How to Address Black or Darkened Gums

Gingival hyperpigmentation—commonly referred to as “black gums”—is a benign, cosmetic condition characterized by dark brown or grayish discoloration of the gingival tissue. It results primarily from increased melanin deposition in the basal and suprabasal layers of the oral epithelium and is most frequently observed in individuals with darker skin phototypes (Fitzpatrick types IV–VI). While not associated with inflammation, infection, or systemic disease, it can cause aesthetic concern for some patients.

The condition is typically physiological and may be influenced by genetic predisposition, hormonal fluctuations (e.g., during pregnancy or with oral contraceptive use), certain medications (including antimalarials like chloroquine and antipsychotics such as phenothiazines), and chronic irritation from tobacco use or ill-fitting dental prostheses. Rarely, it may signal underlying pathology—such as Addison’s disease, Peutz-Jeghers syndrome, or heavy metal toxicity—but these are accompanied by additional clinical signs and systemic symptoms and require thorough evaluation.

Management is elective and driven by patient preference. Nonsurgical options include topical depigmenting agents—most commonly 10–20% hydroquinone or 0.05% tretinoin—applied under professional supervision; however, evidence supporting long-term efficacy and safety remains limited. Surgical approaches offer more predictable, durable results and include gingival depigmentation via scalpel excision, electrosurgery, cryosurgery, laser ablation (especially using diode, CO₂, or Er:YAG lasers), and free gingival grafts. Laser therapy is widely favored due to its precision, minimal bleeding, reduced postoperative discomfort, and favorable re-epithelialization profile.

Patients considering treatment should undergo comprehensive periodontal assessment to rule out active gingivitis or periodontitis, as inflammation can mimic or exacerbate pigmentation. Post-procedure care includes strict oral hygiene maintenance, avoidance of smoking and photosensitizing agents, and regular follow-up to monitor for recurrence—which occurs in approximately 10–30% of cases over 1–3 years, particularly with incomplete melanocyte removal or persistent triggering factors.