Published: 05 June 2020

Measures to reduce the clinical need for dental amalgam. An evidence review

International binding agreements oblige signatories, including Ireland, to reduce their use of mercury to protect the environment. In response, the Irish Government need to phase out the use of dental amalgam by 2030. The aim of this evidence review was to examine factors relevant to phasing out amalgam and consider alternative replacement strategies for treating dental caries.  

We examined evidence where a) exemptions existed to allow the use of dental amalgam and b) measures taken to phase out amalgam. We also drew on 101 systematic reviews to identify alternative interventions to amalgam and their effectiveness.  

We found that exemptions to permit the continued use of amalgam only applied when treating permanent tooth restoration. Measures to phase out dental amalgam ranged from raising public awareness of the risk to the environment to realigning dental insurance policies to prioritise alternatives to amalgam.

There is adequate evidence that a) fluoride technologies and resin-based sealants are effective in preventing dental caries and b) silver diamine fluoride, sealants combined with fluoride and microinvasive strategies are effective in early treatment of caries. Glass-ionomer cements are equal to other restorative materials for restorations in primary teeth. Composite resin formulations are considered the next best restoration alternative to amalgam


  • Martin Keane
  • Caitriona Lee
  • Jean Long

Publication (PDF, 3 MB)

Publication (PDF, 3 MB)

Health Research Board
Health Research Board
Place of publication