Assessment of the Association between Oral Lichenoid Reactions and Amalgam Restorations and to determine the Salivary Concentrations of Interleukin-6 (IL-6) and IL-8 before and after Replacement of the Amalgam Restorations

Main Article Content

Sulaiman S. Alqahtani
Salim A Algarni


Lichenoid reaction, amalgam, IL-6, IL-8


Background: The oral mucosa is affected by chronic autoimmune lesions known as lichen planus of the oral cavity (OLP) and lichenoid reactions of the oral cavity (OLR). OLP resembles OLR in terms of histology and clinical features, however, it is a possibly premalignant condition that affects 2% of people. Some experts believe that an allergic reaction on contact with amalgam restoration or the other
above-mentioned elements is what causes OLP, whilst others assert that OLP and OLR are two distinct disorders.
Aim: This study sought to determine the efficacy of amalgam restoration, which is thought to be the etiology of OLR, and to measure IL-6 concentration and IL-8 concentrations in saliva prior to and following the replacement of amalgam restoration.
Methods and materials: In this study, amalgam restorations were changed in 40 patients by composite restoration, gold restoration, porcelain restoration, or assembly of these materials. These individuals were assessed in the hospital following a follow-up time of between two months and three and a half years. The severity of OLR and extent of OLR were rated as 1 when there was complete healing of all lesions and there was no presence of lesions. The severity of OLR and extent of OLR were rated as 2 when significant improvement (above 80%) was noticed and it was rated as 3 when there was no change in symptoms. ELISA was carried out in accordance with the package recommendations to measure the concentrations of IL-6 and the concentration of IL- 8 in saliva. The outcomes were reported in pg/mL. The experiment was run twice and then three times. In pg/mL, protein concentration was expressed

Results: On amalgam removal, there was complete healing of lesions in 32 study participants, while there was more than 80% healing of lesions in 6 study participants. On the other hand, there was no improvement observed and no deterioration of symptoms in the 2 patients. Statistics revealed that there is a significant reduction in the number of lesions on the removal of amalgam restoration giving
support to the association between amalgam restoration and oral lichenoid reactions. (p˂0.05). . Before the fillings were replaced, IL-6 levels were found to be substantially higher than afterward (P˂ 0.05). The levels of IL-8 that were found prior to replacement were similarly considerably higher than the levels that followed (P<0.05). In control subjects, the levels of IL-6 tested before and after the
intervention did not differ substantially (P ˃0.05). The same holds true for the IL-8 readings (P˂0.05).
Conclusion: Clinical observations showed that tissue recovery from oral lichenoid reaction followed the restorative replacement of amalgam restorations. When amalgam restorations were changed for restorations made of other dental restorations, concentrations of both IL-6 cytokines and IL-8 cytokines in healthy participants returned to normal.


Abstract 157 | pdf Downloads 116


1. Nissalo S, Hietanen J, Malmstrom M, Hukkanen M, Polak J, Kontinnen YT. Disorder- specific changes in innervation in oral lichen planus and
lichenoid reactions. J Oral Pathol Med 2000; 29:361–369.
2. Axell T, Rundquist L. Oral lichen planus – a demographic study. Commun Dent Oral Epidemiol 1987; 36: 141–146.
3. López-Jornet P, Camacho-Alonso F, GomezGarcia F, Bermejo Fenoll A. The clinicopathological characteristics of oral lichen
planus and its relationship with dental materials. Contact Dermatitis 2004; 51: 210.
4. Rice PJ, Hamburger J. Oral lichenoid drug eruptions: their recognition and managmnet. Dent Update 2002; 29: 442–447.
5. Dunsche A, Kastel I, Terheyden H, Springer ING, Chritophers E, Brasch J. Oral lichenoid reactions associated with amalgam: improvement after amalgam removal. Br J Dermatol 2003; 148: 70–76.
6. Wong L, Feeman S. Oral lichenoid lesions (OLL) and mercury in amalgam fillings. Contact Dermatitis 2003; 48: 74–79.
7. Little MC, Griffiths CEM, Watson REB, Pemberton MN, Thornhill MH. Oral mucosal keratinocytes express RANTES and ICAM-1, but
not interleukin-8, in oral lichen planus and oral lichenoid reactions induced by amalgam fillings. Clin Exp Dermatol 2003; 28: 64–69.
8. Pezelj-Ribaric S, Brekalo Prßo I, Abram M, Glazar I, Brumini G, Simunovic-Soskic M. Salivary levels of tumor necrosis factor-alpha in
oral lichen planus. Med Inflamm 2004; 13: 131–133.
9. Greenberg MS, Glick M. Burket’s Oral Medicine: Diagnosis and Treatment, 10th edn. LippincotRaven, Hamilton, Canada, 2006: 108.
10. Richter G. Dental materials-problem substances in allergologic diagnosis? II. Patch test diagnosis and relevance evaluation of selected dental material groups. Hautartz 1996; 47: 844–849.
11. Navazesh M. Methods for collecting saliva. ANNNY Acad Sci 1993; 694: 72–77.
12. Rhodus NL, Cheng B, Myers S, Bowles W, Ho V, Ondrey F. A comparison of the proinflammatory, NF-kappaB-dependent cytokines:
TNF-alpha, IL-1-alpha, IL-6, and IL-8 in different oral fluids from oral lichen planus patients. Clin Immmunol 2005; 114: 278–283.
13. Sumairi BI, Satish KS, Rosnah BZ. Oral lichen planus and lichenoid reactions: etiopathogenesis, diagnosis, management and malignant transformation. J Oral Sci 2007; 49: 89–106.
14. Laine J, Kalimo K, Happonen RP. Contact allergy to dental restorative materials in patients with oral lichenoid lesions. Contact Dermatitis 1997; 36:
141–146. Staines KS, Wray D. Amalgam–tattooassociated oral lichenoid lesion. Contact Dermatitis 2007; 56: 240–241.
15. Thornhill MH, Pemberton MN, Simmons RK,Theaker ED. Amalgam-contact hypersensitivity lesions and oral lichen planus. Oral Surg Oral
Med Oral Pathol Oral Radiol Endod 2003; 95: 291–299.
16. Laine J, Kalimo K, Happonen RP. Contact allergy to dental restorative materials in patients with oral lichenoid lesions. Contact Dermatitis 1997; 36:141–146.
17. Sun A, Wang JT, Chia JS, Chiang CO. Serum interleukin-8 level is a more sensitive marker than serum interleukin-6 level in monitoring the
disease activity of oral lichen planus. Br J Dermatol 2005; 152: 1187–1192.
18. Maie AR, Li Y, Zhou XF et al. Interleukin 6 and Interleukin 8 as potential biomarkers for oral cavity and oral squamous cell carcinoma. Arch
Otolaryngol Head Neck Surg 2004; 130: 929–935.
19. Rhodus NL, Cheng B, Ondrey F. Th1/Th2 cytokine ratio in tissue transudate from patients with oral lichen planus. Med Inflammat 2007; 28: