Amalgam Tattoo — ORE Part 1 MCQ

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EasyOral MedicineAmalgam TattooORE Part 1

A patient presents with a blue/purple discolouration of the attached gingiva adjacent to a large amalgam restoration on the lower first molar. It is non-tender and does not blanch on pressure. What is the most likely diagnosis?

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Correct answer: B — Amalgam tattoo

Explanation lettering: D = shown as A · A = shown as B · B = shown as C · C = shown as D

Amalgam tattoo is the correct diagnosis. The clinical presentation is classic: asymptomatic blue/purple pigmentation adjacent to an amalgam restoration at the gingiva (the most common site), with non-blanching character confirming it is not a vascular lesion. The diagnosis rests on three key features: (1) temporal and spatial proximity to a large amalgam filling (aetiology of incidental particle embedding), (2) asymptomatic, non-tender nature, and (3) non-blanching appearance (excluding vascular lesions). Haemangioma (C) and mucocoele (D) would characteristically blanch on pressure and usually be soft/compressible. Melanoma (B) would not be diagnosed on appearance alone and would require suspicious features (asymmetry, ulceration, growth trajectory) and biopsy. Racial pigmentation (E) is intrinsic and does not explain the temporal relation to the dental restoration. Recognition of amalgam tattoo is essential to avoid unnecessary anxiety and investigation; the diagnosis is straightforward when dental history is integrated with clinical findings.

Reference: Royal College of Surgeons Faculty Dental Journal (2024). 'Oral pigmented lesions: a pragmatic approach to diagnosis and management.' https://publishing.rcseng.ac.uk/doi/10.1308/rcsfdj.2024.30