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BACKGROUND Reflectance confocal microscopy (RCM) is a developing approach for noninvasive detection of oral lesions with label-free contrast and cellular-level resolution. For access into the oral cavity, confocal microscopes are being configured with small-diameter telescopic probes and small objective lenses. However, a small probe and objective lens allows for a rather small field-of-view relative to the large areas of tissue that must be examined for diagnosis. To extend the field-of-view for intraoral RCM imaging, we are investigating a video-mosaicking approach. METHODS A relay telescope and objective lens were adapted to an existing confocal microscope for access into the oral cavity. Imaging was performed using metal three-dimensional-printed objective lens front-end caps with coverslip windows to contact and stabilize the tissue and set depth. Four healthy volunteers (normal oral mucosa), one patient (with an amalgam tattoo) in a clinical setting, and 20 anesthetized patients (with oral squamous cell carcinoma [OSCC]) in a surgical setting were imaged. Instead of the usual still RCM images, videos were recorded and then processed into video-mosaics. Thirty video-mosaics were read and qualitatively assessed by an expert reader of RCM images of the oral mucosa. RESULTS Whereas the objective lens' native field-of-view is 0.75 mm × 0.75 mm, the video-mosaics display larger areas, ranging from 2 mm × 2 mm to 4 mm × 2 mm, with resolution, morphologic detail, and image quality that is preserved relative to that observed in the original videos (individual images). Video-mosaics in healthy volunteers' and the patients' images showed cellular morphologic patterns in the lower epithelium and at the epithelial junction, and connective tissue along with capillary loops and blood flow in the deeper lamina propria. In OSCC, tumor nests could be observed along with normal looking mucosa in margin areas. CONCLUSIONS Video-mosaicking is a reasonably quick and efficient approach for extending the field-of-view of RCM imaging, which can, to some extent, overcome the inherent limitation of an intraoral probe's small field-of-view. Reading video-mosaics can mimic the procedure for examining pathology: initial visualization of the spatial cellular and morphologic patterns of the tumor and the spread of tumor margins over larger areas of the lesion, followed by digitally zooming (magnifying) for closer inspection of suspicious areas. However, faster processing of videos into video-mosaics will be necessary, to allow examination of video-mosaics in real-time at the bedside. Lasers Surg. Med. © 2019 Wiley Periodicals, Inc.

OBJECTIVES To evaluate clinical, demographic, and histopathological characteristics of pigmented lesions of the oral mucosa. MATERIALS AND METHODS A cross-sectional study was conducted over a 64-year period. Information was collected from medical charts, and all archived histopathological specimens with diagnoses of any pigmented lesion were retrieved. Statistical analysis was performed using SPSS software. RESULTS A total of 34,127 archived specimens were reviewed, revealing 458 (1.34%) pigmented lesions, of which 230 were melanocytic and 228 nonmelanocytic. Most patients were females (74.2%), white-skinned (49.1%), in the third and seventh decades of life (mean of 45 years). Most lesions were macular (59.8%), followed by plaques and nodules (4.8%), measuring 0-5 mm (41.9%). Cheek mucosa (21.0%), alveolar mucosa (16.6%), and gingiva (11.8%) were the most commonly affected sites. Amalgam tattoo was applied in 212 cases (46.3%), followed by melanotic macule (22.9%) and nevus (20.5%). Other diagnoses included racial pigmentation, exogenous pigmentation, melanotic neuroectodermal tumor of infancy, melanoma, melanoacanthoma, smoker's melanosis, and heavy metal pigmentation. CONCLUSIONS Pigmented lesions represent an uncommon diagnosis in oral pathology routines. The most frequent entities are amalgam tattoo, melanotic macule, and nevus. Patients are usually middle-aged women presenting a small, long-lasting, macular lesion on the cheek mucosa.

