Oral lichenoid lesions, mercury hypersensitivity and combined hypersensitivity to mercury and other metals: histologically-proven reproduction of the reaction by patch testing with metal salts.
We report 11 patients seen between 1991 and 1994 with oral lichenoid lesions (OLL). In 10 cases, there was contact with dental amalgam fillings, and in patient no. 10 with both amalgam restorations and a gold crown. The last patient had, in addition to her OLL, lichen planus of the skin and genital mucosa. In 5 cases, combined sensitization to mercury and other metal salts, particularly gold sodium thiosulfate (GST) and palladium chloride (PDC), was observed. In 10 patients, the lesions considerably improved or totally cleared within 1 to 9 months of replacement of restoration materials. Histological examination of biopsies from the test sites of amalgam, mercuric chloride, GST and PDC, taken 10 or 17 days after application of patch tests, showed lichenoid changes in 7 patients with at least 1 of the allergens. As at least 2 patients had inflammatory lesions of the oral mucosa related to both amalgam and gold restorations, combined sensitization to inorganic and organic mercury derivatives, GST and, in 1 case, PDC, a "dental restoration metal intolerance syndrome" is proposed.
Koch
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Hautklinik der Universität des Saarlandes, Homburg/Saar, Germany.
Bahmer
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FA
D000328:Adult; D000485:Allergens / Q000009:adverse effects*; D003723:Dental Amalgam / Q000009:adverse effects; D003793:Dental Restoration, Permanent / Q000009:adverse effects; D017449:Dermatitis, Allergic Contact / Q000209:etiology* / Q000473:pathology; D005260:Female; D005831:Genital Diseases, Female / Q000150:complications; D006047:Gold Alloys / Q000009:adverse effects; D012971:Gold Sodium Thiosulfate / Q000009:adverse effects; D006801:Humans; D008010:Lichen Planus / Q000150:complications; D017676:Lichen Planus, Oral / Q000150:complications; D017512:Lichenoid Eruptions / Q000139:chemically induced* / Q000473:pathology; D008297:Male; D008627:Mercuric Chloride / Q000009:adverse effects; D008628:Mercury / Q000009:adverse effects*; D008670:Metals / Q000009:adverse effects*; D008875:Middle Aged; D009059:Mouth Diseases / Q000139:chemically induced* / Q000473:pathology; D010165:Palladium / Q000009:adverse effects; D010328:Patch Tests
D000485:Allergens; D006047:Gold Alloys; D008670:Metals; D008627:Mercuric Chloride; D010165:Palladium; D003723:Dental Amalgam; D012971:Gold Sodium Thiosulfate; D008628:Mercury; C008756:palladium chloride