Policy Statement 6.
18 – Safety of Dental Amalgam1
1. Introduction
1.1 Dental amalgam has been used as a dental restorative material for more than 150 years. It has proved to be
a durable, safe and effective material which has been the subject of extensive research over this timei.
1.2 The FDI World Dental Federation’s position on amalgam safety includes the following:
• Dental amalgam releases very small amounts (nanograms2) of mercury, some of which is absorbed by
the body;
• The level of urinary mercury is positively correlated with the number of amalgam restorations, but can
also be affected by sources other than amalgam;
• There is no evidence to support an association between the presence of amalgam restorations and
chronic degenerative diseases, kidney disease, autoimmune disease, cognitive function, adverse
pregnancy outcomes or any non-specific symptoms;
• Local hypersensitivity reactions can occur on the mucosa adjacent to amalgam restorations, but are
extremely rare and usually resolved on removal of the amalgam;
• Further research into the possible adverse effects of dental amalgam is desirable; and
• Alternatives to amalgam may have adverse effects.
1.3 The National Health and Medical Research Council has attested to the value and safety of dental amalgam
but has suggested that it would be prudent to reduce its use in special populations, including children,
women in pregnancy and persons with existing kidney disease.3
1.4 Despite overwhelming evidence to the contrary, some suggest that amalgam restorations should be removed
and replaced with other materials because of the perceived adverse health effects of mercury.
Definitions
1.5 DENTAL AMALGAM is a mixture of metals including silver, copper and tin with mercury forming a eutectic
alloy.
2. Principles
2.1 Dentists should only use materials that are proven to be safe and are included in the Australian Register of
Therapeutic Goods.
3. Policy
3.1 Dental amalgam should continue to be available as a dental restorative material.
3.2 Dental amalgam restorations should not be removed and replaced with alternative restorative materials for
non-specific or perceived health complaints unless the patient has been fully informed of the implications of
this decision.
3.3 Dentists should minimise the use of dental amalgam in children, pregnant or breastfeeding women and in
individuals with kidney disease.
3.4 Only capsulated dental amalgam complying with ISO 24234:2015 ‘Dentistry - Dental amalgam’ should be
used in dental clinics.
3.5 Dental clinics should practice mercury hygiene and correctly dispose of dental amalgam waste.
1
This Policy Statement is linked to other Policy Statements: 2.1 National Oral Health, 2.4 Research, 6.11 Dental Amalgam Waste Management, 6.19 Minimal
Intervention Dentistry & 6.21 Dentistry and Sustainability
i
Scientific Committee on Emerging and Newly Identified Health Risks (SCENHR) http://ec.europa.eu/health/ph_risk/committees/04_scenihr/docs/
scenihr_o_016.pdf. Accessed 2016-10-16 Scientific Committee on Emerging and Newly Identified Health Risks (SCENHR) http://ec.europa.eu/health/ph_risk/
committees/04_scenihr/docs/scenihr_o_016.pdf. Accessed 2016-10-16 Scientific Committee on Emerging and Newly Identified Health Risks (SCENHR) http://
ec.europa.eu/health/ph_risk/committees/04_scenihr/docs/scenihr_o_016.pdf. Accessed 2016-10-16 Scientific Committee on Emerging and Newly Identified
Health Risks (SCENHR) http://ec.europa.eu/health/ph_risk/committees/04_scenihr/docs/scenihr_o_016.pdf. Accessed 2016-10-16
2
1/1,000,000,000 gram
3
https://www.nhmrc.gov.au/guidelines-publications/oh17.
Page 253 | ADA Policies
Policy Statement 6.18
Adopted by ADA Federal Council, November 18/19, 2010.
Amended by ADA Federal Council April 12/13, 2012.
Amended by ADA Federal Council, August 27/28, 2015.
Amended by ADA Federal Council, April 6/7, 2017.
Page 254 | ADA Policies
