Oral leukoplakia associated with amalgam restorations

Abstract

IntroductionOral leukoplakia (OL) is defined by the World Health Organization as "a white patch or plaque of the oral mucosa that cannot be characterized clinically or pathologically as any other disease" (1). The prevalence of OL ranges from 0.5 to 3.4% with a peak incidence rate in individuals older than 50 years. According to the literature, most oral carcinoma cases are associated with, or preceded by, clinically detectable premalignant lesions such as OL. The malignant transformation rate of OL is reported to be in the range of 0.1 to 17% (2).The etiological factors most commonly associated with OL have been smoking, alcohol abuse, candidiasis, HPV infection, iron deficiency, and low serum levels of vitamin A and beta-carotene (3). Zinsser-Cole Engman syndrome, a genodermatosis commonly known as dyskeratosis congenita, includes oral manifestations such as OL. Many different non-surgical and surgical modalities such as conventional surgery, electrocauterization, laser ablation, cryosurgery, and medications such as vitamin A, vitamin B, and bleomycin, have been reported for treatment of OL (4).Dental amalgams remain the most commonly used posterior restorative material in dental practice. A relationship has been established between contact allergy to mercury and oral lichen planus (5). Although amalgamrelated conditions such as burning mouth, xerostomia, and musculoskeletal and neuropsychological symptoms have been reported, the relationship between amalgam and OL has not yet been examined.This report documents a patient with OL lesions who showed a positive skin patch test reaction to amalgam and who subsequently recovered after his amalgam restorations had been removed and replaced with a different material. Case ReportA 21-year-old male was referred to the Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Erciyes University, with suspected OL. His major complaint was a bilateral burning sensation in the buccal mucosa. The patient had previously received cryotherapy and laser treatment at a dermatology clinic, but the OL lesions had not healed. Intraoral examination revealed white lesions bilaterally affecting the buccal mucosa and tongue (Figs. 1-3). The patient had no systemic disease and no history of tobacco or alcohol consumption. In order to confirm the histological nature of the lesion, an incisional biopsy

Minimization of Adverse Effects Associated with Dental Alloys

“… leukoplakia ( Figure 3 c) is characterized by the emergence of increased keratinization areas on the mucous membrane. The prevalence of leukoplakia ranges from 0.5 to 3.4% and occurs most often in people older than 50 years [ 58 ]. It should be noted that the frequency of malignant transformation of leukoplakia ranges from 0.1 to 17% [ 59 ].…”

“…According to the observations of Gönen Z.B. et al, hyperkeratotic lesions may occur due to a hypersensitivity reaction to amalgam [ 58 ]. erosive and ulcerative lesions ( Figure 3 d) are mostly the form of allergic reactions to metals and manifest as recurrent aphthous stomatitis [ 60 ].…”

“…According to the observations of Gönen Z.B. et al, hyperkeratotic lesions may occur due to a hypersensitivity reaction to amalgam [ 58 ].…”

“…Replacement of dental alloys may be recommended in the following cases: flare-up of autoimmune diseases; severe mouth burning that appears after placement of metallic appliances; positive path-test or blood test to components of dental alloys; and the appearance of potentially malignant oral lesions [ 58 ]. As the clinical picture of dental alloys’ side effects is not specific, other diseases with similar symptoms should be excluded before replacement of metallic appliance, and all the other possible causes should be eliminated ( Figure 4 ).…”

The Effectiveness of Laser-Assisted Surgical Excision of Leukoplakias and Hyperkeratosis of Oral Mucosa: A Case Series in A Group of Patients

“…The prevalence in the general population ranges from 0.6% to 5% and is more frequent in those between 40 and 50 years old [1]. The cause is multifactorial and there are several predisposing factors such as: mechanical irritation, dental materials causing galvanic currents, contact with carcinogens such as tobacco and alcohol and gastroesophageal reflux [2,3]. The predisposition to malignant transformation seems associated to a higher CD8+ cells levels in premalignant lesion [4].…”