Monday, August 25, 2025

State Surgeon General Dr. Joseph A. Ladapo Issues Guidance for Amalgam Restoration Use

Tallahassee, Fla. — State Surgeon General Dr. Joseph A. Ladapo recommends against the use of dental amalgam for routine fillings due to the risk of mercury exposure.

Dental amalgam is a mixture of metals, consisting of liquid (elemental) mercury and a powdered alloy composed of silver, tin, and copper. Approximately half (50%) of dental amalgam is elemental mercury by weight. Dental amalgam is estimated to be responsible for 60-95% of mercury deposits in some human tissues. Researchers have found mercury levels in blood and urine are significantly higher in persons with amalgam than those without, and the levels correlate with the number of amalgam fillings.

Amalgam releases low levels of mercury in the form of a vapor, which can be inhaled and absorbed by the lungs and other organs, and has been found to cause DNA damage in human blood cells and potential impairment with renal function.

Today, there are alternatives to amalgam including composites, glass ionomer, stainless steel crowns, and permanent crowns.

Floridians should be aware of additional concerns related to amalgam fillings, that include:

Maternal amalgam fillings lead to a significant increase in the mercury levels in fetal and infant brain tissues which may increase the risk of delayed neurodevelopment in children.

Women with three or more amalgam fillings have statistically higher mercury levels in maternal serum, cord blood, and placenta than in those without amalgam.

There is a correlation between mercury levels in breast milk and the number of amalgam restorations the mother has received.

Children with the CPOX4 genetic variant may be particularly susceptible to mercury’s neurotoxic effect:

Significant adverse effects on neurobehavioral functions have been associated with chronic mercury exposure.

Patients should discuss alternatives to amalgam with their dental providers. Composites may be chosen for aesthetics, and composites with 65% or more filler content may be utilized for posterior restorations, rather than one material universally. Stainless steel crowns or permanent crowns may be necessary for teeth with extensive damage. Patients are encouraged to discuss risks and benefits with their providers regarding potential treatment options.

The greatest risk of mercury exposure is upon placement and removal of amalgam fillings. Therefore, at this time, it is not recommended to remove or replace intact amalgam fillings unless medically necessary. Patients and their providers should take all available measures to avoid the use of amalgam for future fillings.