Oral Health Topics
- Dental amalgam is a safe, affordable and durable restorative material.
- Dental amalgam has been studied and reviewed extensively. Amalgam restorations have not been found to be associated with adverse health effects.
- Patient concerns regarding longevity of the restoration and about cost may be considerations in decision making about restoration material options.
For more than 150 years, dental amalgam has served as a safe, durable and affordable material in restorative dentistry.1 Dental amalgam is a mixture of metals: liquid (elemental) mercury and a powdered alloy composed of silver, tin, and copper. The fact that its formulation includes mercury has raised safety concerns in the minds of some.
Amalgam Waste Management Best Practices
Dental best management practices for amalgam waste handling and disposal include use of chair-side traps, use of ISO 11143-compliant amalgam separators, regular inspection and cleaning of traps, and use of appropriate commercial waste service to recycle and/or dispose of collected amalgam. Compliance with the EPA final rule on amalgam separators is recommended. Go to the ADA Center for Professional Success for in-depth insight and information.
Statements from Agencies, Associations, Journals
The ADA Council of Scientific Affairs, as well as various government agencies, have issued statements regarding the safety of dental amalgam.
A number of scientific journals and national health associations
including the Alzheimer’s Association and American Cancer Society, also have made official statements regarding the safe use of dental amalgam.
Literature Reviews on Amalgam Safety
Several literature reviews and recent studies have investigated the health effects of dental amalgam.
FDA Literature Review9,10
The FDA published a White Paper in two parts. The first draft, submitted in 2006, reviewed literature published between 1997 and 2006 to identify contributions made to the understanding of human health risks posed by exposure to mercury in dental amalgam. The Addendum to that report reviewed the research published between 2006 and 2009. The 2006 draft White Paper and 2009 Addendum constitute FDA's final White Paper, which concludes “that there is insufficient evidence to support an association between exposure to mercury from dental amalgams and adverse health effects in humans, including sensitive subpopulations.”
Life Sciences Research Office (LSRO)
The Life Sciences Research Office is a nonprofit organization of scientists, who contract with outside agencies to analyze issues that arise in biomedicine, healthcare, nutrition, food safety and the environment. In 2004, the LSRO completed a review of the literature published from 1996 to December 2003 on potential adverse human health effects caused by dental amalgam.
The resulting report11 states that, “The current data are insufficient to support an association between mercury release from dental amalgam and the various complaints that have been attributed to this restoration material. These complaints are broad and nonspecific compared to the well-defined set of effects that have been documented for occupational and accidental elemental mercury exposures. Individuals with dental amalgam-attributed complaints had neither elevated urinary mercury nor increased prevalence of hypersensitivity to dental amalgam or mercury when compared with controls.”
In 2015, the ADA completed a literature review12 of articles published between 2010 and 2014. This update focused on research gaps identified in the original (2004) LSRO project. The authors reviewed the abstracts of 133 articles to identify all studies relevant to amalgam and biochemical, behavioral and/or toxicological effects. They summarized the findings of 19 applicable articles.
- Kingston G. The rise and fall of mercury amalgam. Prim Dent J 2013;2(3):74-5.
- American Dental Association Council on Scientific Affairs. Statement on dental amalgam (adopted 8/09). Accessed December 7, 2015.
- U.S. Food and Drug Administration. About dental amalgam fillings (updated 02/15/15). Accessed December 7, 2015.
- U.S. Environmental Protection Agency. Mercury in dental amalgam. Accessed December 7, 2015.
- Centers for Disease Control and Prevention (CDC) Agency for Toxic Substances and Disease Registry. Public health statement for mercury (last updated 1/21/15). Accessed December 7, 2015.
- European Commission Scientific Committee on Emerging and Newly Identified Health Risks (SCENIHR). The safety of dental amalgam and alternative dental restoration materials for patients and users (adopted 4/29/15). Accessed December 7, 2015.
- European Commission Health and Safety News. Safety of dental amalgam and its alternatives: Final opinion (8/5/15). Accessed December 7, 2015.
- American Dental Association. Dental amalgam: What others say (updated 5/15). Accessed December 7, 2015.
- U.S. Food and Drug Administration. White Paper: FDA Update/Review of Potential Adverse Health Risks Associated with Exposure to Mercury in Dental Amalgam. Accessed December 7, 2015.
- U.S. Food and Drug Administration. Addendum to the Dental Amalgam White Paper: Response to 2006 Joint Advisory Panel Comments and Recommendations. Accessed December 7, 2015.
- Life Sciences Research Office. Executive Summary: Review and analysis of the literature on the health effects of dental amalgam. Accessed December 7, 2015.
- American Dental Association. 2015 update of the LSRO report on the health effects of dental amalgam. Accessed December 7, 2015.
Additional ADA Resources
Prepared by: Center for Science Information, ADA Science Institute
Last Updated: December 19, 2016
Content on ADA.org is for informational purposes only, is neither intended to and does not establish a standard of care, and is not a substitute for professional judgment, advice, diagnosis, or treatment. ADA is not responsible for information on external websites linked to this website.