Dunsche A, Kästel I, Terheyden H, Springer I N G, Christophers E, Brasch J
Department of Oral and Maxillofacial Surgery, University of Kiel, Arnold-Heller-Str. 16, Germany.
Br J Dermatol. 2003 Jan;148(1):70-6. doi: 10.1046/j.1365-2133.2003.04936.x.
The pathogenetic relationship between oral lichenoid reactions (OLR) and dental amalgam fillings is still a matter of controversy.
To determine the diagnostic value of patch tests with amalgam and inorganic mercury (INM) and the effect of amalgam removal in OLR associated with amalgam fillings.
In 134 consecutive patients 467 OLR were classified according to clinical criteria. One hundred and fifty-nine biopsies from OLR lesions were histologically diagnosed according to the World Health Organization criteria for oral lichen planus (OLP) and compared with 47 OLP lesions from edentulous patients without amalgam exposure. One hundred and nineteen patients were patch tested with an amalgam series. In 105 patients (357 of 467 lesions) the amalgam fillings were removed regardless of the patch test results and OLR were re-examined within a follow-up period of about 3 years. Twenty-nine patients refused amalgam removal and were taken as a control group.
Eleven patients with OLR (8.2%) had skin lesions of lichen planus (LP). Histologically, the lesions in the OLR group could not be distinguished from those seen in the OLP group. Thirty-three patients (27.7%) showed a positive patch test to INM or amalgam. Amalgam removal led to benefit in 102 of 105 patients (97.1%), of whom 31 (29.5%) were cured completely. Of 357 lesions, 213 (59.7%) cleared after removal of amalgam, whereas 65 (18.2%) did not improve. In the control group without amalgam removal (n = 29) only two patients (6.9%) showed an improvement (P < 0.05). Amalgam removal had the strongest impact on lesions of the tongue compared with lesions at other sites (P < 0.05), but had very little impact on intraoral lesions in patients with cutaneous LP compared with patients without cutaneous lesions (P < 0.05). Patients with a positive patch test reaction to amalgam showed complete healing more frequently than the amalgam-negative group (P < 0.05). After an initial cure following amalgam removal, 13 lesions (3.6%) in eight patients (7.6%) recurred after a mean of 14.6 months.
Of all patients with OLR associated with dental amalgam fillings, 97.1% benefited from amalgam removal regardless of patch test results with amalgam or INM. We suggest that the removal of amalgam fillings can be recommended in all patients with symptomatic OLR associated with amalgam fillings if no cutaneous LP is present.
口腔苔藓样反应（OLR）与银汞合金补牙之间的发病机制关系仍存在争议。
确定用银汞合金和无机汞（INM）进行斑贴试验的诊断价值以及去除银汞合金对与银汞合金补牙相关的OLR的影响。
对134例连续患者的467处OLR根据临床标准进行分类。根据世界卫生组织口腔扁平苔藓（OLP）标准对159处OLR病变的活检组织进行组织学诊断，并与47例无银汞合金接触的无牙患者的OLP病变进行比较。119例患者用银汞合金系列进行斑贴试验。105例患者（467处病变中的357处）无论斑贴试验结果如何均去除银汞合金补牙，并在约3年的随访期内对OLR进行重新检查。29例患者拒绝去除银汞合金补牙并作为对照组。
11例OLR患者（8.2%）有扁平苔藓（LP）皮肤病变。组织学上，OLR组的病变与OLP组的病变无法区分。33例患者（27.7%）对INM或银汞合金斑贴试验呈阳性。去除银汞合金使105例患者中的102例（97.1%）受益，其中31例（29.5%）完全治愈。在357处病变中，213处（59.7%）在去除银汞合金后消退，而65处（18.2%）没有改善。在未去除银汞合金的对照组（n = 29）中，只有2例患者（6.9%）有所改善（P < 0.05）。与其他部位的病变相比，去除银汞合金对舌部病变的影响最大（P < 0.05），但与无皮肤病变的患者相比，对有皮肤LP的患者口腔内病变的影响很小（P < 0.05）。对银汞合金斑贴试验反应阳性的患者比斑贴试验阴性组更频繁地完全愈合（P < 0.05）。在去除银汞合金后最初治愈后，8例患者（7.6%）的13处病变（3.6%）在平均14.6个月后复发。
在所有与银汞合金补牙相关的OLR患者中，97.1%的患者无论银汞合金或INM斑贴试验结果如何，均从去除银汞合金中受益。我们建议，如果没有皮肤LP，对于所有有症状的与银汞合金补牙相关的OLR患者，均可推荐去除银汞合金补牙。
