Oral lichen planus and allergy to dental amalgam restorations.
OBJECTIVE
To determine contact allergies in patients with oral lichen planus and to monitor the effect of partial or complete replacement of amalgam fillings following a positive patch test reaction to ammoniated mercury, metallic mercury, or amalgam.


METHODS
In group A (20 patients), the oral lesions were confined to areas in close contact with amalgam fillings. In group B (20 patients), the lesions extended 1 cm beyond the area of contact with amalgam fillings. In group C (20 patients), the oral lesions had no topographic relationship with amalgam fillings. Partial or complete replacement of amalgam fillings was recommended if there was a positive patch test reaction to ammoniated mercury, metallic mercury, or amalgam. Control group D (20 patients) had signs of allergic contact dermatitis.


RESULTS
Amalgam fillings were replaced in 13 patients of group A, with significant improvement. Dental amalgam was replaced in 8 patients of group B, with significant improvement. In group C, amalgam replacement in 2 patients resulted in improvement in 1 patient. These results were evaluated after 3 months. No positive patch test reactions to mercury compounds were found in patients with concomitant cutaneous lichen planus and in group D.


CONCLUSIONS
Contact allergy to mercury compounds is important in the pathogenesis of oral lichen planus, especially if there is close contact with amalgam fillings and if no concomitant cutaneous lichen planus is present. In cases of positive patch test reactions to mercury compounds, partial or complete replacement of amalgam fillings will lead to a significant improvement in nearly all patients.
Laeijendecker
Ronald
R
Department of Dermatology, Albert Schweitzer Hospital, Dordrecht, The Netherlands. R.Laeijendecker@asz.nl
Dekker
Sybren K
SK
Burger
Piet M
PM
Mulder
Paul G H
PG
Van Joost
Theodoor
T
Neumann
Martino H A
MH
D000328:Adult; D000368:Aged; D003723:Dental Amalgam / Q000009:adverse effects* / Q000737:chemistry; D020878:Device Removal; D004342:Drug Hypersensitivity / Q000209:etiology*; D005260:Female; D006801:Humans; D017676:Lichen Planus, Oral / Q000209:etiology* / Q000473:pathology / Q000628:therapy*; D008297:Male; D008628:Mercury / Q000009:adverse effects*; D008875:Middle Aged; D019233:Retreatment; D016896:Treatment Outcome
D003723:Dental Amalgam; D008628:Mercury