WHAT CAUSES A BLACK SPOT ON GUMS?

More people than ever pay attention to their gums today due to recent studies that show a connection between gingival disease and general health. These diseases include heart disease, rheumatoid arthritis, dementia, and cancer. When you examine your own gums, it is important to know that healthy gums have a firm and pink appearance.

Inflamed gums caused by periodontal disease have a red appearance and may exhibit bleeding. You may notice various discolorations that cause concern. One of the common discolorations is a black spot on the gums. Although it is not common for cancer or another serious medical condition to cause a black spot on your gums, you should not ignore this or any other abnormality you find in your mouth. You need to contact your dentist as soon as possible.

There are several common causes of black spots on your gums. These are typically grouped into two categories: endogenous causes and exogenous causes.

Endogenous Causes

These causes originate internally or from within the body. An example of an endogenous infection is tuberculosis, where a dormant bacteria present within a person reactivates and causes an infection.

Melanin is a dark pigment composed of cells known as melanocytes found within the skin. An excessive amount of melanin or gingival hyperpigmentation can cause brown or black spots on the gums. Certain drugs such as quinine, minocycline, and chlorpromazine can cause melanin pigmentation. Chronic inflammation of the oral mucosa, as seen with lichen planus, can cause increased production of melanin and black spot formation.

One reversible hyperpigmentation is a condition known as Smoker’s melanosis. This typically causes dark spots on the gums of the upper and lower front teeth. The spots become darker with increased tobacco use. Smoker’s melanosis occurs more often in females. This is benign and does not result in cancer. The gingiva can return to its normal pink color within three years of quitting smoking.

Another endogenous cause of a black or dark spot on the gums is a hemangioma. This is a benign tumor also described as a vascular malformation. These occur more commonly during infancy and can resolve before adulthood. Those which persist in adults rarely require treatment.

One of Addison's disease hallmarks is intraoral black spots or patches caused by the overproduction of melanin. One of the first causes of black spots' sudden appearance to rule out is a problem with the adrenal glands. Even with successful treatment of this adrenal gland disease with hydrocortisone medications, the black spots can remain.

Black spots can appear suddenly in the mouth of someone with HIV. These dark areas can arise inside the cheek, on the roof of the mouth, on the sides of the tongue, and the gums.

Other endogenous causes of black spots on the gums include:

• Melanotic macule
• Blue nevus
• Oral cancer
• Oral melanoacanthoma
• Peutz Jegher’s syndrome

Exogenous Causes

Exogenous causes of black spots on the gums signify the cause comes from factors outside the person. These include:

- Amalgam tattoo. These are the result of particles of a silver filling lodging in the gum tissue. Dentists can easily diagnose these. They cause no harm and require no treatment.

- Large silver fillings. A large and deep silver filling that extends beneath the gum line can eventually cause permanent dark staining of the surrounding gums.

- Facial trauma. A fall or blow to the face can bruise your gums and result in a darkly discolored area. These usually resolve over time without any treatment.

- Lead pencil. Breaking off a piece of lead in the gums is common in people who habitually chew on pencils. This can damage and discolor the gums by leaving a black spot.

- Chewing tobacco. The results of chewing tobacco can range from a black spot on the gums to life-threatening oral cancer.

Treatments

Most black or dark spots on the gums are not serious. However, they can suggest a more serious medical condition such as adrenal gland deficiency or oral cancer.

You should not begin trying any home remedies to treat any gum discoloration until after consulting with your dentist. Some dark spots respond to professional lightening procedures performed by a dentist.

One of these procedures is a cosmetic periodontal procedure known as gum bleaching. You should not try bleaching your gums at home. A dentist can use professional whitening solutions, microdermabrasion, or a laser to remove excess pigmentation and black spots on the gums. The bleaching procedure involves administering a local anesthetic to numb the gums before removing the pigmented layer to expose the underlying healthy pink gum tissue.

The laser technique surgically removes melanocytes, cells that produce melanin, in the gums. As the tissue heals, the new gum tissue is naturally lighter and pink in color. Professional gum lightening is permanent and obviates the need for creams or other future remedies.

The wide variety of causes, from harmless to life-threatening, make regular dental checkups an important part of maintaining optimal oral health. Never delay seeing your dentist when you find any abnormal discoloration in your gums.

--- By Dr. Steven I Received his Doctor of Dental Medicine (DMD) from the Medical College of Georgia before practicing general dentistry in the United States Navy. He then completed a residency in endodontics at the Medical College of Georgia.