Amalgam tattoo

Amalgam tattoo of the oral mucosa in the upper jaw area (region 11).

Histology: Deposits of fine-grained silver sulfide along elastic fibers of the connective tissue of the oral mucosa. Minor chronic inflammatory changes in the form of a lymphocytic aggregate ( bottom right ).

Histology: Silver sulfide deposits are sometimes found mainly in the vicinity of small vessels in the oral mucosa.

Histology: Silver sulfide deposits in the vicinity of skeletal muscle fibers of the oral mucosa.

The amalgam tattoo is the most common localized form of oral mucosal pigmentation. It is painless, bluish-gray to bluish-black stains caused by the penetration of the amalgam filler material through defects in the mucous membrane during dental treatment. The change is usually found on the gums , the alveolar ridge and the cheek mucosa, usually in the vicinity of an amalgam-filled tooth. The lining of the tongue can also be affected less frequently. Amalgam tattoos are harmless incidental findings that can be visually disturbing, but beyond that they usually have no disease value and usually do not require any therapy. However, it is important to differentiate it from other lesions such as smoker's melanosis , melanocytic nevi , malignant melanoma , hematoma or angioma .

Epidemiology

It's a more common change and, depending on the source, is said to occur in up to 0.1 to 8 percent of adults. The prevalence increases with age, which is presumably due to the increasing number of dental treatments. Women are said to be affected slightly more often than men.

causes

Particles of the silver amalgam used as a dental filler , an alloy of silver , tin , copper and zinc with mercury , get into the mucous membrane via small defects during dental treatment (drilling out existing fillings, creating a new filling, tooth extractions) and cause local discoloration . Electrogalvanic current flow between gold and amalgam fillings should also lead to increased corrosion in older types of amalgam, with amalgam loosening and deposits in the adjacent oral mucosa. The most common cause of amalgam tattoos is likely to be drilling out old fillings with a turbine . Due to the enormous speed, the smallest particles are thrown into the oral mucosa.

pathology

Macroscopically , there is a blotchy blue-black discoloration of the mucous membrane, usually less than 0.5 cm (rarely more than 3 cm), with good or even blurred delimitation. Fine-tissue dark, brownish or black, opaque, fine-grain particles of silver sulfide are found , preferably in the area of ​​elastic fibers of the mucosal connective tissue, in the vicinity of blood vessels, nerves or muscles. An association with collagen fibers is also described in the literature, but could not be confirmed with an electron microscope. In about half of the cases, there are also chronic inflammatory changes with fibrosis and facultative granulomatous , sometimes giant-cell-containing foreign body reactions, which are usually not visible macroscopically .

Diagnosis and therapy

The change is considered harmless and therefore does not necessarily require therapy. However, biopsy tissue removal or surgical removal with subsequent histological examination may be indicated if the lesion cannot be classified as an amalgam tattoo with sufficient certainty. Therapy is also carried out for cosmetic reasons, whereby in addition to excision or free transplantation of connective tissue, lasers can also be used. The tattoos can easily be removed using a loop probe with an electrotome.

forecast

The amalgam tattoo is a benign and, apart from the cosmetic aspect, symptom-free change in the oral mucosa. No significant local or systemic toxicity of the deposits has been reported to date. The absence of necrosis within the lesion speaks for a largely biologically inert behavior . However, amalgam tattoos tend to persist for life, which may be explained by the low turnover of elastic fibers with which the deposits are primarily associated. An increase in the change can also occur, most likely as a result of phagocytosis and removal of particles by macrophages .

Individual evidence

1. ↑ ^{a b} G. Klöppel, HH Kreipe, W. Remmele: Pathology: head and neck region, soft tissue tumors, skin. 3. Edition. Springer, 2008, ISBN 978-3-540-72885-6 .
2. ↑ ^{a b c d} K. Bork, W. Burgdorf, N. Noede: Oral mucous membrane and lip diseases. Clinic, diagnostics and therapy. 3. Edition. Schattauer, 2008, ISBN 978-3-7945-2486-0 .
3. ↑ ^{a b} Bond's Book of Oral Diseases. 4th edition. Archive link ( Memento of the original from May 28, 2010 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. 
4. ↑ ^{a b} W. Mohr, E. Görz: The association of silver granules with elastic fibers in amalgamosis of the oral mucosa. In: ENT. 2001; 49, pp. 454-457. PMID 11450512
5. ↑ G. Shah, TS Alster: Treatment of an amalgam tattoo with a Q-switched alexandrite (755 nm) laser . In: Dermatologic Surgery . 2002 Dec; 28 (12), pp. 1180-1181. PMID 12472503 .
6. ↑ CM Campbell, DE Deas: Removal of an amalgam tattoo using a subepithelial connective tissue graft and laser deepithelialization . In: J Periodontol . 2009 May; 80 (5), pp. 860-864. PMID 19405840

This article is about a health issue. It is not used for self-diagnosis and does not replace a diagnosis by a doctor. Please note the information on health issues !