Amalgam tattoo occurs due to a deposit of the dental filler amalgam in the gums. This causes the typical black and dark discoloration, especially at the gum line.
What is an amalgam tattoo?
A deposit of the dental filler amalgam in the gums can cause discoloration of the gums. Amalgam tattooing is a phenomenon in the oral cavity today because many patients have had the filling material amalgam used. Black metal pigments, so-called amalgam particles, are deposited over time around the gums near a filling. Thus, the periodontium and gums in the immediate vicinity of the filling material are affected. In addition, the finding is sometimes seen as an unsightly dark gum line near metal crowns. If the amalgam tattoo occurs on the inside of the cheek, many patients are worried because they think the phenomenon is another serious disease. However, even in this case it is only tiny metal particles in the mucous membrane of the cheeks. The original name of an amalgam tattoo comes from these trapped particles in the mucous membrane of the cheeks. These were thrown against the mucosa of the cheeks when old amalgam fillings were drilled out and actively pressed into it, i.e. tattooed. If the amalgam tattoos are visible on the alveolar ridge, this may indicate excess amalgam or over-pressed fillings that were not removed and washed away carefully enough after an amalgam filling was made.
Causes
The dental material amalgam is considered problematic because of its high mercury content. Measurements of electrolysis in the oral cavity and blood analyses for mercury conclude that over time, the mercury initially firmly anchored in the amalgam as an alloy is dissolved out and swallowed with the saliva. According to current knowledge, the toxic heavy metal mercury is neither metabolized nor rendered harmless by the liver cells. Therefore, no detoxification of the released mercury takes place in the organism. That is why many patients have their amalgam fillings removed. The fillings should be removed only in large pieces and with the help of abundant water spray. The German Society of Dentistry now considers any form of amalgam tattooing to be malpractice. The main causes of amalgam tattoos are considered iatrogenic, this means caused by the actions of the dentist. The problem of amalgam tattoos was not known as such for a long time, and only when such phenomena became more frequent was a more detailed investigation of the causes carried out. The instruments and working methods of dentists have been further optimized, so that today patients hardly have to expect the phenomenon of amalgam tattooing after the removal of old amalgam fillings. Unsightly gum discoloration particularly affects patients who had their old amalgam fillings removed in the 1980s and 1990s.
Symptoms, complaints and signs
Outside of a dental filling, the alloy amalgam has no place, so any form of amalgam tattoo poses a potential health risk to the patient. This is because through contact with the mucous membrane, the mercury that is dissolved out immediately enters the bloodstream and is deposited as a heavy metal in the liver and fatty tissue. Removal is then no longer possible. The signs and symptoms of latent mercury intoxication can be very diverse and, as such, are not directly associated with amalgam over a long period of time. For the patient and dentist, the most important leading symptom of an amalgam tattoo is metal particles trapped in the oral mucosa; these trapped amalgam particles then lead to the pigment-like black discolorations of the buccal mucosa or gums in the vicinity of the amalgam fillings. Amalgam tattoos are mainly considered cosmetically disturbing, the disease value is considered by most dentists to be only minor. Nevertheless, the consequences of years of gradual mercury poisoning should not be underestimated. Especially in view of the fact that every patient reacts differently to mercury.
Diagnosis and course
The diagnosis is made in the dental office on the basis of the visual findings.It is worthwhile for the patient to get a dental second opinion, because even today there are dentists who are unfortunately not aware of the phenomenon of amalgam tattooing. Amalgam tattoos always run chronically in the oral cavity of the affected person, if no therapeutic remedy is found in time. Differentially, an amalgam tattoo must be distinguished from other decay processes of the oral mucosa as well as from malignant melanoma of the oral mucosa. This black skin cancer of the oral mucosa can be strikingly similar to an amalgam tattoo in its initial stage. For differential diagnosis, the affected oral mucosa can also be examined histologically. Fine tissue reveals a so-called foreign body granuloma as a local defense reaction of the mucosa against the amalgam inclusion.
Complications
In itself, an amalgam tattoo in the oral cavity is not a cause for concern. It is true that the unsightly discoloration of the oral mucosa is actually caused by an amalgam inclusion in the oral mucosa. However, the amalgam tattoo does not normally need to be treated. However, the doctor might decide differently if there is a real allergy to heavy metals or specifically amalgam components. Besides the highly toxic mercury, amalgam also contains metallic components such as tin, copper, silver, palladium and zinc. Potentially, allergy can be triggered to any of the contained metals. However, amalgam allergy is very rare. It would become noticeable immediately after the placement of an amalgam filling. The associated discomfort usually disappears after some time. However, further amalgam fillings should be avoided. Amalgam tattooing is itself considered a therapy-related complication that can occur when an amalgam filling is placed. However, the consequences of amalgam tattooing are considered harmless by the medical community. Nevertheless, the dark discoloration of the oral mucosa near the filling can become inflamed due to various circumstances. In this case, it is necessary to consider whether local treatment of the inflamed area is required because of this complication. According to the current medical understanding, the amalgam tattoo itself cannot be understood as a medical complication requiring treatment. Whether or not an alternative practitioner would recommend the expulsion of the amalgam varies.
When should you see a doctor?
