It’s been a couple months now since we shared the amazing news that a deadline has been set for the global phase-out of dental amalgam under the Minamata Convention on Mercury. Named after the Japanese city where industrial mercury poisoning caused massive neurological harm in the mid-20th century, the treaty represents a global effort to reduce all forms of mercury exposure – including dental fillings.
That deadline is 2034.
Of course, some countries are ahead of schedule. Some lag behind. But even here in the US where dentists – for now – are free to continue using amalgam, changes for the better are accelerating.
In fact, just this month, the Indian Health Service (IHS) announced that it will stop using mercury amalgam entirely by 2027.
“This is a commonsense step that protects patients and prevents harm before it starts,” said HHS Secretary Robert F. Kennedy, Jr. “By switching to safer, mercury-free alternatives, IHS puts prevention first and upholds its responsibility to tribal communities and future generations.”
While amalgam use within the IHS has been declining for years already, the announcement marks a complete transition away from the material. As the Associated Press reported, agency documents show that the percentage of the IHS’s roughly 2.8 million patients, amalgam use declined from 12% in 2005 to just 2% in 2023, the latest year of available data.
It’s really no mystery why amalgam remained the default restorative material in publicly funded dental programs for so long. Mercury amalgam is easy to place. It’s durable. And at the point of service, it seems cheap.
But “cheap” depends on what you count.
A 2016 analysis of the real costs of dental mercury found that once you factor in externalities such as environmental disposal, wastewater treatment, and hazardous waste handling – the social and environmental costs of using mercury – amalgam actually proves to be no bargain. Biocompatible composite emerges as the more economical choice. While the age of this study means that the specific dollar amounts are dated, the categories of cost remain quite relevant.
Meantime, new research has given us a glimpse of the measurable changes that come with the end of amalgam.
For instance, a recent peer-reviewed study in Environmental Health analyzed 17 years of biomonitoring data from over 1400 Slovenian children between 2007 and 2024. Urinary mercury levels were tracked across four national sampling campaigns, and the researchers compared trends over time as amalgam use declined. (Slovenia’s phase-out was announced by their Ministry of Health in 2021, with a deadline of January 2025.)
Through this period, the prevalence of dental amalgam among kids dropped dramatically – from roughly 65% to just 3%. At the same time, the median urinary mercury level – the value right in the middle, with half of scores higher and half of scores lower – plummeted from about 0.76 ng/mL in 2007 to about 0.22 ng/mL.
Notably, the researchers accounted for age, sex, region, and other potential sources of mercury exposure. When the number of amalgam fillings was included in their statistical models, it really accentuated the overall trend, making it clear that the changes they saw were indeed likely caused by the decline in amalgam use.
To put it simply, as amalgam used declined, so did measurable mercury in children.
And mercury isn’t the only dental exposure now under review, as the Environmental Protection Agency recently announced its next steps on the matter of water fluoridation:
a comprehensive, current, and accurate review of the best available scientific data on fluoride exposure and health effects, conducted with external peer review and public input to inform potential revisions to federal drinking water regulations that bring the nation closer to evidence-based standards that protect future generations.
Of course, this review follows ongoing litigation and reflects the agency’s obligation to reassess fluoride exposure standards under court order, even as the appeal process continues to move forward. In a related webinar, an EPA official noted that the review will focus on fluoride’s effects on brain and tooth development. According to this official, the review will “only focus on potential harmful effects and will not consider beneficial effects.”
We are staying tuned to see what happens…
