Kisumbi Bernina Kyale, Osiro Olivia Awino, Gathece Loice Warware, Maina Susan Wanjiku
Department of Dental Sciences, University of Nairobi Dental Hospital, Nairobi, Kenya.
Int J Dent. 2025 Sep 12;2025:6688410. doi: 10.1155/ijod/6688410. eCollection 2025.
Nearly a decade since the Minamata Convention on Mercury, the progress on the phase-down of dental amalgam is unclear. Regional and national governments were tasked to develop guidelines and phase-down plans because of variations in oral health statuses and usage of restorative materials. The phase-out date of mercury-added products and manufacturing processes, unless otherwise specified, was between 2020 and 2025. Although dental amalgam was one of the few products recommended for a phase-down, the effects of the control of the manufacture, importation and exportation of mercury-added products are imminent among the many consumers who set a phase-down date of 2030. Therefore, this review aimed to analyse the situation by presenting the status of the dental amalgam phase-down, available alternatives, strategies and preparedness for implementation. A systematic literature search was conducted in three electronic databases (PubMed/MEDLINE, Google Scholar and Web of Science) using relevant keywords and combinations of Boolean terms. This was followed by a manual search of relevant references. The included studies were organized into emergent themes, forming the basis of the present review. A total of 71 articles were included for the qualitative review, the majority being cross-sectional surveys. Four themes were identified-current status of the dental amalgam phase-down, perceptions on dental amalgam alternatives, phase-down strategies and preparedness for the implementation as demonstrated by knowledge, skill, competencies, attitudes, curricula and policies. Regions are at different levels of phasing down the use of dental amalgam, with varying experiences regarding alternative restorative materials. Notably, the teaching and placement of posterior composites is at an all-time high, and there is evidence of curricula changes denoting a paradigm shift towards preventive, minimal intervention and adhesive dentistry. Evidence-based global guidelines would be useful for a synergistic dental amalgam phase-down approach.
自《汞问题水俣公约》签署近十年以来，牙科汞合金逐步淘汰的进展尚不明朗。由于口腔健康状况和修复材料使用情况存在差异，区域和国家政府的任务是制定指导方针和逐步淘汰计划。除非另有规定，含汞产品和制造工艺的淘汰日期在2020年至2025年之间。尽管牙科汞合金是少数建议逐步淘汰的产品之一，但对于许多将淘汰日期设定为2030年的消费者来说，控制含汞产品的制造、进口和出口的影响已迫在眉睫。因此，本综述旨在通过介绍牙科汞合金逐步淘汰的现状、可用替代品、策略和实施准备情况来分析这一形势。使用相关关键词和布尔术语组合在三个电子数据库（PubMed/MEDLINE、谷歌学术和科学网）中进行了系统的文献检索。随后对相关参考文献进行了人工检索。纳入的研究被组织成新出现的主题，构成了本综述的基础。共有71篇文章纳入定性综述，其中大多数是横断面调查。确定了四个主题——牙科汞合金逐步淘汰的现状、对牙科汞合金替代品的看法、逐步淘汰策略以及知识、技能、能力、态度、课程和政策所体现的实施准备情况。各地区在逐步减少牙科汞合金使用方面处于不同水平，对替代修复材料的经验也各不相同。值得注意的是，后牙复合树脂的教学和应用处于历史最高水平，并且有证据表明课程发生了变化，表明向预防性、微创和粘结牙科的范式转变。基于证据的全球指导方针将有助于采取协同的牙科汞合金逐步淘汰方法。
