• Eleven Member States went for a general phase-out: Italy, Croatia, Slovenia, Slovakia, Czech Republic, Finland,  the Netherlands, Ireland, Spain, Greece and Poland. Sweden, ended amalgam use a decade ago. Estonia, with amalgam use already at 1 % is assessing the feasibility of a full phaseout.
• Having long ago banned amalgam in the primary teeth, Denmark prohibited its use in permanent teeth except under four limited exceptions – so now amalgam use is under 2%. Lithuania is following the Danish example and restricts the use to exceptional cases.
• Poland withdraws mercury fillings from the guaranteed benefits, effectively phasing out dental amalgam in 2022.
• In Finland, a composite restoration costs the patient the same as an amalgam restoration.
• Ireland, Slovakia, Czech Republic, Croatia, Slovenia and Hungary will alter its insurance to favor mercury-free fillings in the coming years.
• Croatia and Cyprus stepwise expand the phase out of the use for children by raising the minimum age for amalgam to 18, Slovenia to 25.
• Romania and Spain will permit the use of dental amalgam only in a selected list of medical clinics.
• Cyprus, Czech Republic, the Netherlands, Portugal and Spain, will allow amalgam only with a showing of medical need.
• Portugal, Romania and the Czech Republic will require informed consent to amalgam.
• Lithuania, Latvia and the Netherlands ended the teaching of amalgam placement in its dental schools, effectively ending amalgam as the new generation of dentists take over.
• Austria, Italy and Germany expanded protection by recommending not to use amalgam for those with kidney disease, Austria additionally for those with certain neurological conditions. Lithuania by prohibiting the use for patients with metallic denture frameworks that could interact with amalgam. France and Italy by recommending to avoid the placement of amalgam in direct or indirect contact with precious metal alloys, gold-plated brass anchors or other metallic restorations and strongly discouraging to perform whitening on teeth filled with amalgam.
• Estonia, Lithuania, Latvia, Greece, Cyprus and Germany have submitted interim plans (first assessing the actual use) and will present their long-term plan in the coming years.

• Norway (in 2008), New Caledonia (France, in 2019) and the Republic of Moldova (in 2020) have generally phased out dental amalgam without any exceptions.
• Russia, Kazakhstan, Armenia, Azerbaijan and Georgia have declared not to use mercury fillings at all.
• As dental amalgam was not allowed for children in the Soviet Union since 1982 and hardly used at all, its use never gained significance in Ukraine, Belarus, Kyrgyzstan, Uzbekistan and Turkmenistan.
• Switzerland is prohibiting the use of dental amalgam in cases where mercury-free alternative can be preferred. The use declined to less than 1 %.
• Iceland, Albania and the UK joined the phasing out of the use for children under the age of 15, pregnant and breastfeeding women.

European Union

• Sweden stopped to subsidize dental amalgam in 1999
• In 2009 dental Amalgam was banned with following exceptions: 1) Technical difficulties in the placement of alternative materials 2) Adverse reactions to alternative materials 3) In restorations done under general anaesthesiain Specific medical condition
• Sweden ceased the exemptions in 2018 as they were only applied to very few individual cases

• By 1 January 1995 Denmark prohibited the import, sale and export of dental amalgam, except for fillings in permanent molars, where the filling is worn.
• The exception was specified by the Public Health Authority in 2006 and allowed the use of dental amalgam only in the following cases: 1) lack of possibility of drying 2) difficult accessibility of the cavity 3) especially large cavity 4) large distance to neighboring tooth

• Italy has presented a National Plan which describes the actions necessary to achieve the gradual phasing down of the use of dental amalgam in dentistry, with the ultimate goal of achieving complete elimination of its use (phase out), through non-mandatory measures, by 31 December 2024.

