Oral Lichenoid Lesions May Regress after Amalgama Removal: A Case Report Becomes a Proof of the Concept

Author(s): Bettoni E, Bellucci G, Damiani G, Crescentini M

The aim of this report is to present a clinical case of oral lichenoid lesions (OLL) associated with amalgam and various metal restorations, including palladium, mercury, and gold. The patient presented with symptoms and lesions consistent with OLL, and the diagnosis was confirmed through a synthesis of the patient's medical history, clinical examination, histopathological analysis, and direct immunofluorescence. Oral lichenoid lesions are a group of disorders characterized by lesions that resemble oral lichen planus but are caused by a hypersensitivity reaction to certain substances, such as dental materials. In this case, the amalgam and metal restorations were suspected to be the triggering factors for the lichenoid lesions. The histopathological analysis revealed findings consistent with OLL, further supporting the diagnosis. Additionally, direct immunofluorescence testing provided additional evidence for the presence of OLL. The combination of these diagnostic approaches allowed for a comprehensive understanding of the patient's condition. As part of the treatment plan, the metal restorations were replaced, and this intervention led to significant improvements in the patient's clinical condition. The lichenoid lesions on the tongue and floor of the oral cavity showed regression and almost complete remission, exhibiting a reticular appearance. This outcome indicated a positive response to the removal of the suspected triggering factors. In conclusion, this case highlights the association between oral lichenoid lesions and metal restorations, particularly amalgam, palladium, mercury, and gold. The diagnosis was established through a comprehensive evaluation of the patient's medical history, clinical examination, histopathological analysis, and direct immunofluorescence testing. The removal of the metal restorations resulted in notable improvements in the patient's condition, with regression and near-complete remission of the lichenoid lesions.