CMS is urging every state Medicaid program to phase out coverage for dental amalgam, citing concerns about mercury exposure and the availability of widely used alternatives such as composite resin, porcelain and glass ionomer.
By yourNEWS Media Newsroom
Federal health officials are calling on state Medicaid programs to stop paying for dental fillings that contain mercury, marking a new push to move public dental care away from amalgam and toward mercury-free alternatives.
The Centers for Medicare and Medicaid Services sent letters July 22 to Medicaid directors in every state, encouraging them to restrict or eliminate coverage for dental amalgam. The material, commonly used to treat cavities, combines mercury with other metals.
The request does not immediately prohibit dentists from using amalgam, but it asks states to use Medicaid coverage policies to accelerate a nationwide shift away from the material.
“Americans should feel confident that the health care they receive is always working in their best interest,” CMS Administrator Dr. Mehmet Oz said in a statement.
“That’s why we’re urging state Medicaid programs to end the use of mercury-containing dental fillings. This is a straightforward and meaningful step that reflects our shared commitment to safe, higher quality care for all Americans and supports the Trump Administration’s broader goal to Make America Healthy Again.”
Health Secretary Robert F. Kennedy Jr. said the continued use of mercury in dentistry is no longer justified when other restorative materials are readily available.
“Mercury has no place in the mouths of our children or in modern American health care. For decades, we have relied on a material that contains one of the world’s most toxic heavy metals when safe, effective mercury-free alternatives are widely available. The Make America Healthy Again agenda means confronting outdated practices that needlessly expose Americans to toxic substances,” Kennedy said.
Dental amalgam has been used for generations because it is durable, relatively inexpensive and able to withstand the pressure of chewing, particularly in back teeth. Its use has become increasingly controversial, however, because mercury can be released in small amounts over time.
Research has detected higher mercury concentrations in the blood of some patients with amalgam fillings, while other patients have attributed a range of health symptoms to the material.
The long-term significance of those exposures remains disputed within dentistry and public health. The American Dental Association continues to maintain that amalgam fillings are safe, while federal health agencies have acknowledged gaps in the available evidence for some populations.
The U.S. Food and Drug Administration has said long-term health data involving amalgam use in young children are limited. The agency has also advised that certain groups, including children younger than 6, may face greater health risks from mercury exposure.
The concern extends beyond direct exposure in patients. Mercury from dental offices can enter wastewater systems during the placement or removal of fillings, adding an environmental dimension to the debate over continued amalgam use.
International policy has also moved toward reducing dependence on the material. The United States signed the Minamata Convention on Mercury in 2013. The agreement urges participating countries to restrict the use of dental amalgam and identify suitable alternatives.
Several countries have already phased out or sharply limited mercury-containing fillings, particularly for children, pregnant women and other groups considered more vulnerable to exposure.
The Indian Health Service has also announced plans to discontinue the use of mercury amalgam. In February, the agency said it would end the practice by 2027 because of “health concerns regarding mercury exposure.”
That decision affects dental care provided to American Indians and Alaska Natives and places another major federal health program on a path toward mercury-free restorations.
States now must decide whether to follow the CMS recommendation by changing their Medicaid reimbursement policies. Because Medicaid is jointly funded by the federal government and the states, coverage rules can vary significantly from one jurisdiction to another.
Restricting reimbursement could reduce the use of amalgam by making mercury-free fillings the standard covered option for low-income patients enrolled in Medicaid.
Alternatives include composite resin, porcelain and glass ionomer. Composite resin is frequently selected because its white color closely matches natural teeth and its cost is generally moderate.
The International Academy of Oral Medicine and Toxicology says composite fillings can be as durable as amalgam and are the most commonly chosen substitute.
Porcelain restorations also offer a tooth-colored appearance and can be highly durable, although they may be more expensive. Glass ionomer materials can release fluoride and may be useful in certain locations, particularly where chewing pressure is lower.
The suitability of each material depends on the size and location of the cavity, the condition of the remaining tooth, moisture control during placement and the patient’s individual dental needs.
The federal request represents a broader change in how officials are approaching longstanding medical and dental practices involving potentially toxic substances. Rather than waiting for a nationwide ban, CMS is encouraging states to use payment policy to reduce exposure and speed adoption of newer materials.
No deadline was announced for states to revise their Medicaid programs, and it remains unclear how many will immediately act on the recommendation.
The initiative nevertheless signals that mercury amalgam may face increasing restrictions within publicly funded dental care as federal agencies, international agreements and some health organizations continue pressing for its replacement.
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