1.2. Implementing measures to phase down the use of dental amalgam in accordance with the provisions of the Minamata Convention on Mercury and decisions made by the Conference of the Parties or have phased it out.

Achievement criteria for indicator:

1. Fully achieved: The country reports implementation of option (a) or option (b) as follows:

Option (a) The country is still using dental amalgam and has implemented all three of the following requirements to phase down the use of dental amalgam*:

• excluded or not allowed, by taking measures as appropriate, the use of mercury in bulk form by dental practitioners; and
• excluded or not allowed, by taking measures as appropriate, or recommended against the use of dental amalgam for the dental treatment of deciduous teeth, of patients under 15 years and of pregnant and breastfeeding women, except when considered necessary by the dental practitioner based on the needs of the patient; and
• implemented two or more of the measures from the following list (taking into account the country's domestic circumstances and relevant international guidance):

i. Setting national objectives aiming at dental caries prevention and health promotion, thereby minimizing the need for dental restoration;

ii. Setting national objectives aiming at minimizing its use;

iii. Promoting the use of cost-effective and clinically effective mercury-free alternatives for dental restoration;

iv. Promoting research and development of quality mercury-free materials for dental restoration;

v. Encouraging representative professional organizations and dental schools to educate and train dental professionals and students on the use of mercury-free dental restoration alternatives and on promoting best management practices;

vi. Discouraging insurance policies and programmes that favour dental amalgam use over mercury-free dental restoration;

vii. Encouraging insurance policies and programmes that favour the use of quality alternatives to dental amalgam for dental restoration;

viii. Restricting the use of dental amalgam to its encapsulated form;

ix. Promoting the use of best environmental practices in dental facilities to reduce releases of mercury and mercury compounds to water and land.

Option (b) Phased out dental amalgam:

Country does not use dental amalgam and does not allow its manufacture, import or export.

2. Partially achieved: The country reports using dental amalgam but has implemented only one or two of the requirements to phase down its use.

3. Not achieved: The country reports using dental amalgam but has not implemented any of the requirements to phase down its use.

4. No information: Data are not reported by the country.

Data sources: WHO and Minamata Convention Secretariat, 2023; Minamata Convention Secretariat, 2021; WHO Informal Consultation, 2021; COP4 submissions to the Minamata Convention on Mercury, 2021

Definition: Countries can be Parties to the Minamata Convention on Mercury (through ratification, acceptance, approval or accession), or signatories, meaning that they signed the Convention text after its agreement, but have not yet ratified it formally. Some countries have neither ratified nor signed the Convention.

Preferred Data Sources: Minamata Convention's overview of Parties and Signatories. Link: https://minamataconvention.org/en/parties

Definition: The country has reported if dental amalgam is still used.

Preferred Data Sources: Country reports to WHO and/or the Secretariat of the Minamata Convention. The data for this indicator was compiled using four data sources: the results from the 2023 WHO and the Minamata Convention Secretariat survey, 2021 full national reports submitted by Parties of the Minamata Convention, COP4 submissions to the Minamata Convention on Mercury in 2021. Interpretation may have been used when using the 2021 full national reports or the COP4 country submission. When country-specific data was unavailable through the previously mentioned data sources, data from the 2021 informal global WHO consultation with policymakers in dental public health was used.

Definition: Country reports that dental amalgam has been completely phased out.

Preferred Data Sources: Country reports to WHO and/or the Secretariat of the Minamata Convention. The data for this indicator was compiled using four data sources: the results from the 2023 WHO and the Minamata Convention Secretariat survey, 2021 full national reports submitted by Parties of the Minamata Convention, COP4 submissions to the Minamata Convention on Mercury in 2021. Interpretation may have been used when using the 2021 full national reports or the COP4 country submission. When country-specific data was unavailable through the previously mentioned data sources, data from the 2021 informal global WHO consultation with policymakers in dental public health was used.

Definition: Country reports implementing two or more of the original nine measures listed in subparagraphs (i) to (ix) of part II of Annex A, to phase down the use of dental amalgam in the Minamata Convention on Mercury

A party is required to implement two or more of the following nine measures, taking into account the Party’s domestic circumstances and relevant international guidance:

i. Setting national objectives aiming at dental caries prevention and health promotion, thereby minimizing the need for dental restoration;

ii. Setting national objectives aiming at minimizing its use;

iii. Promoting the use of cost-effective and clinically effective mercury-free alternatives for dental restoration;

iv. Promoting research and development of quality mercury-free materials for dental restoration;

v. Encouraging representative professional organizations and dental schools to educate and train dental professionals and students on the use of mercury-free dental restoration alternatives and on promoting best management practices;

vi. Discouraging insurance policies and programmes that favour dental amalgam use over mercury-free dental restoration;

vii. Encouraging insurance policies and programmes that favour the use of quality alternatives to dental amalgam for dental restoration;

viii. Restricting the use of dental amalgam to its encapsulated form;

ix. Promoting the use of best environmental practices in dental facilities to reduce releases of mercury and mercury compounds to water and land.

Preferred Data Sources:

Country reports to WHO and/or the Secretariat of the Minamata Convention.

The data for this indicator was compiled using four data sources: the results from the 2023 WHO and the Minamata Convention Secretariat survey, 2021 full national reports submitted by Parties of the Minamata Convention, COP4 submissions to the Minamata Convention on Mercury in 2021. Interpretation may have been used when using the 2021 full national reports or the COP4 country submission. When country-specific data was unavailable through the previously mentioned data sources, data from the 2021 informal global WHO consultation with policymakers in dental public health was used.

Definition: The Minamata Convention initially included 9 measures that a party shall take to phase down the use of dental amalgam. At the fourth meeting of the Conference of the Parties (COP4), two mandatory provisions were added.

Country reports implementing the mandatory COP4 measure: "Exclude or not allow, by taking measures as appropriate, the use of mercury in bulk form by dental practitioners"

Preferred Data Sources: Country reports to WHO and/or the Secretariat of the Minamata Convention. The data for this indicator was compiled using four data sources: the results from the 2023 WHO and the Minamata Convention Secretariat survey, 2021 full national reports submitted by Parties of the Minamata Convention, COP4 submissions to the Minamata Convention on Mercury in 2021. Interpretation may have been used when using the 2021 full national reports or the COP4 country submission. When country-specific data was unavailable through the previously mentioned data sources, data from the 2021 informal global WHO consultation with policymakers in dental public health was used.

Definition: The Minamata Convention initially included 9 measures that a party shall take to phase down the use of dental amalgam. At the fourth meeting of the Conference of the Parties (COP4), two mandatory provisions were added.

Country reports implementing the mandatory COP4 measure: "Exclude or not allow, by taking measures as appropriate, or recommend against the use of dental amalgam for the dental treatment of deciduous teeth, of patients under 15 years and of pregnant and breastfeeding women, except when considered necessary by the dental practitioner based on the needs of the patient"

Preferred Data Sources: Country reports to WHO and/or the Secretariat of the Minamata Convention. The data for this indicator was compiled using four data sources: the results from the 2023 WHO and the Minamata Convention Secretariat survey, 2021 full national reports submitted by Parties of the Minamata Convention, COP4 submissions to the Minamata Convention on Mercury in 2021. Interpretation may have been used when using the 2021 full national reports or the COP4 country submission. When country-specific data was unavailable through the previously mentioned data sources, data from the 2021 informal global WHO consultation with policymakers in dental public health was used.

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