STRASBOURG, France: Amalgam is the restorative material of choice for many dentists. It is the gold standard of dental care. However, its popularity has been slowly declining in recent years and so has its use, all thanks to strict governmental regulations. Now, the European Parliament has announced that it will completely ban dental amalgam starting from 1 January 2025—news that came as a shock to many dental professionals and organisations, especially those who have relied heavily on amalgam.
The use of dental amalgam, which consists of approximately 50% mercury, greatly contributes to mercury pollution and poses an environmental threat to ecosystems. Owing to rising health concerns about the material, stringent regulations have been imposed to phase down amalgam use and to ensure safe disposal in dental practices, in line with the Minamata Convention on Mercury, which entered into force in 2017. Additionally, using the material for treating pregnant or breastfeeding women, as well as children under the age of 15, has been banned in the EU since 1 July 2018. Dentists in the Philippines have been prohibited from using amalgam as a restorative material since last year.
Growing disillusionment of dental services in the UK
The ban will greatly affect the UK’s dental services, which have been struggling to recruit and retain dental professionals in recent years. According to the British Dental Association (BDA), amalgam is the material most commonly used for permanent fillings by the National Health Service (NHS). Additionally, the organisation stated that fillings account for approximately a quarter of all courses of NHS treatment delivered in England and that amalgam is used in around a third of all procedures.
Given its wide use, the EU ban on amalgam is expected to result in supply chain issues in the UK. Since it has the most filled teeth proportionally, Northern Ireland will be the most affected UK nation.
Although the BDA supports amalgam reduction, it has called the rapid phase-out of amalgam in dental practices unfeasible and unjustifiable. It said: “Dental amalgam has been in use and extensively studied for 150 years as a restorative material. Its safety and durability are well established, and it remains the most appropriate material for a range of clinical situations.”
Although alternatives exist, they are significantly more costly and take longer to place. BDA Chairman Dr Eddie Crouch commented in a press release: “When alternative materials can’t compete, this will add new costs and uncertainties to practices already on the brink.” According to him, banning amalgam would mean losing a key weapon in the treatment of dental caries, and he cautioned that this could be “the straw that breaks the back of NHS dentistry”.
Amalgam-free restorative materials
Alternatives to amalgam include glass hybrid materials and high-viscosity glass ionomer cements. Each alternative offers unique advantages and disadvantages, and the choice often depends on the specific needs of the patient, including aesthetic considerations, durability requirements and financial constraints.
Prof. Falk Schwendicke summarised this in his recent article: “There is not a single material that fulfils all the requirements for an amalgam replacement; instead, a range of materials with different properties are available, and dentists will need to make informed choices about which material suits which indication best.”
“The era of dental amalgam is slowly coming to an end,” he concluded. Breakthroughs in dental technology may lead to new, more advanced materials for dental restorations in the future.
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