It is one thing to select a tattoo and willingly have it placed on your body. It is quite another to discover one that you did not authorize. An amalgam tattoo is somewhat like the latter – an unauthorized modification of the mouth.

What is an amalgam tattoo?

An amalgam tattoo is not intentional, nor is it what it sounds like. Instead of a gloved technician doodling a design inside of your lip, and amalgam tattoo occurs by accident.

Amalgam fillings are silver and metallic, consisting of a variety of metals including mercury, silver, tin and copper. An amalgam tattoo occurs when pieces of the filling lodge themselves in your cheeks, gums, tongue, or lips.

The most common areas for amalgam tattoos are the gums and the insides of the cheeks or floor of the mouth (the alveolar mucosa). Amalgam tattoos appear as a blue, grey, or black patch that is not elevated and has no texture. These fillings may appear as solid, irregular patches of metal, or they may separate into individual black or brown pieces that generally follow small blood vessels and nerves.

Amalgam tattoos generally appear adjacent to the filled tooth but can appear at any spot in the mouth.

What causes an amalgam tattoo?

Amalga tattoos have four main causes.

1. Accidental deposit during drilling

When getting a filling, your dentist uses a high-speed drill to remove tooth decay.

Once they remove the decay, it is possible that small pieces of the amalgam material can flake off and push into the gum near the drilling site. If there are lesions or scrapes near that site, this is a common cause.

2. Accidental deposit during polishing

Once the amalgam filing sets, your dentist uses a high-speed polisher to keep your bite even and remove stray bits of filling.

It is possible to get an amalgam tattoo at any time during this process.

3. During removal of amalgam fillings

Amalgam fillings have a lifespan of approximately ten to 15 years. Once they near the end of this time frame, you may need to replace them.

These days, composite fillings are the filling material of choice. The amalgam filing needs to be removed by drilling. Amalgam tattoos can occur during filling removal as well.

4. Diffusion through the teeth

This is a very rare cause, but in some cases, splinters of amalgam filling can make their way through the teeth to lodge in the gums adjacent to the dental restoration.

Amalgam tattoos vs mucosal melanoma

These marks are often mistaken for mucosal melanoma. This is a rare but very aggressive and deadly form of cancer that can present itself in a similar fashion as an amalgam tattoo. While their physical appearance is the same, mucosal melanoma has other symptoms that distinguish it from an amalgam tattoos.

These symptoms include:

  • Swelling
  • Ulcers
  • Pain
  • Ill-fitting dentures (that previously fit)
  • Irregular pigmentation with irregular and asymmetrical borders

Unlike amalgam tattoos which generally appear adjacent to a dental restoration, mucosal melanoma typically occur in the palate and the inner part of the sinus cavity.

An X-ray typically confirms diagnosis of amalgam tattoos (as opposed to mucosal melanoma). X-rays can pick up large metallic deposits. If the deposits are fragmented, X-rays may not pick them up and further exploration is necessary.

Another important difference between amalgam tattoos and mucosal melanoma is that although anyone with an amalgam filling can have an amalgam tattoo, the vast majority of mucosal melanoma occur in chronic, long-term tobacco users. If you smoke, you are far more likely to experience oral cancer than someone who does not.

Because the prognosis for mucosal melanoma is so poor (just a 15% survival rate), it is critical to have any discolorations in the mouth examined by your dentist and follow their recommendations for treatment.

Can amalgam tattoos be removed?

Aside from aesthetics, amalgam tattoos are generally considered harmless and do not need to be removed. They will not just disappear on their own, though.

If there is any question as to whether a discoloration on the mouth is precancerous and an X-ray is inconclusive, it is important to remove it for further examination. If there is a history of melanoma (any type of skin cancer), amalgam tattoo removal is recommended.

To remove an amalgam tattoo, your dentist will first apply a local anesthetic such as Novocain. Once the area is numb, they will make an incision and surgically remove any of the discolored material. Many dentists will send the removed tissue for a biopsy, even if no other symptoms are present.

In most cases, the amalgam filling will have already been replaced with a