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EU agrees to phase out Dental Amalgam by January 2025

Strasbourg, 8 February. Dental amalgam will be phased out in the EU by 1 January 2025 with few limited exceptions. This was agreed by representatives of the Commission, the Council and the European Parliament. As dental amalgam consists of 50% mercury and poses a risk to the environment and health, it has long been controversial.

Since 2018, dental amalgam is not allowed to be used for children under 15 years of age and pregnant or breastfeeding women. Now, the phase out is set to be extended to the entire EU population.

Only the Czech Republic and Slovenia should be granted a 18-month transitional period to adapt their healthcare systems, as Dental amalgam is still the only material that is fully reimbursed by their public healthcare system.

The export of dental amalgam will be banned by 1 January 2025 and by 30 June 2026, the production and import of dental amalgam be phased out as well. It will then only be possible for exceptional medical cases and the European Commission is to examine by 31 December 2029 whether the exemption can be withdrawn.

With an average of 0.6 grams per filling and a total consumption of 40 tons of mercury per year, dental amalgam is the largest remaining use of mercury in the EU. About 1000 tons of mercury are still placed in the mouths of European people.

When using dental amalgam, mercury is inevitably released into the environment despite all safety precautions. It is not a local problem but an international threat, as mercury crosses borders through the atmosphere and water bodies. The current state of the environment is alarming:  40% of surface waters in the EU are contaminated with mercury, posing a risk to birds and marine mammals that feed on contaminated fish or shellfish (EEA 2018) and putting the human consumption of fish at risk.

In addition, small amounts of mercury are constantly evaporating from the fillings, which poses a direct risk to the vulnerable population. In particular, mercury is released during placement and removal, which exposes not only patients, but also dentists and dental assistants.

„Nearly half of the EU member states have already phased out its use or reduced it to less than 1%. It has been proven that the alternatives are effective, available and affordable so that hazardous waste shouldn’t be unnecessarily placed into peoples mouth.“ says Florian Schulze, Managing Director of the European Network for Environmental Medicine and a leading expert on dental amalgam in the EU stakeholder process.

Further Information:

European Union:

  • Dental amalgam is being replaced in the public health care system by Glass Ionomers and Alkasite, with fees having been increased by 64%.
  • The Austrian Dental Association still rejects the proposal to fully reimburse Alkasite in the Public Program.
  • The charge of a composite filling in private dentistry continues to be about three times higher.

  • Dental amalgam is being replaced in the public health care by adhesive Materials, with fees having been increased by 10% to 27% depending on the number of dental checkups and access to social care.
  • The charge of a composite filling in private dentistry continues to be about three times higher.

  • Dental amalgam is replaced in the public health care services by Composites with fees increasing by 15%. Children up to 18 years are fully covered, adults pay a low co-payment.
  • The charge of a Composite filling in private dentistry is up to three times higher, depending on the dentist and the size and complexity of the filling.

  • Dental amalgam is replaced in the public health care services by Glass Ionomer Cements with an indication for permanent fillings (glass-hybrid) and Composites for children up to the age of 18.
  • The Dental Association rejects the planned introduction of full reimbursement for composite fillings and only accepts glass ionomer cements for the entire population.
  • The charge of a Composite filling in private dentistry is up to four times higher than currently reimbursed for composites in the public health care services.

  • Non-layered Composite fillings  are replacing dental amalgam with reimbursement fees only being 20% higher. 
  • The charge of a composite filling in private dentistry is about two times higher for Patients up to 18 years and up to five times higher for adults.

  • The General Health System in Cyprus currently only covers preventive services (like check-ups and cleanings), while restorative treatments such as fillings are generally not included.
  • The Health Sector Strategic Plan 2024-2026 is foreseeing to increase the oral health coverage and develop an Oral Health Plan in line with WHA 74.5 Resolution on Oral Health.
  • Dental amalgam is replaced in the public health care services by Single-Layer Composite and Compomere with fees only 12 % higher than for amalgam.
  • The charge of a Multilayer Composite filling in private dentistry is up to four times higher.

  • Dental amalgam is being replaced in the public health care by Mercury-free Alternatives, without specifying the Material, while fees having been increased by 70 %.
  • The charge of a composite filling in private dentistry is only about 40% higher.

  • Dental amalgam is being replaced in the public health care depending on municipality’s pricing structure with Composite Materials or even Laboratory-made Inlays/Onlays. The fees were increased by 72% to 123% depending on the municipality.
  • The charge of a composite filling in private dentistry is about twice as high.

  • Dental amalgam is being replaced in the public health care without specifying the alternative Material. The fees were increased by 52 % while the share of reimbursement to the patient was reduced from 70% to 60%.
  • The charge of a composite filling in private dentistry is now about three times higher.

  • Dental amalgam is being replaced in the public health care by Self-Adhesive Materials and Bulk-fill Composites (in exceptional cases), with fees having been increased by 8 %.
  • The charge of a composite filling in private dentistry continues to be about four times higher.

