Dark gums: when should you worry?
Dark or black gums that are evenly and symmetrically dark, and have always been that way, are usually a natural variation. What needs attention is a new, single, spreading or asymmetrical dark spot: it should be examined, sometimes with a biopsy, to rule out a serious lesion. A color change with pain, swelling or bleeding also needs a diagnosis by a dentist, who identifies the cause and the gum treatment needed, if any.
Why are my gums dark? The main causes
Dark gums are gums whose healthy pink color has turned darker, sometimes to black, and the change can have many different causes.
Dentists distinguish several main categories: natural (inherited) pigmentation, smoking, reactions to medications, foreign material in the tissue (such as an amalgam tattoo) and various diseases. Telling them apart is essential to choose the right treatment.
Natural pigmentation is common in people with darker skin and comes from increased melanin production in the gum. It is a normal, healthy variation that needs no medical treatment, unless the patient is bothered by the way it looks. A color change caused by heavy smoking or long-term use of some medications (such as antimalarials or minocycline), on the other hand, calls for a different approach.
With bacterial infection, as in chronic gingivitis or advanced gum disease, the gums usually look dark red or bluish and swollen rather than black. That kind of color change, with bleeding or swelling, needs treatment of the inflammation by a dentist.
Other causes include an amalgam tattoo (particles of filling material trapped in the tissue), exposure to heavy metals, metal margins of crowns and rare general diseases such as Addison's disease. That is why an examination of dark gums includes a detailed history, a clinical exam and, in some cases, X-rays and a biopsy. According to a review published in Head and Neck Pathology, a biopsy is needed whenever the source of the pigmentation cannot be identified with certainty on examination.
| Cause | What it looks like | Is it dangerous? | What to do |
|---|---|---|---|
| Warning sign: a new spot | A single dark spot that appeared recently, spreads, changes shape or color, is raised or bleeds | It can be a lesion that needs investigating | See a dentist soon; a biopsy is sometimes needed |
| Natural pigment (melanin) | Brown to black, even and symmetrical, always been there | No | No treatment needed; cosmetic removal on request |
| Smoking (smoker's melanosis) | Brown patches, mainly on the front gums of the lower jaw | The patches themselves are not, but smoking doubles the risk of gum disease | Quit smoking; the patches may fade gradually |
| Medications | Gray, bluish or brown color after long-term use of a drug | Usually not | Never stop a medication on your own: talk to your physician |
| Amalgam tattoo | A single gray-blue or black spot near a filling or where one was removed | Usually not | An X-ray or a biopsy when the diagnosis is uncertain |
| Metal-based crown | A gray line at the crown margin, along the gum line | No | Replacing it with a metal-free crown can be considered |
| General disease (such as Addison's) | Several patches, sometimes with skin color changes and general symptoms | Depends on the disease | Assessment by your physician |
Dark gums meaning: natural variations in gum color
Gum color naturally varies widely, mainly because of genetic and ethnic factors and the pigment melanin. In people of African, Asian or Middle Eastern descent, darker gums are common and entirely normal. Many patients do not know this and come in worried, when the pigmentation is in fact a healthy physiological feature, not a medical problem.
Physiological melanin pigmentation usually appears on the attached gum, evenly or as defined patches and bands. It is usually symmetrical, and the color ranges from gray-brown to bluish-black. Although it is perfectly healthy, some patients ask for treatment for cosmetic reasons, and depigmentation can then be considered.
Other possible causes of black gums
Smoking darkens the gums: chemicals in tobacco smoke stimulate the pigment cells of the gum to produce melanin (smoker's melanosis), as explained below in the section on smoking and dark gums.
Drug-induced pigmentation
Long-term use of some medications, such as phenothiazine antipsychotics, antimalarials, minocycline, some chemotherapy drugs and amiodarone, can darken the gums. These drugs can trigger "drug-induced melanosis", an increase in melanin production in the mouth. Never stop such a medication on your own: talk to your physician about your treatment, and ask the dentist about cosmetic options for the gums.
