The World Health Organization (WHO) has released new global guidelines promoting environmentally sustainable and less invasive approaches to preventing and managing dental caries, including a shift toward mercury-free restorative materials.
The guideline, Environmentally Friendly and Less Invasive Oral Health Care for Preventing and Managing Dental Caries, provides evidence-based recommendations aimed at improving patient safety while reducing dentistry’s environmental footprint.
“This guideline represents a landmark in global oral health,” said Dr. Benoit Varenne, dental officer at the WHO. “For the first time, countries have strong evidence showing that safe and less invasive interventions with mercury-free products can effectively prevent, stop and manage dental caries, while providing a more environmentally sustainable alternative to dental amalgam.”
The guideline comes after growing international commitments to phase down mercury use under the Minamata Convention on Mercury. Late last year, a United Nations environmental body decided to phase out mercury use — including dental amalgam — by 2034 as part of global efforts to reduce mercury pollution.
The new guideline will be officially launched during a global webinar marking World Oral Health Day on March 19.
Related: What dentists need to know about the U.N. decision to end dental amalgam by 2034
Dental caries impact 2.7 billion people
Dental caries remains the most common non-communicable disease globally, affecting an estimated 2.7 billion people, according to the WHO. The disease often begins in early childhood and disproportionately affects underserved populations.
Historically, treatment has relied heavily on restorative procedures using dental amalgam, which contains mercury and can pose risks to human health and the environment.
Mercury occurs naturally in the Earth’s crust, but human activities such as mining and fossil-fuel combustion have intensified global mercury pollution. Once released into the atmosphere, mercury can settle into water or onto land, where it is converted into methylmercury — a highly toxic form that accumulates in fish, shellfish and animals that eat fish.
According to the United States Environmental Protection Agency, most human exposure comes from eating contaminated seafood.
Related: Different Physical Stressors Cause Mercury To Be Released from Dental Amalgam Fillings
Prevention and minimally invasive care emphasized
The WHO says the guideline presents a comprehensive package of mercury-free clinical interventions, focusing on prevention, non-invasive management and minimally invasive treatment of dental caries.
It also says the recommendations are supported by systematic reviews examining clinical performance, toxicology, cost-effectiveness and environmental impact.
Among the key recommendations:
- Population-wide prevention, including strong recommendations for fluoride varnish and pit-and-fissure sealants for children at high risk of caries.
- Non-invasive management, such as fluoride varnish for early lesions and biannual silver diamine fluoride to halt moderate lesions.
- Mercury-free restorative materials, including glass ionomer cements and resin-based composites.
- Safety protocols for handling resin-based materials to protect patients and dental personnel.
- Special considerations for vulnerable groups, including limiting products containing BPA derivatives among children, adolescents and pregnant or breastfeeding women.
Aligning oral health with global sustainability goals
The guidance supports implementation of the World Health Organization Global Oral Health Action Plan 2023–2030, which calls for integrating essential oral health services into universal health coverage.
“Oral health care must evolve to support planetary health,” said Dévora Kestel, acting director of WHO’s Department of Noncommunicable Diseases and Mental Health. “By promoting mercury-free products and less invasive clinical procedures, this guideline strengthens both environmental protection and universal access to safe, essential oral health care.”