Oral lichenoid lesion and proximity to restoration

Key Points

• Oral lichenoid lesions (OLLs) may be elicited by dental restorations and amalgam restorations with their mercury content appear to be a major aetiological factor.

• The diagnosis depends mainly on the clinical findings including the lesions' characteristics and relationship to restorations. Patch testing seems to be of limited value.

• Replacement of dental restorations can result in the resolution or improvement of OLLs in most instances.

Abstract

Objective To determine the effectiveness of replacing restorations considered to be the cause of an oral lichenoid lesion (oral lichenoid reaction)(OLL).

Design Clinical intervention and nine-month follow up.

Setting The study was carried out in the University Dental Hospital of Manchester, 1998-2002.

Subjects and methods A total of 51 patients, mean age 53 (SD 13) years, who had oral lesions or symptoms suspected to be related to their dental restorations were investigated. Baseline patch tests for a series of dental materials, biopsies and photographs were undertaken. Thirty-nine out of 51 patients (76%) had their restorations replaced.

Results The clinical manifestations of OLL were variable; the majority of OLL were found to be in the molar and retro molar area of the buccal mucosa and the tongue. Twenty-seven (53%) patients had positive patch test reactions to at least one material, 24 of them for one or more mercury compound. After a mean follow up period of nine months, lesions adjacent to replaced restorations completely healed in 16 (42%) patients (10 positive and 6 negative patch tests). Improvement in signs and symptoms were found in 18 (47%) patients (11 positive and 7 negative patch tests).

Conclusion OLLs may be elicited by some dental restorations. Replacing restorations adjacent to these lesions is associated with healing in the majority of cases particularly when lesions are in close contact with restorations. A patch test seems to be of limited benefit as a predictor of such reactions.

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