The World Health Organization has released a new global guideline, Environmentally friendly and less invasive oral health care for preventing and managing dental caries . The guideline provides evidence-based recommendations to support countries in preventing and managing dental caries through environmentally sustainable and less invasive approaches that promote patient safety, quality of care and environmental protection.
The guideline presents a comprehensive package of safe, effective and mercury-free clinical interventions, reflecting the latest scientific evidence on prevention, non-invasive care and minimally invasive management of dental caries.
Dental caries is the most common noncommunicable disease globally, affecting an estimated 2.7 billion people, The disease often begins in early childhood and disproportionately affects underserved populations. Historically, management of dental caries has relied heavily on restorative treatment using dental amalgam, which contains mercury and poses risks to human health and the environment.
The new guideline responds to growing global commitments to phase out mercury use under the Minamata Convention on Mercury and to strengthen oral health within broader health agendas, including the Bangkok Declaration – No Health Without Oral Health. It supports countries in expanding access to essential, cost-effective, and safe oral health services.
"This guideline represents a landmark in global oral health," said Dr Benoit Varenne, WHO Dental Officer. "For the first time, countries have strong evidence showing that safe and less invasive interventions with mercury-free products can effectively prevent, stop and manage dental caries, while providing a more environmentally sustainable alternative to dental amalgam."
A decisive contribution to achieving Universal Health Coverage for oral health by 2030
The guideline advances the implementation of the WHO Global Oral Health Action Plan 2023–2030, which calls for all countries to ensure access to essential, promotive, preventive and curative oral health services as part of universal health coverage.
By prioritizing prevention, scaling up noninvasive and minimally invasive interventions, and supporting the replacement of mercury-containing dental amalgam with safe, affordable alternatives, the guideline provides a strong technical foundation for integrating essential oral health services into primary health care. It also supports countries in meeting their obligations under the Minamata Convention on Mercury.
The recommendations further align oral health care with broader global commitments on climate action and sustainable development goals, promoting environmentally sustainable approaches within health systems.
"Oral health care must evolve to support planetary health," said Ms Dévora Kestel, Director a.i., WHO Department of Noncommunicable Diseases and Mental Health. "By promoting mercury-free products and less invasive clinical procedures, this guideline strengthens both environmental protection and universal access to safe, essential oral health care."
Clear recommendations grounded in the best available scientific evidence
The guideline provides eight recommendations and two best practice statements, supported by robust evidence that includes systematic reviews on clinical performance, toxicology, cost-effectiveness and environmental impact. Key areas of focus include:
- population-wide preventive interventions, including a strong recommendation for fluoride varnish, and targeted interventions such as pit and fissure sealants for children at high risk of caries;
- non-invasive management, such as fluoride varnish for initial caries lesions and biannual silver diamine fluoride to stop moderate caries lesions;
- mercury-free restorations, with guidance on the use of glass ionomer cements and resin-based composites;
- safety requirements with protocols for handling resin-based materials to protect patients and health personnel; and
- special considerations for vulnerable groups, including individuals with allergies, and limiting BPA (bisphenol A) derivative products among children, adolescents, and pregnant or breastfeeding women.
The guideline also provides actionable guidance for governments, ministries of health and environment, professional associations and front-line health workers to:
- integrate mercury-free products and non-invasive or minimally invasive interventions into national oral health policies and practices;
- strengthen training, curricula and clinical protocols;
- reduce environmental impact through improved waste management, sustainable procurement and supply chains; and
- expand access to oral health services through primary health care and community-based delivery models.
In addition, the guideline identifies key research gaps, particularly in the long‑term effectiveness and cost‑effectiveness of interventions, monitoring of occupational exposure and environmental impact of mercury‑free materials. It calls for strengthened global collaboration to advance evidence and drive innovation in oral health care.
