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Oral health is a neglected area of global health, although oral disease is one of the most common public health issues worldwide.1 Despite advances in modern dentistry, untreated dental caries in permanent teeth was reported as the most prevalent of the 328 conditions assessed in 2016 Global Burden of Disease Study.2 The restorative model for managing dental caries was developed in the 1900s, alongside dental amalgam as one of the restorative materials commonly used to treat dental caries. Together they still provide the backbone of oral health services in most countries today.
A shift away from the restorative model and the widespread use of dental amalgam was perhaps unimaginable even a decade ago, despite the World Health Organization (WHO) calling for oral health to be incorporated into policies for the integrated prevention and treatment of chronic noncommunicable and communicable diseases, and into maternal and child health policies.3
The Minamata Convention on Mercury (2013) is an international legally binding treaty that aims to protect the human health and the environment from anthropogenic emissions and releases of mercury and mercury compounds.4 The convention addresses mercury-added products, including dental amalgam, which is made of approximately 50% of elemental mercury by weight, and proposes nine measures to phase down the use of dental amalgam (Box 1). These measures show the interconnected and interdependent nature of phasing down dental amalgam, and reinforce the need for a multipronged approach as called for by WHO.
The implementation of the convention and its provision for dental amalgam can catalyse the shift away from the restorative model of care and the use of mechanically retained filling materials, such as dental amalgam, towards preventive and minimal intervention dentistry that predominantly uses adhesive dental materials. Implementation will also provide an opportunity to strengthen oral health promotion and oral disease prevention within an integrated, people-centred model of health services (Box 1).
Challenges of a phase down
A report from the United Nations Environment Programme revealed that mercury in dental use accounted globally for 270-341 metric tons in 2010, of which 70-100 tonnes (i.e. 20-30%) likely enters the solid waste stream.5 Disaggregated data on the supply and trade of bulk mercury for dental use as opposed to the encapsulated dental amalgam form is not available at a global...