DISCLOSURE: Noelle Copeland RDH is the oral care specialist and dental consultant to the Brilliant and Baby Buddy oral care lines through Compac Industries. See terms below
Anytime something different or unusual shows up in your mouth, it’s good practice to have it evaluated by your attending dental professional. It may simply be a part of your normal tissue anatomy that you have never noticed before or it could be a symptom of something that needs to be assessed and addressed. Here are some things to consider when you notice a dark spot or black or brown spot on your gum tissue!
Gum disease goes through several stages as it advances and some people may not notice any of those changes, like pain, bleeding or sensitivity, until the disease has progressed quite a bit. This is just another reason why it’s so important to see your dentist regularly.
Gum disease affects blood flow to the gums and causes an environment that is depleted of oxygen where bacteria flourish and replicate. Gum disease produces inflammation, tenderness, bleeding, and encourages the accumulation of calcified tartar. This situation can cause the gums to appear red, and dark, sometimes even black. Typically, it’s not the gums that are black, but the calcified tartar underneath the gums that turns black.
Like gum disease, tooth decay also goes through “warning” stages before being fully developed. Once fully developed, decay can cause dark spots, holes, and enamel breakdown in the teeth that can be seen not only on the tooth itself, but depending on the location of the decay, can also present signs in the gums, including discoloration.
Stages of Tooth Decay/Cavities
- Demineralization – Tooth enamel is the hardest tissue in the human body and is made up mostly of minerals and proteins. Demineralization occurs when a tooth is overly exposed to acids from the diet or stomach. Those acids will absorb the protective minerals right out of the teeth, (“Demineralization”), when they are not properly removed on a daily basis with regular and effective homecare hygiene. This type of mineral loss can initially present as a white spot on the tooth.
- Enamel loss– As demineralization continues, breakdown of the tooth will progress and the initial white spot will darken to a brownish/black color. The enamel is weakened at this point and small holes or pits will begin to appear. If this decay is happening underneath the gums, the gums will appear to suddenly have a dark hue or appearance.
- Dentinal cavitation– Dentin is the softer tissue that lies underneath the enamel in a tooth’s structure. Once the dentin is penetrated by an actively progressing cavity, sensitivity and pain can become present. Decay can rapidly grow and spread at this stage. Sensitivity to hot/cold temperatures are typical and discoloration is usually black and dark at this stage.
All of the stages listed above can show discoloration in the tooth that can also be seen through the gum tissues if large enough. If decay is not addressed, it can continue to grow, causing pulp or nerve damage and eventually an abscess, both of which are extremely painful.
An amalgam tattoo can happen after the placement or removal of an amalgam filling in the mouth. The tattoo occurs when a piece of the silver amalgam filling becomes lodged in the tissues microscopically, henceforth creating a tattoo. Sometimes this tattooing can be mistaken as a melanoma, because of the way it looks. A thorough history of past dental procedures will be taken and evaluated as your dental professional is determining the pathogenesis of this type of anomaly.
Smoking can turn your beautiful, healthy, pink lungs into a black, tarry dying mess! So it’s really no surprise that it can do similar damage to the tissues in your mouth. Including all of the following:
- Smokers Melanosis
- Periodontal Disease
- Nicotine Stomatitis
- Black Hairy Tongue
- Tooth abrasion
Smokers melanosis, specifically, can be attributed to the stimulation of melanocytes that produce melanin in the mouth, and will cause a darkening of the tissue, or what we refer to as tissue pigmentation. This happens in response to the toxic agents in tobacco and the heat that smokers expose their tissues to.
What smoking does to the mouth
- Reduces blood flow to the tissues, essentially starving the gums of needed oxygen and white blood cells, which are essential to health and healing.
- Nicotine affects the immune system, extending the recovery period for any circulatory infection.
Some medications can cause darkened gums. If you notice darker pigments in the mouth after starting a new medication, talk to your doctor. Some examples of medicine induced pigment change include:
- Antibiotics like Minocycline
- Antimalarial drugs
- Cancer therapy drugs
It’s actually quite easy to bruise the gum tissue that surrounds teeth. And just like bruising that develops anywhere else on your body from trauma or injury, bleeding underneath the skin will appear as a dark reddening that shifts to shades of brown, brown spot or black and eventually yellow as it heals.
- Trauma- Fall, bump or hit to the mouth area
- Injury while eating- Sharp edges, hot food, utensils
- Aggressive Oral Care- Brushing or flossing incorrectly, including, using an electric toothbrush incorrectly, also biting or chewing on a toothbrush
- Oral fixations- Chewing on non-food items like pencils, pens, ice, fingers and fingernails
- Mouth appliances- Night guards, Invisalign trays, retainers, partials or any removable mouth piece when not worn correctly
For all the parents out there, seeing a newly formed dark brown or black spot in your child’s mouth can be alarming. One potential culprit can be the formation of an eruption hematoma. When a tooth is just about ready to erupt into the mouth, a cyst can develop that will fill with fluid, sometimes blood, and can appear purple or black. This is typically in response to an injury like a bump or fall and is very common in children.
