Amalgam versus composite: UK study warns of care crisis over 2034 phase-out

The research drew on a survey of over 1,500 UK primary care clinicians, a study of public preferences and modelling that projected the lifetime treatment outcomes and costs of amalgam and composite restorations. The results were striking: amalgam restorations and restored teeth were projected to last longer than composite alternatives and to generate lower lifetime costs for patients, the NHS and clinicians alike, while the estimated risk of postoperative complications was also lower. Among the outcomes quantified, the only one favouring composite was appearance. The analysis did not quantify environmental impacts or broader patient and practitioner safety considerations, however.

The implications for equitable access to care are a central concern. Asked by Dental Tribune International what could happen once amalgam disappears, lead author Dr Oliver Bailey, clinical lecturer in restorative dentistry at Newcastle University, was direct: “A large majority of dentists and therapists in the UK felt that there would be a need for more indirect restorations and more teeth extracted if amalgam was phased out.”

Such changes are likely to fall hardest on lower-income patients, potentially deepening existing oral health inequalities. The analysis found that the point at which further direct restoration was no longer possible would be reached sooner with composite than with amalgam, and the authors argued that this too could increase the need for more expensive treatment or extraction.

So, what needs to change before 2034? Training is one clear priority. “Composite courses and training are not generally making clinicians confident when faced with difficult situations and need to improve,” Dr Bailey noted, pointing to expert consensus guidance now in development for managing complex cavities with composite.

Beyond clinical skill, Dr Bailey argued that the whole system needs rethinking. “Ideally, the NHS dental service should first define its objectives and, within its budgetary constraints, design a system that enables effective monitoring of treatment provision and outcomes while incentivising these objectives and minimising unintended consequences.” Without such reform, the study warned, the amalgam phase-out risks accelerating extractions among the most vulnerable patients—and further straining an already stretched NHS dental service.

The study, titled “Amalgam versus composite restorations: A cost-consequence analysis”, was published on 24 July 2026 in the British Dental Journal.