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Amalgam tattoo is a grey, blue or black area of discoloration on the mucous membranes of the mouth, typically on the gums of the lower jaw. It is a healthcare caused lesion, due to entry of dental amalgam into the soft tissues.
The amalgam tattoo is mostly found on the alveolar or gingival mucosa (however can sometimes found on the buccal mucosa) and is more commonly found in females and older patients. It appears as painless, blue/gray/black, nonulcerated, soft macule without any erythematous reaction surrounding it.
Smoker melanosis in a patient consuming 2 packs of cigarette per day. Smoking or the use of nicotine-containing drugs is the cause to Smoker's melanosis. [10] [11] Tar-components (benzopyrenes) are also known to stimulate melanocytes to melanin production, and other unknown toxic agents in tobacco may also be the cause.
Necrotizing sialometaplasia (NS) is a benign, ulcerative lesion, usually located towards the back of the hard palate. It is thought to be caused by ischemic necrosis (death of tissue due to lack of blood supply) of minor salivary glands in response to trauma. Often painless, the condition is self-limiting and should heal in 6–10 weeks.
Leukoedema lesions disappear when the mucosa is stretched, which helps to differentiate it from other white lesions in the mouth. [2] The differential diagnosis is with leukoplakia , oral candidiasis , oral lichen planus , white sponge nevus , morsicatio buccarum , [ 3 ] hereditary benign intraepithelial dyskeratosis and dyskeratosis congenita.
Some recommend biopsy if the lesions persists more than 6 weeks after giving up smokeless tobacco use, [7] or if the lesion undergoes a change in appearance (e.g. ulceration, thickening, color changes, especially to speckled white and red or entirely red). [8] Surgical excision may be carried out if the lesion does not resolve. [7]
The lesions from a yeast infection can typically be rubbed off while those of leukoplakia cannot. [4] [14] Treatment recommendations depend on features of the lesion. [4] If abnormal cells are present or the lesion is small surgical removal is often recommended; otherwise close follow up at three to six month intervals may be sufficient. [4]
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