Oral Lichenoid Contact Lesions to Mercury and Dental Amalgam—A Review

Abstract

Human oral mucosa is subjected to many noxious stimuli. One of these substances, in those who have restorations, is dental amalgam which contains mercury. This paper focuses on the local toxic effects of amalgam and mercury from dental restorations. Components of amalgam may, in rare instances, cause local side effects or allergic reactions referred to as oral lichenoid lesions (OLLs). OLLs to amalgams are recognised as hypersensitivity reactions to low-level mercury exposure. The use of patch testing to identify those susceptible from OLL is explored, and recommendations for removing amalgam fillings, when indicated are outlined. We conclude that evidence does not show that exposure to mercury from amalgam restorations poses a serious health risk in humans, except for an exceedingly small number of hypersensitivity reactions that are discussed.

Oral lichenoid reaction associate with amalgam restorations A Case report

“…The clinical diagnosis is further complicated because similar oral lesions can occur as a result of drug-related lichenoid reactions or as graft-versus-host disease, discoid lupus erytheatosus, and systemic lupus erythematosus. Diagnosis in such cases is facilitated by a detailed history, clinical findings, and immuno histological findings [2] OLrs caused by hypersensitivity to amalgam or its constituents typically have a clear anatomical relationship to the dental amalgam restoration, so they are usually unilateral and not symmetrical [2,5]. They are most commonly seen on the buccal mucosae and tongue where the covering lining mucosa comes in contact with restorations.…”

“…Most often the allergen is mercury, but occasionally, the response may be to one of the other components of the amalgam alloy such as copper, tin or zinc [5]. Mercury salts that accumulate in healthy and damaged oral mucosa will cause this hypersensitivity reaction in only a susceptible minority of the population with resulting reticular white patches, papules, plaques, erosions, or ulceration, similar to that found in Oral Lichen Planus (OLp) -hence the terminology "lichenoid" [2].This case report describes a case of oral lichenoid reaction associated with an amalgam restoration in the left maxillary second molar. oppposite to 36,37, 38, few striations seen on the periphery of whitish area.…”

“…In the dental environment, substances identified as allergenic include local anaesthetics, antibiotics, restorative materials, and latex [1].Silver amalgam has been used as a dental restorative material for over one hundred and eighty years and still remains the most commonly placed filling material in the world [2]. Its superior compressive strength and minimal technique sensitivity makes it an ideal material for posterior restorations and core build-ups [3].…”

“…Its superior compressive strength and minimal technique sensitivity makes it an ideal material for posterior restorations and core build-ups [3]. Pinkus (1973) first coined the term "lichenoid tissue reaction" to describe the histological pattern featuring damage to keratinocytes, now referred to as apoptosis, infiltrate of inflammatory cells in the connective tissue which may extend into the epithelium and keratosis or hyperkeratosis [2,4]. The oral lichenoid reaction is a lesion indistinguishable clinically and histologically of the oral lichen planus.…”

Local and systemic disorders caused by the presence of foreign bodies in the oral cavity

“…All of these factors can adversely affect the function of the mucosa as well as the rest of the digestive system. 3 The main component of the liquid of the oral environment is saliva, fluid produced by large and small salivary glands. Saliva consists mostly of water; it makes up about 94-99.5% of saliva.…”