Indian Health Service Moving Away From Mercury-Based Dental Fillings

By Joe Morey Rez Life Weekly Editor

A long-standing dental practice within the federal health system serving Native communities is coming to an end, as the Indian Health Service announces plans to eliminate mercury-based dental fillings across its clinics nationwide.

The move signals more than a routine medical update. For many tribal health advocates, it represents a step toward addressing long-standing disparities in health care options available to Native American and Alaska Native patients who rely on federally operated services.

For generations, Indian Health Service dental programs have used amalgam fillings, commonly known as “silver fillings,” to treat tooth decay. The material contains elemental mercury, a substance that has faced increasing scrutiny worldwide because of environmental and potential health concerns. While commonly used in dentistry for decades, critics have argued that continued reliance on mercury fillings within government health systems has created an uneven standard of care between Native patients and those with access to private dentistry.

Many Native leaders and health advocates have said the issue goes beyond dentistry itself. It raises broader questions about whether tribal citizens receive the same modern treatment options routinely available elsewhere.

The Indian Health Service says it will complete its transition to mercury-free dental materials by 2027. Agency data shows the shift has already been underway for years. In 2005, about 12 percent of IHS dental patients received amalgam fillings. By 2023, that number had dropped to just 2 percent among the agency’s approximately 2.8 million patients nationwide.

Federal officials say the decision reflects growing awareness of mercury’s environmental impact and global efforts to reduce exposure to the heavy metal. The U.S. Department of Health and Human Services, which oversees IHS, pointed to international agreements and evolving medical standards as key factors behind the change.

Health Secretary Robert F. Kennedy Jr. called the transition a preventative measure aimed at protecting patients while honoring the federal government’s trust and treaty responsibilities to tribal nations.

Health regulators note that dental amalgam can release small amounts of mercury vapor during placement or removal and even through everyday activities like chewing. The U.S. Food and Drug Administration recommends avoiding the material for certain higher-risk groups, including pregnant women, young children, and individuals with neurological conditions. At the same time, federal regulators and the American Dental Association maintain that existing research has not demonstrated definitive long-term health harm from amalgam fillings.

Still, advocates in Indian Country say the debate has never been solely about safety. It has also been about choice.

Patients relying on IHS or other publicly funded health systems often have fewer options than those receiving private care, according to longtime mercury-free dentistry advocates. For tribal communities, where access to dental providers is already limited by geography, funding constraints, and workforce shortages, treatment decisions are frequently shaped by availability rather than preference.

“This is really about equity,” tribal health advocates have argued in recent years. “Native patients should not receive older materials simply because of where they receive care.”

The policy change also aligns with international momentum. The World Health Organization has encouraged countries to reduce the use of mercury-containing products, and the United States joined the Minamata Convention in 2013, a global treaty aimed at reducing mercury’s harmful effects on human health and the environment. Nations participating in the agreement have committed to phasing out dental amalgam by 2034.

By setting a 2027 deadline within IHS facilities, federal officials say the agency will move ahead of the global timeline, though many developed nations have already discontinued the practice entirely.

Rochelle Diver of the International Indian Treaty Council said the change brings tribal health systems closer to modern dental standards already adopted elsewhere around the world, noting that many dentists now consider mercury fillings outdated.

The American Dental Association, while acknowledging declining use nationwide, continues to describe amalgam as a safe, durable, and affordable treatment option, particularly in situations where cost and longevity remain considerations.

Mercury’s disappearance from dental clinics mirrors a broader trend across medicine. Over the past several decades, mercury has largely been removed from thermometers, blood pressure devices, and other medical equipment as safer alternatives became widely available.

For Native communities, however, the transition carries deeper meaning. Access to quality health care has long been tied to federal treaty obligations, and disparities in funding and services within the Indian Health Service have remained a persistent concern for tribal leaders.

As IHS completes the move toward mercury-free dentistry, advocates say the change represents progress toward a more modern and equitable standard of care, one that reflects both advancements in medicine and the expectation that tribal citizens receive health services equal to those available elsewhere in the country.

For many families who depend on IHS clinics, the shift may feel small at first glance. But within Indian Country, where health care decisions often carry generations of historical weight, it marks another step toward closing long-standing gaps in access, choice, and trust in the system designed to serve Native people.