Our gums typically appear in shades of pink. However, observing a brown discoloration can be a cause for concern. While brown gums can sometimes be a normal, harmless variation, they can also signal an underlying issue. Understanding the reasons behind this change in gum color is important for overall health.
Natural Variations in Gum Color
Gum color varies among individuals, much like skin tone. This variation is influenced by melanin, the pigment responsible for skin and hair color. Melanocytes, specialized cells, produce melanin, determining the amount of pigment in gum tissues.
Individuals with darker skin tones often have naturally darker or brown gums due to higher melanin production, known as physiological melanin pigmentation. This is a normal, benign characteristic. The intensity and distribution of this pigmentation can vary, appearing uniformly or as patchy areas. This genetic predisposition means brown gums are part of an individual’s natural appearance.
Everyday Factors Influencing Gum Discoloration
Beyond natural variations, common factors can contribute to brown gum discoloration. These are often localized or extrinsic causes, resulting from external influences or affecting specific areas of the mouth. Smoking is a significant factor, leading to smoker’s melanosis.
Smoker’s melanosis appears as brown to black pigmentation, often seen on the lower front gums of tobacco users. This discoloration occurs because tobacco chemicals, such as nicotine and benzopyrenes, stimulate melanocytes to produce more melanin, as a protective response. The pigmentation can be dose-dependent, increasing with the amount and duration of smoking. While generally harmless, smoker’s melanosis is a visible sign of tobacco’s impact on oral tissues.
Certain medications can also induce gum discoloration. Minocycline, an antibiotic prescribed for acne and rheumatoid arthritis, can cause blue-gray or muddy brown pigmentation in oral tissues, including the gums. This occurs due to minocycline derivative accumulation, which can chelate with iron and calcium, increasing melanin production. This discoloration can appear after long-term therapy and may not always resolve after stopping the medication.
Another common cause of localized brown or dark spots is an amalgam tattoo. These benign discolorations appear on gums or other oral mucous membranes as blue, gray, or black spots. Amalgam tattoos result from small particles of dental amalgam, the silver material used in fillings, becoming embedded in soft tissues during dental procedures. This can happen during filling placement or removal, or even during root canal procedures. While harmless, their appearance near a tooth with an amalgam filling often helps in their identification.
Systemic Health Conditions Affecting Gum Pigmentation
Less commonly, brown gum pigmentation can indicate underlying systemic health conditions. These conditions affect the body and can lead to changes in various tissues, including the oral mucosa. One such condition is Addison’s disease, also known as adrenal insufficiency.
Addison’s disease occurs when the adrenal glands do not produce enough cortisol and other steroid hormones. In response to low cortisol, the pituitary gland increases the production of adrenocorticotropic hormone (ACTH). Since ACTH shares a precursor with melanocyte-stimulating hormone (MSH), elevated ACTH levels increase MSH, stimulating melanocytes to produce more melanin. This results in hyperpigmentation of skin and mucous membranes, often appearing as patchy, irregular brown or bluish-black spots on gums. Oral pigmentation can be an early indicator of Addison’s disease, sometimes appearing months or years before other symptoms.
Peutz-Jeghers syndrome is a rare genetic disorder characterized by noncancerous polyps in the gastrointestinal tract and distinctive dark spots on skin and mucous membranes. These spots, typically small, round or oval, and blackish-brown, frequently appear on the lips, around and inside the mouth, including oral mucosa and gums. Oral manifestations often appear during childhood and can sometimes precede intestinal polyps, making them an important diagnostic clue. The pigmentation is due to increased melanocytes and melanin production in affected areas.
When to Seek Dental or Medical Attention
While some brown gums are natural, it is important to know when to consult a professional. Any sudden change in gum color, especially with other symptoms, warrants professional evaluation. If discoloration appears rapidly, changes in size or shape, or is accompanied by pain, swelling, or bleeding, seek prompt attention. These symptoms could signal an underlying issue requiring diagnosis and treatment.
During an examination, a dentist or doctor will take a dental and medical history, discuss symptoms, and perform an oral exam. They may inspect the affected area and consider lifestyle habits, such as smoking. An X-ray might be used to identify amalgam tattoos if metal particles are visible. If there is doubt, or to rule out serious conditions like oral melanoma, a biopsy may be recommended.
Treatment for brown gums depends entirely on the underlying cause. If the discoloration is a normal physiological variation, no treatment is necessary. For conditions like smoker’s melanosis, quitting smoking can lead to a reduction or elimination of the pigmentation over time.
If medication is the cause, your doctor may consider alternative prescriptions. In cases of systemic diseases like Addison’s disease or Peutz-Jeghers syndrome, managing the primary condition is the priority, as this may help address the oral manifestations. Cosmetic procedures, such as gum depigmentation, are also available to lighten naturally dark gums or address aesthetic concerns once any underlying health issues have been ruled out.