Recently experts from around the world participated in a World Health Organization (WHO) consultation in Geneva. Five important issues concerning amalgam were identified, and a statement on dental amalgam was unanimously approved by the participating groups.

    A Statement endorsed by the FDI/World Dental Federation has the following five issues reported verbatim:

The Use of Dental Amalgams

    Dental amalgam is a frequently used material for restoring decayed teeth. It has been used successfully for more than a century and its quality has improved over the years. Amalgam restorations are durable and cost-effective; they are, however, not tooth-colored. While much research has been devoted to the development of dental restorative materials, there is currently no direct filling material that has the wide indications for use, ease of handling and good physical properties of dental amalgam. The restorative materials currently available as alternatives to dental amalgam significantly increase the cost of dental care.

Safety of Dental Amalgam

    Dental amalgam restorations are considered safe, but components of amalgam and other restorative materials may, in rare instances, cause local side effects or allergic reactions. The small amount of mercury released from amalgam restorations, especially during placement and removal, has not been shown to cause other adverse health effects.

   Because of concerns over the adverse effects of mercury, some patients, with or without symptoms, may request the removal of their amalgam restorations. While there have been a number of case studies and informal reports, no controlled studies have been published demonstrating systemic adverse effects from amalgam restorations.

   Therefore, after a comprehensive oral examination and appropriate dental treatment, these patients should be considered for referral to other health care professionals for diagnosis and treatment if symptoms persist.

Occupational Risk to Oral Health Personnel

   A potential health risk to oral health personnel from mercury exposure exists if working conditions are not properly organized. The application of proper mercury hygienic requirements, together with the monitoring of mercury vapors in the work environment in dental clinics, will significantly reduce mercury exposure.

Environmental Concerns

   Mercury used in dentistry may contaminate the environment via the disposal of waste products from dental clinics. Equipment is available to collect metallic waste generated during amalgam placement and removal. Appropriate collection and recycling technology is also available to reduce mercury pollution of the environment, including pollution from crematoria.

Public Opinion and Mass Media

   Today, there is a considerable exchange of information on dental amalgam around the world. For environmental reasons, some countries are restricting all uses of mercury, including dental amalgam. Due to publicity in the mass media, however, the situation in those countries which have undertaken restrictive action is often misinterpreted, leading numerous inquiries about the safety of dental amalgam and a demand for the removal of amalgam fillings.

   However, adverse biological reactions to the material do occasionally occur and they must be treated on an individual basis. The WHO recognizes the importance of continued monitoring of safety and effectiveness of all dental restorative materials.