What Causes Black Gums?
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Medically reviewed by Edmund Khoo, DDS
Similar to skin tone, people's gums can vary in color. While many people have red or dark pink gums, gums can also appear black or dark brown. Black gums, or gingival pigmentation, are often a normal effect of having a darker skin tone that contains more melanin (the substance that gives skin its pigment, or color).
However, black gums can also be a sign of underlying health conditions—especially if you didn't used to have black gums. Smoking and certain medications can also darken your gums.
Black Gums Symptoms
Black gums often appear dark purple or brown, but light brown or deep blue discoloration is also considered gingival pigmentation. This discoloration can cover the entire gum area surrounding your teeth. You may also have irregular black patches, spots, or strands of black on your gums.
If you've always had darker gums because of melanin, you likely developed the discoloration at birth. However, underlying health conditions and damage can cause the gums to suddenly or gradually form black patches. The entire gum area may also gradually turn black.
Causes of Black Gums
Black gums can be caused by natural skin variation, medications, and smoking. Noncancerous or cancerous lesions can also cause black spots and discoloration on the gums.
Melanotic Macules
Small, dark patches on the gum may be benign (noncancerous) lesions called melanotic macules. Melanotic macules are caused by increased melanin production in areas of the gums, lower lip, or roof of the mouth (palate). These lesions are one of the most common forms of oral discoloration and don't pose any health risks or cause additional side effects.
Melanotic macules look like small, flat ovals with irregular borders. These lesions are typically only about one centimeter (cm) wide. Lesions usually appear gradually and change from brown to black. However, melanotic macules can also look deep blue or gray.
Oral Malignant Melanoma
This form of skin cancer causes small, black spots on the gums and other oral tissues. These cancerous lesions look similar to melanotic macules but change over time. Oral malignant melanoma is an extremely rare form of melanoma, only causing 0.2%–8% of melanoma cases in the United States.
Like other forms of melanoma, oral malignant melanoma spots look like small, black-brown lesions with irregular borders. The lesion may eventually open, bleed, and swell. Melanoma on the gums may also appear gray, red, or purple. Contact your healthcare provider as soon as possible if you notice any spots on your gums that start to change or bleed.
Smoker's Melanosis
Smoking can also increase melanin in the gums, causing flat black or brown patches that cover the gums and other oral tissue. It's estimated that about 22% of people who smoke develop smoker's melanosis, and it is more common in people born female. Black gums caused by smoker's melanosis on their own are not harmful, but smoking itself can increase your risk of tooth decay and gum disease.
Smoking more frequently increases your risk of developing melanosis. Nicotine and benzo(a)pyrene—ingredients in cigarettes—penetrate gum tissue and activate melanin production. As you continue smoking, you may notice dark patches start to gradually appear on your gums and grow darker over time
Severe Gum Disease
Acute necrotizing ulcerative gingivitis (trench mouth) is a severe form of gum disease that can cause the gumline around your teeth to appear black or dark gray. The color change is gum tissue dying due to infection. Necrotizing ulcerative gingivitis is caused by a bacterial infection in the gum tissue around the teeth—usually due to poor oral hygiene.
In addition to a blackened gum line, this severe form of gingivitis can also cause symptoms like:
Amalgam Tattoo
Amalgam tattoos are black, blue, or gray patches that form above a tooth that was recently filled. The black areas may look like clusters or a single spot up to one cm wide. This discoloration occurs after silver dental filling materials, called amalgam, accidentally embeds into the gum line. The metal particles in the gum over time, which can cause more discoloration.
Amalgam tattoos don't typically require removal because they don't create health risks. However, they are often removed for cosmetic reasons.
Medications
Certain medications can cause most gums to turn black, purple, or dark brown. Drug-induced black gums are typically caused by drugs that can increase melanin. Medication can also damage the middle layer of skin (the dermis) and deposit iron in the area, causing a black pigment. People with drug-induced black gums may find that their lips start to darken in color.
Medications that can cause black gums include:
Minocycline: An antibiotic used to treat bacterial infections
Chlorpromazine: An antipsychotic medication used to treat mental health conditions like schizophrenia and bipolar disorder
Ketoconazole: An imidazole antifungal used to treat fungal infections
Chloroquine and quinine: Antimalarial medications
Bleomycin and cyclophosphamide: Chemotherapy drugs
Zidovudine: An antiretroviral used to manage HIV-1)
Addison's Disease
Black gums and darkening of other mucus membranes in the mouth may be symptoms of a rare condition called Addison's disease. Addison's disease is caused by damaged adrenal glands that can't make enough cortisol and aldosterone hormones. If left untreated, the condition can keep the body from functioning correctly and eventually lead to death. Hormonal medication can manage the condition and help people live healthy lives.
Addison's disease is typically caused by an autoimmune disease that makes the immune system mistakenly attack the adrenal glands. Tuberculosis infections, human immunodeficiency virus (HIV), and cancer can also increase the risk of developing Addison's disease.
