The closer you get to the end of another year, the more likely it is that you find yourself taking stock. You look back on what went well and what didn’t. You think about mistakes you’d rather not repeat and the good things we hope might keep on going – maybe even get better – in the year ahead. It’s not especially dramatic or philosophical. It’s just what we tend to do as one year winds down and another comes into view.
One amazing thing that happened this past year, dentistry-wise, was something that once seemed almost unimaginable: a date was set for the phase-out of the mercury amalgam used to make “silver” fillings. Just this past November, the 153 parties to the Minamata Convention on Mercury agreed to phase-out amalgam worldwide by 2034 – less than a decade from now.
While some 50 countries, including all EU member states, have already phased out dental amalgam—a material made of liquid mercury and silver—many others, including the U.S., still allow it, despite concerns over mercury’s potential health risks and its harmful impact on the environment.
Mercury amalgam has always occupied a strange place in dentistry. For nearly two centuries, many dentists have loved it for being cheap, durable, and relatively easy to place. But being about 50% mercury by weight, it’s also a source of exposure to a well-documented toxin that’s especially harmful to the nervous system, particularly in the form of mercury vapor.
A still-growing body of evidence makes it clear that having a clear end date for amalgam isn’t just reasonable but necessary.
Yet it’s vital to remember that even when amalgam use finally comes to its end, it will remain in the mouths of many living people for decades to come. It will still be present in bodies that will eventually be buried or cremated, potentially introducing mercury into our environment unless precautions are taken. The same goes for dental waste and waste water – other common sources of mercury pollution.
In short, dentistry will be dealing with the legacy of outdated dental materials for many years to come – materials in real people, with real bodies, living real lives. Existing amalgams will continue to need maintenance or removal. This is why being mercury-free isn’t good enough. A practice MUST be mercury-SAFE.
Standards like the IAOMT’s SMART protocol exist to protect patients, dental workers, and our planet, especially from the huge amounts of mercury vapor that are generated whenever an amalgam is drilled, removed, or even polished after a routine cleaning. Mercury is most biologically concerning in this form, as it’s the most readily absorbed. Without appropriate safeguards, that vapor can be inhaled by patients and the dental team – and from the mouth to the lungs to the bloodstream is a quick trip. Without appropriate safeguards, mercury waste can be released into the waste water lines and particulate can pollute the treatment room.
The SMART protocol was designed to minimize these risks,, focusing on containment, high-volume filtration, ventilation, and protective coverings. It acknowledges that removal requires particular care because mercury’s pathways of exposure are well understood.
Here in our own practice, we follow SMART’s established, science-backed safeguards, and in some ways even exceed them. After all, the goal isn’t just to meet a requirement. It’s to practice mindfully and conscientiously, respecting the dynamic relationship between oral and whole body health, as well as environmental health.
Mercury policy matters. An amalgam end date matters. But what will also shape outcomes is how thoughtfully care is delivered in the years that follow. Dentistry doesn’t happen in a vacuum. What happens chairside has ripple effects – for patients, clinicians, and the world beyond each office’s walls.
Seen this way, the recent amendment is a reminder of how progress in healthcare usually works – rarely all at once but through steady, informed choices made day after day.