  • Oral healthcare in Greece is almost entirely provided by private practitioners, with patients paying the entire cost of the care themselves. The participation of private dentists in the public health system (EOPYY) is minimal.
  • Within NHS hospitals dentists provide simple and complex dental fillings for children up to the age of 14 and simple dental fillings for adolescents and adults that are covered by the EOPYY.
  • Aesthetic fillings were added to the reimbursement system in 2011 with fees only 14 % higher than for dental amalgam. Dental fillings are free for citizens up to the age of 18, students, people aged 62 years or older, and pregnant women.
  • The charge of a Multilayer Composite filling in private dentistry is probably up to two times higher.

  • Dental amalgam is being replaced in the public health care by Composite with adhesive, while fees having been increased by 60 %.
  • The charge of a composite filling in private dentistry is about twice as high.

  • Dental care is mostly private in Italy (only 4% of dental care is provided within the National health system) so most of the population (more than 95%) pays for dental care out of pocket.
  • The Servizio Sanitario Nazionale (SSN) guarantees dental restorations to individuals of developmental age and to vulnerable people, but does not specify the material used. There were no significant changes with the ban on dental amalgam.
  • The charge of a Composite filling in private dentistry is up to five times higher than a filling in the SSN.
  • Dental amalgam is replaced in the public health care services by Composite, Compomere and Glass Ionomer Cement with fees only 53 % higher for Composites, but only children up to 18 years and other stipulated groups are covered.  
  • The charge of a Multilayer Composite filling in private dentistry is about five times higher.

  • The Public Health Services only cover dental fillings for children. Medical Centers serving Ministry staff (police, border guards, firefighters, etc.) fully reimburse Composite and Glass Ionomer fillings.
  • The estimated cost for a Composite filling in private dentistry may range between 70 € and 150 €, depending on the dentist and the size and complexity of the filling.

  • Dental Fillings continue to be reimbursed in the public health care system without specifying the material. Children up to 18 years get fully reimbursements, adults 88%. The fees were increased in April 2025 by 12,5%.
  • The charge of a Composite filling in private dentistry is up to three times higher.

  • Malta’s NHS fully covers Dental Fillings in public hospitals or Maltese health centers (public service clinics) for diabetics and people on social security (means tested based on income, assets, or overall financial situation)
  • However, most dentists have their own private practices. For private practice, the patient has to pay directly for the dental treatment received. All restorations done privately are paid for by the patient out of pocket and there is no coverage.
  • Dental amalgam is replaced in the public health care services by Glass Ionomer, Glass Carbomer or Compomere and Composite with fees about 21% to 42 % higher than for dental amalgam, but only children up to 18 years are fully covered.
  • The charge of a Composite filling in private dentistry is usually not higher than in public dentistry as the fee-recommendations by the dental association also apply to adults. Dentists are never the less free to charge more.

  • Dental amalgam is being replaced in the public health care by Glass Ionomer Cements, High Density Glass Ionomer Cements and Resin-reinforced Glass Ionomer Cements, with fees having been increased by 17 %.
  • The charge of a composite filling in private dentistry continues to be about four to five times higher.

  • In Portugal, the public healthcare system covers dental fillings, without specifying the material, only for children and adolescents up to the age of 18, pregnant women and elderly individuals receiving the solidarity supplement. Annual vouchers for dental treatments could last for simple and complex fillings, but also need to be used for preventive measures.
  • The charge of a Composite filling in private dentistry is comparable to the reimbursements received under the public program.

  • Dental Fillings continue to be reimbursed in the public health care system without specifying the material. Children up to 18 years and other stipulated groups get fully reimbursements, adults 60%. The fees increased in October 2024 by 12%.
  • The charge of a Multilayer Composite filling in private dentistry is up to three times higher.

  • Dental amalgam is replaced in the public health care services by Glass-Ionomer Cements or Single Layer Composites with fees about 28% to 48 % higher than for dental amalgam, but only children up to 18 years are fully covered, adults receive subsidies. 
  • The charge of a Multilayer Composite filling in private dentistry is not significantly higher.

  • Dental amalgam is replaced in the public health care by Composite and Compomere while fees are increasing by 96 % for adults older than 26 Years.
  • The charge of a composite filling in private dentistry is about twice as high.

  • The Spanish National Health System (SNS) does not comprehensively cover dental care including dental fillings; much of dental care is paid out-of-pocket or via private insurance.
  • A recent announcement by the Spanish government indicates that an “oral health plan” will benefit about 13 million people by extending public coverage of certain dental services.
  • Dental amalgam is being replaced in the public health care by Composites with adhesive. Subsidies for dental amalgam were already removed in 1999.
  • The charge of a composite filling in private dentistry is less than two times higher than referenced in the public health care system.

Europe:

  • Norway introduced a general ban on dental amalgam in 2008, with three years exemptions for special cases.
  • The Public health services cover Composite and Glass Ionomer fillings for children up to 18 years, mentally and physically disabled people and groups of seniors.
  • The Charge of a Composite filling for adults in private dentistry is up to 25 % higher than in public dentistry, depending on the dentist and the size and complexity of the filling. (approx. 1.000-2.500 kr vs. approx. 1.000-2.000 kr