The U.S. Food and Drug Administration recently advised against the use of dental amalgam in high-risk groups. What do these new recommendations mean for you and your practice? Here’s a closer look.

What is the case against dental amalgam?

Amalgam fillings contain a mixture of silver, tin, copper and mercury.

In its recommendations released Sept. 24, 2020, the FDA suggested that certain groups of people, including pregnant and nursing women, children under 6 and people with certain health conditions, may experience harmful effects of mercury exposure.

The FDA cited “uncertainties about the acceptable reference exposure levels for mercury vapor” and the potential for negative health outcomes. The FDA did not cite any new scientific evidence for this position.

What is Delta Dental’s position on dental amalgam?

Amalgam is a long-lasting, clinically effective tooth restorative material and has a proven track record of over 150 years. Based on the scientific evidence available, amalgam fillings do not pose a health risk to children or adults, except the small group of people who are allergic to the metal components of amalgam.

The mercury in fillings is safe in its bound form. When it breaks down, however, mercury can be released as vapor. Exposure to high levels of mercury vapor — higher than those in fillings — can cause damage to the kidneys and brain, according to industrial studies.

We recommend you discuss treatment options with your patients who fall into these risk groups or otherwise have concerns.

There are no changes to Delta Dental’s coverage of restorative treatments such as amalgam and composite fillings.

When should amalgam fillings be removed?

The FDA advises against removing or replacing existing amalgam fillings that are in good condition unless medically necessary. This aligns with Delta Dental’s recommendation.

Amalgam fillings that are in good condition, with no nearby decay present in the tooth, should not be removed. Removing them may result in loss of tooth structure and unnecessarily releases mercury vapor.

When removing amalgam fillings, please follow best management practices for amalgam waste handling and disposal. By law, you must use amalgam separators of at least a 95% removal efficiency, as required by the Environmental Protection Agency. This rule went into effect July 14, 2017, with compliance for dental offices since July 14, 2020.

For more information about Delta Dental policies around restorative treatments, please refer to your Dentist Handbook under Provider Tools.