Ill-fitting dental work and general diseases
Restorations containing some metals can also discolor the gums. Crowns or bridges that do not fit properly can cause a tissue reaction and local darkening. Some general diseases, such as Addison's disease, Peutz-Jeghers syndrome and neurofibromatosis, can show up as increased pigmentation in the mouth, which calls for coordination with other physicians.
Smoking and dark gums: is there a link?
Dark gums are particularly common in smokers, and the link is well understood. Smoking narrows the blood vessels in the gums and reduces the supply of blood and oxygen to the tissue. As a result, the gums become more vulnerable to bacteria and inflammation. Smoking also stimulates melanin production in the gums and stains the teeth, creating a dark shade that brushing does not remove.
According to the CDC, smokers have twice the risk of gum disease of non-smokers, and the risk rises with the number of cigarettes and years of smoking. Smoking also slows gum healing and makes dental treatment less effective. Besides the color change, smokers may experience gum pain, gum recession and, at later stages, tooth loss.
2×
Smokers' risk of gum disease compared with non-smokers (CDC)
Poor oral hygiene, hormonal imbalance and general diseases add to the risk in smokers, and their combined effect makes gum problems worse.
Quitting is the single most important step a smoker can take for gum health, and the dark patches may fade gradually afterwards.
Black gums: how are they treated?
Treating black gums starts with a professional assessment of the cause, since several different factors can be involved. The most common is natural melanin pigmentation, but smoking, medications, an amalgam tattoo or a general disease are also possible.
When there is also gum inflammation, tartar or surface staining, a professional cleaning is done and, for advanced inflammation, scaling and root planing under local anesthesia. This improves gum health but does not change melanin pigmentation; neither do medications, mouthwashes or natural remedies (aloe vera, tea tree oil, coconut oil). In advanced cases, gum surgery may be recommended.
When natural pigmentation bothers you cosmetically, the clinic offers surgical depigmentation, as the practitioner judges best. Treating dark gums should always be part of an overall plan for your oral health, not only the cosmetic symptom.
Examination, treatment plan and price quote
detailed and personalized
During the consultation, Dr Haim Aseriel examines your teeth, explains all the options and gives you a transparent price quote, with no obligation. The clinic is at 12 HaTnufa Street, Jerusalem.
Crowns and a gray line at the gums: metal or zirconia?
The type of crown affects your oral health in the long term. Zirconia crowns contain no metal, so they do not create the gray line that can appear at the edge of a porcelain-fused-to-metal crown, especially when the gums are thin or have receded. The metal in traditional crowns can cause a gray or black line at the gum line, which makes dark teeth and gums look worse.
| Criterion | Zirconia crown | Porcelain-fused-to-metal crown |
|---|---|---|
| Metal | None | Metal substructure |
| Effect on the tissue | Biocompatible ceramic | The metal can affect the color of the gum at the margin |
| Gum line | No metal margin | A gray or black line may appear |
| 5-year survival | About 92% | About 95% |
In terms of durability, the difference is small: according to a systematic review, about 92% of zirconia crowns and about 95% of metal-ceramic crowns survive five years. For gum health, what matters most is a precise fit of the crown margin, because a well-fitting crown traps less plaque. For patients with dark gums or pigmentation, a crown without a metal margin, such as zirconia, may suit particularly well from a cosmetic point of view; the dentist recommends the restoration that best fits your gums, appearance and long-term durability.
Gum depigmentation: a surgical technique at the clinic
When natural pigmentation or smoker's melanosis bothers you cosmetically, the pigment can be removed. At the clinic, depigmentation is done with a surgical technique, under local anesthesia: the surface layer of the gum, rich in pigment cells, is removed, and new, lighter tissue replaces it as the gum heals.
Another technique is the laser, which the clinic does not use. According to a systematic review, lasers are effective for natural pigmentation and smoker's melanosis and may cause less bleeding than conventional surgery.
