Dental Amalgam Phase-Down-Status, Alternatives, Strategies and Preparedness for Implementation: A Review

Background: Nearly a decade since the Minamata Convention on Mercury, the progress on the phase-down of dental amalgam is unclear. Regional and national governments were tasked to develop guidelines and phase-down plans because of variations in oral health statuses and usage of restorative materials. The phase-out date of mercury-added products and manufacturing processes, unless otherwise specified, was between 2020 and 2025. Although dental amalgam was one of the few products recommended for a phase-down, the effects of the control of the manufacture, importation and exportation of mercury-added products are imminent among the many consumers who set a phase-down date of 2030. Therefore, this review aimed to analyse the situation by presenting the status of the dental amalgam phase-down, available alternatives, strategies and preparedness for implementation. Methods: A systematic literature search was conducted in three electronic databases (PubMed/MEDLINE, Google Scholar and Web of Science) using relevant keywords and combinations of Boolean terms. This was followed by a manual search of relevant references. The included studies were organized into emergent themes, forming the basis of the present review. Results: A total of 71 articles were included for the qualitative review, the majority being cross-sectional surveys. Four themes were identified-current status of the dental amalgam phase-down, perceptions on dental amalgam alternatives, phase-down strategies and preparedness for the implementation as demonstrated by knowledge, skill, competencies, attitudes, curricula and policies. Conclusion: Regions are at different levels of phasing down the use of dental amalgam, with varying experiences regarding alternative restorative materials. Notably, the teaching and placement of posterior composites is at an all-time high, and there is evidence of curricula changes denoting a paradigm shift towards preventive, minimal intervention and adhesive dentistry. Evidence-based global guidelines would be useful for a synergistic dental amalgam phase-down approach.