Periodontal health is defined by absence of clinically detectable inflammation. There is a biological level of immune surveillance that is consistent with clinical gingival health and homeostasis. Clinical gingival health may be found in a periodontium that is intact, i.e. without clinical attachment loss or bone loss, and on a reduced periodontium in either a non-periodontitis patient (e.g. in patients with some form of gingival recession or following crown lengthening surgery) or in a patient with a history of periodontitis who is currently periodontally stable. Clinical gingival health can be restored following treatment of gingivitis and periodontitis. However, the treated and stable periodontitis patient with current gingival health remains at increased risk of recurrent periodontitis, and accordingly, must be closely monitored. Two broad categories of gingival diseases include non-dental plaque biofilm-induced gingival diseases and dental plaque-induced gingivitis. Non-dental plaque biofilm-induced gingival diseases include a variety of conditions that are not caused by plaque and usually do not resolve following plaque removal. Such lesions may be manifestations of a systemic condition or may be localized to the oral cavity. Dental plaque-induced gingivitis has a variety of clinical signs and symptoms, and both local predisposing factors and systemic modifying factors can affect its extent, severity, and progression. Dental plaque-induced gingivitis may arise on an intact periodontium or on a reduced periodontium in either a non-periodontitis patient or in a currently stable "periodontitis patient" i.e. successfully treated, in whom clinical inflammation has been eliminated (or substantially reduced). A periodontitis patient with gingival inflammation remains a periodontitis patient (Figure 1), and comprehensive risk assessment and management are imperative to ensure early prevention and/or treatment of recurrent/progressive periodontitis. Precision dental medicine defines a patient-centered approach to care, and therefore, creates differences in the way in which a "case" of gingival health or gingivitis is defined for clinical practice as opposed to epidemiologically in population prevalence surveys. Thus, case definitions of gingival health and gingivitis are presented for both purposes. While gingival health and gingivitis have many clinical features, case definitions are primarily predicated on presence or absence of bleeding on probing. Here we classify gingival health and gingival diseases/conditions, along with a summary table of diagnostic features for defining health and gingivitis in various clinical situations. ispartof: JOURNAL OF PERIODONTOLOGY vol:89 pages:S74-S84 ispartof: location:IL, Chicago status: published

none 10 no Oral pigmentations (OPs) are often neglected, although a meticulous examination of the oral cavity is important not only in the diagnosis of oral melanoma, but also for the detection of important clinical findings that may indicate the presence of a systemic disease. OPs may be classified into two major groups on the basis of their clinical appearance: focal and diffuse pigmentations, even though this distinction may not appear so limpid in some cases. The former include amalgam tattoo, melanocytic nevi, melanoacanthoma and melanosis, while the latter include physiological/racial pigmentations, smoker's melanosis, drug-induced hyperpigmentations, postinflammatory hyperpigmentations and OPs associated with systemic diseases. We will discuss the most frequent OPs and the differential diagnosis with oral mucosal melanoma (OMM), underlining the most frequent lesions that need to undergo a bioptic examination and lesions that could be proposed for a sequential follow-up. none Lambertini, M; Patrizi, A; Fanti, P A; Melotti, B; Caliceti, U; Magnoni, C; Misciali, C; Baraldi, C; Ravaioli, G M; Dika, E Lambertini, M; Patrizi, A; Fanti, P A; Melotti, B; Caliceti, U; Magnoni, C; Misciali, C; Baraldi, C; Ravaioli, G M; Dika, E

