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