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 reddening.

They are more common in the lower jaw than the upper, typically in the
bicuspid-molar 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

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 tattoos 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

DermNet NZ

Useful Articles:

Refuat Hapeh Vehashinayim 2004.  Amalgam Tattoo (Amalgam Pigmentation) of the Oral Mucosa - Clinical
Manifestations, Diagnosis & Treatment

Dermatol Online J 2008.  Amalgam Tattoo

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

J Oral Med Oral Surg 2019.  Short Case Report.  Extensive amalgam tattoo (amalgam pigmentation) on the palatal
Last Updated 27th December 2019