Graphite oral tattoo: case report

Abstract

Pigmented oral lesions compose a large number of pathological entities, including exogenous pigmentations , such as amalgam and graphite tattoos. We report a rare case of a graphite tattoo on the palate of a 62-year-old patient with a history of pencil injury, compare it with amalgam tattoos, and determine the prevalence of oral tattoos in our Oral Pathology Service. We also compare the clinical and histological findings of graphite and amalgam tattoos. Oral tattoos affect women more frequently in the region of the alveolar ridge. Graphite tattoos occur in younger patients when compared with the amalgam type. Histologically, amalgam lesions present impregnation of the reticular fibers of vessels and nerves with silver, whereas in cases of graphite tattoos, this impregnation is not observed, but it is common to observe a granulomatous inflammatory response, less evident in cases of amalgam tattoos. Both types of lesions require no treatment, but in some cases a biopsy may be done to rule out melanocytic lesions or for aesthetic reasons.

A graphite foreign body granuloma causing palatal perforation. Case report and literature review

“…Microscopically, the characteristic chain-like distribution of granules along collagen bundles, around small vessels, and nerve sheaths, or in the epithelial basement membrane zone of the mucosal epithelium and salivary ducts or acini, is not seen [16]. In ve lesions, including the present one, a foreign body granuloma reaction was seen [4,6,8,10]. However, this is not a discriminatory feature from amalgam tattoo, as it may appear in approximately 1/3 of the later [16].…”

“…Diagnosis is based on history and the exclusion by microscopic examination of other pigmented lesions, in particular amalgam tattoo. Only three patients could recall injury from a pencil, 2 [12], 12 [4], and 43 [10] years before presentation. As for the lesion to appear a lengthy process of disintegration of the "lead" before release of graphite is necessary [1], it is reasonable that a trauma that happened many years ago could not remember by our patient.…”

“…In contrast to an amalgam tattoo, where history combined with clinical and radiographic information may suggest the diagnosis, documentation of a graphite tattoo may be challenging in patients not recalling previous trauma with a pencil, and requires biopsy [6-8]. A review of the pertinent literature disclosed eight documented cases of graphite tattoo in the oral soft tissues [4,[6][7][8][9][10][11][12], four of them consistent with graphite foreign body granuloma [4,6,8,10].…”

Intraoral pencil core granuloma with retained pencil lead

“…Some children have a habit of rotating pencil lead tips in the mouth and accidents can be caused by these tips. [ 5 ] In our case, because the overlying mucosa was normal, no previous injury was suspected as the patient also did not remember any such incident, and thereby, the surgical exposure and orthodontic extrusion of teeth were planned after observing an impacted tooth on the radiograph.…”

“…Pigmented entities are common in the oral mucosa and may be endogenous or exogenous in nature. [ 5 ] Among these, the most frequently found are amalgam tattoos, followed by graphite tattoos. [ 6 ] The objects may get either impregnated in the oral mucosa of gums, tongue, and floor of the mouth or the cavities of the broken or fractured teeth and the root canals of the teeth with open pulp chambers.…”