You or your dentist may notice a gray, blue or black spot in your mouth that looks like a tattoo. Dentists call these spots amalgam tattoos. They can appear in the mouth of someone with amalgam fillings or metal false teeth (also known as "caps" or "crowns"). Amalgam fillings contain silver, tin, mercury, copper and zinc. Amalgam tattoos are made up of tiny metal particles from the filling or crown that become embedded in the tissue. They can appear on your gums, cheek, lips, tongue or the roof of the mouth (palate).
The tattoos are flat and usually quite small — only a few millimeters. But they're relatively easy to see.
A tattoo can be created while your dentist is placing or removing fillings or crowns that contain metal. It can also occur during many other dental procedures, such as tooth extractions or root canal treatment. A tattoo also can appear over time. For example, a filling on the outer side of a tooth may touch your inner cheek. Particles from the filling may rub off over time.
Amalgam tattoos are quite common, although many people don't even know they have them.
These tattoos are not dangerous and will not cause you harm. However, a small percentage of gray/blue areas are not amalgam tattoos. These other areas can be precancerous, non-cancerous or even a normal blood vessel. They need to be seen by a specialist, such as an oral surgeon or a dentist with special training in pathology or oral medicine.
If a gray/blue area in your mouth grows larger or changes color, see your general dentist right away. Your dentist may be able to make a diagnosis or refer you to an appropriate specialist.
Amalgam tattoos have no symptoms. In most cases, you won't even know you have one. They usually are found during a dental cleaning or a routine test for oral cancer.
To diagnose an amalgam tattoo, your dentist will look at the spot and check on your dental history. This includes whether you have amalgam fillings or had them in the past. A dental X-ray can sometimes show the metal particles, if they are large enough.
Some blue or gray spots may show signs of being an early cancer rather than an amalgam tattoo. In these cases, your dentist may refer you for a biopsy. In a biopsy, a small piece of tissue is removed and examined in a laboratory. Biopsies are common if the area has grown larger or changed color over time — for example, from gray to black.
An amalgam tattoo is permanent unless it is surgically removed.
Your dentist can reduce the chances that an amalgam tattoo will form. The usual way to do this is to use a rubber dam in your mouth during dental procedures. A dam is a flat piece of latex that isolates specific teeth from the rest of your mouth. Using a rubber dam, however, does not guarantee that an amalgam tattoo will not occur.
If you or your dentist finds a small gray or blue area in your mouth, the dentist will take an X-ray and review it to look for metal particles. The area should be measured. Then the dentist will watch it over time.
If the area gets larger or changes color, a biopsy should be done. If the biopsy shows precancerous or cancerous cells, you'll need another biopsy to remove the entire area.
If the area turns out to be an amalgam tattoo, further treatment is not necessary. However, you may want to have it removed if it is on the edge of your lip or somewhere else that makes you feel self-conscious.
The procedure uses Q-switched ruby lasers to shatter the metal particles and remove the tattoo. Cells in your body will then be able to carry them away, or they may come out through the skin. Talk to your dentist about having the tattoo surgically removed for cosmetic reasons.
If you notice a new gray, black or blue area on your gum or cheek, call or visit your dentist. Your dentist probably will have the area marked in your chart notes if it is an amalgam tattoo and it has been there since your last visit to the office.
If the area is sore or seems to be growing or changing color over time, visit your dentist to have it checked out. Your dentist may refer you to a specialist for a biopsy. The specialist may be an oral surgeon or a dentist with special training in pathology or oral medicine.
Because amalgam tattoos do not cause harm, the outlook is excellent. Treatment is not necessary. Most people never even notice amalgam tattoos.