For over two centuries, dental amalgam has been a trusted material, but its future is uncertain. As dentistry evolves, staying updated on industry shifts is crucial. Are you ready to adapt beyond the clinic?

Amalgam From a Historical Point of View

Amalgam has been a cornerstone in dentistry for approximately two centuries, valued for its affordability, ease of use, strength, durability, and ability to inhibit bacterial growth. It is used for treatment across nearly all age groups, in stress-bearing areas, and even in cases of compromised oral hygiene. Moreover, under optimal conditions, it possesses superior longevity and resilience, outperforming other restorative materials, with minimal technique sensitivity (1).

The debate over whether to continue or discontinue using amalgam has persisted for a significant period, dating back quite some time.

In 1843, the American Society of Dental Surgeons (ASDS), founded in New York City, deemed the use of amalgam malpractice due to concerns over mercury poisoning among patients and dentists (2). Consequently, all members were forced to pledge abstention from its use.

This was the beginning of the ‘amalgam war’ (3).

The ASDS’s strong opposition to amalgam led to a decline in membership, ultimately resulting in the organization’s dissolution in 1856, thus bringing the ‘amalgam war’ to a close.

In 1859, the American Dental Association (ADA) was founded, taking a different stance by not forbidding the use of amalgam (4). This position has remained unchanged since the association’s foundation.

By the 1920s, concerns emerged over the loose binding of mercury in amalgam, leading to discouragement of its use.

However, in 1991, the National Institute of Health-National Institute for Dental Research (NIH-NIDR) and the FDA jointly concluded that there was insufficient evidence to support claims of significant health hazards posed by amalgam (5).

Despite this, assertions regarding amalgam hazards continued to be published in non-scientific journals and occasionally in scientific circles.

Reasons Behind the Prolonged Presence of Dental Amalgam Products on the Market, Despite Concerns About Their Toxicity

Despite its numerous benefits, concerns have emerged regarding the potential mercury toxicity associated with amalgam use. Mercury, naturally occurring in the Earth’s crust and prevalent in the environment, exposes individuals to trace amounts through various sources. Consequently, even without amalgam restorations, everyone is exposed to small but measurable amounts of mercury in their blood and urine.

Dental amalgam restorations may raise these levels slightly, but this increase has no practical or clinical significance. The main exposure to mercury from dental amalgam occurs during the placement or removal of restorations in the tooth.

Once the reaction is complete, only minimal amounts of mercury are released, far below the current health standard (6).

Dr Tamer explains, “In my experience, from a practical point of view, my initial concern with amalgam was not primarily about its toxicity but rather its dependence on macro-mechanical retention, which often necessitates more extensive removal of sound tooth structure.”

Changes in Policies Over the Years About the Use of Dental Amalgam & How they were Implemented or not Implemented

Dental Amalgam Policy Shifts, their Implementation and Implications

Dental amalgam has long served as a reliable filling material for teeth in various cases. However, growing concerns over its mercury content and potential effects on patients and dental professionals have prompted the

to recognize the need to reduce its usage, particularly for vulnerable groups such as those with allergies to amalgam or specific medical conditions like severe renal disease, pregnant or breastfeeding women, and children aged 15 and below.

Since 2013, the Minamata Convention on Mercury (an international treaty developed by the United Nations Environment Programme, governing the mining, trade, and use of mercury) has supported a gradual reduction in dental amalgam use, while simultaneously promoting alternative restorative materials and techniques, such as composite resin, to replace amalgam restorations (7).

Dr Tamer, “I understand the challenges of banning amalgam due to its economic advantages and longevity as a restoration, yet I decided to discontinue the use of dental amalgam in my private practice over a decade ago. Thanks to the continuous advancements in restorative dentistry, which introduced innovative alternatives like composite resins and reinforced glass ionomer-based restorations.“

He goes on to say, “While my decision may be controversial among some of my peers, embracing safer alternatives is important. Despite this, the economic value of dental amalgam, particularly in terms of affordability and insurance coverage, may continue to influence its presence in the market.”

Conclusion

Even with ongoing discussions about safety, amalgam fillings are still a popular choice for dentists because of their durability, affordability, and technique insensitivity While amalgam will likely be replaced someday, it’s more likely due to newer, more aesthetic materials than health concerns. This shift would mark the end of over two centuries of valuable service to both dentistry and patients.

The Global Dentists’ Pool

With dentistry shifting towards new materials and technologies, dentists must stay ahead. If you’re a dentist looking to learn more on the latest advancements in Dental materials and devices or are explore new revenue channels, the time to act is now.

The Global Dentists’ Pool^TM by NamNR Pro is a platform for dentists and dental devices/service providers to navigate the MedComms landscape more closely.  If you are a dentist intrigued about upgrading your career portfolio by becoming a Premium Dental Advisor & supporting DenTech companies worldwide,    

Then feel free to reach us at team@namnrpro.org, and let’s discuss how we can support you.  

The Premium Dental Advisor Program

Recognising the immense opportunity in the DenTech space, we’ve created the Premium Dental Advisor Program—an e-learning and mentorship initiative specifically designed for dentists interested in expanding into the dental tech arena.

If you’re a dentist looking to explore new revenue channels, the time to act is now. With the Premium Dental Advisor Program, you can take charge of your career, reduce burnout, and unlock new financial opportunities in a growing industry. Not only will you gain valuable knowledge, but you’ll also position yourself as a key player in the future of dental tech. 

Together, let’s reshape what’s possible for dental professionals—beyond the clinic walls. 

You can find more details about the programme and how it can help you diversify your career here. 

 Author Details:

Dr. Tamer Farouk is a leading clinician with a master’s degree in the field of Prosthetic & Restorative Dentistry and expertise in Digital Smile Design. He has been actively practising for almost 25 years and as the CEO & Founder of “The Dentist Clinic”. He is dedicated to improving oral health and transforming smiles with personalized dental care for patients of all ages. He also believes in building trusting relationships with patients and staying current with the latest advancements in dentistry to deliver exceptional dental experiences and optimal oral health for every individual. 

Disclaimers 

The opinions expressed in this article are the author’s own and not necessarily shared by NamNR Pro.