What does a black spot on your gums mean?

What Does a Black Spot on Your Gums Mean?

Discovering a dark or black spot on your gums can be alarming. In most cases, these patches are harmless, but a small number may signal something more serious. This guide covers common causes, red flags, next steps and when to seek professional care.

Common Benign Causes

Many pigmented lesions in the mouth are non-cancerous. According to Scully & Cawson’s review of oral mucosal pigmentation, about 75–80% of such spots are harmless.

• Physiologic (racial) pigmentation
  • More common in people with darker skin tones
  • Even, bilateral bluish-brown patches on the gingiva
  • Develop gradually, usually present by teenage years

• Smoker’s melanosis
  • Associated with tobacco use
  • Brownish or blackish spots mostly on the anterior gums
  • May fade if you quit smoking

• Amalgam tattoo
  • Occurs when dental filling particles embed in gum tissue
  • Looks like a flat blue-gray or black spot adjacent to a restored tooth
  • Permanently embedded; usually no treatment needed

• Melanotic macule
  • Small, well-defined brown-black spot, often on lower lip but can occur on gums
  • Slow growth, usually under 1 cm in diameter
  • Biopsy may be done if size or shape changes

• Blue nevus
  • Benign collection of melanocytes (pigment cells) deep in the gum
  • Smooth, blue-black papule, generally under 1 cm
  • Rarely changes once formed

Less Common but Concerning Causes

While most gum pigmentations are harmless, a few warrant prompt evaluation:

• Oral melanoma
  • Rare (0.5% of all melanomas), but aggressive
  • Irregular shape, variegated black/brown color, possibly ulcerated or bleeding
  • Rapid growth over weeks to months

• Kaposi’s sarcoma
  • Associated with HIV/AIDS or immunosuppression
  • Reddish-purple to black patches or nodules, may affect gums, palate
  • Often multiple lesions; may be tender

• Drug-induced pigmentation
  • Certain medications can cause gum discoloration (e.g., antimalarials, some antibiotics, antipsychotics)
  • Diffuse gray-brown or blue-black patches
  • May improve if medication changes

• Heavy metal or systemic deposits
  • Lead, bismuth, or silver exposure can deposit in mucosa (“lead lines,” “bismuth lines”)
  • Often accompanied by other symptoms of toxicity

• Addison’s disease (adrenal insufficiency)
  • Increased ACTH stimulates melanocytes, causing generalized pigmentation including gums
  • Look for fatigue, weight loss, low blood pressure
  • Requires hormone evaluation

Conditions Not Usually Associated

• Liver disease (e.g., cirrhosis) typically causes yellowing (jaundice), not black spots.
• Iron deficiency or anemia may lead to pale gums, not dark pigmentation.

Red Flags: When to Worry

If you notice any of the following, seek evaluation by a dentist or doctor promptly:

• Rapid change in size, shape or color
• Irregular borders or multiple colors in one lesion
• Bleeding, ulceration or pain at the spot
• Lesions that feel firm or raised
• New spots appearing suddenly without clear reason
• Other systemic signs: unexplained weight loss, fatigue, fevers

What to Expect: Evaluation and Diagnosis

1. Clinical examination
   • Your dentist or doctor will look at the size, shape, color and exact location of the spot.
   • They’ll review your medical history, medications and risk factors (smoking, implants, systemic diseases).

2. Imaging
   • In some cases, X-rays can help rule out embedded particles (e.g., amalgam fragments).

3. Biopsy
   • A small tissue sample may be taken if the lesion is suspicious (irregular, growing, bleeding).
   • Pathology will distinguish benign pigmented lesions from melanoma or other malignancies.

4. Blood tests
   • If a systemic cause is suspected (Addison’s, heavy metal exposure), blood tests may be ordered.

At-Home Monitoring

While waiting for your appointment, keep track of:

• Photographs of the spot every 1–2 weeks
• Any changes in color, size or texture
• New symptoms (pain, bleeding, numbness)

Next Steps and Self-Care

• Maintain excellent oral hygiene with gentle brushing and flossing.
• Avoid tobacco and reduce alcohol consumption.
• If you smoke, consider quitting to reduce smoker’s melanosis and cancer risk.
• Report any medication changes to your provider.

Free Online Symptom Check

If you’re not sure whether your spot is serious, you might consider doing a free, online “symptom check for” gum discoloration to get preliminary guidance. (link: https://www.UbieHealth.com)

When to See Your Doctor

• If the spot fits any red-flag criteria above
• If it doesn’t improve or clearly changes over 2–3 weeks
• If you have systemic symptoms like weight loss or fatigue

Even benign-looking lesions can hide serious conditions. A professional exam ensures timely diagnosis and peace of mind.

---

Key Takeaway
Black spots on the gums are most commonly harmless, related to pigmentation, smoking or dental materials. However, a small percentage can be melanoma or other systemic issues. Any rapid changes, irregular features, bleeding or systemic symptoms warrant prompt evaluation.

Speak to a doctor about any gum lesion that looks concerning or changes over time, especially if accompanied by pain, bleeding or other health changes. Early diagnosis and treatment can make all the difference.