If there are amalgam tattoos in the gums, those affected should definitely see a dentist. The grayish discoloration on the gums indicates that there is too much abrasion from old amalgam fillings. Therefore, the visit to the dentist should clarify whether and in what way the fillings need to be removed. It is probably advisable to replace the old amalgam fillings with plastic fillings or ceramic inlays. The likelihood of late effects from amalgam wear increases with the number of amalgam fillings. Environmental health experts say that more than nine fillings with detectable amalgam tattoos are dangerous. The dentist should determine to what extent there are already other reasons for a necessary Zahnsanierungvon. These can include, for example, immune deficiency or small electric shocks in the oral cavity. It is also advisable to visit the dentist in case of amalgam tattoos, because diseases such as Alzheimer’s and Parkinson’s can occur as a late consequence of the abrasion of amalgam or mercury particles over many years. The abrasion is not harmful from the point of view of orthodox medicine, but in individual cases it can be different. The dentist or a trained environmental physician can determine whether there are signs of chronic poisoning, intolerance or allergy to dental materials. Problematically, most conventional medical practitioners follow the paradigm that amalgam tattoos are harmless. Unfortunately, a purely symptom-based medicine will hardly do any causal research. Therefore, the choice of physician must be made with care.
Treatment and therapy
Since the exact cause of amalgam tattooing is known, patients can be offered causal therapy, which can be used to remove the amalgam inclusions in the mucosa completely and permanently. However, this may require several therapy sessions. To remove the amalgam tattoo, a patient should only visit dentists who are familiar with the electrolytic method of removal and have experience in this field. This is because any removal of amalgam involves the additional risk of mercury release.For the therapy of choice, the dentist works with the so-called loop electrode of an electrotome. The electrode is applied to the tattooed area with a medium current. Once the individual granules are exposed, they adhere to the loop and can be carefully removed from the oral cavity.
Outlook and prognosis
Usually, amalgam tattooing causes discoloration on the gums, making them look black. This can significantly reduce the health of the affected person, so that further even amalgam poisoning can occur. In most cases, the discoloration is not directly visible, so there are no particular complications or discomfort. If the affected person does not take amalgam at regular intervals, no further complaints will occur. The diagnosis of this disease can be made directly by a dentist. The treatment of amalgamation can be done by removal. In most cases, the affected person has to undergo several sessions, as the treatment is associated with pain in some cases. However, no further discomfort occurs and the symptoms disappear after the treatment. Whether the body itself suffers any consequential damage depends on the amount of amalgam absorbed. Partly it comes to headache or tiredness. With small quantities, however, no life-threatening complaints occur. Possibly, the affected person must have his tooth fillings renewed and do without the amalgam.
Prevention
The best prevention against amalgam tattoos is the absolute renunciation of the dental material amalgam. In almost all cases of fillings for caries treatment, this is possible today. If old amalgam fillings are to be removed, the dentist must exercise the necessary filigree care in addition to the required instruments, so that amalgam tattoos as typical iatrogenic damage cannot occur in the first place.
Aftercare
Amalgam tattooing is not a serious condition. Possible symptoms of poisoning have not been documented. If treatment is performed, visual considerations are usually relevant. If the discoloration is visible when laughing or speaking, affected persons feel uncomfortable among other people. The risk of a personality change arises. Since aftercare refers to scheduled check-ups in case of a disease, it does not play a role in case of amalgam tattooing. Patients consult their dentist as soon as they notice the blue-gray or blue-black spots. Together with the affected person, the dentist decides on a therapy. Several treatment appointments are often necessary. Removal by means of a sling probe with an electrotome has become established. After a successful treatment the therapy is completed. However, there is no immunity against the amalgam tattoo. The patient can suffer from the spots again at any time. Only an independent precaution prevents a repeated occurrence. Affected persons should avoid the material amalgam, which triggers the discolorations. A longer aftercare is conceivable in rare cases. If the patient has developed an allergy to heavy metals, old amalgam fillings must be removed. These fillings are no longer used in today’s dental restorations. Follow-up care then aims to document the state of recovery.
What you can do yourself
Once the diagnosis of amalgam tattooing is confirmed and it is determined that the discoloration in the mouth is not a malignant mucosal melanoma, the patient can breathe a sigh of relief. Whether the amalgam particles deposited in the oral mucosa represent a burden for the body is discussed differently. However, even if there is no discomfort, the dark area may be cosmetically disturbing and should be removed. Depending on the size of the amalgam tattoo, however, this procedure can be quite costly because grafts are then needed to cover the resulting defect. If the patient with an amalgam tattoo suffers from diffuse complaints such as headaches or chronic fatigue, amalgam poisoning can be considered. This is especially true if the patient is known to be allergic to certain metals and amalgam components. Also then a removal of the tattoo should be tackled. Subsequently, excretory and detoxifying measures are helpful.For this purpose, the patient should go into the hands of a naturopathic doctor or alternative practitioner, who will prescribe appropriate homeopathic remedies. But also sauna sessions, steam baths and sweaty sports detoxify the organism. Even various foods have a detoxifying effect, such as asparagus or fruits rich in water. During the detoxification process, the patient should get plenty of rest and avoid alcohol and nicotine.
