Pigmented gingiva – How oral ailments may present differently based on the color of gingiva

I recall coming into school absolutely fascinated by oral hygiene and the various ways in which ailments can present in the oral cavity. My curiosity continued to grow as I delved deeper into my dental education, however I always had a looming question in the back of my head, why don’t my own “healthy” and “normal” gums resemble those that are deemed normal and healthy in my lectures?

During my introduction to periodontics and prevention courses, I was absolutely fascinated to learn about the inflammatory processes that affect the gums and other supporting structures around the teeth. It was captivating to see how the clinical features of periodontal diseases presents differently based on severity. Every time we learned about a specific clinical feature, we were shown a baseline feature of what was considered normal / healthy tissue. What was interesting to learn however, was that the appearance of tissue in the oral cavity can vary based on the level of cutaneous pigmentation. Factors such as the color and texture of the tissue can differ based on an individual’s race and the region of origin. This pigmentation arises from melanin that is produced by melanocytes that are present in the gingival epithelium. Based on both genetic and environmental factors, it was intriguing to learn that everyone’s version of “normal” and “healthy” can very much vary.

Healthy, pigmented gingiva Healthy, gingiva

Recently, a medical student named Malone Mukwende created a handbook called ‘Mind the Gap’ that diagnoses conditions in black and brown skinned individuals. He created the book with the intention to bring awareness to the fact that illnesses may manifest differently based on a patient's skin color. A similar handbook which diagnoses oral ailments based on gingival pigmentation would be a very valuable clinical tool for dental students in the clinical setting. With the dental and medical fields constantly evolving, such a project seems to be an achievable feat.

Sources:

Rehab A. Abdel Moneim, Mona El Deeb, Amany A. Rabea, Gingival pigmentation (cause, treatment and histological preview), Future Dental Journal, Volume 3, Issue 1, 2017, Pages 1-7, ISSN 2314-7180, https://doi.org/10.1016/j.fdj.2017.04.002.

(http://www.sciencedirect.com/science/article/pii/S231471801630074X)

Abstract: Facial appearance depends on several oral and extraoral factors. The gingiva is an important intraoral tissue which when affected particularly by pigmentation is mainly responsible for the unpleasant appearance. Several causes of gingival pigmentation were previously mentioned in text together with the possible techniques of treatment. In this review, we will focus on this topic with a histological point of view.

Keywords: Gingiva; Melanin pigmentation; Gingival depigmentation techniques; Melanocytes

https://pocketdentistry.com/structural-biology/

Mukwende, Malone; Tamony, Peter; Turner, Margot (2020): Mind the Gap: A handbook of clinical signs in Black and Brown skin. St George's, University of London. Online resource. https://doi.org/10.24376/rd.sgul.12769988.v1

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This post was contributed by Shreya Kolar, Director of Diversity at ADEA COSRF District 2 and student at University at Buffalo School of Dental Medicine ('23). Instagram: @shreyasmiles_