Amalgam (Part 2): Safe Use and Phase Down of Dental Amalgam



## Scope
In 2013, the Minamata Convention on Mercury supported a gradual phase down of dental amalgam usage in restorative dental treatment. It was adopted in 2017 making it necessary to plan and act strategically to reduce the need for dental amalgam for restorative treatments. The Convention also emphasized the need to strengthen dental curricula towards disease prevention and health promotion as well as teaching alternative restorative materials and techniques, including the minimum intervention approach as appropriate.

## Definitions
Minamata Convention on Mercury: an international treaty developed by the United Nations Environment Programme, governing the mining, trade in and use of mercury.
Dental amalgam: filling material for teeth prepared by mixing mercury with dental amalgam alloy.Dental amalgam alloy: powder or compressed powder pellets of an alloy consisting mainly of silver, tin and copper which, when mixed with mercury, produces a dental amalgam.PRINCIPLES FDI supports the World Health Organization for the phase down of dental amalgam usage, through decreasing demand for its need. Decreasing demand may be accomplished through increased emphasis on disease prevention and health promotion, and research into development and availability of equivalent alternative treatment options. Dental treatment should ensure that dental restorative materials continue to be used in a safe and effective manner for patients and oral healthcare providers, while respecting the environment. international dental journal 7 2 ( 2 0 2 2 ) 1 2  1 3 POLICY All treatment decisions should be based on the current scientific evidence, the best interests of patients and the sound clinical judgement by the dental practitioner, while considering the integrity of the environment and the health of the population. Amalgam tattoos cause tissue discoloration but are otherwise benign. No treatment is necessary. Localized oral lichenoid lesions may occur next to amalgam restorations in very rare instances, due to many factors such as an autoimmune reaction or allergic reaction to amalgam components. If such patients are positive to skin allergy patch testing for mercury or other amalgam components, replacement of the restorations may improve their mucosal lesions. FDI supports the following practices in the phase down of dental amalgam: Increased emphasis on disease prevention and health promotion. Enhanced research and development of quality mercuryfree materials for dental restorations, including on their potential health and environmental impacts. Appropriate education in the use of appropriate alternative restorative materials and techniques in universities and continuing education courses. Reduce and if possible avoid the use of dental amalgam in:
lesions that are suitable for other restorative materials, especially in first restorative treatment and young patients;
individuals with special medical conditions such as severe renal disease, or those 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 and the clinical situation. This policy may be implemented differently in various countries or regions and where special regulations may apply.

## 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 socioeconomic constraints.
[fig] CONTEXT: The existing FDI Policy Statements on the safety of dental amalgam (Possible Local Adverse Effects of Amalgam Restorations, 2007; Safety of Dental Amalgam, 2007) and their use in the context of phase down according to the Minamata Convention on Mercury (Dental Amalgam and the Minamata Convention on Mercury, 2014; Dental Amalgam Phase Down, 2018) are updated by and integrated into this Policy Statement. [/fig]