• Overview
  • Why does it matter?
  • About the project
  • Senegal
  • Thailand
  • Uruguay

Dental amalgam is a common filling material that has been a mainstay of dental restorative care around the world for over 175 years due to its ease of placement, material strength, longevity and cost-effectiveness. However, it consists of approximately 50% mercury which is why a shift away from the restorative model and use of dental amalgam is now becoming a reality, underpinned by the Minamata Convention on Mercury.

Parties to the Convention are required to implement several measures to phase down the use of dental amalgam according to Article 4, Annex A, Part II of the Convention which was amended in 2022 at the fourth meeting of the Conference of the Parties, COP-4.

COP-5, in 2023, concluded to amend Annex A, Part II of the Convention with a new measure to be taken by Parties which have not phased out use of dental amalgam yet. The amendment includes more specifically the development of a national action plan or a report with respect to progress they have made or are making to phase down or phase out dental amalgam every four years. COP5 also decided to consider amending both Part I and Part II of the Annex regarding dental amalgam at COP-6. Consult the amendment text.

Mercury-added products dental amalgams provisions

 

Learn more why it matters and explore the catalogue of resources, news and events.

Resources

News

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Mercury is a toxic substance and a global pollutant that poses adverse effects to human health and the environment. It is one of the top 10 chemicals of major public health concern according to WHO. Mercury pollution exposes people and wildlife, regardless of proximity to source, to harmful effects.

Dental amalgam is a restorative material used to fill cavities caused by dental caries (tooth decay). It is composed of a mixture of metals, consisting of elemental mercury (~50%) and a powdered alloy composed of silver, tin, and copper.  Mercury pollution may occur during the amalgam life cycle from production, supply, cavity placement, removal of fillings and disposal. Estimates suggest 30 to 40 per cent of mercury in amalgam enters solid waste streams, accumulates in water, soil and the atmosphere without breaking down. In this context, promoting the environmentally sound management of dental amalgam waste alongside prevention is key to reduce risks to human health and the environment. Furthermore, estimates suggest that between 3,000 to 5,000 metric tons of mercury are stored in the mouths of people worldwide in the form of dental amalgam, making the waste amalgam created by the dental industry a global issue.

Dental caries is the most common non-communicable disease worldwide, affecting more than 2.5 billion people, including 514 million school-aged children. Therefore, central to the phase down of dental amalgam use are efforts to strengthen public health approaches on dental caries prevention and oral health promotion, representing an important shift from the traditional restorative dental model. A renewed global focus on disease prevention would be a fundamental step towards better oral health, thereby reducing the need for restorative oral health care and fillings (including dental amalgam). Moreover, a focus on prevention and treatment of dental caries can be further supported by creating an enabling environment for the use of quality mercury-free products and minimal intervention.

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The Global Environment Facility (GEF) funded project Accelerate implementation of dental amalgam provisions and strengthen country capacities in the environmental sound management of associated wastes under the Minamata Convention (GEF 7 Phasing Down Dental Amalgam Project) is a 3-year project implemented by the United Nations Environment Programme (UNEP) and executed by the World Health Organization (WHO) with targeted technical assistance from the UNEP Global Mercury Partnership. 

The project officially started on 1 March 2023 and a global project kick-off meeting was held on 28 April 2023 at WHO headquarters in Geneva.

The project will support the implementation of the Minamata Convention on Mercury in both global and national contexts, with several activities to be implemented in three countries: Senegal, Thailand and Uruguay.

The project consists of the following components:

phasing down mercury dental amalgamPhase down of dental amalgam use through improved policies and technical capacity, focusing on technical guidance and regulatory strengthening in the three target countries through multi-sectoral collaboration;

 

life-cycle of mercury dental amalgamImprove management of mercury and hazardous waste from dental use, focusing on the environmentally sound lifecycle management of dental amalgam wastes to reduce emissions to air and releases to land and water of mercury and mercury compounds;

 

raise awarenessKnowledge management and global awareness, focusing on the dissemination at global level of the lessons learned and products developed at the national and global level

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Senegal flagThe Republic of Senegal is a country in West Africa with a population of 17,316,4491 inhabitants and an area of 196 722 km2. Senegal ratified the Minamata Convention on March 3, 2016 and presented its Initial Minamata Assessment (IMA) and its National Action Plan on Artisanal and Small-Scale Mining (PAN) in 2018 and 2019 respectively. A focal point has been appointed in accordance with the country's obligations to participate in all mercury negotiations on behalf of Senegal.

The estimated prevalence of untreated caries in Senegal is 37.9% for deciduous teeth (primary teeth or baby teeth) and 38.5% for permanent teeth. Dental amalgam remains the material of choice for dental restorations in the public sector and it is widely taught in dental schools, however, there is a growing shift among oral health professionals towards the use of mercury-free alternatives.