• store amalgam capsules in a cool, ventilated environment;
• work in ventilated rooms with decontaminable non-textile coverings;
• always carry out under cooling, suction and isolation of the operating field, milling and polishing of amalgam;
• do not place dental amalgam in the vicinity of other metal restorations in order to avoid corrosion risks;
• in case of supervening local reactions, especially lichenoid lesions in the vicinity of an amalgam, or in cases, definitely established, of allergy to such material, removal of the filling is indicated.

• Poland announced on 25 February 2022 to withdraw mercury fillings from the guaranteed benefits without any transition period (effectively phasing out dental amalgam). In place of the dental amalgam, the following dental restorative materials will be used for the entire population of beneficiaries:
  • Glass ionomer cements,
  • high density glass ionomer cements and
  • resin-reinforced glass ionomer cements.
• Patients will also be reimbursed for the removal of amalgam fillings as a guaranteed benefit.
• Only dental clinics where amalgam is removed, must be equipped with amalgam separators.

• Since 24 February 2020, alternative fillings (glass ionomer cements with an indication for permanent fillings (glass-hybrid) and composite) have become the standard material for children up to the age of 18 as well as pregnant and nursing women in compulsory health insurance.
• The right to full reimbursements of alternative fillings will be further extended to all insured persons by 31 December 2025, which will effectively phase out dental amalgam.

• Slovakia anchored a total ban on amalgam from 1 January 2031 in the national legislation Act no. 578/2004 Coll. The competent regional authority may grant dentists a fine of up to EUR 3,919.
• An adjustment of the subsidy for alternative fillings is planned in the next few years.
• Glass-ionomer cement, fully covered by all health insurance companies for the entire population, has been identified as a substitute for filling dental cavities.

• The NAP envisages that by 2030, the use of dental amalgam will represent only 1% of the total number of restorations.
• At the latest by 1 January 2025 it should be possible to have uniform payments for dental fillings regardless of the material by the public health insurances.
• From 2030 onwards, amalgam fillings will only be reimbursed in exceptional indications where no alternatives are available and the patient wishes to have an amalgam filling.

• The long-term objective is to phase out the use of amalgam completely by 2030.
• Short-term goals: Reduce amalgam consumption by at least 25% by 2022 from 2019; 50% by 2025 and 75% by 2028.
• In 2021, according to a survey conducted by the Ministry of Social Affairs and Health, 86 % of dental practices did not use amalgam at all. Most dental practices that still used amalgam used it very rarely.
• In Finland, there are no policies or programs that would favor dental amalgam use over mercury-free dental restoration, a composite restoration costs the patient the same as an amalgam restoration.

• Ireland supports a phase down towards phase out/ban of amalgam across all age groups by 2030.
• The use of amalgam will be allowed only in exceptional clinical circumstances. The ongoing need for clinical exemptions will be reviewed periodically.
• The public payment system will be revised to support mercury-free alternatives for eligible persons across all age groups.

• Spain plans to reduce the use of dental amalgam to exceptional cases (both in the at-risk population and in the general population) by 2030.
• Exclusive health centers authorized to place, remodel or extract dental amalgam fillings will be established.

• The Government of Portugal is committed to progressively reducing the use of dental amalgam by replacing it with other mercury-free materials. It is proposed to reduce the possibility of dental restorations using amalgam in NHS health units (within the scope of primary health care and hospital health care), and only in duly justified situations.
• From 2021, whenever the need for an amalgamated restoration is justified, the patient must accept this procedure through the declaration of informed consent.

• From 1 January 2025 the use of dental amalgam is prohibited in persons under the age of 18 unless the dentist considers it strictly necessary because of the patient’s specific medical needs.
• Until 1 January 2025 Cyprus assess the possibility of prohibiting the use of dental amalgams throughout the population unless the dentist deems it absolutely necessary due to patient’s specific medical needs.

• The objective of Hungarian NAP is to reduce the use below 1% until 2030,
• The public reimbursement schemes will be adopted and Mercury-free alternative become the preferred choice for new fillings.

