Oral Health Consequences of Asthma in Children and Adolescents: Dental Risks and Preventive Strategies

Asthma is one of the most common chronic diseases in children and adolescents, and its impact extends beyond the respiratory system. Growing evidence shows that asthma and its pharmacological treatment can negatively affect oral and dental health, increasing the risk of caries, erosion, periodontal inflammation, and mucosal alterations.

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Understanding these oral health consequences of pediatric asthma is essential for early prevention and effective interdisciplinary management.

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✅ Etiology: Why Does Asthma Affect Oral Health?
The oral consequences associated with asthma are multifactorial and include:

▪️ Chronic mouth breathing, leading to reduced salivary flow
▪️ Use of inhaled medications, especially corticosteroids and β2-agonists
▪️ Lower salivary pH and buffering capacity
▪️ Alteration of oral microbiota
▪️ Increased plaque accumulation
👉 Asthma-related xerostomia is a key factor in oral disease development.

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✅ Main Oral and Dental Consequences of Asthma

1. Dental Caries
Children with asthma have a higher prevalence of dental caries, mainly due to:

▪️ Reduced salivary flow
▪️ Increased consumption of sugary beverages to relieve dry mouth
▪️ Acidic formulations of inhaled medications
Asthmatic children are at increased risk of early enamel demineralization.

2. Dental Erosion

▪️ Frequent exposure to acidic inhalers
▪️ Reduced salivary neutralization
▪️ Possible association with gastroesophageal reflux, common in asthmatic patients
Dental erosion may affect both primary and permanent dentition.

3. Gingivitis and Periodontal Inflammation

▪️ Increased plaque retention due to dry oral tissues
▪️ Altered immune response
▪️ Inflammatory effects of corticosteroids
Asthma has been linked to higher gingival inflammation indices in adolescents.

4. Oral Candidiasis

▪️ Common in children using inhaled corticosteroids without spacers
▪️ Favored by immunosuppressive effects and reduced saliva

5. Malocclusion and Craniofacial Changes
Chronic mouth breathing may contribute to:

▪️ Anterior open bite
▪️ Posterior crossbite
▪️ Narrow maxillary arch

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✅ Clinical Signs and Symptoms
Common findings include:

▪️ Dry mouth (xerostomia)
▪️ White spot lesions
▪️ Increased caries activity
▪️ Gingival redness and bleeding
▪️ Burning mouth sensation
▪️ Fungal plaques on oral mucosa

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✅ Preventive Measures
Effective prevention requires a combined medical and dental approach:

▪️ Use of spacers with inhalers
▪️ Rinsing the mouth with water after inhaler use
▪️ Daily fluoride toothpaste (age-appropriate concentration)
▪️ Topical fluoride applications
▪️ Saliva-stimulating strategies
▪️ Dietary counseling to reduce sugar intake
👉 Simple preventive habits significantly reduce oral complications in asthmatic children.

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✅ Dental Treatment Considerations

▪️ Schedule dental appointments during periods of asthma control
▪️ Avoid known asthma triggers in the dental office
▪️ Monitor caries risk closely
▪️ Use minimally invasive restorative approaches
▪️ Collaborate with pediatricians and pulmonologists when needed

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💬 Discussion
Asthma in children and adolescents presents a significant but often underestimated risk factor for oral disease. The combination of respiratory alterations, medication effects, and behavioral factors contributes to an environment favorable to dental pathology.
Early identification and preventive strategies can dramatically reduce long-term oral complications.

🎯 Clinical Recommendations
▪️ Include asthma status in dental risk assessment
▪️ Educate parents and caregivers on inhaler-related oral risks
▪️ Reinforce preventive dentistry protocols
▪️ Ensure regular dental follow-ups
▪️ Promote interdisciplinary care

✍️ Conclusion
Asthma is not only a respiratory condition—it also affects oral health. Children and adolescents with asthma are at increased risk for caries, erosion, gingivitis, and mucosal infections. With proper preventive measures, patient education, and coordinated care, these oral complications can be effectively prevented and managed.

