individual nations should work to gradually scale down the use of dental amalgam. Environmental impact and prevention of amalgam poisoning Dental amalgam is thought to be relatively safe to be used as a restorative material as it is used in low doses. Amalgam vapour can be released through chewing but this is minimal. However, there is an increased release of mercury following the exposure of electromagnetic fields generated by MRI machines. Some patients may develop allergic reactions to it. Resin composite, glass ionomer cements and ceramic or gold inlays can be used as alternatives to amalgam. U.S. amalgam disposal regulation In the United States, dental offices have typically disposed of amalgam waste down the drain. The wastewater is sent to the local sewage treatment plant, which is not designed to treat or recycle mercury or other heavy metals. The mercury contaminates the sludge processed at the treatment plant, and thereby can spread the mercury in surrounding communities, if the sludge is land-applied for disposal. Dental amalgam is the largest source of mercury received by U.S. treatment plants. The U.S. Environmental Protection Agency (EPA) promulgated an effluent guidelines regulation in 2017 which prohibits most dental practices from disposing dental amalgam waste down the drain. Most dental offices in the U.S. are required to use an amalgam separator in their drain system. The separator captures the waste material, which is then recycled. EU amalgam disposal regulation The European Commission has issued a Waste Directive that classifies amalgam waste as a hazardous waste. The waste should be separated from other waste by fitting amalgam separators in all dental practices. Avoidance in pregnant women Mercury can cross the placenta leading to stillbirths and birth defects. Although there is no evidence linking amalgam use and pregnancy damage, it is advisable to delay or avoid dealing with amalgam fillings in pregnant patients. Awareness among dentists The dental operating team should deal with amalgam with proper use of personal protective equipment to protect themselves. A popular methodology for removal and replacement is the Safe Mercury Amalgam Removal Technique or S.M.A.R.T. protocol. Oral lesions Some individuals have a sensitivity to amalgam and may develop oral lesions in which case a change of filling type is recommended. References External links Position Paper on Amalgam Fillings, National Council Against Health Fraud Composite Fillings - Tooth-Colored Fillings, American Dental Association Amalgam Archives at Listserv.dfn.de (Forum) Dental materials Restorative dentistry Chinese inventions