Amalgam Tattoo (Focal Argyrosis)
What are Amalgam Tattoos?

An Amalgam Tattoo (also called a focal argyrosis) is the
most common pigmentation of the oral cavity.  It is an area
of permanent bluish-gray pigmentation resulting from
amalgam (silver) filling particles falling into small, open
wounds created during dental treatment or by trauma
shortly after a dental treatment, when small, fresh
particles still cling to the mucosa.
Photos of Amalgam Tattoos
What are the Signs & Symptoms of an Amalgam Tattoo?

The amalgam tattoo presents as a soft, painless, non-ulcerated, blue / gray / black
macule (a small, flat, distinct, coloured area of skin that is ≤ 10 mm in diameter and
does not include a change in skin texture or thickness) with no surrounding

They are more common in the lower jaw than the upper, typically in the
region.  The tattoo is found more frequently in women than in men, perhaps
because women more frequently seek dental care.  It is also seen more frequently
with advancing patient age, presumably because of increased exposure to dental
procedures over time.

There are no symptoms of an
amalgam tattoo.  In most cases, you won't even
know you have one.

How are they treated?

Reassurance.  No treatment is necessary but a biopsy can be performed to rule out
melanoma or another pigmented lesions.

Tattoos visible on the X-ray are usually not biopsied and those occurring on the
visible part of the lips can be removed for cosmetic reasons.

There is
no malignant potential for this lesion.

Do they come back?

An amalgam tattoo is permanent unless it is removed surgically.  As amalgam
do not cause harm, the prognosis is excellent.

Useful Websites:

Doctor Spiller

University of Arkansas, College of Health Sciences

Bond's Book of Oral Diseases (4th Edition)  / The Maxillofacial Center for
Diagnostics & Research

Useful Articles:

NEJM 2011.  Images in Clinical Medicine.  Amalgam Tattoo

Austral J Basic & Appl Sci 2012.  Prevalence of Oral Pigmented Lesions - A
Prospective Study

Q J Med 2012.  Clinical Picture.  Pigmented Lesions in the Oral Mucosa - The Ugly
But Good