The Indian Health Service, which provides health care to Native Americans and Alaska Natives, said it will end the use of dental fillings that contain mercury and replace them with mercury-free alternatives by 2027. The decision follows a broader decline in mercury amalgams in private dentistry over the past two decades, as alternatives became more common and government regulators changed how the fillings were classified.
In an announcement this month, the agency said it will fully implement the mercury-free approach by 2027, building on progress already underway within its system. The Indian Health Service said its filings are part of an effort to address both health concerns and environmental issues tied to mercury exposure.
The U.S. Department of Health and Human Services, which oversees the Indian Health Service, said the shift was driven by “growing environmental and health concerns about mercury exposure” and by “global efforts to reduce materials containing the hazardous heavy metal.” Health Secretary Robert F. Kennedy Jr. framed the change as preventive health policy, saying in a statement that it is “a commonsense step that protects patients and prevents harm before it starts.”
The Health and Human Services department also linked the decision to the agency’s responsibilities to tribes. It said the switch to mercury-free alternatives upholds legal responsibilities the U.S. government has to the 575 federally recognized tribes.
Indian Health Service officials cited federal regulatory and international health context for the policy change. The U.S. Food and Drug Administration has said dental amalgam fillings can release small amounts of mercury vapor during placement, removal, teeth grinding and gum chewing. The FDA recommends that certain people at high risk for adverse effects of mercury exposure, including pregnant women, children under 6, and those with existing neurological conditions, avoid the fillings.
At the same time, the FDA and the American Dental Association have said available evidence does not link mercury-containing fillings to long-term negative health outcomes. The American Dental Association, in a statement accompanying the announcement, said mercury-containing fillings remain a “safe, durable and affordable material.”
The Indian Health Service’s policy shift also reflects an international timeline set by global health and treaty efforts. The World Health Organization has created a plan to encourage countries to phase out dental amalgams, and in 2013 several countries, including the United States, signed onto the Minamata Convention, which targets the adverse effects of mercury on health and the environment. In November, the convention’s signatories agreed to phase out the use of mercury-containing dental amalgams by 2034.
Within the U.S. system, the department’s timetable for IHS patients would place the agency ahead of the global schedule. Rochelle Diver, a United Nations environmental treaties coordinator for the International Indian Treaty Council, said in response to the announcement that “The rest of the world is light years ahead of us,” adding that IHS patients should not receive treatment that many dentists consider antiquated. Diver’s comments were echoed by advocates arguing that people who rely on government care may have less ability to choose alternative materials.
Charles G. Brown, president of the World Alliance for Mercury-Free Dentistry, said access and choice differ depending on where patients receive treatment. He said, “If you’re on Medicaid, if you are stuck in the Indian Health Service, if you were stuck in a prison or other institution, you just don’t have any choice,” describing limits that advocates say keep some patients from opting out of mercury-containing fillings even as they become less common elsewhere.
The Indian Health Service said the percentage of its roughly 2.8 million patient users receiving mercury-containing fillings has dropped substantially over time, declining from 12% in 2005 to 2% in 2023, the latest year of available data, based on agency documents. The agency said it will now accelerate the remaining transition to align with its stated phaseout plan.