Dental amalgam in dentistry represents the largest use of mercury in the European Union and is a significant source of pollution with consequences for environmental and human health. In May 2017, the EU institutions formally adopted the new Mercury Regulation ((EU) 2017/852), aligning European legislation with the International Convention on Mercury (Minamata Convention) to facilitate a phase-down of mercury use. In force since 1 January 2018, the regulation mandates important time-bound restrictions for Member States’ use and disposal of dental amalgam in dental practice.
HCWH Europe has developed a publicly available tool to measure progress of Member States’ implementation of the EU Mercury Regulation. The four maps presented below illustrate Member State’s compliance with the regulation’s objectives and are intended to serve as a source of best practice and a catalyst for policy development in Member States that use dental amalgam extensively.
HCWH Europe welcomes contributions from relevant stakeholders to help reflect the current regulatory status as accurately as possible. If you have any questions or would like to provide data or other relevant information, please contact our Circular Healthcare Projects Officer, Katia Pacella, at kpacella@hcwh.org.
Map 1: Coverage of dental amalgam fillings by health insurance schemes
The use of dental amalgam in dentistry can be encouraged when covered under national health insurance schemes. By replacing amalgam with alternatives in insurance schemes Member States can support a phase-down.
Map 2: Dental amalgam phase-out for vulnerable groups
Some populations, including children as well as pregnant and breastfeeding women, are particularly vulnerable to the negative health impacts of mercury exposure. To prevent risks that may arise due to contact with mercury, from 1 July 2018, dental amalgam shall not be used for dental treatment of deciduous teeth, children under 15 years, and pregnant or breastfeeding women, except when deemed strictly necessary by the dental practitioner based on the specific medical needs of the patient.
Map 3: Dental separators requirement
The use of amalgam separators to remove amalgam particles from dental waste is one of the most common measures that can be taken to limit the amount of mercury entering the environment. According to the regulation, from 1 January 2019, operators of dental facilities in which dental amalgam is used or dental amalgam fillings or teeth containing such fillings are removed, must ensure that their facilities are equipped with amalgam separators for the retention and collection of amalgam particles, including those contained in used water.
Map 4: Implementation of national phase down action plans
The EU Mercury Regulation supports Member States' progress towards the ultimate goal of a dental amalgam phase-out in the EU. By 1 July 2019, each Member State must have set out a national action plan on measures to phase down the use of dental amalgam – these action plans must be publicly available within one month of their adoption.