Use of dental amalgam in fillings decreases significantly in five years

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dental amalgam in fillings
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A study on the use of dental amalgam in fillings used in the US shows a decrease of up to 73 per cent in posterior teeth from 2017-2022, and that fewer than six per cent of dental fillings in posterior teeth in 2022 were composed of dental amalgam—but that amalgam use can vary depending on population.

The Epic Research study analysed 1,346,918 posterior tooth filling encounters in that five-year span 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 per cent of fillings in 2017 to 5.7 per cent of fillings in 2022. It also noted its use decreasing across all patients, among all age groups, and across both rural and urban areas since 2017, but that “patients with the highest social vulnerability are still most likely to receive amalgam fillings”.

Concerns about exposure to mercury as well as its potential impact to the environment have prompted a ban on amalgam for restorations in a number of countries including Sweden, Norway, and Germany. The study notes that the US and other countries are following a “phase-down” approach with amalgam restorations as outlined in the Minamata Convention on Mercury, a global treaty to protect health and the environment from the effects of mercury.

Also noted during that time frame from 2017-2022 is the use of resin/composite restorations having increased from 79.9 per cent in 2017 to 94.5 per cent in 2022.

In groups with the highest social vulnerability—a score linked to key barriers blocking overall patient wellness as well as challenges during a natural disaster and public health emergencies—the percentage of people who received amalgam fillings also decreased, but not by as much: 58 per cent since 2017, which compares to a 73 per cent decrease in the overall rate of amalgam fillings. The discrepancy owes in part to amalgam restorations’ better longevity than restorations using other materials, making amalgam potentially “preferential in patient populations where future dental care follow-up is less assured,” according to the study.

The percentage decrease in amalgam fillings used on very young children is the smallest decrease the researchers found.

“Even though patients ages 0-6 make up the smallest proportion of patients getting fillings, we were surprised to see that this age group had the smallest decrease in use of amalgam in the past five years,” co-author Danessa Sandmann said.

“This was especially interesting given patients 0-6 are considered at high-risk for the effects of mercury, per the FDA.”

Patients aged 15-48 account for the majority of posterior tooth fillings and as such, represent the majority of patients with amalgam fillings in the general population. This age group also had the greatest decline over time in the proportion of fillings that used amalgam.

The original version of this story is published on the Dentistry iQ website.

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