The IADR Policy and Position Statements on Safety of Dental Amalgam

Abstract

Dental amalgam has served as a widely used restorative material in dentistry for over 150 years, demonstrating long-term clinical performance, cost-effectiveness, safety, and ease of placement, especially in situations where alternative restorative materials may be clinically less effective or economically less feasible. Composed of approximately 50% elemental mercury alloyed with silver, tin, copper, and other metals, current scientific evidence supports the safety of dental amalgam for the general population, excluding individuals with allergies to amalgam components or severe renal impairment. The International Association for Dental, Oral, and Craniofacial Research (IADR) affirms that mercury bound within the amalgam alloy poses a negligible health risk under normal conditions of use and endorses the continued availability of amalgam when its clinical, practical, or economic benefits are evident. Nonetheless, IADR acknowledges that dental amalgam use contributes to cumulative mercury exposure throughout its life cycle, including exploitation, manufacturing, clinical application, and disposal of residual material or when a removal of the restoration is clinically indicated. Aligned with the Minamata Convention on Mercury, IADR supports a responsible phase-down strategy, emphasizing the importance of enhanced, evidence-based dental caries prevention to reduce the overall need for restorative interventions. Concurrently, the advancement of biocompatible and environmentally sustainable restorative materials with demonstrated equivalent or superior long-term clinical longevity and cost-effectiveness is critical to facilitating the amalgam phase-down without compromising oral health of patients by inferior restorative outcomes. This policy statement reflects a balanced integration of current scientific knowledge, environmental stewardship, and patient-centered clinical decision-making.