Concerns have been raised about the future availability of silver dental fillings in Northern Ireland due to an imminent phasing out of the amalgam across the EU. The plan to phase out amalgam by 1 January next year will apply in Northern Ireland as a result of Brexit trading arrangements and will also affect dental care in other parts of the UK, dentist representatives said. This is because the ban includes a prohibition on exports of the product from the EU, and with much of the supply of the amalgam coming from Germany, there are fears supplies to the NHS will dry up. The British Dental Association (BDA) said Northern Ireland will be “disproportionately” affected, not just because of Brexit but because of the state of the health service in the region, the weakest in the UK with the longest waiting lists and the highest use of the filler. The BDA says amalgam is an affordable and efficient treatment for dental restoration. An open letter from the BDA to the UK’s four chief dental officers, said: “This recent EU development is of critical importance for Northern Ireland. We do not believe the phase-out is feasible by 1 January 2025 given the significant state of unreadiness in oral health prevention and mitigation strategies currently in place. Urgent action must be taken.” Under the Windsor framework, and the Northern Ireland protocol before it covering the special Brexit arrangements for Northern Ireland, some previous EU rules must be observed, including those on the dental amalgam. “We are extremely concerned about the impact this EU phase-out will have on services across the UK, both directly under post-Brexit arrangements and indirectly as a result of supply chain collapse in Europe,” said the BDA. A spokesperson said data from Northern Ireland showed that the amalgam was used in 46% of fillings, the highest use of amalgam in the UK, a reflection of the poorer health outcomes in the region. England, by contrast, only used amalgam in about 33% of fillings. Regulations in the UK and the EU restricted use of the part-mercury fillings in 2018 as part of the Minamata Convention on Mercury treaty to reduce global environmental pollution caused by mercury, including the release of the heavy metal during the production of dental amalgam. Although, according to the NHS Education for Scotland literature, there is no evidence of any harm caused by amalgam, the use of amalgam fillings in children under 15 and pregnant or breastfeeding woman was prohibited under the 2018 regulations, unless the dentist deemed it necessary. The BDA says amalgam is about 50% cheaper than the white filling material and is also longer lasting, raising fears of increased costs of NHS dental services, which it says are already in a “precarious” state. “The loss of a vital restorative material and its replacement with more expensive and time-consuming alternatives is only a further blow to the financial viability of NHS dentistry. It is a particular loss in the context of high-needs patients for whom amalgam remains the best treatment option,” it said in its letter to the UK dental officials. MEPs have backed an amendment to limit the socioeconomic impact of the move. The Scottish government has passed an amendment to its existing Statement of Dental Remuneration legislation to mitigate the extra costs caused by the phasing out of amalgam. However, with the continued suspension of the power-sharing government in Stormont, no such legislation can be progressed in Northern Ireland. Referring to talks on the final text of the rule that the European parliament has already approved, a Northern Ireland Office spokesperson said: “This proposal is still subject to further negotiations between the EU parliament and the council. “The UK’s position is simply to phase down the use of dental amalgam but our priority remains that everyone seeking dental care can receive it when they need it.” If finally agreed, the EU’s proposal could be stopped in Northern Ireland under the “Stormont brake” mechanism in the Windsor framework, but this would require Stormont to be up and running.