Frictional Keratosis

Amalgam tattoo is the most common localised form of oral mucosal pigmentation [23]. Lesions usually form painless, bluish-black macules, which may be well defined or diffuse, and the most common sites are the gingiva, alveolar mucosa and floor of the mouth. They are caused by ingress of dental amalgam through a mucosal breach during a restorative procedure or tooth extraction and can also follow an apicectomy with retrograde root filling.

Microscopy shows dark, refractile particles of amalgam in the corium [44]. These may be coarse, but usually form fine, black or brownish granules. These are deposited along collagen and elastic fibres, and around small blood vessels, nerves and muscles. About half of cases show a fibrous and chronic inflammatory reaction, with or without multinucleated foreign body giant cells. Occasionally, there is a granulomatous reaction.

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