The Albuquerque Indian Dental Clinic in Albuquerque run by the Indian Health Service on Friday. (Savannah Peters/AP Photo)
The industry has largely abandoned them in favor of plastic resin alternatives
ALBUQUERQUE – The federal agency that provides health care to Native Americans and Alaska Natives has announced it will phase out the use of mercury-containing dental fillings.
The Indian health service has used fillings, known as dental amalgams, containing elemental mercury to treat decayed and damaged teeth for decades. Native American rights and industry advocates have called for an end to the practice, arguing it exposes patients who may not have access to private dentistry to a harmful neurotoxin.
The use of mercury-containing amalgams, also known as “silver fillings” because of their appearance, has declined sharply since 2009, when the US Food and Drug Administration reclassified the devices from low to moderate risk. The industry has largely abandoned them in favor of alternative plastic resins, which are also preferred for aesthetic reasons.
The Indian Health Service says it will fully implement the switch to mercury-free alternatives by 2027. Already, the percentage of the Indian Health Service’s roughly 2.8 million patient users receiving them has dropped from 12 percent in 2005 to 2 percent in 2023, the latest year of data available, according to agency documents.
The U.S. Department of Health and Human Services, which oversees IHS, said growing environmental and health concerns about mercury exposure and global efforts to reduce materials containing the dangerous heavy metal prompted the change announced this month.
“This is a common-sense step that protects patients and prevents harm before it starts,” said Health Secretary Robert F. Kennedy Jr.
The agency’s move to mercury-free alternatives also supports the legal responsibilities the U.S. government has to the 575 federally recognized tribes, he said.
According to the US Food and Drug Administration, dental amalgam fillings can release small amounts of mercury vapor during placement, removal, teeth grinding, and gum chewing. It recommends that certain people at high risk for adverse effects from mercury exposure, including pregnant women, children under 6, and those with existing neurological conditions avoid fillings. But the administration, along with the American Dental Association, says the available evidence does not link mercury-containing fillings to long-term negative health outcomes.
The World Health Organization has created a plan to encourage countries around the world to phase out the use of dental amalgams, citing the potential for mercury exposure. In 2013, many countries, including the US, signed the Minamata Convention, a global agreement targeting the adverse health and environmental effects of mercury. In November, signatories to the convention agreed to phase out the use of mercury-containing dental amalgams by the year 2034.
While Kennedy’s decision to end its use within the IHS by 2027 puts the US ahead of the global timetable, the country still lags behind many other developed nations that have already banned the practice.
“The rest of the world is light years ahead of us,” said Rochelle Diver, the UN’s environmental conditions coordinator for India’s International Treaty Council, adding that IHS patients should not receive treatment that is considered outdated by many dentists.
In a statement, the American Dental Association acknowledged the decline in the use of mercury-containing fillings, but said they remain a “safe, durable and affordable material.”
The use of mercury in other medical devices, including thermometers and blood pressure devices, has also declined sharply in recent decades. While mercury-containing amalgams have fallen out of favor in the U.S. private dental sector, patients who rely on government services may not have a say, according to Charles G. Brown, president of the Global Alliance for Mercury-Free Dentistry.
Many state Medicaid programs continue to cover fillings containing mercury as a treatment for tooth decay, Brown said.
“If you’re on Medicaid, if you’re stuck in the Indian Health Service, if you’ve been stuck in a prison or another institution, you just don’t have a choice,” Brown said.
