Sir, H. Al Salieti makes some very interesting points about discrepancies between teaching in dental schools and the realities of practice, particularly with regards to the teaching and use of dental amalgam.1Whilst the use of amalgam post-qualification in the UK may differ from Jordan, the argument with regards to amalgam use may soon become more pressing and increasingly complex.

Recent EU proposals2 suggest:

‘The revised Mercury Regulation targets the last intentional remaining uses of mercury in a variety of products in the EU in line with commitments set out in the EU's Zero Pollution Ambition. It sets rules that put the EU firmly on the track to becoming the first mercury-free economy by:

  • Introducing a total phase-out of the use of dental amalgam from 1 January 2025 in light of viable mercury-free alternatives, thereby reducing human exposure and environmental burden;

  • Prohibiting to manufacture and export of dental amalgam from the EU from 1 January 2025.'

Whilst not yet ratified [at the time of writing] there is a high chance the UK will be affected. Once EU production ceases, although procurement routes will still exist from Australia and USA, costs are likely to increase accordingly. Northern Ireland may be disproportionately affected due to the Windsor Framework.

Much as H. Al Saleti describes, undergraduate teaching in the UK has also shifted, in favour of composite placement over amalgam wherever practicably possible. In the UK, however, amalgam is still in widespread use amongst dental practitioners.3 Accordingly, Peninsula Dental School and some others currently provide practical amalgam teaching, in order to graduate safe practitioners. In light of the EU proposal, this leads us to consider: (i) what are the contingency plans for teaching and assessment involving amalgam? (ii) what are the options for advanced cavities in posterior teeth where adequate isolation is not possible?

Dental education and the profession as a whole need to urgently start considering the implications of disrupted supply chains on their practice and what this may mean for our patients. The impact on wider clinical care should not be underestimated, particularly against a backdrop of a crisis in NHS dentistry within the UK. Dental amalgam - here today - may be gone tomorrow.