Indian Health Service to phase out use of dental fillings containing mercury by 2027

ALBUQUERQUE, New Mexico — The federal agency that provides health care to American Indians and Alaska Natives has announced it will phase out the use of dental fillings containing mercury.

The Indian Health Service has for decades used fillings, known as dental amalgam, that contain elemental mercury to treat decayed or otherwise damaged teeth. Native American rights advocates and the industry have called for an end to the practice, arguing that it exposes patients who may not have access to private dentistry to a harmful neurotoxin.

The use of mercury-containing amalgam fillings, also called “silver fillings” because of their appearance, has declined sharply since 2009, when the U.S. Food and Drug Administration reclassified these devices from low to moderate risk. The industry has largely abandoned them in favor of alternatives to plastic resin, also favored for aesthetic reasons.

The Indian Health Service says it will fully implement the transition to mercury-free alternatives by 2027. Already, the percentage of the approximately 2.8 million patient users of the Indian Health Service who receive them has declined, from 12% in 2005 to 2% in 2023, the latest year of available data, according to agency documents.

The U.S. Department of Health and Human Services, which oversees the IHS, said growing environmental and health concerns about mercury exposure, as well as global efforts to reduce materials containing the dangerous heavy metal, prompted the change announced this month.

“This is a common-sense measure that protects patients and prevents harm before it begins,” Health and Human Services Secretary Robert F. Kennedy Jr. said in a statement.

The agency’s shift to mercury-free alternatives also respects the U.S. government’s legal responsibilities to the 575 federally recognized tribes, he said.

According to the U.S. Food and Drug Administration, dental amalgam fillings can release small amounts of mercury vapor during placement, removal, teeth grinding and gum chewing. It recommends that certain people at high risk of adverse effects from mercury exposure, including pregnant women, children younger than 6, and people with neurological problems, avoid fillings. But the administration, along with the American Dental Association, says the available evidence does not link mercury-containing fillings to negative long-term health outcomes.

The World Health Organization has created a plan to encourage countries around the world to phase out the use of dental amalgam, citing the potential for mercury exposure. In 2013, several countries, including the United States, signed the Minamata Convention, a global agreement targeting the adverse health and environmental effects of mercury. In November, signatories to the convention agreed to phase out the use of dental amalgam containing mercury by 2034.

Although Kennedy’s decision to stop its use in the IHS by 2027 puts the United States ahead of the global timeline, the country remains behind many other developed countries that have already banned the practice.

“The rest of the world is light years ahead of us,” said Rochelle Diver, U.N. environmental treaty coordinator for the International Indian Treaty Council, adding that IHS patients should not receive a treatment considered outdated by many dentists.

In a statement, the American Dental Association acknowledged the decline in the use of mercury-containing fillings but said they remain a “safe, durable and affordable material.”

The use of mercury in other medical devices, including thermometers and blood pressure monitors, has also declined sharply in recent decades. Even as mercury-containing amalgam fillings have fallen out of favor in the U.S. private dental sector, patients who rely on government services may not have a say, according to Charles G. Brown, president of the Global Alliance for Mercury-Free Dentistry.

Many state-run Medicaid programs continue to cover mercury-containing fillings as a treatment for tooth decay, Brown said.

“If you’re on Medicaid, if you’re stuck in the Indian Health Service, if you’re stuck in a prison or other facility, you just don’t have a choice,” Brown said.

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Brewer reported from Oklahoma City.