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What Is an Amalgam Tattoo?

Medically Reviewed by Melinda Ratini, DO, MS on May 28, 2021

‌An amalgam tattoo isn’t like a rose drawn on your arm. This type of tattoo is actually a side effect of common dental fillings. Amalgam tattoos often mimic the symptoms of certain dental or skin conditions, so diagnosing an amalgam tattoo is important. 

What’s an Amalgam Tattoo?

‌An amalgam tattoo is a common discoloration in the mouth. They typically appear as slightly gray or black spots that are less than 0.5 inches across. The area isn’t raised, and it doesn’t have any noticeable symptoms.

Causes of an Amalgam Tattoo

Dental amalgam. Amalgam tattoos are caused by “silver” dental fillings called amalgam. Dental amalgam is used to fill cavities and treat tooth decay. These “silver” fillings are actually a mixture of various metals, including mercury, silver, tin, and copper. 

When you get your dental fillings removed, your dentist will likely use a high-speed handpiece, or a drill, to do it. The tool can send tiny particles of dental amalgam flying around your mouth. 

The tiny particles can get stuck in the soft tissue of your mouth. The lesions created by the tiny particles eventually heal, trapping the metal pieces in your mouth’s tissue. Those tiny metal particles start to leak silver into the tissue, effectively tattooing the tissue with the metallic pigment. 

Symptoms and Complications of an Amalgam Tattoo

‌Amalgam tattoos aren’t hazardous to your health. Even though amalgam is around 50% mercury, particles that form an amalgam tattoo are not toxic. There’s no risk of mercury poisoning

As amalgam tattoos pose no risk, their existence is cosmetic. Unless you seek to treat them, they’re permanent. 

Diagnosing an Amalgam Tattoo

‌A dark spot in your mouth is cause for concern. Your doctor or dentist can easily diagnose an amalgam tattoo based on its appearance and your dental history. ‌

If the spot is near a tooth that has or previously had a dental amalgam, it may be an amalgam tattoo. Your doctor or dentist can perform a dental radiograph to detect the presence of metal particles. Less than a quarter of amalgam tattoos are diagnosed using radiography. 

Not an Amalgam Tattoo?

‌There could be a variety of other reasons for a strange pigmentation that resembles an amalgam tattoo. Further testing such as radiography or biopsy can be used to eliminate other possibilities. 

‌Mucosal melanoma. Amalgam tattoos can resemble spots of mucosal melanoma, a type of skin cancer of internal membranes. Mucosal melanoma is very rare, but more advanced stages require more invasive treatment. 

‌Hemangioma. Hemangioma is a red-colored birthmark caused by extra blood vessels in the area. Certain factors can cause the mark to appear darker and resemble an amalgam tattoo. 

Drug-induced hyperpigmentation. This type of pigmentation can occur due to a variety of drugs and medications. They cause an abnormal build-up of melanin and darken areas of your tissue or skin. Smokers can have these dark spots in their mouth, resembling amalgam tattoos.

Other diseases. Certain diseases can lead to oral pigmentation that resembles amalgam tattoos. These include the following: ‌

Graphite tattoos. These tattoos are typically the result of a schoolhouse mishap. When a piece of graphite or lead from a pencil gets stuck in your mouth, it can cause discoloration later on in life. ‌

‌Lead shot and bullets. Firearm ammunition can leave tattoo-like rubbings when it grazes your skin. Metal particles can become lodged in the skin. An unfortunate wound near the mouth could potentially cause amalgam tattoos. 

‌Asphalt tattoos. Asphalt tattoos occur when someone takes a spill on paved ground. Someone who has experienced “road rash” may end up with pieces of asphalt or metal in their skin, leading to pigmentation. But these are less common in the mucosal tissue of the mouth. 

Treating Amalgam Tattoos

‌Because amalgam tattoos are inside your mouth, they aren’t noticeable. But sometimes the gray pigmentation can be seen at the corner of your mouth or on your lip. If the amalgam tattoos are unacceptable to you, here are some treatment options. ‌

‌Surgical excision. This procedure is the most used for treating amalgam tattoos. This involves using a surgical knife or scalpel to remove the discolored tissue. In certain cases, your doctor or dentist may be able to transplant mucosal tissue.‌

‌Laser treatment. Laser treatments are becoming more popular for treating amalgam tattoos. The lasers destroy the tattoo particles, which are then safely removed. 

Show Sources

SOURCES: 

‌Brigham and Women’s Hospital: “Amalgam Tattoo.”

Dermatology Online Journal: “Amalgam tattoo.” 

‌Hassan, S., Zhou, X. StatPearls. StatPearls Publishing, 2021.

Journal of Oral Medicine and Oral Surgery: “Extensive amalgam tattoo (amalgam pigmentation) on the palatal mucosa: a short case report.” 

‌Mayo Clinic: “Hemangioma.” 

‌Medscape: “How are amalgam and graphite tattoos differentiated from oral malignant melanoma?” 

‌Memorial Sloan Kettering Cancer Center: “Mucosal Melanoma.” 

‌U.S. Food & Drug Administration: “Dental Amalgam Fillings.”

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