Mucosal reactions to amalgam restorations

Abstract

Amalgam restorations have been implicated both in contact sensitivity reactions and in lichenoid reactions. This appears to be related principally to the mercury content, although other metals cannot be discounted. The cases of two patients are reported who showed features of lichenoid reactions of the oral mucosa, in addition to features of a contact hypersensitivity to mercury. The mucosal lesions resolved following replacement of the amalgams with non-metallic restorations. Consideration is given to the selection of materials and procedures currently available for treatment of these patients. This paper supports the view that sensitivity to heavy metals must be considered as a possible cause of erythematous and lichenoid reactions of the oral mucosa.

Adverse Drug Reactions in the Orofacial Region

“…These reactions are presumably due to allergic or toxic reactions to compounds released or generated, the Koebner phenomenon, or possibly due to plaque accumulated on the surfaces of the restorations (Holmstrup, 1991). Some of these oral lesions may improve after substitution of the amalgam by other materials (Finne et al, 1982;Jolly et al, 1986;Lind et al, 1986;Bolewska et al, 1990;Jameson et al, 1990;Skoglund and Egelrud, 1991;Laine et al, 1992;Bircher et al, 1993;Ostman et al, 1994;Henriksson et al, 1995;Smart et al, 1995;Bratel et al, 1996;Ibbotson et al, 1996), though this is often not the case with gingival lesions (Henriksson et al, 1995).…”

Update On Oral Lichen Planus: Etiopathogenesis and Management

“…However, contact with or proximity to restorations involving amalgams or other materials causes some lichenoid reactions-that is to say, lesions that clinically and histologically resemble LP closely, but have an identifiable etiology. These reactions are presumably due to allergic or toxic reactions to compounds released or generated, the Koebner phenomenon, or possibly plaque accumulated on the surfaces of the restorations (Holmstrup, 1991) Metal restorations Some lesions resembling OLP may occur in direct relation to amalgam restorations (Lundstrom, 1984;Lind et al, 1986;Bolewska et al, 1990a,b), and some of these oral lesions may improve after substitution of the amalgam by other materials (Finneetal., 1982;Jolly etal., 1986;Lind et al, 1986;Bolewska et al 1990a,b;Jameson et al, 1990;Skoglund and Egelrud, 1991;Laine et al, 1992;Bircher et al, 1993;Skoglund, 1994, Henriksson etal., 1995, Smartet al, 1995, Bratel et al, 1996Ibbotson et al, 1996), though this is often not the case with gingival lesions (Henriksson et al, 1995) Significant reactions to mercuric salts on skin-testing may be seen in some patients with OLP (Finne et al, 1982, Eversole andRinger, 1984;Mobacken et al, 1984a;lames et al, 1987;Ostman et al, 1994), though others have not found this (Hietanen et al, 1987) Finne et al (1982 demonstrated mercury sensitivity by patch testing in 62% of 29 patients with OLP and only 3.2% of a control group, and oral lesions regressed in a few patients when their amalgams were removed (Finne et al, 1982). Reactions to mercuric chloride have been reported (Skoglund and Egelrud, 1991;Smart et al, 1995).…”

Oral Lichen Planus and Allergy to Dental Amalgam Restorations

“…Conventional silver amalgam fillings consist of about 50% mercury and about 50% alloy powder containing silver, tin, copper, and zinc. 17,20 Mercury and mercury compounds appear to be the most common allergens in amalgam, with the other metals being rarely responsible for allergic reactions. 6,21 Contact sensitivity to mercury in amalgam confirmed by patch testing was previously reported by Shovelton.…”

“…[13][14][15] However, several authors have reported resolution of signs and symptoms in OLP after replacement of amalgam, particularly if there was a positive patch test result to mercury, which is the most important allergen in amalgam. 6,[16][17][18] The aim of this study was to determine contact allergies in patients with OLP and amalgam fillings and to investigate whether there are specific subgroups of patients with OLP, based on differences in the relationship between oral lesions and amalgam fillings. A second objective was to monitor the effect of partial or complete replacement of dental amalgam restorations following a positive patch test reaction to ammoniated mercury, metallic mercury, or amalgam.…”