Context

Mercury is a widely present environmental pollutant that in certain forms poses a threat to ecosystems. Dental amalgam is a clinically well-proven and successful filling material, but the use of dental amalgam is one of several sources of mercury pollution, albeit minor. However, the dental profession recognizes the need to expedite the reduction in the use of mercury including dental amalgam and safe mercury waste management. Increased focus on caries prevention and ongoing research and development of new dental restorative materials with improved quality, safety, longevity and adhesive properties favour a phased reduction in the use of dental amalgam.

Scope

In 2013, the Minamata Convention on Mercury was agreed as a gradual phase down in the use of dental amalgam in restorative treatment. The convention was ratified in 2017 making it necessary to strategically plan and act to reduce the need for restorative treatment using dental amalgam. Emphasis is also given to strengthening dental students’ curricula towards prevention and teaching alternative restorative materials and techniques, including the minimum intervention approach, where appropriate.

Definitions

• Minamata Convention on Mercury: A global treaty to protect human health and the environment from the adverse effects of mercury.
• Phase down of dental amalgam: A task to reduce the use of dental amalgam through increased prevention, health promotion, and research on advanced restorative materials and techniques – maintaining or improving adequate clinical performance.

Principles

FDI and its partners (mainly National Dental Associations) support the World Health Organization in the phase down of dental amalgam use through increased emphasis on prevention and research into alternative treatment options. Dental treatment should ensure that dental restorative materials continue to be used in a safe and effective manner for the patient, while respecting the environment.

Policy

FDI supports a gradual phase down in the use of dental amalgam through an increased emphasis on prevention and research. These measures should be accompanied by appropriate teaching of other restorative materials and techniques in universities and continuing education courses.

All treatment decisions should be based on best available scientific evidence, the best interests of the patient and the best clinical judgement by the practitioner while considering the integrity of the environment.

FDI supports the following practices in the phase down of dental amalgam:

• Increased emphasis on disease prevention and health promotion.
• Increased research and development of quality mercury-free materials for dental restorations including their potential environmental impact.
• Promotion of best environmental management practices for amalgam waste including encapsulated forms.
• Reduce and if possible avoid the use of amalgam particularly in:
  • lesions that are suitable for other restorative materials, especially in first restorative treatment and young patients;
  • patients with special medical conditions, such as severe renal disease or patients with allergic reactions to amalgam or (erosive) lichenoid contact lesions in the oral mucosa;

   

  except when deemed necessary by the dental practitioner based on the specific needs of the patient.

This policy may be implemented differently in various countries.

Disclaimer

The information in this Policy Statement was based on the best scientific evidence available at the time. It may be interpreted to reflect prevailing cultural sensitivities and socio-economic constraints.

References

1. Minamata Convention on Mercury. Geneva, United Nations Environment Programme, 2013. Available from: http://www.mercuryconvention.org/Convention. Accessed 24 July 2018.
2. Regulation (EU) 2017/852 of the European Parliament and of the Council of 17 May 2017 on mercury, and repealing Regulation (EC) No 1102/2008. Official Journal of the European Union 2017. Available from: http://eur-lex.europa.eu/legal-content/EN/TXT/PDF/?uri=CELEX:32017R0852&from=EN. Accessed 24 July 2018.
3. Opinion on the safety of dental amalgam and alternative dental restoration materials for patients and users. Scientific Committee on Emerging and Newly Identified Health Risks (SCENIHR) of the European Commission 2015. Available from: https://ec.europa.eu/health/scientific_committees/emerging/docs/scenihr_o_046.pdf. Accessed on 24 July.

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