Published on Mar 13, 2021 and last reviewed on Nov 29, 2022 - 5 min read
Black gums or black gingiva results from excess melatonin in the body and are commonly seen in dark-skinned individuals. Please read the article to know if your black gums need to be treated.
Gingival depigmentation is one of the important components of esthetic dentistry, which aims to remove the melanotic pigmentation present in the gingiva. It employs almost every technique ranging from scalpel method to electrocautery. However, every effort is made to remove the epithelial lining of the gingiva, but sometimes there are chances of recurrence.
When we talk of esthetic dentistry, we consider both teeth and gums since they are most visible during a healthy smile. Clinicians perform every esthetic procedure to improve the look of the teeth, but there are very few chances of improving the gums that make perfect harmony with the teeth. Esthetic dentistry is limited to modifications in shape and size, but it also aims to preserve the function and structure of the gingiva. The oral cavity encounters a lot of pigmentations, which are both physiological and pathological. Certain conditions like Addison’s disease and Peutz-Jeghers syndrome cause excessive pigmentation. These conditions require specific treatments by the use of long-term medications.
1) Metal Deposition - Many metals get deposited in the form of sulfides or other salts in the oral cavity due to unintentional ingestion or direct exposure. These include cadmium, bismuth, arsenic, mercury, and lead. The deposition of these metals are fatal pathology and requires emergency treatment.
2) Melanin Pigmentation - Melanin pigmentation is not a pathological phenomenon. It is a physiological phenomenon that is characterized by blackish pigmentation in the skin and the gums. This melanin is secreted by melanocytes, which are released through melanophores and are digested by melanophages. The incidence of occurrence varies from:
61 % in the hard palate.
60 % in the gingiva.
10 % in the tongue.
The removal of melanin pigmentation is employed by many dentists to provide esthetic looks. It includes the use of:
Free gingival grafts.
1) Scalpel Method:
It is the most commonly used method. It is performed under local anesthesia with the use of a scalpel.
Easy to perform.
No need for any armamentarium.
Chances of excessive postoperative bleeding.
Chances of infection.
This procedure employs the use of liquid nitrogen by cryoprobe and works on freezing the involved tissue.
Does not require local anesthesia.
No need for sutures.
Excessive postoperative swelling.
Excessive tissue destruction due to freezing of tissues.
It employs different wavelengths ranging from 810 to 2940 nm. It involves the ablation of tissue by selective wavelength.
Does not require sutures.
Lesser chances of trauma to tissues.
Delayed healing is one of the commonest side effects of lasers.
4) Chemical Methods:
Phenols and alcohol are also used in depigmentation.
Lack of local anesthesia.
Immediate burning sensation.
Special care in kidney failure patients.
It makes use of electric current through an electrode. Application of excessive heat causes the destruction of tissue.
Less scar formation.
Because of excessive tissue destruction due to electric current, there is a foul smell which is sometimes uncomfortable to the patients.
6) Free Gingival Grafts:
It is an esthetic procedure. Free gingival graft employs the use of graft from the palate.
Painful postoperative wound.
Limited donor tissue.
Alloderm uses a membrane to cover the tissue.
Better esthetics than free gingival graft.
The cost factor is a major issue.
Contraction of graft is also reported in some cases.
It is the latest method developed for depigmentation. It uses radio frequencies in the form of an electrode and causes coagulation of tissues.
Self-sterilizing in nature.
Provides blood-less surgery.
A foul smell makes the patient uncomfortable.
It requires two sittings.
Special precaution is required in cardiac pacemaker patients.
9) Bur Abrasion:
It involves the use of diamond bur with rotary instruments.
Repetition can be done.
Easy to perform.
Enamel or bone loss due to excessive destruction.
Healing is one of the important phenomena. After the scalpel method, there is a need for periodontal dressing to cover the surgical area. It is observed that the newly attached gingiva is formed with minor scar tissue. Healing in cryosurgery is characterized by superficial necrosis accompanied by a white slough separated from the underlying tissue (pink colored). In electrosurgery, clot formation is the first step accompanied by necrosis and then replacement of granulation tissue. In laser, first, there is evidence of a yellow area that is removable in nature. It is followed by re-epithelialization. Healing of grafts is associated with degeneration followed by re-epithelialization and connective tissue formation. But in addition, a fibrous attachment also occurs.
