EU Silver Filling Ban Raises Concerns in Northern Ireland

UK: Dental professionals in Northern Ireland are expressing apprehension about the future availability of silver dental fillings as the European Union prepares to phase out dental amalgam by January 1, 2025. This action, a consequence of Brexit trading arrangements, will not only impact Northern Ireland but will also affect dental care across the United Kingdom. 

The ban includes a prohibition on the export of amalgam from the EU, and concerns arise as a significant portion of the supply originates from Germany, potentially leading to shortages in the National Health Service (NHS).

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Disproportionate Impact on Northern Ireland’s Health Service

The British Dental Association (BDA) highlights that Northern Ireland is set to be “disproportionately” affected due to the region’s weakened health service, characterized by extended waiting lists and the highest usage of amalgam in the UK. The BDA emphasizes that amalgam is an affordable and efficient treatment for dental restoration, crucial for addressing the specific oral health needs in Northern Ireland.

Quoting an open letter from the BDA to the UK’s four chief dental officers, they state, “This recent EU development is of critical importance for Northern Ireland. We do not believe the phase-out is feasible by 1 January 2025 given the significant state of unreadiness in oral health prevention and mitigation strategies currently in place. Urgent action must be taken.”

Legislative Framework and Concerns for the UK

Under the Windsor framework and the Northern Ireland protocol, certain EU rules, including those related to dental amalgam, must be observed. The BDA expresses deep concern about the potential impact of the EU phase-out on dental services in the UK, both directly under post-Brexit arrangements and indirectly due to the collapse of the supply chain in Europe.

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Data from Northern Ireland reveals that amalgam is utilized in 46% of fillings, the highest among the UK regions, reflecting the region’s poorer health outcomes. The BDA argues that amalgam is about 50% cheaper than white filling material and is longer-lasting, raising fears of increased costs for NHS dental services already deemed “precarious.”

Environmental Regulations and Alternatives

Regulations in the UK and the EU restricted the use of part-mercury fillings in 2018 as part of the Minamata Convention on Mercury treaty aimed at reducing global environmental pollution. Although there is no evidence of harm caused by amalgam according to NHS Education for Scotland literature, its usage in children under 15 and pregnant or breastfeeding women was prohibited unless deemed necessary by the dentist.

Mitigation Efforts and Legislative Challenges

MEPs have backed an amendment to limit the socioeconomic impact of the EU’s move. The Scottish government has passed an amendment to its existing legislation to counter the extra costs associated with amalgam phase-out. However, the suspension of the power-sharing government in Stormont hinders such legislation in Northern Ireland. While the EU’s proposal could potentially be stopped in Northern Ireland under the “Stormont brake” mechanism in the Windsor framework, the requirement for Stormont to be operational presents a significant hurdle.

A spokesperson from the Northern Ireland Office states, “The UK’s position is simply to phase down the use of dental amalgam but our priority remains that everyone seeking dental care can receive it when they need it.”

The situation remains subject to further negotiations between the EU parliament and the council, emphasizing the need for urgent attention to address potential disruptions to dental care in Northern Ireland.