Even before the birth of the NHS, amalgam was the go-to material – and it remains the most common material for NHS permanent fillings in all corners of the UK.
On 14 July, the European Commission adopted a proposal to revise the Mercury Regulation, to introduce a total phase-out of the use of dental amalgam and prohibit the manufacture and export of dental amalgam from the EU from 1 January 2025 - 5 years earlier than expected.
This vote will hit all four home nations but will have a disproportionate impact on services in Northern Ireland, which tops the UK league table for oral health inequality, and has the highest proportion of filled teeth.
Under post Brexit arrangements, Northern Ireland will be expected to phase out dental amalgam on the same basis as EU member states. Divergence means the rest of the UK faces disruption and higher costs given the impact on supply chains, but not a formal ban.
Our members deserve clarity. In an open letter to all four UK Chief Dental Officers we’ve made our position clear. We have stressed there are currently no alternative restorative materials that compete with amalgam on speed of placement or longevity.
So we urge all four CDOs to work together and with the profession and industry to:
- Urgently address the impact of the direct application of the EU regulation to Northern Ireland
- Adopt a renewed focus on prevention to reduce the need for dental restorations
- Work with industry to secure an ongoing supply of amalgam
- Work with the BDA to ensure that there is no financial impact on dentists from the need to use alternative materials
MEPs backed amendments stating that Member States need to “ensure appropriate reimbursement is made available for mercury-free alternatives” to limit the socio-economic impact. That is precisely what’s needed from UK Governments.Without action a ban will eat into clinical time and resource that are in short supply, likely creating further access barriers. There are no indications where the millions in additional funding required will come from nor the workforce to carry out the tens of thousands of extra clinical hours.
The Nuffield Trust warned in December that NHS dentistry was at the most precarious moment in its 75-year history. Without decisive action, this ban will only hasten the service’s demise.
We have long supported a phase-down in dental amalgam. But this rapid phase-out is neither feasible nor justifiable. Dental amalgam has been in use and extensively studied for 150 years as a restorative material. Its safety and durability are well established, and it remains the most appropriate material for a range of clinical situations.
“When we are set to lose a key weapon in the treatment of tooth decay all four UK Governments appear asleep at the wheel” says BDA Chair Eddie Crouch.
“When alternative materials can’t compete, this will add new costs and new uncertainties to practices already on the brink.”
“Without decisive action this could be the straw that breaks the back of NHS dentistry.”
There remain many unanswered questions. We will be developing FAQs for members as we secure answers.