A significant and longstanding division exists within the global health and dental community regarding the safety of mercury-containing dental amalgams (often called "silver fillings"). This divergence in opinion is particularly evident when comparing the stances of traditional or established dental authorities, various governmental and international health bodies, and holistic or biologically-oriented dental organizations.
Traditional Dental Authorities
Organizations such as the American Dental Association (ADA) have historically maintained that dental amalgam is a safe, durable, and cost-effective restorative material. Their position generally asserts that the mercury in its alloyed form within amalgam is stable and that the amount of mercury vapor released during normal functions like chewing is too minimal to cause adverse health effects in the general population. Critics of this stance often point to institutional inertia and a perceived resistance to fully incorporating newer research on chronic low-dose mercury exposure and individual susceptibility into their primary recommendations.
Governmental & International Health Bodies
Agencies like the U.S. Food and Drug Administration (FDA) and the World Health Organization (WHO) have, for many years, largely aligned with the general safety assessments provided by traditional dental authorities. However, their positions have become more nuanced over time. In 2020, the FDA issued updated recommendations advising that certain "high-risk" groups should avoid dental amalgam fillings whenever possible. These groups include pregnant women and their developing fetuses, women planning to become pregnant, nursing women and their newborns/infants, children (especially those under six), individuals with pre-existing neurological diseases, those with impaired kidney function, and individuals with known allergies to mercury or amalgam components. The WHO, while not calling for an outright ban, supports global efforts to phase down the use of dental amalgam under the Minamata Convention on Mercury, an international treaty aimed at protecting human health and the environment from anthropogenic emissions and releases of mercury and mercury compounds.
Holistic and Biological Dental Organizations
In contrast, various holistic, biological, or "mercury-free" dental organizations, such as the International Academy of Oral Medicine and Toxicology (IAOMT), the International Academy of Biological Dentistry and Medicine (IABDM), and the Holistic Dental Association (HDA), strongly oppose the use of dental amalgam. They cite concerns about mercury's known toxicity and highlight research suggesting that mercury can bioaccumulate in body tissues from amalgam fillings. These groups argue that such exposure can potentially contribute to or exacerbate a range of health issues, including autoimmune disorders, neurological problems, and kidney dysfunction, particularly in genetically susceptible or health-compromised individuals. They advocate for the use of mercury-free alternative dental materials and have developed specific protocols (like IAOMT's SMART protocol) for the safe removal of existing amalgam fillings to minimize mercury exposure to patients and dental personnel.
Global Trends and Regulatory Divergence
Internationally, there is a clear trend towards reducing the use of dental amalgam. The European Union, for instance, banned the use of amalgam in children under the age of 15, as well as in pregnant and breastfeeding women, starting from July 1, 2018, and requires member states to set out national plans to phase down its use. Several countries, including Norway, Sweden, and Denmark, have implemented even stricter regulations, moving towards a near-total phase-out of amalgam. This contrasts with regions where amalgam may still be a common restorative material, sometimes offered without comprehensive discussion of its mercury content or available alternatives, highlighting the ongoing global divergence in practice and policy.