The World Health Organization (WHO) released a new global guideline recommending environmentally sustainable and less invasive approaches for the prevention and management of dental caries.
The guideline, Environmentally friendly and less invasive oral health care for preventing and managing dental caries, provides evidence-based recommendations to help countries adopt safer, cost-effective strategies that promote patient safety, quality of care, and environmental protection.
Dental caries remains the most common noncommunicable disease worldwide, affecting an estimated 2.7 billion people. The disease frequently begins in early childhood and disproportionately affects underserved populations. Historically, management of dental caries has relied heavily on restorative treatment with dental amalgam, which contains mercury and can pose risks to human health and the environment.
The new guideline presents a package of safe, effective, mercury-free clinical interventions based on the latest scientific evidence on prevention, noninvasive care, and minimally invasive management of dental caries.
“This guideline represents a landmark in global oral health,” said Benoit Varenne, DDS, MPH, PhD, 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.”
Supporting global oral health goals
The guideline aligns with global efforts to phase out mercury use under the Minamata Convention on Mercury and supports broader health initiatives such as the Bangkok Declaration – No Health Without Oral Health.
WHO officials said the recommendations also support implementation of the WHO Global Oral Health Action Plan 2023–2030, which calls for countries to ensure access to essential oral health services as part of universal health coverage. The guidance prioritizes preventive strategies, promotes noninvasive and minimally invasive treatments, and encourages the transition from mercury-containing dental amalgam to safe and affordable alternatives.
According to WHO, integrating these approaches into primary health care systems could help expand access to essential oral health services while reducing environmental impact.
“Oral health care must evolve to support planetary health,” said Dévora Kestel, MsC, 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.”
Key clinical recommendations
The guideline includes eight recommendations and two best practice statements supported by systematic reviews on clinical performance, toxicology, cost-effectiveness, and environmental impact.
Key areas of focus include:
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Population-level prevention, including a strong recommendation for fluoride varnish and targeted interventions such as pit and fissure sealants for children at high risk of caries
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Noninvasive management, including fluoride varnish for early caries lesions and biannual application of silver diamine fluoride to arrest moderate lesions
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Mercury-free restorations, with guidance on the use of glass ionomer cements and resin-based composites
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Safety protocols, including procedures for handling resin-based materials to protect patients and dental personnel
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Considerations for vulnerable populations, including patients with allergies and recommendations to limit products containing bisphenol A derivatives among children, adolescents, and pregnant or breastfeeding women
Policy and implementation guidance
In addition to clinical recommendations, the guideline provides guidance for governments, ministries of health and environment, professional associations, and frontline health workers. Recommended actions include integrating mercury-free products and minimally invasive interventions into national oral health policies, strengthening training and curricula, and improving clinical protocols.
The guidance also calls for reducing environmental impacts through improved waste management, sustainable procurement, and supply chain practices. Expanding oral health services through primary health care and community-based delivery models is another key recommendation.
WHO noted that the guideline also identifies research gaps, including the need for more data on the long-term effectiveness and cost-effectiveness of interventions and monitoring of occupational exposure and environmental impacts associated with mercury-free dental materials.
Development and launch
The guideline was developed through a collaborative effort led by WHO involving experts in oral health, public health, environmental science, biomaterials, toxicology, and health systems. The work was overseen by the WHO–UNEP Steering Committee and developed as part of the Global Environment Facility-funded GEF7 Phasing Down Dental Amalgam project.
WHO plans to formally introduce the guidelines during a global webinar marking World Oral Health Day on March 19, 2026. The event will feature presentations on the guidelines and share country experiences related to its implementation.
