Prevention Over Restoration
In October 2025, the World Health Organization (WHO) developed the “WHO Guideline on Environmentally Friendly and Less Invasive Oral Health Care for Preventing and Managing Dental Caries.”1 While the bulk of the document focuses on eliminating mercury by decreasing the use of amalgam, the recommendations heavily emphasize minimally invasive treatment and prevention. These measures are procedures that can typically be performed by a dental hygienist — meaning, once again, our profession should be at the forefront of solving dental disease.
As the document states, dental caries is a major global oral health problem, impacting individuals of all ages. In fact, dental caries affects 2.7 billion people worldwide, with low-access populations taking the hardest hit.2 The WHO guideline marks a definitive shift in professional philosophy. We are no longer merely managing a clinical condition; we are responding to a global environmental and public health imperative. The new WHO recommendations move beyond a simple substitution of materials. They advocate for a fundamental reorientation toward minimally invasive dentistry. Unlike amalgam, which requires mechanical retention through the removal of healthy tooth structure, mercury-free alternatives support more conservative preparations, preserving the biological integrity of the dentition.
Additionally, the WHO highlights that the most effective mercury-free alternative is prevention. This includes the use of high-concentration fluoride toothpastes, fluoride varnishes, and pit-and-fissure sealants to arrest lesions before restoration is required. Furthermore, the guideline emphasizes nonrestorative interventions. By prioritizing preventive strategies and the arrest of early-stage lesions, the dental community can reduce the cumulative restorative burden. This upstream approach is essential for achieving the equity goals outlined in the WHO mandate, ensuring that the transition to mercury-free dentistry does not exacerbate existing disparities in access to care.
The WHO specifically advises a precautionary approach for certain groups to minimize both mercury and chemical exposures:
- Children and Pregnant Patients: Glass ionomer cements (GICs) are often preferred over resin-based composites in children and pregnant women to avoid potential endocrine disruptors such as bisphenol-A derivatives found in some resins.
- High-Caries Risk: GICs are recommended due to their ability to act as a fluoride reservoir, releasing ions into the surrounding tooth structure to prevent secondary lesions.
- Marginalized Populations and Remote Settings: The use of atraumatic restorative treatment using high-viscosity GICs is promoted for use in settings with limited access to electricity or specialized dental equipment, as it requires only hand instruments.
Our objective is clear: to foster a system in which oral health is maintained through prevention and restored through safe, sustainable, and mercury-free innovation. The roadmap has been provided; our task now is the systematic integration of these standards into every clinic, curriculum, and community. It’s a fascinating time for oral healthcare as we balance high-level environmental policy with day-to-day clinical excellence. That excellence is the heart of the dental hygiene profession.
References
- World Health Organization. UNEP/MC/COP.6/INF/31/Add.1 – World Health Organization Guideline on Environmentally Friendly and Less Invasive Oral Health Care for Preventing and Managing Dental Caries. Available at https://minamataconvention.org/en/documents/unep-mc-cop-6-inf-31-add-1-world-health-organization-guideline-environmentally-friendly. Accessed March 17, 2026.
- GBD 2021 Oral Disorders Collaborators. Trends in the global, regional, and national burden of oral conditions from 1990 to 2021: a systematic analysis for the Global Burden of Disease Study 2021. Lancet. 2025;405:897-910.
From Dimensions of Dental Hygiene. March/April 2026;24(2):6
