For several years now, the FDA guidance on dental amalgam – the stuff used to make “silver” fillings – has said that it should be avoided for some patients. The mercury content makes amalgam fillings too risky for children, pregnant and nursing mothers, women who plan on pregnancy, and people with certain health problems.
But over in Colorado, a dentist who worked in two correctional facilities specifically serving women and people with complex medical conditions has claimed that he was fired for raising concerns about the routine use of amalgam. He has filed a whistleblower lawsuit.
The FDA found that mercury-containing fillings, which have been commonly used for more than a century, released small amounts of mercury vapor over time with regular wear and tear, and that while the vapors are typically not harmful, they can cause problems in high-risk patients.
[Dr. Charles] Hardin grew concerned that the prison system was over-relying on mercury amalgam when “safer alternative materials existed,” and when at-risk or mentally ill prisoners could not knowingly consent to the mercury mix’s risks, according to the lawsuit.
Though the case is still unfolding, the situation alone is revealing. It shows how hard it can be to challenge entrenched norms inside large institutions – especially when cost, convenience, and bureaucratic inertia outweigh individual decision-making. It reminds us of how slowly change can move in settings where patients have little or no ability to choose their dentist or the materials used in their care.
Meantime, beyond prison walls, dentistry continues to move away from amalgam. The global treaty known as the Minamata Convention now states that all nations involved – including the US – must phase out the material completely by 2034.
Even now, in private dental settings, patients are now routinely offered mercury-free alternatives, often described as “tooth-colored fillings.” Yet in publicly funded dental settings – corrections facilities, the military, the Indian Health Service, and other large programs – the old ways tend to linger. They persist because things like standardization and short-term cost control drive the decision-making process.
What these settings share is limited choice. When patients can’t choose their provider or materials, outdated practices tend to last longest.
Cost is often cited as the main reason to keep using mercury amalgam – a sign of fiscal responsibility. Yet as research has shown, amalgam is the cheaper option only if you ignore its real world costs, such as environmental contamination, waste handling, mercury separation, occupational exposure, and long-term public health impacts. Once you factor in these external costs, amalgam actually proves to be more expensive than “white” composite fillings.
But it’s communities, ecosystems, and health systems that bear those costs and manage the fallout.
Our own practice has been mercury-free and mercury-safe for decades now. It’s not a choice we made to seem cool or cutting edge. We did it because mercury isn’t biocompatible.
Instead, we have an array of composite resins and ceramic materials to choose from and have testing available to identify the safest materials for individual patients. We follow mercury-safe protocols that protect patients, dental staff, and the environment.
Just as importantly, we prioritize prevention and conservative treatment planning, so you’re less likely to need extensive dental restorations in the first place. We believe patients deserve dentistry that supports their whole body health for the long-term.
We hope to see this type of dental care become the norm everywhere – not just where patients have lots of options but where they have the fewest, too. Perhaps the Colorado lawsuit will help move us closer to that ideal.
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