• As soon as the use of amalgam will increase above 1%, the Netherlands will evaluate actions how to further reduce the use.
• The Dutch dentistry faculties have stopped teaching students to use dental amalgam since 1997.
• The Royal Dutch Dental Association (KNMT) announced to produce an overview of the situations in which the use of amalgam is considered medically necessary.

• As of May 2021, dental amalgams may only be used for few limited and justified indications such as
  • for the restoration of defects in the masticatory surfaces of molars (Class I, II),
  • medium to large dental cavities (at least 2 mm deep),
  • when it is not possible to restore the tooth with an alternative filling due to difficulties in controlling the moisture or the accessibility of the cavity
• The use of dental amalgams is prohibited if patients have dentures made of other metals that could cause galvanizes by interacting with the dental amalgam alloy.
• Dentistry students in Lithuanian universities are only introduced to the history of tooth filling, listing the materials used, including amalgams, but they have not been trained in dental amalgams since 2008.
• The implemented measures to phase out dental amalgam will be evaluated every calendar year.

• Since 1995, amalgam is not indicated in patients with impaired renal function or progressive degenerative diseases of the peripheral or central nervous system.
• Dental amalgam is not allowed to be used • for retrograde root fillings; • as material for stump abutments under crowns or bridges; • as sealing material for cast crowns.

• The Federal Government has set itself the goal of working towards further reducing the use of amalgam in dental treatment and limiting it to indispensable special cases.
• The first National Plan is focusing on further strengthening the prevention of caries and collecting data about the actual use of dental amalgam. It will be periodically updated in subsequent years.
• As of January 01, 2021, dentists are obliged to declare the use of dental amalgam in the invoicing with statutory health insurers.
• Public health insurences fully reimburse composite fillings for children under the age of 15 and pregnant and breastfeeding women, patients allergic to any component of dental amalgam, and patients with severe kidney disease.

• The NAP focuses primarily on oral health prevention and highlights the continued decrease in the use of dental amalgam. No measures to further reduce the use are foreseen.
• In 2014, the Agence nationale de sécurité du médicament et des produits de santé (French Agency for the Safety of Health Products) updated its 👉 recommendations for the use of dental amalgam, encouraging professionals to use dental amalgam only for few limited and justified indications.
  • The patient must be fully informed about the different filling materials available before any amalgam-based restoration is performed.
  • Dental amalgam should only be used in posterior permanent teeth (molars and premolars) in the case of multiple and extensive lesions.
  • Dental amalgam should not be used in patients with impaired kidney function and in patients with a known allergy to mercury.
  • The placement of amalgam in direct or indirect contact with precious metal alloys, gold-plated brass anchors (screw-post type) or other metallic restorations should be avoided.
  • It is strongly discouraged to perform whitening on teeth filled with amalgam.
  • The presence of localized lichenoid lesions in direct contact with amalgam fillings may warrant removal of otherwise satisfactory fillings.

• Dental amalgam is practically no longer used in Estonia. The measure of the national plan to reduce the use of dental amalgam is to find a solution at the legal level to officially ban the use of amalgam.

• Information on the use of amalgam in adult dentistry, is currently not available. Such data should be available in perspective with the introduction of an information system developed by dentists for the period 2020-2021.
• “Procedures for the Organisation and Payment of Health Care Services” (28 August 2018) ensures access to state-funded dental services (including use of alternatives) for children under 18 years of age.
• In November 2021 the Ministry of Health published a 👉 report about the interim measures with findings about the current use. These should serve now for the development of a long-term plan.
• Compared to 2018, there has been a 50.3% reduction in the use of dental amalgam in 2019 and 67.7% in 2020.
• There is no training on the use of Hg amalgam in training programs.

• The interim National Plan calls for first collecting data on the actual use of dental amalgam.
• The prevention of caries diseases will be promoted.
• A campaign to inform dentists and the public about the health effects of mercury and the contribution that reducing the use of dental amalgam makes to limiting mercury releases is to be launched.

