What are the other Names for this Condition? (Also known as/Synonyms)

• Dental Amalgam Tattoo

What is Amalgam Tattoo? (Definition/Background Information)

• Amalgam Tattoo is an oral mucosal lesion of blue, gray, or black discoloration that typically forms near a dental filling made of amalgam, usually while the fillings are being placed or replaced. Amalgams are metal alloys used by dentists as filler materials for tooth cavities
• Amalgam Tattoos are benign and asymptomatic lesions, but they may be mistaken for skin cancers such as a melanoma. The condition is not an allergic reaction or inflammatory response of the oral mucosa to the amalgam material. An Amalgam Tattoo does not require any treatment

Who gets Amalgam Tattoo? (Age and Sex Distribution)

• Amalgam Tattoo is a common condition that may be seen in both children and adults who have dental amalgam fillings
• It can affect both males and females
• The condition occurs worldwide; individuals of all racial and ethnic background may be affected

What are the Risk Factors for Amalgam Tattoo? (Predisposing Factors)

• The primary risk factor for Amalgam Tattoo is the exposure of mouth mucosal surfaces to tooth fillings made of amalgam

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Amalgam Tattoo? (Etiology)

Amalgam Tattoos form when the amalgam filling material that is made of metals, such as mercury, silver, tin, and copper, gets embedded into the soft tissues of the mouth. The condition does not develop as an allergy-induced or irritant-induced oral mucosal reaction/response.

The condition develops inadvertently during any of the following dental procedures that involves amalgam fillers:

• Placement or replacement of amalgam fillings in dental (tooth) cavities
• Polishing amalgam fillings following its placement
• Root end surgery (apicoectomy)
• Removal of dental fillings
• Use of high-speed dental drills in the vicinity of dental amalgams
• Tooth extraction - either near amalgam-filled teeth, or extraction involving teeth with amalgam fillings

Occasionally, flossing one’s teeth immediately after dental amalgam filling placement can also result in Amalgam Tattoos.

What are the Signs and Symptoms of Amalgam Tattoo?

The signs and symptoms of Amalgam Tattoo may include:

• Presence of an irregular-shaped blue, gray, or black lesion (tattoo) next to the amalgam filling
• The lesion is observed localized (focal lesion), meaning it does not spread to other sites or generally grow in size
• In some cases, the discolored oral mucosal lesion may form away from the site of tooth cavity filling
• Most of the tattoos are observed on the gums, near to the site of filling. However, some have been observed inside the cheeks (buccal mucosa), on the tongue, or on the roof of the mouth

There is no pain, irritation, or discomfort associated with the condition.

How is Amalgam Tattoo Diagnosed?

The following are the diagnostic methods and tests that may be used for Amalgam Tattoo:

• A thorough physical (oral) examination and a complete medical history are important (including history of amalgam dental fillings)
• Skin patch testing (against the amalgam), if necessary
• Tissue biopsy, if necessary: A tissue biopsy is performed and sent to a laboratory for a pathological examination, who examines the biopsy under a microscope. After putting together clinical findings, special studies on tissues (if needed) and with microscope findings, the pathologist arrives at a definitive diagnosis. A biopsy is performed to rule out other similar conditions

In most cases, no tissue biopsy is required, and the healthcare provider can diagnose the condition following a visual examination and medical history assessment.

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Amalgam Tattoo?

• Generally, there are no significant complications noted from an Amalgam Tattoo
• In some individuals, it may cause emotional stress due to concerns of a malignancy

How is Amalgam Tattoo Treated?

• Typically, Amalgam Tattoos do not require any treatment
• The healthcare provider, following preliminary tests and exams to diagnose the condition, may offer reassurances regarding its benign nature

How can Amalgam Tattoo be Prevented?

• Currently, it may be very difficult to prevent Amalgam Tattoo that typically occurs from dental procedures involving amalgam fillings
• Dentists and oral care healthcare providers may adhere to best medical practices to decrease the risks for such inadvertent conditions

What is the Prognosis of Amalgam Tattoo? (Outcomes/Resolutions)

• The prognosis of Amalgam Tattoo is generally excellent since it is an asymptomatic and benign lesion
• Nevertheless, it is important to note that not all individuals with amalgam dental cavity filling develop Amalgam Tattoos

Additional and Relevant Useful Information for Amalgam Tattoo:

The following DoveMed website link is a useful resource for additional information:

https://www.dovemed.com/healthy-living/dental-health/