Disparities in Amalgam use and Mercury levels in children in the United States 2015-2018

In the U.S, dental amalgam use declines but remains disproportionately prevalent among children from low socioeconomic status, particularly those under five. Using NHANES 2015-2018 data (n = 6701), we examined amalgam use and blood and urinary mercury levels in children aged 1-19 years. Mexican American children aged 1-5 had a 4-fold prevalence of amalgam restorations (95% CI: 1.74, 11.30) and detectable blood inorganic Hg (11.93%vs. 1.63%; adjRR: 6.17, 95% CI: 1.85, 20.60) compared to white. In this group, children with amalgam restorations had a 25-fold higher prevalence of detectable blood inorganic Hg (95% CI: 11.74, 52.89). Among children aged 3-19, 23.58% had detectable urinary Hg, with the highest levels in Asian children (42.24%vs 17.97% white). Black children had increased risk for detectable Hg levels (adjRR: 1.65, 95% CI: 1.29, 2.12). Our findings revealed significant dental amalgam use disparities, with higher prevalence among children from lower-income households and lower educational attainment.