As of January 2025, Luxembourg has officially implemented a ban on dental amalgam, marking the end of an era for this long-used filling material. The move follows revised European Union regulations aimed at curbing mercury use due to its environmental and health risks. Dentists in Luxembourg, including Marlène Becker-Dubois, explain the rationale behind the ban, its impact on current dental practices, and the future of amalgam fillings.
A Long History with Amalgam
For over 150 years, amalgam, an alloy primarily composed of mercury, silver, tin, and copper, has been the go-to material for dental fillings, particularly for back molars subjected to heavy chewing. Known for its durability, cost-effectiveness, and ease of application, amalgam has been a staple in dental care for decades. However, its disadvantages – notably its greyish color and potential toxicity – have increasingly led to its decline.
“Marlène Becker-Dubois, a Luxembourg-based dentist, notes that while amalgam is resilient and cost-efficient, its drawbacks include its unattractive appearance and the presence of mercury, a potent neurotoxin. Although amalgam fillings are considered stable once set in place, handling the material during insertion or removal may release small amounts of mercury vapors, which can pose health risks,” she explains.
The EU Mercury Regulation and its Implications
The ban is part of the European Union’s broader initiative to reduce mercury exposure. In 2023, an estimated 40 tonnes of mercury were still being used annually across EU member states for dental amalgam, underscoring the environmental and health concerns surrounding this substance. The EU’s revised mercury regulations aim to minimize its environmental impact and to protect both human health and ecosystems.
Amalgam’s mercury content, while stable in its final form as a dental filling, has prompted concerns, particularly during dental procedures such as filling insertion or removal, where minimal mercury vapor could be released into the air.
What Happens to Existing Fillings?
For patients with existing amalgam fillings, there is no immediate need for removal, provided the fillings remain intact. As Becker-Dubois clarifies, “If the amalgam filling is undamaged, there is no need to replace it.” However, some patients may opt to replace their amalgam fillings for aesthetic reasons or if the seal has begun to weaken, leading to potential gaps that could invite bacteria or food particles.
In such cases, Becker-Dubois emphasizes that a rubber dam, a dental tool designed to isolate the treatment area from moisture, should be used to minimize exposure to mercury during the replacement process.
Shifting to Alternative Materials
While the amalgam ban will not drastically alter daily dental practices for most professionals, it does encourage the continued shift toward more modern materials such as ceramics, reinforced plastics, and glass ionomer cements. These alternatives are more aesthetically pleasing and environmentally friendly. However, they come with their own challenges, including increased complexity during application.
Composites, which are often used in place of amalgam, require precision to ensure proper adhesion to the tooth. Unlike amalgam, which expands slightly to fill the cavity, composites shrink slightly during polymerization, which can affect the seal of the filling and increase the risk of future cavities. “The key to success with composite fillings lies in the precise application and use of a dry environment during the procedure,” Becker-Dubois states. To address this, many dentists now rely on rubber dams, which have been reimbursed by Luxembourg’s National Health Fund (CNS) since 2024, to maintain dryness and ensure optimal bonding.
Exceptional Circumstances for Amalgam Use
Despite the ban, there are exceptions to the rule. In certain cases, amalgam fillings may still be used for patients with specific medical needs. For example, in individuals who may have difficulty remaining still during treatment or those under general anesthesia, amalgam may be preferred due to its ease of handling in moist conditions.
Mercury and Its Broader Environmental Impact
Mercury is a naturally occurring substance that can be found in various products, from thermometers to light bulbs. In recent years, there has been a global push to minimize human exposure to mercury due to its neurotoxic effects, especially in vulnerable populations like pregnant women and young children. While the presence of mercury in certain fish has raised concerns, scientific studies suggest that normal consumption does not pose a significant health risk to the general population.
Looking Ahead: A Shift in Dental Practices
As the use of amalgam in dentistry becomes a thing of the past, the industry is embracing newer, safer, and more aesthetic alternatives. For patients in Luxembourg, the end of amalgam fillings is part of a broader trend toward environmentally responsible and health-conscious dental care.
For those with existing amalgam fillings, rest assured that there is no immediate need for removal, unless the filling is compromised. However, for those considering replacements or new fillings, modern alternatives offer a more attractive and sustainable solution – one that reduces both mercury exposure and the environmental footprint of dental practices.
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