: It has been documented that these particles can move from the patient’s mouth to the hands, arms, face, chest, and other parts of the dental personnel and or the patient.


  • The IABDM encourages dentists to utilize the standards set by OSHA for mercury exposure.
  • Not all dentists want to wear full body hazmat suits rated for mercury (very expensive and cumbersome to wear).
  • Isolation gowns have not yet been rated for use against mercury vapor and particulate matter.
  • If one chooses not to wear PPE rated for mercury, then we suggest using Polyethylene-Coated Isolation Gowns, as preliminary testing has shown that this material is more protective of mercury than breathable single layer isolation gowns or those made from cloth.

Polyethylene-Coated Isolation Gowns

  • Are ONE TIME USE ONLY, they become contaminated with mercury during removal of an amalgam filling.
  • You must dispose of them according to local, state, and federal regulations.
  • NO WASHABLE GOWNS! This is asking for trouble. Staff would handle items highly contaminated with mercury. That mercury has the potential to contaminate the washing machine and dryer.

After the removal process is complete.

  • Contaminated PPE MUST be isolated immediately into an airtight container and removed from the premises as soon as possible.
  • Do not attempt to wash contaminated clothing as it will be another potential exposure to employees and will contaminate cleaning equipment and send excess mercury into the wastewater.
  • Wash hands and don new gloves, paper mask and jacket.
  • After the procedure is completed and the patient is dismissed.
  • ALL contaminated areas (Everything is considered contaminated) are wiped down with mercury capturing wipes.

It is suggested the high-volume suction equipment be run for at least an hour after amalgam removal to continue to capture transient mercury particulate that escaped collection. For even greater effectiveness, it could be run all day.

MANDATORY: A dental office removing amalgams must have enough mercury separators to handle the load of mercury generated.
Filters, garments, or disposables contaminated with mercury MUST be disposed of properly. (Per EPA, State and local agencies)
All respirators and eye protection, when worn without face shields, will accumulate mercury particulate and must either be thoroughly cleaned after EACH use or thrown away.
• Exercise extreme caution when cleaning respiratory protection equipment, as it may be contaminated and pose a risk of mercury exposure.
Respirator Cleaning Procedures (Mandatory)



It is important to note that as a safety precaution, the IABDM does not encourage amalgam filling removal for women who are pregnant or breast-feeding. Emergencies do arise and IF that occurs, contact the patients OB-GYN for their advice as they may permit emergency action on a single tooth. The best time to do this is during the 2nd trimester.

The IABDM has chosen to protect pregnant or breast-feeding dental assistants, we feel that they should be discouraged from participating in assisting chairside on cases involving amalgam removal.

Because mercury is (colorless, odorless, invisible) this makes it impossible to detect it without specialized equipment. The IABDM encourage you to periodically check your dental office for mercury. Real-time mercury vapor analyzers can be purchased or rented. The IABDM has a mercury vapor analyzer that is available to rent for $150 a day plus $100 shipping cost. Use of color changing mercury detection wipes may help you discover mercury contaminated particulate matter that has accumulated on surfaces and floors.

If your office tests positive for mercury, you can purchase mercury kits that include products to help decontaminate surfaces and equipment.
For more advanced contamination issues, contact a hazardous materials company to aid with decontamination.

    Your Cart
    Your cart is emptyReturn to Shop