The safety of dental amalgam and alternative dental restoration materials for patients and users

In the light of new developments and studies on dental amalgam a request was submitted by the Commission to update the SCENIHR opinion produced in 2008 on the safety and performance of both dental amalgam and possible alternatives, such as resin-based composites, glass ionomer cements, ceramics and gold alloys. This updated 2015 Opinion evaluates the scientific evidence on the potential association between amalgam and possible alternatives and adverse health effects, such as allergies and neurological disorders. The SCENIHR recognises that dental amalgam is an effective restorative material and is a material of choice for specific restorations. 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. Because dental amalgam is neither toothcoloured nor adhesive to remaining tooth tissues, alternative tooth-coloured filling materials have become increasingly used. The change is indicated by trends in education on dental treatment towards an increased use of alternative materials instead of amalgam. This reduction is in line with concern about the use of mercury, the metallic element used in dental amalgam and the general aim to reduce mercury use within the European Union. The exposure of the general population to mercury is mainly due to fish consumption (organic mercury, methyl mercury) and dental amalgam (elemental mercury, inorganic mercury). The present Opinion reviews only the toxicology of elemental and inorganic mercury being relevant to amalgam safety considerations.