Research | Published:

No more amalgams: Use of amalgam and amalgam alternative materials in primary dental care

BDJ volume 225, pages 171176 (27 July 2018) | Download Citation


Key points

  • Provides readers with a greater appreciation of the challenges facing the profession in terms of the Minamata Treaty.

  • Explores the challenges in moving from amalgam to resin composite for the restoration of posterior teeth.

  • Discusses the relevant evidence base for placing posterior resin composites.



The aim of this study was to investigate the use of dental amalgam and amalgam alternate materials in primary dental care in Wales.


Following pre-piloting, a questionnaire was distributed to 667 dentists registered as working in primary dental care in Wales. The questionnaire sought to determine the current use of amalgam, and amalgam alternative materials in primary dental care services in Wales. In addition, the questionnaire sought to determine the attitudes and confidence of dentists in respect of placement of resin composites as alternatives to dental amalgam.


A response rate of 40.4% was achieved (n = 270). High levels of reported confidence were seen in relation to placing resin composites in posterior teeth, but these levels reduced as the complexity of the cavity increased (while 82% of respondents 'strongly agreed' that they felt confident in placing resin composites in occlusal cavities, this reduced to 52.6% for three-surface occlusoproximal cavities). Patterns of care suggested that 73.3% of respondents often, or always, place amalgam restorations for NHS-funded dentistry in adults, where two or more posterior restorations are required. This proportion drops to 27% for the same scenario in children, and 19.4% in privately-funded care for adults. Sixty-seven percent of respondents reported that restoring posterior teeth with resin composite is too expensive for NHS-funded dentistry. A similar proportion of respondents (65.9%) agreed, or strongly agreed, that having to place resin composite routinely in posterior teeth would cause appointment delays. Respondents estimated that it would take them 1.61 times as long on average to place a resin composite, compared to an amalgam, in a moderately deep two-surface proximal-occlusal cavity in a lower first permanent molar. Respondents felt that the NHS fees would have to increase by 55–60% to support the restoration of posterior teeth with resin composite, rather than dental amalgam.


This study provided insight into current practising arrangements of primary dental care practitioners in relation to the use of dental amalgam and resin composites in the restoration of posterior teeth. Based on a sample of mainly UK-trained dentists, it would seem that amalgam remains the material typically selected for restoring posterior teeth in adults for NHS-funded care. While dentists are knowledgeable and embracing of new techniques for posterior resin composite placement, funding arrangements in NHS dentistry appear to be a barrier to the increasing use of resin composite-based, minimum intervention approaches to the restoration of posterior teeth.

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This study was funded by a grant from the Wales School for Primary Care Research, for which CDL and IGC were co-Principal Investigators. The assistance of the funder, and in particular Mr Robyn Davies and Michaela Gal, is gratefully appreciated.

We are also very grateful to those practitioners who took time from their busy schedules to complete the questionnaire.

Author information


  1. Professor/ Consultant in Restorative Dentistry, University Dental School & Hospital/ University College Cork, Wilton, Cork, Ireland

    • C. D. Lynch
  2. Senior Lecturer in Medical Statistics, School of Dentistry, Heath Park, Cardiff, CF14 4XY, United Kingdom

    • D. J. J. Farnell
  3. Research Associate, Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Heath Park, Cardiff, CF144YS, United Kingdom

    • H. Stanton
  4. Professor and Honorary Consultant in Dental Public Health, School of Dentistry, Heath Park, Cardiff, CF14 4XY, United Kingdom

    • I. G. Chestnutt
  5. Dean, Faculty of Dentistry, University of Otago, Dunedin, New Zealand

    • P. A. Brunton
  6. Emeritus Professor of Dentistry, King's College London Dental Institute, London, United Kingdom

    • N. H. F. Wilson


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Corresponding author

Correspondence to C. D. Lynch.

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