385 Improvement of Oral Lichenoid Reaction Symptoms after Removal of Amalgam Restorations: An Anusual Case of Type IV Hypersensitivity

BACKGROUND: Chemical and mechanic iritations may play causative role in development of lichenoid reactions in oral mucosa, similar to skin, in predisposed patients. It has recently been reported that lichenoid reactions and Wickham striae with papular/reticular characteristics are observed in mucosal regions which are in direct contact with amalgam restorations (1). A 38-year-old male patient admitted initially to the Department of Oral Diagnosis and Radiology, chiefly complaining of bilateral buccal pain and itching. In his intraoral inspection, hyperkeratotic white lesions at his molar teeth level at both right and left buccal mucosa were observed. The purpose of this study is to find out the nature and decide on the management of these buccal lesions. METHODS: In dental inspection of the patient, large amalgam restorations and white lesions in buccal surface in direct contact with amalgam were observed in left first and second, and right second molar teeth region. A 4-mm punch biopsy from buccal mucosa was performed. In addition, a skin patch test with amalgam was done in back region of the patient. RESULTS: In punch biopsy, histopathological features were compatible with lichenoid mucositis. In addition, skin patch test results indicated a very strong positive reaction to amalgam. The lesion healed up after replacement of restorations with composite filling material. The patient, his family and his dental practitioner were strictly advised to use alternative restorative materials in case of a need for restoration. CONCLUSIONS: Amalgam and its components may cause type IV hypersensitivity reactions (1) and, very unusually, immediate hypersensitivity (2). The clinician should be aware of all possible pathological etiologies of white lesions. If there is any doubt about the diagnosis and management of an anusual oral lesion, referral to appropriate specialists is mandatory.