May 05, 2014
Amalgam tattoos can be described as exogenous pigmentation in the oral mucosa. It can be in the form of dark-grey or blue macule located at the area adjacent to a restored tooth. The amalgam tattoo is mostly positioned in the gingival mucosa where the tissues are much softer and the blood vessels are closely packed. The alveolar and buccal mucosa can also possess this pigmentation. Other recorded instances include the localisation of the amalgam tattoo pigmentations on the floor of the mouth. Amalgam present in the oral body tissues in a form of dark irregular pellets of metal or present as numerous brown or black granules that are dispersed around small blood vessels and nerves.
Large fragments of amalgam tattoos are always surrounded by dense connective tissue and blood vessels. A radiograph is always recommended for the diagnosis of this oral pigmentation condition. A biopsy is also known to have the ability to rule out early stages of melanoma. An amalgam filling usually consists of an alloy of liquid mercury that has varying amounts of silver, tin and copper and is used for dental implantations and restorations. Amalgam tattoos are usually caused by amalgam splinters implanted into the mucosa during dental restoration procedures. There is direct link that shows that the amalgam splinters are the main reason for the pigmentations of the oral mucosa. Another major cause of the amalgam tattoos might be direct diffusion of fragments through the teeth into the surrounding connective tissue.
The amalgam is a commonly used material for dental fillings. The deposits of amalgam in the mucosa may be visible as localized pigmented areas with grey, black or blue patches or macules. Amalgam tattoo can be difficult to discern from other pigmented elements such as the mucosal melanoma. Deposits of amalgam are always seen as granules along collagen fibers and blood vessels. It is believed that amalgam tattoo is harmless and asymptomatic, meaning that you can live with it without any sensitivity or discomfort. The pigmentations can be diagnosed safely by the finding of radio-opaque granules on the x-ray.
Differential diagnosis with mucosal melanoma
Amalgam tattoos are described as the main causes of intraoral pigmentation resulting from the placing of amalgam fillings. Amalgam tattoos should not be mistaken with the mucosal melanoma which is an aggressive malignant formation that has typical a dark brown, black or bluish-grey plaque. Mucosal melanoma is also characterized with swelling, bleeding and ulcerations that cannot be found around the amalgam tattoos. Discomforts localized at the maxillary mucosa and palate are often preceded by a pigmented premalignant lesion. Another great difference is that mucosal melanoma can cause metastasis and is therefore life threatening. It is difficult for the general dental practitioner to assess the differential diagnosis of these two intraoral pigmentations. It is advisable to refer the patient to a specialist if the dentist is unsure about the origin of the gingival pigmentation.
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