Black Gums: Symptoms, Causes, and Treatment (2024)

Like skin color, gums come in a variety of shades. People with more melanin tend to have darker gums. Therefore, black gums may be perfectly normal for some people.

On the other hand, if black gums are not your natural shade, they could be indicating a health condition, a side effect from medication, or damage from smoking.

This article explains black gums' causes, symptoms, and treatment.

Symptoms of Black Gums

The main symptom of black gums is gum color that appears black or dark brown. The color variation of black gums may include:

• Light brown
• Blue-black
• Red
• Purple

Pigmented spots on gums can be benign (noncancerous). However, it can also be a symptom of more severe diseases, like oral malignant melanoma. Therefore, if your gums have black spots, you should see a dentist or your healthcare provider for an evaluation.

Causes of Black Gums

Natural variations in gum color, benign lesions, smoking, left-behind dental procedure particles, medication, and some health conditions, including cancer, can cause black gums.

Melanotic Macules

Melanotic macules are benign dark patches on the gums. They are the most common cause of dark pigmentation in the mouth, accounting for 86% of dark lesions.

Aside from dark spots, these lesions do not cause symptoms. They usually are less than 1 centimeter in diameter and flat. They may be brown, black, blue, or gray.

Since melanotic macules look similar to other conditions that are not benign but rather harmful, a healthcare provider may take a biopsy (a tissue sample to be analyzed in a lab) to rule out malignancy.

Smoker’s Melanosis

Smoking can sometimes cause melanin to accumulate in the gums. When this occurs, it is called "smoker's melanosis." It looks like a flat area on the gums that is black or brown.

The condition is common, affecting 22% of smokers. It is dose-dependent, meaning that the more someone smokes, the greater the likelihood of having smoker's melanosis. The condition is benign, but a healthcare provider may take a biopsy to rule out malignancy.

Amalgam Tattoos

An amalgam tattoo occurs when silver (amalgam) dental filling material deposits into the gums after a dental procedure. This results in a black or bluish-gray flat area on the gums that most often occurs near the tooth that had dental work.

Dentists diagnose amalgam tattoos by appearance and your dental history. They may also be able to see filling particles on an X-ray.

Medications

Certain drugs can cause melanin pigmentation on the gums. These include:

• Chloroquine (antimalarial medication)
• Quinine (antiparasitic medicine)
• Minocycline (antibiotic)
• Zidovudine (antiretroviral)
• Chlorpromazine (antipsychotic)
• Ketoconazole (antifungal)
• Bleomycin (chemotherapy drug)
• Cyclophosphamide (chemotherapy drug)

Addison's disease

Addison's disease is a rare disorder in which the body doesn't produce enough cortisol and aldosterone hormones. It is caused by adrenal gland dysfunction. Symptoms include abdominal pain, dizziness, fatigue, and skin darkening. Skin darkening often occurs in mucus membranes, including the gums.

Peutz-Jeghers Syndrome

Peutz-Jeghers syndrome (PJS) is a rare disorder in which benign growths appear in the gastrointestinal tract. In addition, dark blue to dark brown freckling occurs around the mouth, including the gums. PJS is a genetic condition caused by a gene mutation.

Oral Malignant Melanoma

Oral malignant melanoma is a form of skin cancer that develops in the mouth, including on the gums. Oral melanomas are rare, involving 0.2%–8% of melanomas in the United States.

Early on, malignant melanoma can be asymptomatic (causing no symptoms) but can show signs of changes in shape, symmetry, and color. Later on, there may be open sores, unusual bleeding, and swelling in the mouth. They are usually dark brown to bluish-black. But, occasionally, skin-colored or white lesions occur. Healthcare providers diagnose melanomas through a tissue biopsy.

How to Treat Black Gums

Treating black gums depends on the cause. No treatment is necessary if black gums are your standard gum color. Likewise, if a benign lesion causes black gums, you may not need any treatment.

However, if black gums cause you problems or pain, or if they develop into cancer, you may need treatment. In addition, some people prefer treatment for cosmetic reasons. Some treatment options for black gums include:

• Surgical abrasions (some skin is sanded off)
• Scalpel gingivectomy (surgical tissue removal)
• Laser vaporization (destroying cells with a laser)
• Cryosurgery (tissue freezing)
• Electrosurgery (using electrical current to cut tissue)
• Chemical methods
• Gingival grafts (replacing gum tissue with tissue from the roof of your mouth)

Are There Tests to Diagnose the Cause of Black Gums?

To diagnose the cause of black gums, healthcare providers may use the following to assess your gums:

• A complete dental history, including your current symptoms
• Evaluating your medical history, including tobacco use and medications
• Full oral exam
• Examination of the lesion
• Biopsy

When to See a Healthcare Provider

If your gums have always been black, there is likely no cause for concern. However, if your gums—or a patch on your gums—is suddenly black, that's worth checking out. Make an appointment with a dentist trained in diagnosing diseases of the mouth.

Summary

Black gums can be a normal pigmentation for people with dark skin tones. However, black gums or black patches on your gums that are new may indicate a health concern. Conditions that cause black gums include melanotic macules, smoking, amalgam tattoos, medications, certain (systemic) diseases, and cancer. Treatment isn't always necessary, but there are several options for removing black spots on the gums.

A Word From Verywell

You may become worried if you've noticed new black gums or black patches on your gums. Take heart; chances are they're nothing to be concerned about. Oral melanomas are extremely rare. Even so, if you notice any new lesions in your mouth, it's best to get them evaluated. A dentist can rule out the possibility of malignancy.