The biggest problem we face after treating depigmentation is re-pigmentation. The reason attributed to re-pigmentation is the immigration of melanocytes from the nearby tissues. The time duration varies according to the cases. In some cases, it appears in 22 to 55 days, while in some cases, it may appear after one year. Cryosurgery cases were found to have re-pigmentation after 20 months, while lasers (especially carbon dioxide) showed re-pigmentation in two years. In the scalpel method, the time duration varied from 33 days to 7 years. Re-pigmentation was observed in chemical methods also, but there are some positive results too. It was observed that after the scalpel method, re-pigmentation was not observed after a long follow-up of 431 days. Some studies support ND: YAG (Neodymium-doped Yttrium Aluminum Garnet) laser, which showed no re-pigmentation after 180 days.
Black gums due to melanin pigmentation are not a problem. But sometimes, especially in the case of a gummy smile, it is a great esthetic problem. So if clinicians are opting for this procedure, they should focus on the complete removal of melanocytes since the recurrence rate is high. The method should be done according to patient requirements, feasibility, and medical conditions. On the aspect of patients, I recommend regular follow-ups as per the clinician’s protocol.
Like how skin color varies with people, gum color also varies. It is normal to have black and dark brown gums. Having black gums is normal if it has been the same the whole life since childhood. However, if the gum color becomes black and patchy or changes within a short period, it is not normal.
Naturally occurring black gums are due to the body’s melanin content. Melanin is a natural pigment that gives dark color to the skin, hair, eyes, and gums. People with more melanin have darker skin, hair, eyes, and gums.
If black gums are present from childhood through the whole life, it is normal. But if a sudden color change occurs, it might be due to an underlying pathological condition.
- Medications like Minocycline.
- Acute necrotizing ulcerative gingivitis (severe gum infection).
- Gum discoloration due to dental amalgam fillings.
- Addison’s disease.
- Peutz-Jeghers syndrome.
- Malignant melanoma (type of oral cancer).
- Metal deposition (arsenic, mercury, lead, etc.).
It is natural to have black gums. Natural black gums are not medical conditions to heal. But if your black gums are of sudden origin with associated symptoms like pain, bruising, bad breath, and other systemic conditions, correction of the underlying cause helps in its healing.
Black teeth in children can be due to,
- Genetics (and it is normal).
- Severe gum disease (ulcerative and necrosed gum tissue).
- Eruption hematoma (during teething).
Quitting smoking is found to lighten the gums to some extent. When compared to the gums of people who continued to smoke, those who quit smoking were able to improve their gum color.
A black spot on the gum after tooth extraction may be of local bruise or blood clot due to minor contusions during extraction. This is of minimal concern and heals on its own as the extracted site heals.
Antibiotics are necessary for the treatment of gum infection to ward off the infection. Otherwise, it might lead to persistent infection, abscess formation, ulceration, cyst formation, trench mouth, and destruction of oral structures. Minor gum diseases can be corrected through scaling, root planing, and Chlorhexidine mouthwash.
Quitting smoking likely reverses your normal gum color. It does not happen as soon as you quit. It might take at least three years for the black gums to lighten.
Whether your gum is pink or brown or black by nature, they are healthy until you do not have any soft or hard deposits and food debris in your mouth and regularly follow all oral hygiene procedures. You can maintain your gum health by,
- Brushing twice a day.
- Massaging the gums with specially designed brushes or fingers.
- Using a mouthwash.
- Having a well-balanced diet.
Gum depigmentation or bleaching is the procedure to lighten the gums. They are done with various agents and methods like,
- Surgical method.
- Free gingival grafts.
- Laser depigmentation.
- Chemical bleaching.
Gingival pigmentation can be performed with any one of the following methods,
- Surgical Method-Performed under local anesthesia with scalpels.
- Cryosurgery-Freezes the gingival tissue with a cryoprobe.
- Laser-It involves gingival tissue ablation.
- Chemicals-Uses chemical agents like phenols and alcohols to be applied over the gums.
- Radiosurgery-Radio frequencies from the electrodes cause tissue coagulation.
- Electrocautery-The heat from the electric currents destroys the gum tissues for depigmentation.
- Bur Abrasion-Rotary diamond burs are used.
Gum bleaching procedures are invasive procedures that cause pain. But you will not feel pain as these are done after your gums are numbed. These procedures will be performed under local anesthesia. Post-procedure you will be given painkillers.
Based on the technique of gum depigmentation, the time may vary. Mostly it might take 30 to 45 minutes, and the results have claimed to last for at least 20 years or even up to a lifetime. Some people experience repigmentation within a few months to years.
Gum depigmentation procedures are safe and are performed under local anesthesia.
Last reviewed at:
29 Nov 2022 - 5 min read
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