Oral lichenoid reaction to dental amalgam and its association with desquamative gingivitis “a diagnostic conundrum”: A case report

Abstract

Oral lichenoid lesions (OLLs) are chronic inflammatory lesions of the oral cavity, and they can hardly be distinguished from oral lichen planus (OLP). Various terms have been used in the literature, including lichenoid contact lesions, lichenoid contact stomatitis, and oral lichenoid reactions. The concept of contact allergy to dental restorative materials in OLLs has been widely recognized but somewhat controversial. The most common causative allergen is mercury in dental amalgam, with a few reported cases from other materials. These lesions are most often seen in direct topographic relation to the causative agent. The possible correlation between the presence of desquamative gingivitis (DG) associated with autoimmune diseases and the worsening of periodontal parameters has been discussed in the literature, since both conditions can share immuno-inflammatory mechanisms in their pathogenesis. The DG may indirectly worsen the accumulation of plaque in the affected sites, since pain and bleeding may inhibit the patient’s oral hygiene. The aim of this report is to present a clinical case of OLLs associated with amalgam restoration and its association with DG for a three-month follow-up period.