A study on the use of dental amalgam in fillings used in the US shows a decrease of up to 73 percent in posterior teeth from 2017-2022, and that less than 6 percent of dental fillings in posterior teeth in 2022 consisted of dental amalgam—but this use of amalgam may vary by population.
The Epic Research study analyzed 1,346,918 posterior tooth filling encounters over this five-year period to assess the rate of amalgam fillings compared to resin or composite fillings each year, concluding that the rate of amalgam fillings has decreased from 21.5 percent of of fillings in 2017 to 5.7 percent of Fillings in 2022. He also noted that its use has been declining in all patients, in all age groups, and in rural and urban areas since 2017, but that “patients with the highest social vulnerability are still more likely to receive amalgam fillings.”
Concerns about mercury exposure as well as its potential effects on the environment have led to amalgam being banned for restorations in several countries, including Sweden, Norway and Germany. The study notes that the US and other countries are taking a “step-down” approach with amalgam restorations, as described in the Minamata Convention on Mercury, a global treaty to protect health and the environment from the effects of mercury.
Also noted during this time frame from 2017-2022 was the use of resin/composite restorations which increased from 79.9 percent in 2017 to 94.5 percent in 2022.
In groups with the highest social vulnerability—a score linked to key barriers that impede patients’ overall well-being as well as challenges during a natural disaster and public health emergency—the proportion of people who received amalgam fillings also decreased, but not that much: 58 per cent from 2017, which compares to a 73 percent decrease in the overall amalgam filling rate. The difference is due in part to the better longevity of amalgam restorations than restorations using other materials, making amalgam potentially “preferable in patient populations where future follow-up of dental care is less assured,” according to the study.
The percentage reduction in amalgam fillings used in very young children is the smallest reduction the researchers found.
“Although patients aged 0-6 make up the smallest proportion of patients receiving fillings, we were surprised to see that this age group had the smallest decrease in amalgam use over the past five years,” said co-author Danessa Sandmann.
“This was particularly interesting given that patients 0-6 are considered high risk for the effects of mercury, according to the FDA.”
Patients aged 15-48 years represent the majority of posterior tooth fillings and therefore represent the majority of patients with amalgam fillings in the general population. This age group also had the greatest decrease over time in the proportion of fillings using amalgam.
The original version of this story is published on Dentistry iQ website.
