For centuries, humans have found all kinds of practical uses for mercury, often without really understanding – or sometimes ignoring – its risks. In the Victorian era, mercury-based pigments created brilliant red colors for book covers and illustrations. But as people began to connect these beautiful vermillion publications to mysterious health issues, especially among bookbinders and those who frequently handled books, publishers quietly moved away from mercury-infused inks.
Medicine followed a similar path. Mercury-based antiseptics such as Mercurochrome used to be standard in every medicine cabinet. Their distinctive red color was a familiar sight in treating cuts and scrapes. Doctors regularly prescribed mercury compounds for everything from syphilis to teething pain. Gradually, though, these treatments were phased out and replaced with safer ones.
Most recently, we’ve seen the removal of mercury-containing thimerosal from childhood vaccines, reflecting a growing awareness of the special danger that mercury poses to developing nervous systems.
In these and similar cases, people ultimately came to recognize that mercury’s toxicity outweighs its utility…except when it comes to dentistry. Despite the fact that dozens of nations have restricted it, mercury amalgam continues to be used here in the US and many other nations around the world.
The contradiction hasn’t gone unnoticed.
Last month, the International Academy of Oral Medicine & Toxicology (IAOMT) and Dental Amalgam Mercury Solutions (DAMS) formally petitioned the FDA to ban dental amalgam. More, this petition raises some fundamental questions about how mercury amalgam has been regulated in the first place.
In fact, many people don’t realize that dental amalgam was never even tested for safety before it was approved for use in human mouths. Unlike almost every other medical device that’s meant to stay in the body for a long time, amalgam was simply grandfathered in. The FDA basically agreed with the American Dental Association (ADA) that since dentists had been placing mercury fillings for more than a century, amalgam must be safe.
By the way, did you know that one key reason why the ADA even came into existence back in the mid-1800s, was the desire by some dentists to keep using mercury after the American Society of Dental Surgeons had said no, we need to restrict it? The ADA has maintained its support of amalgam fillings to this day.
But we digress…
Under current FDA guidelines, any device intended to be left in the human body for more than 30 days should automatically be classified as a Class III device. Such devices are considered to have the highest risk profile and thus need to prove their safety and effectiveness. Amalgam fillings are designed to last for decades.
If the FDA were to reclassify amalgam as Class III, manufacturers would face an enormous, unprecedented challenge: prove for the first time in history that mercury filings are actually as safe and effective as claimed. Given the wealth of scientific evidence showing mercury’s toxic effects, this is practically impossible.
But there’s another key issue beyond regulation: patient awareness and choice. Even today, many people don’t fully understand what they’re actually getting when amalgam is placed in their mouths – that their so-called “silver” fillings contain far more mercury than silver (about 50% by weight).
How many patients do you think would choose mercury fillings if they fully understood what they contained? The petition notes that patients deserve to make informed decisions about their dental care without being defaulted into getting “the cheapest and most toxic option” available.
The problem of consent becomes even more troubling when you consider who’s most likely to wind up with mercury fillings. While roughly half of American dentists are now mercury-free, economic factors still push many patients toward mercury amalgam.
For instance, most dental plans treat amalgam as the standard option, offering minimal coverage for mercury-free alternatives. More than a few patients are forced to choose between either accepting mercury or paying out-of-pocket for safer alternatives.
The situation is even starker for those whose dental care is funded by the government. Veterans through the VA system, along with active military, Native Americans served by the Indian Health Service, and children in public health programs are routinely given amalgam fillings. For them, real choice doesn’t exist.
By continuing to allow and support amalgam use, we are forcing these vulnerable groups to receive the cheapest, and most toxic option, without choice.
Yet there are some excellent amalgam alternatives out there, including ceramics, composite resins, and other mercury-free materials. Modern composites can be an especially good choice, being both strong and durable. They look better, bond directly to tooth structure, and, according to recent research, fail significantly less often than amalgam fillings. “Composite is superior to amalgam,” concluded one 2024 study on the matter.
The IAOMT and DAMS petition represents more than a regulatory request. It’s a call to align American dental practice with current scientific understanding and changing global standards. It poses a very straightforward question: If mercury is too dangerous for use across a full range of consumer products, why is it still okay in dental fillings?
This petition offers an opportunity to complete the long arc of mercury removal from the goods and materials we use. The question isn’t whether we’ll eventually move beyond mercury dentistry. It’s whether we’ll move sooner or later than the rest of the developed world.