In its MIA, Senegal reported on the use of dental amalgam in the oral health sector and identified it as a priority area for action. This includes implementing appropriate legislative or regulatory measures, as well as carrying out awareness and education campaigns aimed at the public and oral health professionals.

However, the problem of managing dental amalgam waste arises in Senegal, which has very little information on the latter despite the implementation in August 2008 of the dioxin and mercury management program (PROGEDIME) which had as key objectives the implementation in health establishments of models using best practices for biomedical waste management which highlight a strategy for reducing and eliminating releases of dioxins and mercury into the environment; the establishment at the national level of a training program, intended for model health structures for the training of specialists, sanctioned by the issuance of a certificate in biomedical waste management.

Through this new project, Senegal will:

  • Conduct a comprehensive assessment of the national context regarding the use of dental amalgam and associated waste management in order to identify country-specific strategic interventions for the implementation of the Minamata Convention on mercury, including decisions taken by the Conference of the Parties;
  • Build capacity and foster an enabling environment for reducing the use of dental amalgam, with emphasis on promoting the use of mercury-free materials for the prevention and treatment of dental caries;
  • Improve dental amalgam and mercury waste management practices;
  • Share information and knowledge with other countries.

Senegal

(Click on the country flag to see its Minamata Convention Party profile)

Traduction française

La République du Sénégal est un pays d’Afrique de l’Ouest avec une population de 17 316 449 habitants et une superficie de 196 722 km2. Le Sénégal a ratifié la Convention de Minamata le 3 mars 2016 et a présenté son Évaluation initiale de Minamata (EIM) et son Plan d’action national sur les exploitations minières artisanales et à petite échelle (PAN) en 2018 et 2019 respectivement. Un point focal a été nommé conformément aux obligations du pays qui participe à toutes les négociations sur le mercure au nom du Sénégal.  

La prévalence estimée des caries non traitées au Sénégal est de 37,9% pour les dents de lait (dents primaires ou dents de lait) et de 38,5% pour les dents permanentes. L’amalgame dentaire reste le matériau de choix pour les restaurations dentaires dans le secteur public et il est largement enseigné dans les écoles dentaires, cependant, il y a un changement croissant parmi les professionnels de la santé bucco-dentaire vers l’utilisation d’alternatives sans mercure. 

Dans son AMI, le Sénégal a fait état de l’utilisation de l’amalgame dentaire dans le secteur de la santé bucco-dentaire et l’a identifié comme un domaine d’action prioritaire. Cela comprend la mise en œuvre de mesures législatives ou réglementaires appropriées, ainsi que la réalisation de campagnes de sensibilisation et d’éducation à l’intention du public et des professionnels de la santé buccodentaire.

Cependant le problèmes de gestion des déchets d’amalgames dentaire se pose avec acquitté au Sénégal qui détient très peu d’informations sur ces derniers malgré la mise en œuvre en aout 2008 du programme de gestion des dioxines et du mercure (PROGEDIME) qui avait comme objectifs phares la mise en place dans  les établissements de santé des modèles utilisant les meilleures pratiques de gestion des déchets biomédicaux qui mettent en exergue une stratégie de réduction et d’élimination des rejets de dioxines et de mercure dans l’environnement ; la mise en place au niveau national d’un programme de formation, destiné aux structures de santé des modèles pour une formation de spécialistes, sanctionné par la délivrance d’un certificat en gestion des déchets biomédicaux.

A travers ce nouveau projet, le Sénégal va :

  • Procéder à une évaluation complète du contexte national en ce qui concerne l’utilisation des amalgames dentaires et la gestion des déchets qui y sont associés afin d’identifier les interventions stratégiques spécifiques à chaque pays pour la mise en œuvre de la Convention de Minamata sur le mercure, y compris les décisions prises par la Conférence des Parties ;
  • Renforcer les capacités et favoriser un environnement favorable à la réduction de l’utilisation des amalgames dentaires, en mettant l’accent sur la promotion de l’utilisation de matériaux sans mercure pour la prévention et le traitement des caries dentaires ;
  • Améliorer les pratiques de gestion des déchets d’amalgames et de mercure dentaires ;
  • Partager l’information et les connaissances avec d’autres pays. 
Videos
20 mars 2024: Journée mondiale de la santé #BuccoDentaire

Thailand flagThe Republic of Thailand is a country in Southeast Asia with a population of 69,951,000 and an area of 513,140 km2. Thailand became a Party to the Minamata Convention on 22 June 2017.

The estimated prevalence of untreated caries in Thailand is 44.7% for deciduous teeth (primary teeth or milk teeth) and 27% for permanent teeth. A 2018-19 survey conducted in the Ministry of Public Health facilities revealed that most of the dental fillings were restored with alternative materials to dental amalgam. Furthermore, the material of choice for primary teeth in children aged under 15 years old was resin-based composite. There has been a declining trend in the use of dental amalgam for fillings; however, additional efforts could even further accelerate phasing down its use and implementing practices to adequately manage its waste.