Other symptoms of Addison's disease include:
Unexpected or sudden weight loss
Chronic (long-lasting) fatigue
Loss of appetite
Abdominal pain
Hypotension (low blood pressure)
Hypoglycemia (low blood sugar)
Darkening of scars, skin folds, elbows, knees, knuckles, and toes
Darkening of the interior lining of the cheeks
Peutz-Jeghers Syndrome
Peutz-Jeghers syndrome (PJS) is a rare condition caused by a gene mutation that forms noncancerous growths in areas of the gastrointestinal tract, like the stomach and intestines. However, the condition can increase your risk of developing gastrointestinal tract, pancreatic, cervix, ovarian, and breast cancer.
People with PJS often develop small, dark spots on the gums and mouth as children. These tiny black areas usually fade with age. Other symptoms of PJS that typically appear during childhood and adolescence include:
Dark spots on the hands and feet
Dark spots around the eyes, nostrils, and anus
Recurrent bowel obstructions
Chronic bleeding
When to Contact a Healthcare Provider
Contact your dentist if you notice any gradual gum changes that form black patches, lines, or spots, or if a black patch or spot suddenly appears on your gums. Your dentist may refer you to a periodontist—a dentist who has special training in treating gum-related diseases.
Other gum-related symptoms to watch for include:
Inflamed or swollen gums
Bleeding gums
Changing spots on the gums
Loose teeth
Halitosis
You may need to seek emergency dental care if you experience a cracked tooth, severe pain that can't be remedied at home, bleeding that won't stop, or fever.
How Are Black Gums Diagnosed?
A dentist or periodontist will typically diagnose the underlying cause of your black gums by performing an oral exam. This can help them determine color variations, discoloration shapes, and affected gum areas. Your provider will ask you about your dental history, medical history, medications, and current symptoms—as well as if you smoke.
If lesions are causing black gums, your provider might examine the lesion and do a biopsy. During the biopsy, your provider will numb the area and surgically remove a small sample of gum tissue. This sample will be examined under a microscope for abnormalities. Your provider may also take X-rays to identify bone health issues or look for metal filling material under your gum line.
Black Gums Treatment
Treatment for black gums depends on the root cause. Black gums that cause pain, dental issues, or increase your risk of cancer need treatment. Treatment is not necessary if black gums are caused by your natural melanin content. However, cosmetic treatments are available if you're not happy with the color of your gums.
Black gum treatments include:
Scalpel gingivectomy: Discolored gum tissue and the underlying connective tissue layer are surgically removed using a scalpel.
Bur abrasion: A tool with a medium grit bur is spun at high speeds to sand off black gum tissue.
Electrosurgery: Electrical currents are applied to discolored gum tissue to destroy tissue.
Radiosurgery: A type of electrosurgery that uses radio frequency energy to destroy discolored gum tissue—while also clotting blood to minimize bleeding.
Cryosurgery: Black gum areas are frozen with liquid nitrogen to destroy discolored tissue.
Laser ablation: Lasers are targeted into discolored gum tissue, which absorbs lasers easily to destroy discolored cells.
Chemical methods: Chemicals like phenol and alcohol are applied to dark gum areas to burn and destroy pigmentation.
Gingival grafts: Discolored gum tissue is replaced with a skin graph using tissue from the roof of your mouth.
Your provider will prescribe an antibiotic if a gum infection is causing black gums. You may also need a gingivectomy to remove dead or infected tissue. If the infection has damaged your gum line, a gingivoplasty can surgically reshape gum tissue around your teeth.
Prevention
You can help prevent black gums caused by oral hygiene habits and smoking by taking care of your teeth. Ineffective brushing can cause bacterial and food buildup (aka plaque) to decay and discolor your teeth. Plaque that is not removed hardens into tartar, which increases your risk of gum bleeding, infection, and discoloration.
Only dental professionals can remove tartar buildup, which is partially why regular dental cleanings are so important. Your dentist can also help you prevent tooth decay and other mouth-related side effects caused by medications and underlying health conditions.
Oral hygiene tips that can help prevent black gums include the following:
Brush your teeth twice a day to help remove plaque and avoid buildup
Floss regularly—or using a dentist-approved water flosser or floss pick—to remove plaque between teeth
Avoid smoking, which discolors teeth and increases the risk of gum disease
Limit sugary drinks and sweets that encourage plaque buildup
Use toothpaste and drinking water that contains fluoride to protect against tooth decay
A Quick Review
Black gums can be normal if you have more melanin in your skin. However, sudden black patches or gradual discoloration is likely a sign of an underlying health condition. Smoking, medications, and cancer can all lead to black gums.
Contact your dentist if you are concerned about any black gum changes or related tooth pain. Treatment isn't always needed for black gums, but your provider can help determine the underlying cause and if treatment is necessary.
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