📚 References

✔ Alavaikko, S., Jaakkola, M. S., & Jaakkola, J. J. K. (2011). Asthma and caries: A systematic review and meta-analysis. American Journal of Epidemiology, 174(6), 631–641.
✔ Godara, N., Godara, R., & Khullar, M. (2011). Impact of inhalation therapy on oral health. Lung India, 28(4), 272–275.
✔ Ryberg, M., Möller, C., & Ericson, T. (1991). Saliva composition and caries development in asthmatic patients. Journal of Dental Research, 70(3), 479–483.
✔ Thomas, M. S., & Parolia, A. (2010). Asthma and oral health: A review. Australian Dental Journal, 55(2), 128–133.
✔ Wogelius, P., et al. (2004). Dental caries and asthma in children. Community Dentistry and Oral Epidemiology, 32(5), 347–353.

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Hairy Tongue in Children: Etiology, Clinical Features, and Treatment

Hairy tongue (lingua villosa) in pediatric patients is an uncommon but benign oral condition characterized by elongation and delayed desquamation of the filiform papillae on the dorsal surface of the tongue.

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Although more frequently reported in adults, children may develop hairy tongue, often associated with antibiotic use, poor oral hygiene, or systemic conditions. Early recognition is essential to avoid misdiagnosis and unnecessary treatment.

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✅ Etiology in Pediatric Patients
In children, hairy tongue is primarily caused by impaired keratin shedding, leading to accumulation of keratin on the filiform papillae.

Common pediatric-related etiological factors include:
▪️ Recent or prolonged antibiotic therapy
▪️ Inadequate oral hygiene habits
▪️ Mouth breathing
▪️ Xerostomia related to medications
▪️ Liquid or soft diets
▪️ Use of antiseptic mouth rinses without supervision
Importantly, hairy tongue is not an infectious disease and does not represent a systemic pathology by itself.

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✅ Clinical Signs and Symptoms
Pediatric patients are often asymptomatic, and the condition is usually detected during routine dental examination.

Typical clinical features include:
▪️ Hair-like projections on the dorsal surface of the tongue
▪️ Color changes (white, yellow, brown, or black)
▪️ Mild halitosis
▪️ Occasional gag reflex or foreign body sensation
Pain, ulceration, or bleeding are not characteristic findings.

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✅ Diagnosis in Children
Diagnosis is purely clinical and based on visual examination. The elongated filiform papillae are easily distinguished from other oral conditions.

Differential diagnosis should include:
▪️ Oral candidiasis (especially after antibiotics)
▪️ Geographic tongue
▪️ Oral hairy leukoplakia (rare in immunocompetent children)
▪️ Biopsy or laboratory tests are rarely required.

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✅ Treatment and Management in Odontopediatrics
Management focuses on behavioral and hygienic measures, rather than medication.

Recommended pediatric management includes:
▪️ Gentle tongue brushing or scraping
▪️ Reinforcement of age-appropriate oral hygiene education
▪️ Discontinuation of unnecessary mouth rinses
▪️ Review of recent antibiotic use
▪️ Adequate hydration
Antifungal or antibiotic treatment is not indicated unless another condition is confirmed.

📊 Comparative Table: Pediatric Hairy Tongue – Clinical Characteristics

Aspect	Advantages	Limitations
Clinical Appearance	Easily identifiable during oral examination	May alarm parents due to dark coloration
Etiology	Often reversible and related to modifiable factors	Sometimes linked to necessary antibiotic therapy
Treatment Approach	Non-invasive and conservative	Requires cooperation from child and caregivers
Prognosis	Excellent with complete resolution	Possible recurrence if habits persist

💬 Discussion
In pediatric dentistry, hairy tongue is frequently underrecognized or misdiagnosed as oral candidiasis, leading to unnecessary antifungal prescriptions. Understanding its benign and self-limiting nature allows clinicians to focus on education, reassurance, and preventive strategies, which are fundamental principles in odontopediatrics.