Extensive pigmentation may need more than one session, and the pigment can come back over time: in the systematic review, recurrence was reported in 21% to 45% of cases in the studies that looked at it. Depigmentation is not suitable when the color change comes from a general disease, a medication or a lesion that has not been diagnosed.
How to prevent dark gums
Natural variation in gum color is common and mostly genetic, so it cannot be prevented. However, several external factors can be controlled to avoid darker gums.
Quit smoking
Smoking is a major cause of darker gums. Quitting can lead to a visible improvement in gum color over time, and improves the health of your whole mouth.
Careful oral hygiene
Brushing thoroughly twice a day and cleaning between the teeth reduce the plaque that causes gum inflammation and color changes. A powered toothbrush can help: according to a Cochrane review, it reduces plaque and gum inflammation slightly more than a manual brush.
Diet and regular check-ups
A balanced diet rich in vitamins, particularly vitamin C, supports gum health. Regular visits to the dental hygienist, at the frequency your dentist sets according to your personal risk, remove tartar and allow early detection of changes in gum color or texture.
When to see a dentist about dark gums
A sudden change in gum color, especially with pain, swelling, bleeding or bad breath, needs a prompt dental visit. A new, single, spreading or asymmetrical dark spot also needs an examination, sometimes with a biopsy, to rule out a serious lesion. These signs can point to advanced gum disease or, more rarely, to a general condition that needs medical care; the assessment includes a clinical exam, X-rays and, in some cases, blood tests through your physician.
Even when pigmentation causes no symptoms but bothers you cosmetically, a consultation is worthwhile. When it is linked to a medication, your physician may consider alternatives.
Dark gums: consultation in Jerusalem. The team led by Dr Haim Aseriel examines your gums, explains the cause in English and presents the options, with a written estimate if treatment is planned. The clinic is at 12 HaTnufa Street in Talpiot, south Jerusalem.
Dark gums: frequently asked questions
Dark gums are most often caused by natural pigmentation: increased production of melanin, more common in people with darker skin and seen mainly on the attached gum. Other causes are smoking, some medications (for example antimalarials, minocycline or some chemotherapy drugs), an amalgam tattoo and general diseases such as Addison's disease.
Black or very dark gums usually mean harmless natural pigment (melanin), especially when the color is even, symmetrical and has always been there. A new, single, spreading or irregular dark spot, or dark gums that come with bleeding, swelling or pain, can mean something else and should be examined by a dentist, sometimes with a biopsy.
Yes. Chemicals in tobacco smoke stimulate the pigment cells of the gum to produce melanin, a condition called smoker's melanosis, seen mainly on the front gums of the lower jaw. After quitting, the dark patches may fade gradually. According to the CDC, smokers also have twice the risk of gum disease.
Treating dark gums starts with finding the cause. Natural pigmentation needs no treatment; when it bothers you cosmetically, the clinic removes it with a surgical technique. When the cause is smoking or a medication, the cause is addressed, and a medication is changed only after talking to your physician.
Gum depigmentation suits natural pigmentation and smoker's melanosis, but not a color change caused by a general disease, a medication or a lesion that has not been diagnosed. The pigment can come back: a systematic review of laser depigmentation reported recurrence in 21% to 45% of cases in the studies that looked at it. The clinic does not use a laser and removes gum pigmentation with a surgical technique.
Sources
- Rosebush MS et al., Head and Neck Pathology, 2019 – View the study
- Centers for Disease Control and Prevention, Smoking, Gum Disease, and Tooth Loss – View the page
- Abduljabbar T et al., Journal of Photochemistry and Photobiology B, 2017 – View the study
- Sailer I et al., Dental Materials, 2015 – View the study
- Yaacob M et al., Cochrane Database of Systematic Reviews, 2014 – View the study
- Fee PA et al., Cochrane Database of Systematic Reviews, 2020 – View the study
