Safety of dental amalgam and alternative dental restoration materials for patients and users

SCENIHR WG Dental amalgam
SCENIHR members: Eduard Rodríguez-Farré, Emanuela Testai
External experts: Ellen Bruzell, Wim De Jong, Arne Hensten, Gottfried Schmalz, Mogens Thomsen
Aknowledgements: Wolfgang Dekant, Philippe Grandjean, Jan van Dijken
Contact: SANCO-C2-SCENIHRec [dot] europa [dot] eu (SANCO-C2-SCENIHR[at]ec[dot]europa[dot]eu)
On request from: European Commission
Doi: 10.2772/42641
Adopted on: 29 April 2015

Content of the opinion:

The Opinion, which updates SCENIHR’s previous Opinion of 2008, evaluates the scientific evidence on the potential association between amalgam and its alternatives, and allergies, neurological disorders or other adverse health effects.

The SCENIHR recognises that dental amalgam is an effective restorative material and is a material of choice for specific restorations for the general population, with low risk of adverse health effects. However, the choice of material should be based on patient characteristics such as primary or permanent teeth, pregnancy, the presence of allergies to mercury or other components of restorative materials, and the presence of impaired renal clearance.

Placement and removal results in short-time exposure to the patients compared to leaving the amalgam intact. Therefore there is no general justification for unnecessarily removing clinically satisfactory amalgam restorations, except in those patients diagnosed as having allergic reactions to one of the amalgam constituents.

Recent studies do not indicate that dental personnel, despite somewhat higher exposures than general population, suffer from adverse effects that could be attributed to mercury exposure due to dental amalgam. However, exposure of both patients and dental personnel could be minimised by the use of appropriate clinical techniques.

The SCENIHR concludes that amalgam alternatives have certain clinical limitations and toxicological risks. More experimental, clinical and epidemiological research is required to ensure patient safety in the future.

Currently in the EU, there is a shift away from the use of dental amalgam in oral health care towards an increased use of alternative materials. This change is not only for technical and aesthetic reasons, but also reflects the increasing concern about the use of mercury – a major component in dental amalgam - and the general aim to reduce mercury use within the EU.

To reduce the use of mercury-added products in line with the intentions of the Minamata Convention (reduction of mercury in the environment) the Opinion recommends that for primary teeth, and in pregnant patients, alternative materials to amalgam should be the first choice. The SCENIHR recognises that there is a need for further research, particularly relating to (i) evaluation of the potential neurotoxicity of mercury from dental amalgam and the effect of genetic polymorphisms on mercury toxicity and (ii) to expand knowledge of the toxicity profile of alternative dental restorative materials. Furthermore, there is a need for the development of new alternative materials with a high degree of biocompatibility.

Keywords:

Dental amalgam, mercury, toxicology, exposure, resin-based composites, glass ionomer cements, allergy, systemic health effects, SCENIHR

Opinion to be cited as:

SCENIHR (Scientific Committee on Emerging and Newly-Identified Health Risks), Scientific opinion on the Safety of Dental Amalgam and Alternative Dental Restoration Materials for Patients and Users (update), 29 April 2015.