Gingival hyperpigmentation is the noticeable darkening of the gums, appearing as brown or black patches. This discoloration is primarily caused by an excessive deposition of the natural pigment melanin in the gum tissue. While usually benign and not indicative of a health problem, this extra melanin can be a significant aesthetic concern for many individuals seeking to improve their smile’s appearance. The intensity of the pigmentation varies widely, ranging from light brown spots to deep purplish-black areas. Understanding the factors that contribute to this accumulation of pigment is the first step toward finding an appropriate solution.
Why Gums Change Color
The color of gum tissue is determined by factors like epithelial thickness and vascularity, but the most common cause of dark gums is increased melanin production. This is often referred to as physiological or ethnic pigmentation and is a genetically determined trait, particularly common in individuals with darker skin tones. Melanocytes, the cells responsible for producing melanin, are more active in these individuals, leading to a darker hue present from a young age.
A significant acquired cause of gum darkening is smoker’s melanosis, where chemicals in tobacco smoke stimulate melanocytes to produce more pigment than normal. These flat, brown or black spots often appear on the front gums and the inside of the cheeks. Prevalence is directly related to the duration and amount of tobacco use. Certain medications can also induce a change in gum color as a side effect, including specific antibiotics like minocycline, some antimalarial drugs, and psychiatric medications.
In rare instances, a change in gum color can signal an underlying systemic health issue. Conditions such as Addison’s disease, which affects the adrenal glands, can cause increased pigmentation not only in the gums but also in other areas of the body. Another rare genetic disorder, Peutz-Jeghers syndrome, is characterized by pigmentations around the mouth and on the oral mucosa, alongside growths in the gastrointestinal tract. If a sudden or rapid change in gum color occurs, seeking a professional medical evaluation is important to rule out these less common causes.
Correcting Underlying Health Factors
Addressing the root cause is the initial, non-surgical approach to managing gingival hyperpigmentation, especially when the cause is environmental or systemic. For individuals with smoker’s melanosis, the most effective action is complete tobacco cessation. Quitting smoking is linked to a gradual reduction in discoloration over time, as melanocytes are no longer constantly stimulated by tobacco compounds.
If the discoloration is linked to a medication, it is necessary to consult with the prescribing physician or dentist to explore alternative treatment options. Never stop taking prescribed medication without professional guidance, but a healthcare provider can assess whether a chemically different drug can be substituted to stabilize or reverse the pigmentary changes. Finding a viable alternative may prevent further pigment accumulation and could allow the existing discoloration to fade naturally.
When a systemic condition is identified as the source of the pigmentation, the focus shifts to treating that underlying medical issue. For example, managing the hormonal imbalance associated with Addison’s disease may help stabilize or improve the appearance of the affected gum tissue. While treating the systemic disease may not completely eliminate the existing pigment, resolving the primary health problem is the most important step and may prevent further darkening.
Professional Treatments for Gum Depigmentation
When the discoloration is physiological, or when addressing the underlying cause does not achieve the desired aesthetic result, professional cosmetic treatments can physically remove the excess pigment. One of the most common and effective modern methods is laser depigmentation, valued for its precision and minimal invasiveness. Lasers like the diode, Nd:YAG, or CO2 selectively target and vaporize the pigmented cells in the outer layer of the gum tissue. This process results in reduced bleeding because the laser cauterizes the tissue, promoting faster healing compared to traditional surgical techniques.
Another established method is surgical or scalpel excision, which involves using a surgical blade to carefully shave off the thin, pigmented layer of the gum tissue. This traditional technique is highly effective at immediately removing the discoloration and is suitable for localized, dense areas of pigmentation. The procedure removes the epithelial layer where the melanin is concentrated, allowing a new, non-pigmented layer of gum tissue to heal in its place. However, scalpel surgery is more invasive and may require sutures, leading to a longer recovery period.
Rotary abrasion is a technique that uses a specialized, high-speed dental burr to physically buff away the pigmented surface layer of the gums. This procedure is less invasive than scalpel surgery and achieves a similar removal of the melanin-containing tissue. Less common methods include microdermabrasion, which uses fine abrasive particles to exfoliate the pigmented layer, and the application of certain chemical agents, although chemical methods are rarely used today due to inconsistent results and tissue sensitivity. Consultation with a periodontist or specialized dentist is important to determine the most appropriate technique, considering factors like the depth of the pigmentation, the extent of the affected area, and the potential for repigmentation over time.