The gums or gingiva as they are called are the soft tissue covering the teeth in the mouth. The health of the gums is important for the good functioning of the teeth. Bleeding gums, with red swollen gums indicate a condition called gingivitis. But did you know what the normal gingiva looks like?
The normal gingiva is described as being coral pink in colour. The gingiva envelopes the teeth in a collar-like fashion. It is firm and resilient and presents a surface texture like that of orange-peel, referred to as being stippled. The coral pink colour of the gingiva is due to
- The blood supply to the gums
- The thickness of the gums
- The presence of pigment containing cells
Melanin, a non-hemoglobin derived brown pigment is responsible for the normal pigmentation of the skin, gums and the rest of the oral cavity. It is present in all normal individuals. It is absent or severely diminished in albinos. Melanin pigmentation of the gums is more prominent in darker individuals. Gingival pigmentation occurs as a diffuse deep purplish discolouration or as irregularly shaped brown and light brown patches. It appears as early as 3 hours after birth and is the only evidence of pigmentation.
Colour changes in the gingiva
Colour changes in acute gingivitis
Gingivitis is the first stage of infection of the gums. This is characterised by bleeding gums and a reddish discolouration of the gums. In most instances it is a bright red colour. It remains this colour till the condition reverts. If the condition worsens, the red colour changes to a shiny slate grey, which gradually becomes a dull whitish grey.
Colour changes in chronic gingivitis
When the initial gum infection is not treated, the chronic inflammation intensifies the red or bluish red colour. This is because of the increase in the blood flow to the area. The colour becomes paler when the blood flow is reduced. Venous stasis will add the bluish hue. Originally a light red, the colour changes through varying shades of red, reddish blue and deep blue with increasing chronicity of the inflammatory process.
Heavy metals absorbed from the body from medication or due to occupational hazard may discolour the gum and other areas of the mouth.
- Bismuth, arsenic and mercury produce a black line in the gums.
- Lead produces a bluish red or deep blue linear pigmentation (burtonian line)
- Exposure to silver causes a violet marginal line with diffuse bluish grey discolouration of the mouth.
Colour changes associated with systemic factors
Many diseases causes colour changes in the mouth and gums.
1) Endogenous pigmentation can be due to melanin, bilirubin or iron. Melanin pigmentation is prominent in darker individuals. Diseases that increase melanin pigmentation include
- Addison’s disease–Cause by adrenal dysfunction and causes isolated patches of discolouration varying from bluish black to brown.
- Peutz-jeghers syndrome–melanin pigmentation in mouth and lips.
- Albright’s symdrome
- von Recklinghausen’s disease.
Jaundice may cause yellowish colour of the mouth.
Hemochromatosis–deposition of iron causes blue- grey pigmentation of the mouth.
Endocrine and metabolic disturbances like diabetes and pregnancy may produce colour changes.
Anemia, polycythemia and leukaemia may produce colour changes.
2) Exogenous factors capable of causing gingival colour changes are
Atmospheric irritants like coal, metal dust and colouring agents in foods and lozenges. Tobacco causes grey colour of the gums. Bluish black area of pigmentation is seen commonly due to amalgam embedded in the gums.