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🎯 Clinical Recommendations
▪️ Reassure parents about the benign nature of the condition
▪️ Avoid prescribing antifungals without clear clinical indication
▪️ Reinforce daily tongue hygiene as part of oral care routines
▪️ Monitor children receiving prolonged antibiotic therapy
▪️ Schedule follow-up visits to confirm resolution

✍️ Conclusion
Hairy tongue in children is a benign, reversible condition associated with hygiene and medication-related factors. Early diagnosis, conservative management, and parental education ensure favorable outcomes without invasive interventions. Odontopediatricians play a key role in preventing overtreatment and promoting oral health awareness.

📚 References

✔ Gurvits, G. E., & Tan, A. (2014). Black hairy tongue syndrome. World Journal of Gastroenterology, 20(31), 10845–10850. https://doi.org/10.3748/wjg.v20.i31.10845
✔ Neville, B. W., Damm, D. D., Allen, C. M., & Chi, A. C. (2016). Oral and maxillofacial pathology (4th ed.). Elsevier.
✔ Houghton, J., & McCullough, M. J. (2017). Oral conditions associated with antibiotic use. Australian Dental Journal, 62(3), 309–315. https://doi.org/10.1111/adj.12524

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Dental Prostheses Without Proper Care Can Lead to Serious Oral Damage

Dental prostheses are designed to restore function, aesthetics, and oral health, but when they are poorly fitted or inadequately maintained, they may become a significant source of chronic trauma and oral disease.

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Both fixed and removable dental prostheses can lead to painful, inflammatory, and potentially serious lesions affecting soft and hard tissues.

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Understanding which lesions are associated with each type of prosthesis is essential for early diagnosis, prevention, and appropriate clinical management.

✅ Etiology: Why Do Dental Prostheses Cause Oral Lesions?
The main etiological factors include:

▪️ Poor marginal adaptation
▪️ Overcontoured prosthetic surfaces
▪️ Incorrect occlusal contacts
▪️ Prosthetic instability or overextension
▪️ Inadequate oral hygiene
▪️ Long-term use without professional follow-up
👉 Chronic mechanical irritation remains the primary mechanism leading to tissue damage.

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✅ Lesions Caused by Poorly Fitted Fixed Dental Prostheses
Poorly adapted crowns, bridges, and implant-supported restorations can cause localized but progressive tissue damage.

Common lesions include:
▪️ Traumatic gingivitis caused by overhanging margins
▪️ Chronic periodontal inflammation due to plaque accumulation
▪️ Violation of the biologic width, leading to persistent bleeding and attachment loss
▪️ Gingival recession associated with improper emergence profiles
▪️ Secondary caries at restoration margins
▪️ Periapical lesions related to occlusal overload
▪️ Oral ulcerations caused by sharp or overcontoured prosthetic edges
👉 Poor marginal fit is a major risk factor for biological failure of fixed prostheses.

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✅ Lesions Caused by Poorly Fitted Removable or Complete Dentures
Ill-fitting removable partial dentures and complete dentures affect larger mucosal areas and are strongly associated with chronic inflammatory conditions.

Common lesions include:
▪️ Denture stomatitis, characterized by erythematous palatal mucosa
▪️ Traumatic ulcers due to instability or overextension
▪️ Epulis fissuratum caused by chronic flange irritation
▪️ Inflammatory papillary hyperplasia, especially in long-term denture wearers
▪️ Angular cheilitis, often related to reduced vertical dimension
▪️ Residual ridge resorption due to uneven force distribution
▪️ Denture-associated oral candidiasis, particularly in elderly or immunocompromised patients
👉 Continuous use of ill-fitting dentures significantly increases mucosal pathology risk.

