Our ref: DE00000859350 

Dear Granito,  

Thank you for your further correspondence of 5 May about mercury in amalgam fillings.  I have been asked to reply.

I was sorry to read that you were dissatisfied with the Department of Health’s previous reply of 13 March (our ref: DE00000843237), and I note your continuing concerns about this matter.

Dental amalgam has been in use for over 150 years with fillings placed in billions of people.  Only a very few adverse reactions have been noted in the very small number people who are allergic to mercury.  There have been successive expert reports corroborating the empirical evidence on safety.  Mercury exposure from fillings is thought to be about the same as that from the diet, and therefore does not pose a significant health risk.

NHS dentists can replace amalgam fillings with mercury-free fillings in cases where an exceptional medical condition exists and where the request is supported by an appropriate consultant’s report.  Additionally, if there are substantial clinical reasons why mercury-free fillings should be used from the outset of treatment, such as an allergy, then they are available on the NHS.

In February 2002, the United States Food and Drug Administration reported evidence that came to similar conclusions to the European Commission, namely that no valid scientific evidence has ever shown that amalgam causes harm to patients with dental restorations, except in the rare case of allergy.

The World Health Organization (WHO) report ‘Future Use of Materials for Dental Restorations November 2009’ concluded that dental amalgam remains a dental restorative material of choice in the absence of an ideal alternative.  The WHO concurs that the available evidence suggests that dental amalgam is a safe and effective filling material and notes that alternative filling materials are not without clinical limitations and toxicological hazards.  The Department of Health concurs with the conclusions of the report which can be found by going to the WHO’s website, www.who.int, and searching for ‘amalgam fillings’.

The general view amongst experts remains that dental amalgam is the most convenient and durable material for filling cavities in back teeth.  ‘White’ fillings are available for restoring front teeth but the use of white fillings on back teeth is more for cosmetic reasons than clinical effectiveness.  However, dentists can use white fillings on back teeth providing this is clinically necessary, for example if a patient is allergic to mercury.  The European Commission Scientific Committee report also concluded that alternative filling materials are not without risk.

As a precautionary measure the Department advises dentists to avoid the placement or removal of amalgam fillings during pregnancy unless clinically necessary, although there is no evidence of any harm to unborn children from the use of amalgam.

More recently, the Minamata Convention agreed to
phase down and not ban the use of dental amalgam.  Parties to the Convention (which include the UK) agreed also to include two or more measures from a list, including:
All EU Member States agreed with this, so there is no outright European ban due.

In conclusion, amalgam will continue to be used in the NHS, but in decreasing quantities as dental health continues to improve.  The Department will continue to monitor research into its effects, the appropriateness of alternative materials and the best available international evidence.

I hope this reply is helpful.

Yours sincerely,
Paul Swiderski
Ministerial Correspondence and Public Enquiries
Department of Health

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