Oral lichenoid reactions related to mercury sensitivity

Lichen planus is a common disorder of unknown aetiology. It has been proposed that in some cases it represents a form of allergic reaction to the metals contained in dental amalgam, particularly mercury. Twenty-nine consecutive dentate patients who had lichen planus of the oral mucosa were patch-tested to the range of metals contained in dental amalgam. Ten out of 29 (34%) showed an allergic reaction to mercury and all of these patients had amalgams greater than 5 years old. The amalgams were poorly contoured and had corroded, resulting in continued release of mercury ions. Six patients had their amalgams replaced with composite or glass ionomer materials resulting in resolution of ulcerated lesions. In a follow-up of 3-24 months, one patient had a recurrence of ulcerated areas and another, despite resolution of the oral lesions had persistent discomfort.