Dental amalgam controversy demonstrated that mercury released from amalgam restorations does not give rise to toxic effects on the nervous system of children. More recently, a Cochrane Systematic review in 2014 found, "insufficient evidence to support or refute any adverse effects associated with amalgam or composite restorations." Those opposed to dental amalgam suggest that mercury from dental amalgam may lead to nephrotoxicity, neurobehavioural changes, autoimmunity, oxidative stress, autism, skin and mucosa alterations, non-specific symptoms and complaints, Alzheimer's disease, and multiple sclerosis. Both those opposed and those not opposed to dental amalgam recognize that amalgam has been found to be a rare contributor to
Amalgam tattoo common sites, although any mucosal site in the mouth is possible. It is painless, and appears as a blue-black or grey discolored macule on the surface of the mucosa. The borders of the tattoo are variable, and may be well defined, irregular or diffuse. Amalgam tattoo is caused by implantation of amalgam into the tissues. It may occur in several ways: Over time, the amalgam particles embedded in the soft tissues corrode. Macrophages take up the exogenous particles, and the silver in amalgam leads to staining of collagen fibers. A similar appearance can be caused by implantation of graphite (e.g.