We sought to systematically review the literature related to oral lichenoid lesions (OLLs) and amalgam restorations.
Cohort and case-controlled studies (no randomized controlled trials or controlled clinical trials available) were reviewed with respect to inclusion criteria and data on patients with OLLs, treatment interventions, and the measurement of outcomes.
Fourteen cohort and 5 case-controlled trials met the criteria. The study population consisted of 1158 patients (27% male and 73% female; age range, 23-79 years). From 16% to 91% of patients had positive patch test results for at least 1 mercury compound. Of 1158 patients, 636 had to have their restorations replaced. The follow-up period ranged from 2 months to 9 1/2 years. Complete healing ranged from 37.5% to 100%. The greatest improvements were seen in lesions in close contact with amalgam.
Protocols must be standardized to obtain valid results. The replacement of amalgam restorations can result in the resolution or improvement of OLLs. Patch testing seems to be of limited value. The topographic relationship between an OLL and an amalgam restoration is a useful--but not conclusive--marker.
"• Uncontrolled studies that did not include an untreated control group or that did not report the results for controls in sufficient detail. Case reports and case series not captured by the original limits also belonged to this category (Alanko et al, 1996; Bolewska et al, 1990a; Ditrichova et al, 2007; Dunsche et al, 2003; Finne et al, 1982; Ibbotson et al, 1996; Issa et al, 2005; James et al, 1987; Jontell et al, 1987; Koch and Bahmer, 1995; Laeijendecker et al, 2004; Laine et al, 1992, 1999; Little et al, 2003; Lundstrom, 1984; Martin and Drangsholt, 2005; Nakayama et al, 1972; Ostman et al, 1996b; Pezelj-Ribaric et al, 2008; Skoglund, 1994; Skoglund and Egelrud, 1991; Smart et al, 1995; Stejskal et al, 1996; Thornhill, 2006; Thornhill et al, 2003; Yuan et al, 1993). • Reviews other than systematic reviews (Grossman et al, 2008; Schuurs and van Amerongen, 1996; Swartzendruber, 1993; Thornhill, 2006; van der Waal, 2009; van Joost and Laeijendecker, 1993; Veien, 1990; Wright, 2007) • Letters (Nogi, 1989; Zhu, 1989) After these exclusions, only five studies remained, all conducted in northern Europe (Table 4). "
[Show abstract][Hide abstract] ABSTRACT: Lichen planus (LP) is a common disorder affecting the oral cavity (OLP) and skin. Despite intensive research, LP ⁄ OLP etiology and treatment remain controversial. We investigated four controversial topics: (i) Is hepatitis C virus (HCV) infection associated with LP and involved in its pathogenesis? (ii) Should all patients with LP be screened for HCV? (iii) Should patients with OLP have all their amalgam restorations removed? (iv) Are there any new treatments for OLP? Results from extensive litera-ture searches suggested that: (i) Robust evidence from three meta-analyses indicate that HCV is associated with LP and might be involved in OLP pathogenesis (ii) It would be prudent to screen patients with LP ⁄ OLP at significant risk with an ELISA for HCV antibodies using country-specific screening strategies (iii) There is no evidence that either OLP or oral lichenoid lesions patients would rou-tinely benefit from having all their amalgam restorations replaced. Weak evidence from potentially very biased, small, non-randomized, unblinded studies suggests that a small fraction of patients may benefit from targeted amalgam replacement. (iv) There is weak evidence that, among new OLP treatments, topical pimecrolimus, aloe vera, and oral curcuminoids may be useful. The develop-ment of specific formulations for oral delivery of topical medications is a promising field.
"In most of the papers dealing with series comprising lichenoid lesions associated with silver amalgams it is probably true that a number of processes have been included: lichen planus, lichenoid lesions associated with drugs, idiopathic lichenoid lesions, erythroleukoplasia, etc. This would serve to explain the disparities found with regard to patch testing positivity in some studies and the fact that no improvements were obtained once the restorations had been removed (7,14). "
[Show abstract][Hide abstract] ABSTRACT: Oral lichenoid lesions (OLLs) are linked to a heterogeneous group of pathologies involving the oral mucosa that cannot be distinguished from the oral lichen planus excepting the fact that direct causal factors such as silver amalgam restorations (SARs) can be allocated to them.
To analyze the prevalence of mucosal lesions associated with SAR in a group of SAR carrying patients in the Basque Country. StuDY DESIGN: A clinical prospective study was carried out on 100 adult patients over 30 years of age at the UPV/EHU Clinical Odontology Service whose rear teeth had at least one SAR. Patients were identified and mucosal lesions and amalgam restorations were characterized. Patch tests were performed on patients with lesions and amalgams were replaced with composite material. A statistical and comparative analysis was performed with the resulting data.
OLLs were found in 7 patients whose predominant lesion was bilateral, asymmetrical and asymptomatic white papule-macule. Lesions were related to old and corroded SARs. Patch testing was positive in two cases. SAR substitution produced an improvement in 5 cases.
The presence of lichenoid lesions associated with SARs is infrequent in our environment and is preferentially related to old and corroded restorations.
"An example of this is observed in the frequency of sensitization to allergens contained in amalgam restorations. Ammoniated mercury presented a frequency of general sensitization of 20%, a value that differs from those found in other studies, which report a maximum percentage of 13% (16,26). The percentage of sensitization to amalgam in this study was 10%, which is much greater than other studies, which report estimated values of 1.1% (16). "
[Show abstract][Hide abstract] ABSTRACT: Some studies report that atopic patients have a greater frequency of delayed-type sensitization than non-atopic patients. Objective: To determine the influence of the atopic condition on delayed sensitization to dental materials.
Forty (40) atopic subjects and forty (40) non-atopic subjects, of both sexes, between 20 and 65 years of age were included. The determination of delayed sensitization to dental materials was performed using patch test. An oral exam was also carried out to check for lesions of the oral mucosa.
61.25% of the patients were positive for delayed-type sensitization to one or more allergens, being palladium chloride (21.25%), ammoniated mercury (20%), benzoyl peroxide (12.5%) and amalgam (10%) the most frequent. The frequency of sensitization was 67.5% in the group of atopic patients, compared to 55% in the non atopic group (p>0.05). The materials with the greatest difference of sensitization in atopic compared to non-atopic patients were ammoniated mercury, benzoyl peroxide, amalgam and Bisphenol A Dimethacrylate (BIS-GMA).
The atopic condition is not related to a higher frequency of delayed sensitization to a battery of dental materials.
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