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Tattoo in the Oral Cavity

Published:December 22, 2020DOI:https://doi.org/10.1016/j.amjmed.2020.11.016
      A 60-year-old female patient with an unremarkable medical history presented with a grayish patch on her upper right gums. She also wanted to get her broken tooth fixed. The patient noticed this patch 1 year prior, and its size had not increased since then. On intraoral examination, a flat grayish diffuse pigmentation was present on the right upper buccal alveolar mucosa adjacent to the broken second premolar, measuring about 1 cm × 2 cm (Figure, A, black arrow). The pigmentation was nontender, with an intact overlying mucosal surface and no ulceration. The patient was asymptomatic, with absence of lymphadenopathy. Intraoral periapical radiograph showed a radiopacity at the apical third region of the root of the second premolar (Figure, B, black arrow). Further questioning revealed that this tooth had undergone root canal treatment along with periapical surgery and possible retrograde filling with amalgam around 20 years prior. Amalgam is a common material used for dental fillings and it contains silver, tin, mercury, and other metals.
      • Müller S
      Non-neoplastic lesions of the oral cavity.
      Such grayish pigmentation can be caused by the diffusion of dental amalgam into the soft tissue during dental procedure and is termed ‘amalgam tattoo’. Other exogenous pigmentations that can mimic an amalgam tattoo include graphite, coal dust, and intentional tattooing, or it can even be confused with melanotic lesions like pigmented nevi, oral melanotic macule, oral melanoacanthoma, and melanoma.
      • Müller S
      Non-neoplastic lesions of the oral cavity.
      Additional investigations are necessary if amalgam tattoos occur in sites distant from dental work or if the clinical diagnosis is uncertain.
      • Fiqhi MK
      • Essaoudi MA
      • Khalfi L
      • Khatib KE.
      Extensive amalgam tattoo (amalgam pigmentation) on the palatal mucosa: a short case report.
      No biopsy was performed in this case, as the clinical findings and radiographic evidence of restoration of silver amalgam was clearly suggestive of an amalgam tattoo. Once the diagnosis of an amalgam tattoo has been established, the removal of this lesion is not necessary, except for aesthetic reasons.
      • Buchner A.
      Amalgam tattoo (amalgam pigmentation) of the oral mucosa: clinical manifestation, diagnosis and treatment.
      The patient's tooth was restored with the post and core and porcelain fused to a metal crown without removal of the amalgam filling (Figure, C). The patient is asymptomatic at 4-year follow-up.
      Figure
      Figure(A) Mucosal pigmentation in relation to the upper second premolar (black arrow). (B) Intraoral periapical radiograph showing radiopacity at the apical third region of the root of the upper second premolar (black arrow). (C) Porcelain fused to metal crown done on the upper second premolar (black arrow).
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      References

        • Müller S
        Non-neoplastic lesions of the oral cavity.
        in: Thompson LDR Bishop JA Head and Neck Pathology: A Volume in Foundations in Diagnostic Pathology. 3rd ed. Elsevier, Philadelphia2019: 175-196.e2
        • Fiqhi MK
        • Essaoudi MA
        • Khalfi L
        • Khatib KE.
        Extensive amalgam tattoo (amalgam pigmentation) on the palatal mucosa: a short case report.
        J Dent Oral Disord. 2018; 4: 1095
        • Buchner A.
        Amalgam tattoo (amalgam pigmentation) of the oral mucosa: clinical manifestation, diagnosis and treatment.
        Refuat Hapeh Vehashinayim (1993). 2004; 21: 19-22