• Romania will permit the use of dental amalgam only in a selected list of medical clinics.
• Patients will be obliged to complete an informed consent before using amalgam.

• The Romanian Dental Association (Colegiului Medicilor Stomatologi România) had called on the Ministry to immediately extend the ban on the use of dental amalgam to children up to 18 years of age when drafting the national plan for dental amalgam and to completely ban the use of dental amalgam by 1 July 2025.

• The NAP emphasises the need for data collection, providing information to dentist students as well the need for increased prevention on oral health and provide more information on risks of dental amalgam to the population.
• No further measures to reduce the use are foreseen.

• The Health Directorate has drawn up a national plan which has as its objectives the prevention of dental caries throughout life, easy access to treatment with mercury-free materials, objective communication on risks and alternatives to reduce the use of dental amalgam and professional management of amalgam waste to avoid environmental contamination.
• No further measures to reduce the use are foreseen.

• The NAP focuses primarily on oral health prevention and highlights the ongoing decrease in the use of dental amalgam.
• No further measures to reduce the use are foreseen.

• Malta has not presented a National Plan to reduce the use of amalgam.

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Europe

• In 1991, Norway issued guidelines that the use of amalgam should be limited due to environmental impacts. Stronger guidelines were issued in 2003, requiring materials other than amalgam to be considered as the first choice in tooth fillings.
• In 2008 Norway general bans mercury containing products. This included a ban on amalgam, with an exemption period –now expired –for special cases.
• Amalgam use has been eliminated since 2011.

• For the protection of health and the environment, the production, placing on the market and use of Dental Amalgam is prohibited by 15.02.2020.

• On 16 September 2019 the Haut-Commissariat de la République en Nouvelle-Calédonie decided to immediately stop the use of dental amalgam and referred to the National Medical Devices Regulation.

• The Russian Federation consistently reported to have phased out use of dental amalgam

• Purchase and usage of mercury-added dental amalgam were banned by the joint order 07/27 of 2011 by the Minister and Health and the Chief of National Emergency Management Authority.

• Dental amalgam is not used in the Republic of Kazakhstan

• Dental fillings containing mercury, are not used in dental clinics of Armenia for a long
  time already

• There is no use of dental amalgams in Azerbaijan

• Dental amalgam is no more in use by dental clinics and not imported in the country.

• In September 2015 Switzerland amended the Swiss Ordinance on Risk Reduction (ChemRRV) related to chemical products to prohibit the use of dental amalgam in cases where mercury-free alternative can be preferred for medical reasons.
• In any case, the patient’s consent to the treatment procedure is absolutely necessary.
• In July 2018 Switzerland amended the ChemRRV to end the export of mercury for use in dental amalgam capsules by 31 December 2027.

• Dental amalgam is regulated in the Swiss ORRChem ordinance (Annex 1.7 ORRChem). This ordinance applies in Liechtenstein based on the Customs Union Treaty.
• According to ORRChem the use of dental amalgam is prohibited. An exemption from the general prohibition is granted if priority cannot be given to a different filling material for medical reasons.

• From 1 July 2019 the use of dental amalgams for the dental treatment of deciduous teeth, children under the age of 15 and pregnant and breastfeeding women is prohibited.
• The Minister of Health, in consultation with the Minister in charge of public health and prevention, announced to issue an action plan for measures that need to be taken in order to reduce the use of dental amalgam. The action plan shall be made public.

• From 1 July 2021 the use of dental amalgams for the dental treatment of deciduous teeth, children under the age of 15 and pregnant and breastfeeding women is prohibited.
• By 1 July 2021 the Ministry of Health should prepare a national plan with measures to be taken for phasing out the use of dental amalgam.

• The European mercury regulation from 2017 has passed into national law post-Brexit, prohibiting the use of dental Amalgam for dental treatments of deciduous teeth, children under the age of 15 and pregnant and breastfeeding women in  England, Scotland, Wales and Northern Ireland.