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✅ Clinical Signs and Symptoms
Patients with prosthesis-related lesions may present with:

▪️ Persistent oral pain or discomfort
▪️ Erythema and swelling
▪️ Ulcerations that do not heal
▪️ Bleeding during brushing
▪️ Burning mouth sensation
▪️ Difficulty chewing or speaking
Early recognition is key to preventing progression.

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✅ Diagnosis
Diagnosis is based on:

▪️ Detailed clinical examination
▪️ Evaluation of prosthesis fit, contours, and occlusion
▪️ Assessment of oral hygiene status
▪️ In selected cases, biopsy to rule out dysplastic or malignant lesions

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✅ Treatment and Clinical Management
Management depends on lesion type and severity and may include:

▪️ Prosthesis adjustment or replacement
▪️ Removal of traumatic factors
▪️ Improvement of oral hygiene protocols
▪️ Topical antifungal therapy for denture-related candidiasis
▪️ Anti-inflammatory or protective agents
▪️ Temporary discontinuation of denture use in severe cases
Treating the lesion without correcting the prosthesis will lead to recurrence.

💬 Discussion
Poorly fitted dental prostheses remain a preventable cause of oral lesions. Fixed prostheses tend to cause localized periodontal and biological complications, while removable dentures are more frequently associated with extensive mucosal inflammation and chronic trauma.
Routine follow-up and patient education are essential to reduce long-term complications.

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🎯 Clinical Recommendations
▪️ Always evaluate prosthesis fit during recall visits
▪️ Educate patients on proper prosthesis hygiene
▪️ Replace or reline dentures periodically
▪️ Avoid prolonged use of unstable or damaged prostheses
▪️ Investigate non-healing lesions promptly

✍️ Conclusion
Dental prostheses should improve oral health—not compromise it. Poorly fitted fixed and removable prostheses can cause serious oral lesions if not properly designed, monitored, and maintained. Early intervention and regular professional care are essential to prevent long-term damage.

📚 References

✔ Budtz-Jørgensen, E. (1990). Oral mucosal lesions associated with the wearing of removable dentures. Journal of Oral Pathology & Medicine, 19(2), 65–70.
✔ Felton, D. (2016). Edentulism and comorbid factors. Journal of Prosthodontics, 25(Suppl 1), S2–S20.
✔ Goodacre, C. J., Bernal, G., Rungcharassaeng, K., & Kan, J. Y. (2003). Clinical complications in fixed prosthodontics. The Journal of Prosthetic Dentistry, 90(1), 31–41.
✔ Gendreau, L., & Loewy, Z. G. (2011). Epidemiology and etiology of denture stomatitis. Journal of Prosthodontics, 20(4), 251–260.
✔ Lang, N. P., & Berglundh, T. (2011). Periimplant diseases. Journal of Clinical Periodontology, 38(Suppl 11), 178–181.

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Congenital Syphilis: Dental Manifestations – Hutchinson Incisors and Mulberry Molars

Congenital syphilis remains a preventable yet clinically significant condition, with oral and dental findings that may serve as key diagnostic clues for dentists and pediatric specialists.

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Among the most characteristic features are Hutchinson incisors and mulberry (Moon) molars, which reflect systemic disruption during tooth development caused by Treponema pallidum infection.

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✅ Etiology and Routes of Transmission
Congenital syphilis is caused by vertical transmission of Treponema pallidum from an infected mother to the fetus. Transmission occurs primarily via:

▪️ Transplacental spread, especially after the first trimester
▪️ Untreated or inadequately treated maternal syphilis
▪️ Late prenatal diagnosis or absence of prenatal care
The risk of fetal infection increases with higher maternal spirochete load and earlier stages of maternal disease.

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✅ Pathogenesis of Dental Alterations
Dental manifestations result from chronic inflammatory damage to developing tooth germs, particularly during the bell and apposition stages of odontogenesis. The infection interferes with ameloblast and odontoblast function, leading to enamel hypoplasia and abnormal crown morphology.

