Black gums, or gum hyperpigmentation, are a darkening of the gum tissue. While a change in gum color can be concerning, it isn’t always serious. Gum colors naturally vary from pink to brown, depending on an individual’s background. However, a sudden or unexplained change to black gums may signal an underlying issue. This article explores the causes of gum discoloration, from benign factors to serious medical conditions.
Natural Pigmentation and Everyday Factors
The most common reason for naturally dark gums is melanin pigmentation. Melanin, a natural pigment responsible for skin, hair, and eye color, can also darken gum tissue. Individuals with darker skin tones, particularly those of African, Asian, or Mediterranean ancestry, often have more melanin, resulting in naturally dark brown or black gums. If gums have always been dark and appear uniform, this is typically a normal variation and not a health concern.
Lifestyle choices, such as smoking, can cause gum discoloration, known as smoker’s melanosis. Nicotine and other tobacco chemicals stimulate melanocytes, increasing melanin production in the gums. This can cause brown or black patches, or affect the entire mouth, including inner cheeks and lower lip. This discoloration may diminish if smoking is stopped, as it can be reversible.
Medication and Dental-Related Causes
Certain medications can lead to changes in gum pigmentation. The antibiotic minocycline is known to cause bluish-gray discoloration in oral tissues, including the gums. Antimalarial drugs, such as chloroquine and hydroxychloroquine, can also induce bluish-gray to black hyperpigmentation, particularly on the hard palate, often after prolonged use. Some tricyclic antidepressants and certain chemotherapy drugs have also been associated with gum darkening by stimulating melanin production or depositing drug metabolites.
Dental procedures and materials can contribute to localized dark spots, most notably amalgam tattoos. An amalgam tattoo appears as a flat, blue, black, or gray spot on oral mucous membranes, frequently on gums near an old filling. These tattoos occur when silver amalgam fragments, used in dental fillings, become embedded in gum tissue during procedures like filling placement, polishing, or removal. Amalgam tattoos are common and permanent unless professionally removed.
Underlying Medical Conditions
Darkened gums can indicate more serious, systemic medical conditions. Addison’s disease, a rare disorder affecting adrenal hormone production, can cause increased pigmentation of skin and mucous membranes, including the gums. This occurs because the body produces more adrenocorticotropic hormone (ACTH), which stimulates melanin-producing cells. Oral pigmentation can be an early sign of Addison’s disease, appearing as brown patches on the gums, lips, or tongue.
Peutz-Jeghers syndrome is a genetic disorder characterized by dark brown or black spots on mucous membranes and skin, often including the lips and oral cavity. These spots, known as melanotic macules, may appear in childhood and are associated with an increased risk of gastrointestinal polyps and certain cancers. While the oral lesions are benign, their presence signals a need for monitoring of potential systemic complications.
Acute Necrotizing Ulcerative Gingivitis (ANUG), also known as trench mouth, is a severe gum infection that can cause gums to appear gray or black due to dead tissue. This painful condition is characterized by bleeding gums, ulcers, and foul-smelling breath, often linked to poor oral hygiene, stress, or a weakened immune system. Though rare, oral melanoma, an aggressive cancer, can manifest as dark, irregularly shaped patches on the gums. These may resemble benign pigmentation but can be painful or rapidly changing.
When to Consult a Professional
Any unexplained or concerning change in gum color warrants consultation with a healthcare professional, such as a dentist or doctor. Seek professional advice if you notice new dark spots, or if existing discoloration changes rapidly in size, shape, or color. Accompanying symptoms like pain, bleeding, swelling, or ulcers also indicate a need for immediate evaluation. Only a healthcare provider can accurately diagnose the underlying cause of black gums through examination and, if necessary, additional tests. Prompt diagnosis ensures appropriate management and treatment, especially if discoloration is a symptom of a more serious medical condition.