Indian Health Service to phase out use of dental fillings containing mercury by 2027

The use of mercury-containing amalgams, also known as “silver fillings” due to their appearance, has declined sharply since 2009 when the U.S. Food and Drug Administration reclassified the devices from low to moderate risk. The industry has largely abandoned them in favor of plastic resin alternatives, which are also preferred for aesthetic reasons.

The Indian Health Service says it will fully implement the move to mercury-free alternatives by 2027. Already, the percentage of the Indian Health Service's roughly 2.8 million patient user population receiving them has declined from 12% in 2005 to 2% in 2023, the latest year of available data, agency documents show.

The U.S. Department of Health and Human Services, which oversees IHS, said growing environmental and health concerns about mercury exposure, and global efforts to reduce materials containing the hazardous heavy metal prompted the change announced this month.

“This is a commonsense step that protects patients and prevents harm before it starts,” Secretary of Health and Human Services Robert F. Kennedy Jr., said in a statement.

The agency's switch to mercury-free alternatives also upholds legal responsibilities the U.S. government has to the 575 federally recognized tribes, he said.

According to the U.S. Food and Drug Administration, dental amalgam fillings can release small amounts of mercury vapor during placement, removal, teeth grinding and gum chewing. It recommends that certain people at high risk for adverse effects of mercury exposure, including pregnant women, children under 6, and those with existing neurological conditions avoid the fillings. But the administration, along with the American Dental Association, says available evidence does not link mercury-containing fillings to long-term negative health outcomes.

The World Health Organization has created a plan to encourage countries around the world to phase out the use of dental amalgams, citing potential for mercury exposure. In 2013 several countries, including the U.S., signed onto the Minamata Convention, a global agreement targeting the adverse health and the environment effects of mercury. In November, signatories to the convention agreed to phase out the use of mercury-containing dental amalgams by the year 2034.

While Kennedy’s decision to stop its use within the IHS by 2027 puts the U.S. ahead of the global schedule, the country is still behind many other developed nations that have already banned the practice.

“The rest of the world is light years ahead of us,” said Rochelle Diver, the U.N. environmental treaties coordinator for the International Indian Treaty Council, adding that IHS patients should not receive treatment that is considered antiquated by many dentists.

In a statement, the American Dental Association acknowledged declining use of mercury-containing fillings, but said they remain a “safe, durable and affordable material.”

The use of mercury in other medical devices, including thermometers and blood pressure devices, has also declined sharply in recent decades. While mercury-containing amalgams have fallen out of favor in the U.S. private dental sector, patients relying on government services may not have a say, according to Charles G. Brown, president of the World Alliance for Mercury-Free Dentistry.

Many state-administered Medicaid programs continue to cover mercury-containing fillings as a treatment for tooth decay, Brown said.

“If you’re on Medicaid, if you are stuck in the Indian Health Service, if you were stuck in a prison or other institution, you just don’t have any choice,” Brown said.

Brewer reported from Oklahoma City.