Healthy oral tissue is pink. However, a percentage of the population has a normal healthy variance of color called oral pigmentation. Mostly seen in those with darker skin tones, oral pigmentation is driven by the production of melanin. Melanin is produced by melanocytes and affects the color of the oral mucosa and the skin, but not necessarily both. It is estimated that only 3% of the population has normal variance oral pigmentation. So instead of the gum tissue being completely pink, it can vary in differing degrees and locations with darker shaded pigment, ranging from black to gray, to brownish purple.
When noted orally, a blue nevus in the mouth appears as:
- Harmless mole
- Flat or slightly raised
- Blue or black in color
- Similar in size to a freckle
- More common in women
- If size changes, will need further assessment
Addison disease can happen in anyone, adults or children, and is often the direct outcome of adrenal gland destruction from autoimmunity within the body.
Oral hyperpigmentation associated with Addison disease occurs in over 90% of patients and may precede other manifestations of the disease by up to 10 years. The pigmentation appears as blue, black, or brown spots or streaks. Found mostly on the:
- Gingiva (gums)
- Buccal Mucosa (Inside cheeks)
- Hard Palate (Roof of the mouth)
Honestly, oral cancer is usually never black or spotty. However, since you’re here reading this, we’re gonna talk about it anyways because it’s serious and deadly.
Most people would probably think that oral cancer would look dark, suspicious, and different. And of course, sometimes it does, but most often, it doesn’t! Most often, oral cancer appears white and lacy, or red and infected. It hides and tries to blend into the tissues and when someone does notice it, it’s usually not because of how it looks but because of how it feels; nodular, thicker, harder, or even tighter.
Dental professionals are trained to see and feel for oral cancers, and an oral cancer screening should be a part of every maintenance visit you have with your dental professional. If your dental professional is not telling you that they are performing an oral cancer screening, you NEED to ask if one is being done. And if for some crazy reason, they say they are not doing it, then you need to find a new dentist.
Having said all of that, let’s review some of the oral cancer symptoms you should be aware of at home. This is just a few of the most common and is not an exhaustive list.
- Open sores that won’t heal
- Unusual bleeding
- Swelling in the mouth without a known cause
- Chronic sore throat
- Change in your voice
- White or red patch in the mouth. Under the tongue or on the sides of the tongue, and on the inside of the cheeks.
- Enlarged neck lymph nodes
- Recurrent ulcers
- Growths or lumps
- Teeth becoming loose
- Unexplained mouth pain or ear pain
- Difficulty swallowing
Risk factors for developing oral cancer.
- Consuming large amounts of alcohol
- Using tobacco in any form- Cigarettes, Cigars, Pipes, Chew, Snuff, Vaping
Exposure to Human Papillomavirus
Additional risk factors
- Radiation exposure
- Excessive sun exposure to the lips- Those with fair skin are at higher risk for lip cancers
- Gender- Men are more likely to develop oral cancer than women
- Poor Oral Hygiene combined with any of the other risk factors increases risk
- Poor Diet/Nutrition
- Weakened Immune system
The bottom line is that active self care and professional care are absolutely essential. Anything new should be checked and you should be very familiar with how your mouth looks and feels on a regular basis so you can quickly spot anything new or worrisome.
A small black spot on your gums is probably going to be harmless in most cases. In fact, I have personally removed debris from underneath patients’ gums that appeared “black in color and suddenly in presentation” multiple times in my career. In all those times it was never anything serious, and in several circumstances it was a piece of pepper or some sort of seed that had lodged itself into a nice little cozy spot under the tissue.
On the flip side, I have also personally experienced the agony of telling my patient that during my oral cancer screening, I noticed something “Unusual or Suspicious”, only to have the Doctor concur, which then led to an oral biopsy, landing eventually on the diagnosis of mouth cancer.
Of all the times in my career that this unfortunate situation has occurred, the only upside was that we caught it early, and got it treated early. Most oral cancers are squamous cell carcinomas, and this type spreads quickly, so early detection is so critical. That being said, the 5 year survival rate after oral cancer treatment is around 50%.
Because the mouth and lips are so easy to examine, the Oral Cancer Screening is an absolute necessity for dental professionals and patients. If you have any questions about oral cancer and your specific risk factors, find a trusted professional to talk to today.
If you already have a diagnosis of oral cancer and you are in active treatment or recovery. You may experience oral sensitivity that makes oral care difficult and painful. Brilliant Oral Care has a toothbrush for sensitive gums and teeth, and we also carry a “Special Soft” toothbrush that I personally think is the best toothbrush for sensitive teeth and gums when battling the challenges of oral cancer therapy and treatment. Please reach out to m me at firstname.lastname@example.org if you have any questions about how our toothbrushes can help.
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Noelle Copeland RDH is an Oral Care Specialist and Dental Consultant who provides content for Brilliant Oral Care and Baby Buddy.