Amalgam tattoo

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Amalgam tattoo (also called local argyrosis , or focal argyrosis ) is a gray, blue or black area of ​​the mucous membrane of the mouth, usually at gums of the lower jaw. This is an iatrogenic lesion, caused by the inclusion of amalgam teeth into the soft tissues. It is common, painless, and benign, but can be misconstrued as melanoma.

Video Amalgam tattoo

Signs and symptoms

Amalgam tattoos usually occur in the mandibular gingiva, often in areas where apicoectomy ("root filling") with amalgam is performed. After gingiva, the alveolar mucosa and buccal mucosa are the next most common sites, although there are mucosal sites in the mouth. It does not cause pain, and appears as a blue-black or gray macule on the mucosal surface. Border tattoos vary, and can be well defined, irregular or spread.

Maps Amalgam tattoo

Cause

Amalgam tattoos are caused by implantation of amalgam into the tissues. This can happen in several ways:

• During amalg filling placement, for example if a blister in the mucosa is present which allows entry of amalgam dust
• Not long after amalgam filling placement, e.g. the amalgam particles may contaminate the dental floss and lead to a linear amalgam tattoo between the teeth, especially if flossing is done immediately after placement of an amalgam mixture with mesial or distal aspects
• Polish the amalgam mixture
• The pressure of a high-speed turbine tooth drill is sufficient to force the amalgam particles into the soft tissue, which may occur when the old amalgam filling is removed
• When teeth with amalgam stuffing are extracted, e.g. mixed pieces of amalgam fill to fall into unconscious socket extraction
• When amalgam filling is placed in the same designation as the extracted tooth, as is possible in "quadrant dentistry"
Apicectomies are a common cause of amalgam tattoos, because amalgam is placed inside the alveoli and the soft tissue is replaced above

Over time, amalgam particles embedded in soft tissue corrode. Macrophages take exogenous particles, and silver in amalgam leads to staining collagen fibers.

Similar appearances can be caused by implantation of graphite (eg from pencil), and sometimes called tattoo graphite, although this is less common than tattoos with amalgam.

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Diagnosis

The diagnosis is clinical. Amalgam tattoos can be distinguished from other causes of local oral pigmentation because it does not change significantly in size or color, although it may appear to slowly enlarge for several months after the initial implantation of the metal particles. Some amalgam tattoos appear radio-opaque on radiography (ie they appear on x-rays), although in many cases amalgam tattoos have no radiographic features because the responsible particles (s) of amalgam are very small even though the clinical mucosal areas change color. much bigger.

If necessary, the diagnosis can be confirmed histologically by excisional biopsy, which excludes nevi and melanoma. If a biopsy is taken, the histopathologic appearance is:

• Pigmented fragments of metal in connective tissue
• Reticulin fiber dye with silver salt
• The arrangement of large, dark, dense scattered fragments or fine brown, black or dark grains
• Large particles can be surrounded by chronic inflamed fibrous tissue
• Smaller particles are surrounded by more significant inflammation, which may be granulomatous or a mixture of lymphocytes and plasma cells

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Prevention

Theoretically, regular use of dental dams during dental procedures involving amalgam should reduce the risk of amalgam tattoos.

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Treatment

No treatment is needed because the lesions are completely benign. Some people argue that amalgam tattoos are best done with surgery to make sure lesions do not represent melanoma. Others say that excision should only be done if there is any doubt about the diagnosis, and that amalgam tattoos are managed with simple assurances about the nature of the lesion. For example, if the radio-opaque particle is shown on x-rays, a biopsy is not necessary.

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Epidemiology

Amalgam tattoos are found in 1% of people in the general population. This is the most common cause of solitary pigmentation or focal mucosa of the mouth.

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Note

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References

Source of the article : Wikipedia