Through this project, Thailand will: 

  • Conduct a comprehensive assessment of the national context with regards to the use of dental amalgam and the management of its associated waste to identify country-specific strategic interventions for implementing the Minamata Convention on Mercury, including decisions made by the Conference of the Parties;
  • Develop measures to reduce the use of amalgam fillings in all age groups, especially in pregnant women and children under 15-year-old;
  • Build capacity and foster a supportive environment for reducing the use of dental amalgam, with a focus to promote the use of mercury-free materials for the prevention and treatment of dental caries;
  • Improve dental amalgam waste management practices;
  • Cancel the production, import and export of amalgam tablet and limiting the use of amalgam material in capsule form only;
  • Study the feasibility of amalgam separator installation in dental clinics;
  • Share information and knowledge with other countries.

Thailand

(Click on the country flag to see its Minamata Convention Party profile)

Uruguay flagUruguay, a Latin American country with a population of 3,422,794 and a surface area of 176,220 km2, was one of the first countries to ratify the Minamata Convention in September 2014. The estimated prevalence of untreated caries in Uruguay is 42.9% for deciduous teeth (primary teeth or milk teeth) and 37.6% for permanent teeth. 

Caries disease is the most prevalent oral disease worldwide, being the greatest public health problem. Uruguay is no exception to this situation. It has a high prevalence of caries with a higher incidence at lower sociocultural and economic levels. The prevalence in preschoolers from Montevideo is 70.9%. Studies show a higher prevalence in females. The percentages of caries-free among 15 to 24 years of age are 17% for males and 13% for females. There is a clear increase with age.

Since 2008, the country has undertaken significant efforts to discourage the use of dental amalgam. These efforts include the elimination of training on the material from the university curriculum, collecting data on mercury used in dental facilities, and ultimately, the issuance of a decree in 2018 that classified dental amalgam as an obsolete material, removing it from the oral health services catalogue offered by the Integrated National Health System. 

Through this project, Uruguay will:

  • Conduct a comprehensive assessment of the national context and document its journey in significantly phasing down the use of dental amalgam, and identify strategic interventions to further limit the use of the material across all sectors;
  • Strengthen national regulatory and institutional frameworks and technical capacities for the sound management of dental amalgam waste, which is a priority for the country;
  • Strengthen the strategy for addressing the oral health needs of the population, focusing on a model that promotes oral health and prevents and controls dental caries through minimal intervention approaches;
  • Share information and knowledge with other countries.

Uruguay

(Click on the country flag to see its Minamata Convention Party profile)

 Traducción Española

Uruguay, país latinoamericano con una población de 3.422.794 habitantes y una superficie de 176. 220 km2 18, fue uno de los primeros países en ratificar el Convenio de Minamata en setiembre de 2014. La prevalencia estimada de caries no tratada en Uruguay es 42,9% para los dientes deciduos (dientes primarios o dientes de leche) y 37,6% para los dientes permanentes.  

La enfermedad caries es la patología bucal más prevalente a nivel mundial, siendo el mayor problema de salud pública. Uruguay no escapa a esta situación. Presenta una alta prevalencia de caries con mayor incidencia en niveles socioculturales y económicos más bajos. La prevalencia en preescolares de Montevideo es de 70,9%. Los estudios realizados muestran una mayor prevalencia en el sexo femenino. Los porcentajes de libres de caries entre los 15 y 24 años son 17% para el sexo masculino y un 13% para el sexo femenino. Hay un claro aumento con la edad. 

Desde 2008, el país ha realizado importantes esfuerzos para desalentar el uso de amalgamas dentales. Estos esfuerzos incluyen la eliminación de la capacitación sobre el material de la currícula universitaria, la recopilación de datos sobre el mercurio utilizado en las instalaciones dentales y, finalmente, la emisión de un decreto en 2018 que clasificó la amalgama dental como un material obsoleto retirándose del catálogo de prestaciones de salud bucal que ofrece el Sistema Nacional Integrado de Salud.

A través de este proyecto, Uruguay va a:  

  • Llevar a cabo una evaluación exhaustiva en el contexto nacional y documentar su trayectoria en la significativa reducción gradual del uso de amalgamas dentales, e identificar intervenciones estratégicas para limitar aún más el uso del material en todos los sectores; 
  • Fortalecer los marcos normativos institucionales nacionales y las capacidades técnicas para la gestión racional de los residuos de amalgama dental, que es una prioridad para el país; 
  • Fortalecer la estrategia para atender las necesidades de salud bucal de la población, enfocándose en un modelo que promueva la salud bucal y prevenga y controle de la caries dental a través de procedimientos de mínima intervención;
  • Compartir información y conocimiento con otros países.  

The overall goal of the UNEP Global Mercury Partnership is to protect human health and the environment from the releases of mercury.

© United Nations Environment Programme