Clinicopathological and Immunohistochemical Study of Oral Amalgam Pigmentation

Prevalence and clinical features of pigmented oral lesions

“…An amalgam tattoo results from accidental or iatrogenic implantation of amalgam particles into oral soft tissues during dental procedures, resulting in bluish‐gray macular pigmentation often near an amalgam‐filled tooth. Findings of our study confirmed that gingivae and alveolar mucosa are the most common sites for amalgam tattoo . Occasionally, amalgam tattoos appear in atypical sites such as palate and floor of the mouth.…”

“…In these cases, particularly when a radiograph fails to show any evidence of the radiopaque remnants of amalgam, excisional biopsy might be needed to confirm the diagnosis. Histologically, the amalgam tattoo appears as discrete dark granules or fragments arranged mainly around collagen bundles and blood vessels causing little inflammatory reaction . Inquiry about previous history of trauma, particularly with pencils, is important because implantation of foreign bodies (e.g., graphite) into oral mucosa can produce lesions similar to an amalgam tattoo.…”

Electron Probe Microanalysis of Exogenous Pigmentation of Oral Mucosa Originating from Dental Alloy: Two Case Reports

“…Furthermore, similar to findings described in previous reports [1] [3] [4] [8]- [10], blackish-brown fine particles were deposited in the basal membrane of the oral mucosa, the minor salivary duct, peripheral glandular acini, the basal membrane of vessels, and fibroblast cells. In Case 2, there was formation of lymphoid tissues underneath the mucosal epithelium, but an aberrant dental alloy in the mucosa usually causes no body inflammatory reaction or only mild chronic inflammation as previously reported [3] [10]. These difference in tissue responses seem to be related to composition of the aberrant dental alloy because the metal particles were revealed by EPMA to be a silver alloy in Case 1 and a gold-silver palladium alloy in Case 2.…”

“…It is particularly important to differentiate between pigmented nevus caused by the proliferation of nevus cells and malignant melanoma derived from melanocytes. Therefore, histopathological examinations are required [1]- [3].…”

Graphite oral tattoo: case report

“…However, our patient's tattoo was the first case affecting the palate (Table 1). Amalgam tattoo in the palate is also rather unusual, with only 6 cases related [5,6]. When it occurs in the palate, the clinician may confuse these lesions with melanoma or melanocytic and blue nevus.…”