Florida Surgeon General Dr. Joseph A. Ladapo is recommending against the use of dental amalgam for routine fillings, citing potential risks from mercury exposure.
Dental amalgam is a mixture of metals, roughly 50% elemental (liquid) mercury by weight, combined with a powdered alloy of silver, tin and copper. Mercury binds the alloy particles into a strong, durable, and solid filling, according to the FDA.
However, amalgam releases low levels of mercury vapor, which can be inhaled and absorbed by the lungs and other organs. According to Ladapo, multiple studies have linked mercury exposure from so-called “silver fillings” to DNA damage in blood cells and kidneys.
Researchers estimate that amalgam may account for 60% to 95% of mercury deposits in some human tissues. Studies, including one from 2025 involving 108 Jordanians, show that blood and urine mercury levels are significantly higher in individuals with amalgam fillings, correlating with the number of restorations.
“Today, there are alternatives to amalgam including composites, glass ionomer, stainless steel crowns, and permanent crowns,” Ladapo said in the guidance issued Monday.
He advises patients to discuss these options with providers to choose the material that best fits their needs.
Health experts warn that intact fillings should not be removed unless medically necessary. According to Ladapo, “the greatest mercury exposure occurs during the placement or removal of amalgam fillings.”
The guidance comes despite the Food and Drug Administration, American Dental Association and other organizations asserting the compound is safe except for certain high-risk groups.
The FDA and American Dental Association say most evidence shows exposure to mercury from dental amalgam does not lead to negative health effects in the general population.
For years, amalgam fillings in pregnant woman have been tied to increased mercury levels in fetal and infant brain tissue, possible neurodevelopmental delays in children, and elevated mercury in maternal serum, cord blood, placenta and breast milk.
Also, mercury’s neurotoxic effects may affect children with the gene variant CPOX4, which plays a key role in the production of hemoglobin, myoglobin and certain enzymes.
According to the FDA, other risk groups include people with preexisting neurological disease, impaired kidney function, or an allergic reaction to mercury, silver, copper or tin.
