WHO guideline on environmentally friendly and less invasive oral health...

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WHO guideline on environmentally friendly and less invasive oral health care for preventing and managing dental caries

Executive summary

Background
Dental caries is a major public health problem affecting all age groups. It often begins in early childhood and increases across the life course. Although largely preventable and treatable at an early stage, dental caries affects 2.7 billion people worldwide, with a disproportionate impact on marginalized populations that have limited access to essential oral health care services (1). Dental amalgam has been used for decades to restore teeth affected by dental caries. It contains mercury, about 50% by weight, chemically bonded to other metallic elements such as silver and tin. Mercury is a highly toxic heavy metal that poses a global threat to human health and the environment.
The Minamata Convention on Mercury, a global treaty in force since 2017, seeks to protect human health and the environment from anthropogenic emissions and releases of mercury. The World Health Organization (WHO), mandated by Member States through World Health Assembly resolutions, supports countries in implementing the Minamata Convention, promoting oral health and mercury-free dental practices, and ensuring access to essential oral health care. In collaboration with the United Nations Environment Programme (UNEP), WHO is executing a project to phase down the use of dental amalgam and to manage associated waste in line with the provisions of the Minamata Convention.

Rationale and objective
As mercury is harmful to both human health and the environment, there is a need for strong evidence-based guidance on the use of alternative materials that are free from mercury and effective in the management of dental caries. This guideline provides recommendations on safe, less invasive and environmentally friendly oral health care for preventing and managing dental caries using mercury-free dental products.
The mandate for WHO to develop such guidance comes directly from World Health Assembly resolution WHA74.5 on oral health (2). In addition, both the Minamata Convention on Mercury and the WHO Global Strategy and Action Plan on Oral Health 20232030 call for phasing down the use of dental amalgam, which requires sufficient uptake of alternative materials to manage dental caries.

Scope and target audience
The scope of this guideline is to identify and promote mercury-ree dental products, including those that can be considered direct alternatives to dental amalgam, for preventing and managing dental caries.
This guideline is intended for governments, intergovernmental organizations, non-state actors, oral health professional organizations, ministries of health and environment, health authorities, public health policymakers, health programme managers, nongovernmental organizations, industry, oral health professionals and health workers.

Methods
These recommendations in this guideline are based on the most current, high-uality scientific evidence. They were formulated using processes and methods that meet the highest international standards for guideline development, as outlined in the WHO handbook for guideline development (3). Oversight of the development process was provided by the WHO Oral Health Programme, with support from a dedicated WHO–UNEP Steering Committee.
A Guideline Development Group (GDG), composed of independent international experts with diverse expertise and perspectives, was convened to identify key questions, review the evidence and formulate recommendations. The evidence base was drawn from systematic reviews, both existing and newly commissioned, on the clinical effectiveness, cost-effectiveness, toxicity and environmental impact of mercury-free dental products for preventing and managing dental caries.
The GDG assessed this evidence and developed recommendations using the Grading of Recommendations Assessment, Development and Eval‎uation (GRADE) approach to determine the certainty of the evidence. In addition, the group considered other factors, including whether the balance of benefits to harms was sensitive to variability in patient values and preferences; the relative costs; resource use and cost-effectiveness; the acceptability and feasibility of interventions in the intended populations and settings; and anticipated impacts on equity of access and outcomes.

Recommendations and best-practice statements
This WHO guideline is grounded in the guiding principles of prioritizing preventive strategies, promoting minimally invasive interventions, fostering open communication between patients and oral health care professionals, and the precautionary principle.
This guideline includes eight recommendations and two best-practice statements. Clinical recommendations are grouped according to their primary indication: prevention of dental caries, nonrestorative interventions for managing dental caries, and direct restorations (excluding indirect restorations and advanced caries stages). Two additional recommendations and two best-practice statements address risk mitigation among clinical teams and patients.
Each recommendation and best-practice statement is accompanied by remarks to support interpretation. The guideline also summarizes the GDG discussions and the rationale behind each decision. Finally, it highlights important knowledge gaps that require further investigation through primary research.

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*Suggested citation. WHO guideline on environmentally friendly and less invasive oral health care for preventing and managing dental caries. Geneva: World Health Organization; 2025. Licence: CC BY-NC-SA 3.0 IGO.

WHO caries care guideline_2025.pdf

1.21MB