Purpose The grey-bluish discoloration of gingiva (known as “amalgam tattoo”) does not appear only in the presence of amalgam restorations. It may also be seen in cases of teeth restored with cast dowels and porcelain-fused-to-metal (PFM) restorations. The aim of this article was to determine the clinical characteristics of abutment teeth with gingival discoloration. Materials and Methods This research was conducted on 25 patients referred for cast dowel and PFM restorations. These restorations were manufactured from Ni-Cr alloys. Ninety days after cementing the fixed prosthodontic restorations, the abutment teeth (n = 61) were divided into a group with gingival discoloration (GD) (n = 25) and without gingival discoloration (NGD) (n = 36). The control group (CG) comprised the contralateral teeth (n = 61). Plaque index, gingival index, clinical attachment level, and probing depth were assessed before fabrication and also 90 days after cementation of the PFM restorations. Results The gingival index, clinical attachment level, and probing depths of the abutment teeth that had GD were statistically higher before restoration, in comparison with the abutment teeth in the NGD and control groups. Ninety days after cementation, the abutment teeth with GD had significantly lower gingival indexes and probing depths, compared to the abutment teeth in the NGD group. Both abutment teeth groups (GD and NGD) had significantly higher values of clinical attachment levels when compared to the control group. There were no statistically significant differences in plaque index values between the study groups. Conclusions The results of this study indicated that impairment of periodontal status of abutment teeth seemed to be related to the presence of gingival discolorations. Therefore, fabrication of fixed prosthodontic restorations requires careful planning and abutment teeth preparation to minimize the occurrence of gingival discolorations. Clinical relevance: With careful preparation of abutment teeth for cast dowels and crown restorations it may be possible to decrease the frequency of gingival discolorations adjacent to abutment teeth.

Amalgam tattoos are common, asymptomatic, pigmented oral lesions that clinically exist as isolated, blue, gray, or black macules on the gingival, buccal, and alveolar mucosae, the palate, and/or the tongue. In this case report, the successful use of an erbium, chromium-doped:yttrium, scandium, gallium, and garnet laser for the removal of an amalgam tattoo is explained. A 46-year-old man is presented with a half decade history of an amalgam tattoo on his left maxillary premolar–molar gingiva. Depigmentation procedure was performed under topical anesthesia with the use of an erbium, chromium-doped:yttrium, scandium, gallium, and garnet laser at 2 W in the soft tissue pulsed mode for 10 min. The pigmented tissue was completely removed. The de-epithelialization area healed completely on the 10th day after treatment. The period of healing was uneventful. The amalgam tattoo was completely removed with erbium, chromium-doped:yttrium, scandium, gallium, and garnet laser, and the treated area healed without any adverse effect.

Background: A 56-year-old female presented for periodontal treatment with a large amalgam tattoo located in alveolar mucosa on the facial aspect of her maxillary central incisors. The lesion had been present for 42 years since having endodontic surgery at teeth #8 and #9 after a traumatic childhood incident.Methods: A two-stage surgical approach was used to eliminate the lesion, beginning with a subepithelial connective tissue graft to increase tissue thickness subjacent to the amalgam tattoo. After 6 weeks of healing, the overlying pigmented tissue was removed using laser surgery to expose the underlying grafted connective tissue.Results: After 2 months of healing following laser surgery, the amalgam pigmentation was completely removed, with good color match and an increased width of keratinized tissue at the surgical site.Conclusion: A relatively large amalgam tattoo in the esthetic zone can be adequately removed by a two-stage procedure using grafted palatal connective tissue and laser deepithelialization.

Background: Solitary pigmented lesions of melanocytic origin are uncommon in the oral mucosa. These lesions include the oral and labial melanotic macule, oral melanocytic nevus, oral melanoacanthoma, oral melanoma and atypical melanocytic proliferation. The purpose of the study was twofold: to report a large series of solitary melanocytic lesions from one source, and to determine the relative frequency of these lesions. Methods: The study was based on a systematic search of the files of the Pacific Oral and Maxillofacial Pathology Laboratory, University of the Pacific, San Francisco for solitary pigmented melanocytic lesions (benign and malignant) accessed during the years 1984–2002. Results: Of the 89 430 biopsies accessed during the 19-year period, 773 (0.83%) cases of solitary pigmented melanocytic lesions in the oral mucosa were identified. Oral and labial melanotic macules were the most common melanocytic lesions comprising 86.1% of the entire group and 0.7% of the total number of accessed biopsies. The vermilion border and gingiva were the most common sites (31.1% and 31.0% respectively). Oral melanocytic nevi comprised 11.8% of the entire melanocytic group and 0.1% of the total number of biopsies. The most common site was the palate (44%). Intramucosal nevi were the most common (64%), followed by compound nevi (16.5%) and common blue nevi (16.5%). Junctional nevi were uncommon (3.0%). Oral melanoacanthoma comprised only 0.9% of the entire melanocytic group and 0.008% of the total number of biopsies. Oral melanoma and atypical melanocytic proliferation were the least common lesions each comprising 0.6% of the entire melanocytic group and 0.006% of the total number of biopsies. The most common site for oral melanoma was the palate (60%). Conclusion: The palate was the most common location for both melanocytic nevi and oral melanoma. Thus, all melanocytic lesions in the palate should be viewed with caution and biopsy is recommended to rule out melanoma. Further studies are required to elucidate the entity of oral atypical melanocytic proliferation.

