Florida Surgeon General Dr. Joseph A. Ladapo is warning against the routine use of dental amalgam for fillings due to potential mercury exposure. He recommends that patients discuss alternatives with their dental providers.
Dental amalgam is a mixture of metals. About 50% of it is liquid mercury, which is combined with a powdered alloy of silver, tin, and copper. Mercury helps bind the metals into a strong, durable filling, according to the U.S. Food and Drug Administration (FDA).
However, amalgam can release small amounts of mercury vapor. This vapor can be inhaled and absorbed into the lungs and other organs. Ladapo says studies have linked mercury from “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. A 2025 study of 108 Jordanians found that people with amalgam fillings had higher mercury levels in their blood and urine. The amount of mercury rose with the number of fillings.
“Today, there are alternatives to amalgam, including composites, glass ionomer, stainless steel crowns, and permanent crowns,” Ladapo said in guidance issued Monday. He advises patients to talk with their dentists to choose the material that best suits their needs.
Experts caution that existing fillings should not be removed unless necessary. Ladapo noted, “The greatest mercury exposure occurs during the placement or removal of amalgam fillings.”
The guidance comes despite statements from the FDA, American Dental Association (ADA), and other groups saying dental amalgam is generally safe. These organizations note that most people do not experience harmful health effects from mercury in fillings.
Amalgam use in pregnant women has been linked to higher mercury levels in fetal and infant brain tissue. Studies suggest possible neurodevelopmental delays in children and elevated mercury in maternal blood, cord blood, placenta, and breast milk.
Mercury may also affect children with a gene variant called CPOX4, which plays a role in making hemoglobin, myoglobin, and certain enzymes.
The FDA identifies other high-risk groups as people with neurological diseases, kidney problems, or allergies to mercury, silver, copper, or tin.
