Healing of oral lichenoid lesions after replacing amalgam restorations: A systematic review

University Dental Hospital of Manchester, England, UK.
Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology (Impact Factor: 1.46). 12/2004; 98(5):553-65. DOI: 10.1016/S1079210404000216
Source: PubMed


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.

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    • "Exposure to mercury in relation to AID has been studied extensively in the literature, both in experimental animals[8,11,25,26]and humans[27]. In men, long-term exposure to inorganic mercury was evaluated in Brazilian gold miners and was found to be associated with increased levels of ANA and systemic inflammatory cytokines[28][29]and reduction of anti-thyroid and anti-nuclear autoantibodies[30], no consensus for a pathogenic role of Hg in AID was reached31323334. Also, a meta-analysis on the relation between amalgam exposure and the most prominent AID in this context, multiple sclerosis, did not show a significant association[15]. "
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    ABSTRACT: The role of metal exposure in the development of autoimmune disease (AID) is still controversial. Here, we studied the relationship between oral metal exposure, metal allergy and autoimmunity. A mixed population (n = 78) of non-allergic volunteers, metal-allergic patients and patients with oral problems putatively due to metal alloys was evaluated for oral Ni, Pd, Au and Hg exposure and skin hypersensitivity. Clinical autoimmune parameters were based on medical histories; additionally, serum levels of the four most common autoantibodies were measured. Skin hypersensitivity, as seen mainly for Ni and/or Pd, was not positively associated with autoimmune parameters. In contrast, metal hypersensitive individuals showed an extremely low frequency of thyroid autoantibodies (3% vs 20% in non-hypersensitive controls). Next, the relation between metal exposure and autoimmunity was evaluated in individuals >35 years (n = 58), since from that age on metal exposure had plateaued and was not correlated with age. In this subgroup, oral Ni exposure was associated (p < 0.01) with self-reported AID, irrespective of autoantibody levels. These unexpected findings warrant further confirmation in a larger test group. Of note, oral Pd, Au or Hg contacts were not associated with any of the clinical or serological autoimmune phenomena tested. The results of this study support the view that development of metal contact allergies may prevent autoimmune activation, and, second, that oral exposure to Pd, Au or Hg does not facilitate the development of AID.
    No preview · Article · Apr 2015 · Autoimmunity
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    • "• 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). "
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    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.
    Full-text · Article · Nov 2012 · Oral Diseases
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    • "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). "
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    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.
    Full-text · Article · Feb 2012 · Medicina oral, patologia oral y cirugia bucal
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