Background: Malignant melanoma is rare in the oral cavity and accounts for less than 1% of all melanomas. Nevertheless, the disease can be fatal, and early diagnosis and treatment may improve prognosis dramatically. The purpose of this paper is to report 3 new cases of primary malignant melanoma of the oral cavity arising in the gingiva, and to review the literature regarding intraoral melanoma. Methods: Three cases are presented. One case was in the right mandibular molar area; the second in the right maxillary canine-premolar area; and the third in the left mandibular canine-premolar region. All patients were treated surgically, with postoperative radiotherapy. Results: The first patient lived for 2 years and the second for 3 years before distant metastases were diagnosed from which they subsequently died. The third patient was lost from follow-up after 18 months. Conclusion: Primary oral malignant melanoma is a deadly disease. Early suspicion of this disease will allow prompt treatment and increase the...

A 35-year-old woman exhibited bluish-brown discoloration of her buccal mucosa suggesting malignant melanoma. Histopathological examination revealed that the pigment was not melanin but caused by metal deposits. Electron microscopically, metallic particles were located on the lamina densa of basal laminae at mucosal epithelium, nerve fibers, and blood vessels and on the microfilaments of elastic fibers as well as in macrophages and fibroblasts. Electron microscopic point X-ray microanalysis revealed that these metallic particles were composed of Ag, Se, Fe, Co, Cu, and S. Analysis suggests that these metals were derived from dental amalgam and that the discoloration was caused by amalgam tattoo.

We report on a lichenoid reaction that developed in association with amalgam particles within an amalgam tattoo of the oral mucosa.

A common tattoo occurring in the mouth is caused by the insertion of amalgam filling material into the soft tissues. Fifteen amalgam tattoos were examined. Amalgam or its derivatives were found within macrophages, fibroblasts and multinuclear giant cells. Fine particles were found associated with: the basement-membranes of mucosal epithelium, of striped muscle fibres, and of muscle cells of blood vessels; collagen; elastic tissue; and the connective tissue of nerves. Amalgam consists mainly of mercury, silver and tin. The analytical results suggest that corrosion occurs and that mercury and some tin are lost from the tattoos, leaving silver and tin in macrophages and giant cells, and silver in fibroblasts and in the above-mentioned extracellular sites.

It is known that macrophages play an important role in the removal of foreign particulate matter from tissue. When powdered dental amalgam is introduced into the soft tissues an amalgam tattoo is formed due to the intracellular degradation of amalgam by macrophages and their polykaryons. It was therefore feasible to study the effects of particulate amalgams as well as their individual phases on macrophages in vitro. The parameters compared were rate of the phagocytosis, changes of cellular morphology, and release of lactate dehydrogenase (LDH) to demonstrate plasma membrane permeability. It was shown that all the alloys except the Sn8Hg particles (gamma 2-phase) and gamma 2-containing Revalloy were effectively phagocytized by macrophages, and the alterations in cellular morphology were slight during the first day. Prominent cellular damage was seen in cultures treated with particulate Ag2Hg3 (gamma 1-phase) and Revalloy for 1 week. A slight increase in LDH activity in the medium was seen one hour after the alloy treatment. The LDH activities due to the amalgam treatment increased in the order Dispersalloy less than Revalloy less than Sybraloy. Intraperitoneal phagocytosis did not cause any morphological changes in macrophages, but the per cent of phagocytosis was diminished.