The UK – like the European Union (EU) – has a duty to reduce the negative impact of mercury on the environment and human health as per its own regulations and the Minamata Convention, which the UK signed along with 130 countries in 2013.
Silver fillings available on the NHS – dental amalgam – are made up of a mixture of metals including mercury. Mercury-free alternatives are available, but are more expensive.
A “major use” of metallic mercury in England is dental amalgam, according to a 2021 report commissioned by the Environment Agency on the challenges facing the water environment due to mercury.
Mercury is highly toxic to humans, according to the World Health Organisation, and exposure, even to small amounts, may have toxic effects on the nervous, digestive and immune systems, and on the lungs, kidneys, skin and eyes. It can also have a devastating impact on aquatic ecosystems, as it biomagnifies up the food chain.
Despite being deemed safe for use, dental amalgam has been banned in the UK for use on children aged 15 years or under and for use on pregnant and breastfeeding women, “except when deemed strictly necessary by the dental practitioner”.
On Thursday, the European Council and Parliament agreed that mercury in dental amalgam must no longer be used by 1 January 2025, with exports of dental amalgam also set to be prohibited from this date – with an 18 month derogation for certain circumstances, for example if a country has “not yet adjusted their reimbursement system to cover alternatives”.
The next stage is for this to be set into law, but while the EU is on its way to completely phasing out dental amalgam in all of its member states within the next three years, post-Brexit UK has not set a date.
On top of this, at a meeting of the Minamata Convention in November 2023, the UK was among a small number of countries globally that disagreed with plans to phase-out the manufacturing and trade of dental amalgam by 2030.
President of the World Alliance for Mercury-Free Dentistry, Charlie Brown - who describes dental amalgam as “toxic teeth” - expressed dismay that the UK government has “made clear” that it favours amalgam and is not planning on a phase out.
He said that DEFRA needs to “stand up and ban this tooth unfriendly pollutant from the Victorian era”, which he described as “no longer needed in dentistry and definitely no longer wanted by any consumer who finds out it is mainly mercury”.
Brown, who is an attorney in the US, also highlighted that dental workers “breathe in an office laden with the most volatile of the heavy metals, mercury”.
“Amalgam’s use is disappearing in private health care where consumer choice counts but [its use is] continuing by the NHS and other bureaucracies where consumer choice is ignored,” he continued.
In contrast, the British Dental Association has said it is firmly against dental amalgam being phased out. Chair of the organisation, Eddie Crouch, described the EU ban as the “straw that breaks the back of NHS dentistry.”
The body submitted an open letter to the UK’s four chief dental officers asking that they work with industry to secure an ongoing supply of amalgam in the face of the ban which they say will have a detrimental impact on costs.
A department of health and social care spokesperson said:
“The UK’s position remains to phase down the use of dental amalgam."
As per the government's 2019 national action plan for England, it committed to a "minimal intervention approach" for restoring teeth, and to emphasise preventative measures, to reduce the need for fillings. It did not commit to a ban.
DEFRA has been approached for a comment.