Oral cavity & oropharynx

Other nonneoplastic

Amalgam tattoo


Editorial Board Member: Molly Housley Smith, D.M.D.
Deputy Editor-in-Chief: Kelly Magliocca, D.D.S., M.P.H.
Sarah H. Glass, D.D.S.

Last author update: 16 May 2022
Last staff update: 16 May 2022

Copyright: 2002-2022, PathologyOutlines.com, Inc.

PubMed Search: Amalgam tattoo

Sarah H. Glass, D.D.S.
Page views in 2021: 153
Page views in 2022 to date: 677
Cite this page: Glass SH. Amalgam tattoo. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/oralcavityamalgamtattoo.html. Accessed August 10th, 2022.
Definition / general
  • Iatrogenic implantation of exogenous foreign material, specifically dental amalgam, into the tissues of the oral cavity
Essential features
  • Deposition often occurs during oral procedures involving amalgam
  • Gray, blue or black macule on clinical exam in the oral cavity
  • Large black deposits or fine black granules in the connective tissue with affinity for reticulin fibers
Terminology
  • Foreign body tattoo
ICD coding
  • ICD-10: M79.5 - residual foreign body in soft tissue
Epidemiology
  • Person with history of amalgam tooth restorations (dental fillings)
  • Affects 3.3% of the U.S. adult population (Head Neck Pathol 2019;13:47)
Sites
  • Any location in the oral cavity, with gingiva and alveolar mucosa being the most common location due to proximity to the teeth
Pathophysiology
  • Implantation of dental amalgam into oral mucosa
Etiology
Clinical features
Diagnosis
  • In some cases, the diagnosis may be presumed on clinical exam with corresponding historical information and radiographic features
  • If the diagnosis cannot be made confidently on clinical exam, a biopsy is recommended for definitive diagnosis (Head Neck Pathol 2019;13:47)
Radiology description
  • Radiopaque fragments may be noted on radiographic exam if amalgam particles are large; however, this is not common
Radiology images

Contributed by Sarah H. Glass, D.D.S. and Duane Schafer, D.D.S., M.S.
Radiopaque amalgam fragments Radiopaque amalgam fragment Radiopaque amalgam fragments

Radiopaque amalgam fragments

Prognostic factors
  • Excellent prognosis
Case reports
Treatment
  • No treatment is needed once diagnosis is established
  • Conservative surgical excision can be recommended for esthetic concerns, especially for the anterior maxilla (J Esthet Restor Dent 2020;32:770)
Clinical images

Contributed by Sarah H. Glass, D.D.S. and Duane Schafer, D.D.S., M.S.
Buccal mucosa amalgam tattoo

Buccal mucosa amalgam tattoo

Large maxillary amalgam tattoo

Large maxillary amalgam tattoo

Alveolar ridge amalgam tattoos Alveolar ridge amalgam tattoos

Alveolar ridge amalgam tattoos

Gross description
  • Well defined or diffuse black, gray or blue pigmentation in connective tissue on cross section
Gross images

Contributed by Sarah H. Glass, D.D.S.
Excisional biopsy specimen

Excisional biopsy specimen

Cross section

Cross section

Microscopic (histologic) description
  • Large black deposits of foreign material with or without a chronic inflammatory response in the connective tissue
  • Fine black granules in the connective tissue; may demonstrate affinity for reticulin fibers (Head Neck Pathol 2019;13:47)
Microscopic (histologic) images

Contributed by Sarah H. Glass, D.D.S.
Extensive amalgam deposition

Extensive amalgam deposition

Scattered amalgam granules

Scattered amalgam granules

Around blood vessels

Around blood vessels

Large amalgam fragment

Large amalgam fragment

Giant cell engulfment

Giant cell engulfment

Sample pathology report
  • Oral cavity, excisional biopsy:
    • Foreign body tattoo (see comment)
    • Comment: The histopathology and clinical information are consistent with an amalgam tattoo.
Differential diagnosis
Board review style question #1

A biopsy from the oral cavity shows exogenous black foreign material around blood vessels and along collagen fibers in a patient with a history of amalgam dental fillings. What is the diagnosis?

  1. Amalgam tattoo
  2. Oral melanotic macule
  3. Peutz-Jegher syndrome
  4. Submucosal hemorrhage
Board review style answer #1
A. Amalgam tattoo. Although all answer choices can result in pigmented macules in the oral cavity, amalgam is the only exogenous material. This foreign material has a particular affinity for reticulin fibers and can be seen around blood vessels.

Comment Here

Reference: Amalgam tattoo
Board review style question #2
What is the etiology of an amalgam tattoo from the oral cavity?

  1. Drug related discoloration
  2. Iatrogenic implantation of dental filling material
  3. Increased melanin production
  4. Trauma induced hemosiderin deposition
Board review style answer #2
B. Iatrogenic implantation of dental filling material. A dental professional may inadvertently implant amalgam, an exogenous foreign material, into the oral mucosa during a dental procedure.

Comment Here

Reference: Amalgam tattoo
Back to top
Image 01 Image 02