✅ Key Dental Manifestations

➤ Hutchinson Incisors
▪️ Permanent maxillary central incisors
▪️ Screwdriver-shaped crowns
▪️ Notched or crescent-shaped incisal edges
▪️ Reduced mesiodistal width
These incisors are considered pathognomonic of congenital syphilis.

➤ Mulberry (Moon) Molars
▪️ Typically first permanent molars
▪️ Irregular occlusal anatomy with multiple rounded enamel nodules
▪️ Poor cusp definition and abnormal enamel texture
These features reflect impaired enamel mineralization during early childhood.

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✅ Associated Oral and Systemic Manifestations

In addition to dental anomalies, affected children may present with:
▪️ Enamel hypoplasia in other permanent teeth
▪️ Delayed tooth eruption
▪️ High caries susceptibility

Classically, dental findings are part of Hutchinson’s triad, which includes:
▪️ Interstitial keratitis
▪️ Sensorineural hearing loss
▪️ Dental anomalies

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✅ Clinical Diagnosis in Dentistry
Dentists play a critical role in detection, as dental signs often persist even after systemic disease resolution. Diagnosis is based on:

▪️ Characteristic dental morphology
▪️ Medical history suggestive of congenital infection
▪️ Serologic confirmation (VDRL, RPR, treponemal tests)
▪️ Interdisciplinary evaluation with pediatrics and infectious disease specialists

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✅ Treatment and Dental Management

Medical Treatment
▪️ Penicillin G remains the gold standard for treating congenital syphilis
▪️ Early treatment prevents systemic complications but does not reverse dental defects

Dental Management
▪️ Restorative rehabilitation (composites, crowns, veneers)
▪️ Preventive care to reduce caries risk
▪️ Long-term monitoring of occlusion and eruption

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💬 Discussion
Despite global prevention strategies, congenital syphilis is re-emerging in many regions, making dental recognition increasingly relevant. Hutchinson incisors and mulberry molars are permanent markers of early systemic disease, underscoring the dentist’s role in early identification, referral, and multidisciplinary care.

🎯 Clinical Recommendations
▪️ Carefully evaluate atypical enamel defects and tooth morphology
▪️ Include congenital infections in the differential diagnosis of enamel hypoplasia
▪️ Refer suspected cases for serologic testing
▪️ Provide long-term restorative and preventive dental care

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✍️ Conclusion
Dental manifestations of congenital syphilis are not merely cosmetic findings but critical diagnostic indicators. Recognizing Hutchinson incisors and mulberry molars allows dental professionals to contribute to early diagnosis, comprehensive patient care, and improved long-term outcomes. Dentistry plays a vital role in identifying systemic diseases through oral signs.

📚 References

✔ Centers for Disease Control and Prevention. (2023). Congenital syphilis – STI treatment guidelines. https://www.cdc.gov/std/treatment-guidelines/congenital-syphilis.htm
✔ Neville, B. W., Damm, D. D., Allen, C. M., & Chi, A. C. (2023). Oral and maxillofacial pathology (5th ed.). Elsevier.
✔ Shafer, W. G., Hine, M. K., & Levy, B. M. (2019). Shafer’s textbook of oral pathology (8th ed.). Elsevier India.
✔ World Health Organization. (2022). WHO guidelines for the treatment of Treponema pallidum (syphilis). https://www.who.int/publications/i/item/9789240051400

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Is Dental Amalgam Being Phased Out Worldwide?

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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However, concerns regarding mercury toxicity and environmental pollution have prompted regulatory action in many countries. As dental practice evolves, there is a clear global transition toward composite resins and glass ionomer cements as preferred restorative materials.

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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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✅ Which Countries Have Restricted or Banned Dental Amalgam?
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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✅ Dental Materials Transition: Composite and Glass Ionomer Systems
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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💬 Discussion
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.

🎯 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

📊 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

📚 References

✔ 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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