Dental amalgam, historically known as “silver fillings”, has been used for over a century to restore carious teeth due to its durability and ease of use.
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✅ What Is Dental Amalgam?
Dental amalgam is an alloy containing elemental mercury (~50%) combined with silver, tin, copper, and other metals. Mercury acts as a binding agent, providing structural strength. Although research (including FDA and IADR assessments) acknowledges that amalgam is effective as a restorative material, environmental and potential health concerns have increasingly influenced policy decisions.
✅ Environmental and Public Health Concerns
Mercury from dental amalgam contributes to environmental pollution, especially during waste management and cremation processes, leading to bioaccumulation in water, soil, and food chains. As a result, international treaties and national regulations are phasing down or banning its use, emphasizing mercury-free alternatives.
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Many countries have taken explicit action:
▪️ European Union: The EU’s Mercury Regulation (amending EU 2017/852) will phase out dental amalgam use by January 1, 2025, with narrow exceptions for specific medical needs, and bans on export, import, and manufacture by mid-2026.
Link (EU Regulation): European Parliament & Council regulation on mercury-added products — Article 10 of EU 2017/852 (amended) https://eur-lex.europa.eu/eli/reg/2024/1849/oj
▪️ Peru: Fully banned the use of dental amalgam (Ministerial Resolution N° 859-2024-MINSA); mercury-free materials are prioritized, with very limited exceptions.
▪️ Switzerland, Liechtenstein, Iceland: Prohibit dental amalgam where mercury-free alternatives are feasible.
▪️ Japan, Bolivia, El Salvador, Paraguay, Guyana, Saint Lucia, Uruguay, Mozambique: Have withdrawn amalgam from public dental programs, effectively phasing out its use.
▪️ Senegal, Thailand, Uruguay: Are implementing programs to reduce dental mercury waste and phase down use in alignment with the Minamata Convention.
Some countries have not banned but severely restricted amalgam, especially for vulnerable populations (children under 15, pregnant or breastfeeding women) based on the Minamata Convention.
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With stricter regulations, the dental profession is shifting toward mercury-free restorative materials:
▪️ Composite resins: Tooth-colored, adhesive materials suitable for most cavity classes.
▪️ Glass ionomer cements (GICs): Release fluoride and bond chemically to tooth structure, beneficial in high-caries risk patients.
▪️ Resin-modified glass ionomers: Combine the advantages of resin and glass ionomer chemistry for better strength and aesthetics.
These materials are increasingly supported by clinical evidence showing adequate performance and esthetics without mercury.
✅ Clinical Considerations
Dentists must balance:
▪️ Restoration longevity and function
▪️ Esthetic demands
▪️ Environmental and patient safety concerns
▪️ Local regulations on amalgam use
Patient-centered care now often prioritizes mercury-free options, with amalgam reserved only when clinically justified or permitted by specific regulations.
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The evolution of restorative dentistry reflects broader societal priorities toward environmental sustainability and patient safety. While amalgam has established a long clinical history, the availability of reliable alternatives and global regulatory momentum accelerate its decline. Dental professionals should adapt by enhancing skills in adhesive dentistry and advocating for environmentally responsible practices.
✍️ Conclusion
The phase-out of dental amalgam is advancing globally due to environmental and health concerns and international agreements such as the Minamata Convention. Dentists are increasingly transitioning to composite resins and glass ionomer systems. Understanding regulatory frameworks and material science will be essential for modern, sustainable dental practice.
馃幆 Clinical Recommendations
▪️ Favor composite and glass ionomer restorations when clinically appropriate
▪️ Stay informed on national and international regulations
▪️ Educate patients on material choices and environmental impacts
▪️ Ensure compliance with amalgam separator and waste management protocols
▪️ Adopt minimally invasive caries management to reduce restorative needs
馃搳 Comparative Table: Dental Amalgam vs Mercury-Free Restorative Materials
| Aspect | Advantages | Limitations |
|---|---|---|
| Durability | Proven long-term clinical track record | Contains mercury; environmental disposal issues |
| Esthetics | Excellent (tooth-colored composites) | Amalgam is metallic and visible |
| Biocompatibility | Mercury-free materials reduce patient concern | Composite may be technique-sensitive |
| Environmental Impact | No mercury-related pollution | Amalgam contributes to mercury waste |
| Fluoride Release | Glass ionomers release fluoride | Amalgam does not |
✔ IADR. (2025). Safety of Dental Amalgam and Mercury Policy Review. International Association for Dental Research.
✔ European Parliament & Council. (2024). Amendment to Mercury Regulation (EU 2017/852) — Dental Amalgam Provisions. EU Official Journal.
✔ EnvMed Network. (2025). Countries Phasing Out Dental Amalgam.
✔ Environmental Medicine. (2025). Global Dental Amalgam Tracker.
✔ Environmental and Health Perspectives. (n.d.). Mercury Contamination from Dental Amalgam.
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