All You Need to Know About Dental Amalgam Safety

Dental amalgam has been used as a filling material for over 150 years and remains one of the most debated topics in dentistry. The primary concern centers on its mercury content and whether this poses health risks to patients. This guide presents the facts about dental amalgam, the current scientific evidence, regulatory positions, and the alternatives available today.

What Is Dental Amalgam?

Dental amalgam is a filling material made from a mixture of metals. Its composition is approximately:

50 percent mercury – Acts as a binding agent
22-32 percent silver – Provides strength
14 percent tin – Contributes to setting properties
8 percent copper – Enhances strength and corrosion resistance
Small amounts of zinc, palladium, or indium in some formulations

When these metals are combined, they form a hard, stable, and durable material that has been used to fill cavities in teeth for over a century. Amalgam is known for its strength, longevity, and low cost.

The Mercury Concern

Mercury in its elemental (liquid) form is a known neurotoxin. This fact has understandably raised concerns about the safety of dental amalgam, which contains approximately 50 percent mercury by weight. However, the mercury in dental amalgam exists in a different form than pure elemental mercury.

How Mercury Behaves in Amalgam

When mercury is mixed with the other metals in amalgam, it forms a stable compound. The mercury becomes chemically bound to the other metals, which significantly reduces its release. However, dental amalgam fillings do release small amounts of mercury vapor, particularly during:

Chewing
Teeth grinding (bruxism)
Drinking hot beverages
Placement and removal of fillings

The amount of mercury vapor released from amalgam fillings is extremely small. Studies indicate that a person with multiple amalgam fillings absorbs approximately 1 to 3 micrograms of mercury per day, which is well below the levels considered harmful by most health organizations.

What Do Health Organizations Say?

World Health Organization (WHO)

The WHO acknowledges that dental amalgam releases small amounts of mercury vapor but states that for the majority of people, amalgam fillings do not pose a health risk. However, the WHO supports the phase-down of amalgam use through the Minamata Convention on Mercury, which aims to reduce all mercury use globally.

U.S. Food and Drug Administration (FDA)

The FDA classifies dental amalgam as a Class II medical device and considers it safe for adults and children ages 6 and older. In 2020, the FDA updated its recommendations to advise against amalgam use in certain high-risk groups, including:

Pregnant women and their developing fetuses
Women who are planning to become pregnant
Nursing women and their infants
Children under 6 years of age
People with pre-existing neurological disease
People with impaired kidney function
People with known allergies or sensitivities to mercury

European Union

The EU has taken a more restrictive approach. Since July 2018, dental amalgam has been banned for use in children under 15 and in pregnant or breastfeeding women. Several EU member states have gone further, with countries like Norway, Sweden, and Denmark effectively banning or severely restricting amalgam use entirely.

The Minamata Convention on Mercury

Signed in 2013, this international treaty calls for a global phase-down of dental amalgam use. It does not call for an outright ban but requires participating countries to take measures to reduce amalgam use, promote alternatives, and discourage its use in vulnerable populations.

Arguments in Favor of Amalgam Safety

Proponents of dental amalgam point to several factors:

Over 150 years of clinical use with a strong safety record
The amount of mercury released is far below established safety thresholds
Amalgam is extremely durable, often lasting 10 to 15 years or longer
It is the least expensive filling material available
Multiple large-scale studies have found no consistent link between amalgam fillings and systemic health problems in the general population

Arguments Against Amalgam Use

Critics raise the following concerns:

Mercury is a known neurotoxin, and any exposure should be minimized according to the precautionary principle
Certain individuals may be more susceptible to mercury’s effects due to genetic variations in mercury metabolism
Safe alternatives (composite resin, glass ionomer, ceramic) are now widely available
Environmental concerns about mercury in dental waste contaminating water supplies
The cumulative effect of low-level mercury exposure over decades is not fully understood
Several countries have already moved to ban or phase out amalgam

Who Should Avoid Amalgam Fillings?

Based on current evidence and regulatory guidance, the following groups should consider alternatives to amalgam:

Pregnant or breastfeeding women
Children under 15 years of age
Individuals with kidney disease or impaired kidney function
People with neurological conditions such as multiple sclerosis or Parkinson’s disease
Individuals with known mercury allergies or sensitivities
Anyone who prefers to minimize their mercury exposure

Modern Alternatives to Dental Amalgam

Several mercury-free filling materials are now available that offer excellent performance:

Composite Resin

Tooth-colored composite resin is the most popular alternative to amalgam. It bonds directly to the tooth structure, requires less removal of healthy tooth material, and provides excellent aesthetics. Modern composites have improved significantly in durability and are suitable for most cavities.

Glass Ionomer Cement

Glass ionomer releases fluoride, which can help prevent further decay. It bonds chemically to tooth structure and is commonly used for small fillings, particularly in children and in areas below the gum line.

Ceramic Inlays and Onlays

For larger cavities, ceramic (porcelain) restorations provide superior aesthetics and durability. These are custom-made in a dental laboratory and bonded to the tooth, offering a long-lasting, mercury-free solution.

Should You Have Your Amalgam Fillings Removed?

This is a personal decision that should be made in consultation with your dentist. Current guidelines from most dental associations recommend against removing intact, well-functioning amalgam fillings solely due to mercury concerns. This is because:

Removing amalgam releases significantly more mercury vapor than leaving it in place
The filling removal process exposes both the patient and dental staff to mercury vapor
Removing a filling unnecessarily weakens the tooth

However, if an amalgam filling is damaged, leaking, or has decay around it, replacement with a mercury-free material is appropriate and recommended. If you choose to have amalgam fillings removed for personal reasons, ensure your dentist uses proper safety protocols including rubber dam isolation, high-volume suction, and adequate ventilation. Learn more about our safe amalgam filling removal service.

At Serenity International Dental Clinic, we use exclusively mercury-free filling materials for all new restorations, offering our patients modern, tooth-colored alternatives that are both safe and aesthetically pleasing.

Frequently Asked Questions

Are amalgam fillings banned in Vietnam?

Amalgam is not banned in Vietnam, but its use has declined significantly as modern alternatives have become widely available. Many dental clinics in Vietnam, including Serenity International Dental Clinic, have transitioned entirely to mercury-free materials.

Can mercury from fillings cause autoimmune disease?

Some research has suggested a possible association between mercury exposure and autoimmune conditions, but large-scale studies have not established a definitive causal link. Individuals with concerns about autoimmune conditions should discuss filling material options with their dentist.

How do I know if I have amalgam fillings?

Amalgam fillings are silver-gray in color and are easily distinguishable from tooth-colored composite fillings. Your dentist can identify all filling materials in your mouth during a routine dental examination.

Is it safe to get amalgam fillings removed while pregnant?

Most dental organizations advise against elective amalgam removal during pregnancy because the removal process releases mercury vapor. If an amalgam filling needs to be replaced due to damage or decay during pregnancy, your dentist will take appropriate precautions.

Safe Amalgam Filling Removal — How we safely remove amalgam fillings and replace them with mercury-free materials
The Dangers of Amalgam Fillings — A deeper look at why mercury-free dentistry is the better choice
Composite Fillings — The most popular mercury-free alternative to amalgam for tooth restorations
Dental Crowns — Porcelain crown options for larger restorations after amalgam replacement
Routine Dental Checkup — Schedule an examination to assess the condition of your existing fillings
About Dr. Emily Nguyen — Meet the dentist who authored this guide and leads our mercury-free practice