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

• Amalgam Contact Hypersensitivity Lesions (ACHL)
• Amalgam-Associated Oral Lichenoid Reaction (AAOLR)
• Oral Lichenoid Amalgam Reaction

What is Lichenoid Amalgam Reaction? (Definition/Background Information)

• Lichenoid Amalgam Reaction is a rare allergic reaction of the oral mucosa (mouth insides) to dental fillings made of amalgams from long-term exposure. The condition is also known as Amalgam-Associated Oral Lichenoid Reaction (AAOLR)
• In many cases, the surface of the cheek in contact with the amalgam dental filling develop a lichenoid skin lesion that may present pain and discomfort. However, Lichenoid Amalgam Reaction is generally not severe and can be resolved by replacing amalgam fillers with suitable alternatives

Who gets Lichenoid Amalgam Reaction? (Age and Sex Distribution)

• Lichenoid Amalgam Reaction is an uncommon condition that is typically seen in middle-aged adults, although individuals of a wide age category may be potentially affected
• It can affect both males and females, although females are affected much more than males
• The condition occurs worldwide; individuals of all racial and ethnic background may be affected

What are the Risk Factors for Lichenoid Amalgam Reaction? (Predisposing Factors)

• The risk factors for Lichenoid Amalgam Reaction is a long-term exposure of the mouth mucosal surfaces to tooth fillings made of amalgam
• For some unknown reason, middle-aged women seem to have a higher risk for the condition

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 Lichenoid Amalgam Reaction? (Etiology)

The exact cause of development of Lichenoid Amalgam Reaction is unknown (idiopathic).

• Dental fillings to treat dental cavities may be made of various materials including amalgams (such as silver, gold, along-with mercury)
• A long-term exposure of the mouth surfaces to amalgam dental fillings causes Lichenoid Amalgam Reaction. Some experts believe that it is a hypersensitivity reaction of the mucosal surfaces to amalgam

Lichenoid Amalgam Reaction is similar to oral lichen planus, which develops from unknown causes.

What are the Signs and Symptoms of Lichenoid Amalgam Reaction?

There are three types of Lichenoid Amalgam Reaction depending on the location of the oral lesions in reference to the amalgam dental filling.

• Group I Oral Lichenoid Amalgam Reaction: The lesion is observed at the area of contact with the dental filling
• Group II Oral Lichenoid Amalgam Reaction: The lesion is observed at and beyond the area of contact with the dental filling
• Group III Oral Lichenoid Amalgam Reaction: The lesion is observed at a distant location; there is no contact of the lesion with the amalgam filling

The signs and symptoms of Lichenoid Amalgam Reaction may include:

• In a majority, the reaction develops next to the filling and usually affects the inside of the cheek (buccal mucosa)
• The next site is the side/edge of the tongue nearest to the amalgam filling
• The oral lichenoid reaction may be noted in several patterns such as reticular (net-like; it is the most commonly noted pattern), plaque-like, atrophic, or erosive
• Individuals may experience pain and discomfort
• Some may show sensitivity while eating hot-spicy foods
• In some individuals, the lesions are asymptomatic and do not present any pain

How is Lichenoid Amalgam Reaction Diagnosed?

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

• A thorough physical examination and a complete medical history are important (including history of amalgam dental fillings)
• A diagnosis of Lichenoid Amalgam Reaction may be arrived at clinically by analyzing the presentations, particularly based on:
  • Proximity of the lesion to dental filling made of amalgam
  • The oral cavity lesion is localized to the region of the filling
  • The presentation is asymmetrical
• Skin patch testing (against the constituents of the amalgam): It is not known to be a very effective test for Lichenoid Amalgam Reaction
• Tissue biopsy: A oral 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
• A differential diagnosis may be considered to eliminate conditions presenting similar signs and symptoms such as oral lichen planus

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 Lichenoid Amalgam Reaction?

The complications of Lichenoid Amalgam Reaction may include:

• Emotional stress
• Bacterial and fungal infections: The longstanding lesions may provide a suitable environment for bacteria and fungi to grow and thrive
• Recurrence of the condition

According to medical literature, a progression of the condition to oral cancer is not noted.

How is Lichenoid Amalgam Reaction Treated?

In most individuals, Lichenoid Amalgam Reaction tends to resolve following substitution of the amalgam filling with a suitable alternative dental filling.

If necessary, the following treatment measures may be recommended, particularly for longstanding or severe oral lesions:

• Use of topical steroidal applications
• Immunosuppressive medication such as tacrolimus
• Administration of oral steroid medications such as prednisone
• Follow-up care with regular screening and checkups

How can Lichenoid Amalgam Reaction be Prevented?

• Currently, there are no specific methods or guidelines to prevent Lichenoid Amalgam Reaction
• In individuals with amalgam dental fillings, who develop the condition, suitable alternative dental cavity filling materials may be recommended
• It has not been observed that dietary factors, such as oily foods and chocolate-based products, contribute to Lichenoid Amalgam Reaction development

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

• In over 90% of the cases, Lichenoid Amalgam Reaction resolves following replacement of the dental cavity filling material with a non-amalgam alternative
• In others, a combination of alternative dental filling material and treatments may be required. Nevertheless, the prognosis of Lichenoid Amalgam Reaction is generally excellent

Additional and Relevant Useful Information for Lichenoid Amalgam Reaction:

It is important to note that not all individuals with amalgam dental cavity filling develop Lichenoid Amalgam Reaction. In individuals who develop the oral reaction, a simple substitution of the amalgam filler material with a suitable alternative can help improve the condition. Also, since amalgam based fillers are cost effective materials in dentistry, they are still in use; and, the discontinuation of amalgam for tooth fillings is not advocated.