Amalgam Use in Steep Decline

Amalgam Use in Steep Decline

With the departure of amalgam from some UK practices a matter of history while others “phase down,”, a new study from the USA involving over a million restorations, shows that the end might be near for one of dentistry’s most enduring materials.

The UK and US and some other countries are following a “phase-down” approach with amalgam restorations as outlined in the Minamata Convention on Mercury, the global treaty to protect health and the environment from the effects of mercury.

The study from software company Epic Research analysed 1,346,918 posterior tooth fillings provided in the five-years from 2017 to 2022, to assess the rate of amalgam fillings compared to resin or composite fillings each year. It concluded that the rate of amalgam fillings has decreased from 21.5 per cent of fillings in 2017 to 5.7 per cent of fillings in 2022. This represents a decrease in use of 73%.

Whilst amalgam use decreased across all patient groups, among all age groups, and across both rural and urban areas since 2017, patients with the highest social vulnerability were still the most likely to receive amalgam fillings.

In groups with the highest social vulnerability, the percentage of people who received amalgam fillings did decrease, but not by as much: 58 per cent since 2017. The discrepancy is something of a tribute to the old material, since it was attributed in part to amalgam restorations longevity compared to those using other materials. According to the study, this made amalgam potentially “preferential in patient populations where future dental care follow-up is less assured,”

At the same time the use of composite restorations increased from 79.9 per cent in 2017 to 94.5 per cent in 2022.

In contrast to the phase down approach, Sweden, Norway and Germany have banned the use of amalgam. In the UK use in those under the age of 15 and pregnant women has been restricted since 2018.

It is worth noting that in the Department of Health’s 2019 National Plan to phase down the use of Dental Amalgam in England stated that: “The main vehicle for reducing the use of amalgam is action to improve oral health.” The report referred to “reforming the current primary care dental system in England. Over 70 practices are trialling a new way of delivering care explicitly focussed on prevention and with chair side digital access to best practice prevention guidance.”

A good deal has happened in UK dentistry since the plan was published in 2019. The abandonment of the pilots, effects of the pandemic, and ongoing access crisis, could give amalgam a further stay of execution in the UK.


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