Black gums are generally caused by excess melanin linked to genetics, smoking, or medications. Rarely, they may be a sign of severe conditions like cancer.

Recognizing the Symptoms of Black Gums

Black gums often appear dark purple or brown. Light brown or deep blue discoloration is also considered gingival pigmentation.

This discoloration can cover the entire gum area surrounding your teeth. You may also have irregular black patches, spots, or strands of black on your gums.1 

If you've always had darker gums because of melanin, you likely developed the discoloration at birth. Underlying conditions and damage can cause the gums to form black patches suddenly or gradually. The entire gum area may gradually turn black.1 

What Are the Causes of Black Gums?

Black gums can be caused by natural skin variation, medications, and smoking. Non-cancerous or cancerous lesions can also cause black spots and discoloration on the gums.1

Melanotic Macules

Small, dark patches on the gum may be benign (non-cancerous) lesions called melanotic macules.

Melanotic macules are caused by increased melanin production in areas of the gums, lower lip, or roof of the mouth (palate). These lesions are one of the most common forms of oral discoloration and don't pose any health risks or cause additional side effects.2

Melanotic macules look like small, flat ovals with irregular borders. These lesions are typically only about 1 centimeter wide.3

Lesions usually appear gradually and change from brown to black. However, melanotic macules can also look deep blue or gray.3 

Oral Malignant Melanoma

This form of skin cancer causes small, black spots on the gums and other oral tissues. These cancerous lesions look similar to melanotic macules but change over time.

Oral malignant melanoma is an extremely rare form of melanoma. they cause 0.2-8% of melanoma cases in the United States.4 

Like other forms of melanoma, oral malignant melanoma spots look like small, black-brown lesions with irregular borders. The lesion may eventually open, bleed, and swell. Melanoma on the gums may also appear gray, red, or purple.4 

Contact a dentist as soon as possible if you notice any spots on your gums that start to change or bleed.

Smoker's Melanosis

Smoking can also increase melanin in the gums, causing flat black or brown patches that cover the gums and other oral tissue.

It's estimated that about 22% of people who smoke develop smoker's melanosis. It's more common in women.5 

Black gums caused by smoker's melanosis on their own are not harmful. However, smoking itself can increase your risk of tooth decay and gum disease.5 

Smoking more frequently increases your risk of developing melanosis. Nicotine and benzo(a)pyrene—ingredients in cigarettes—penetrate gum tissue and activate melanin production. You may notice dark patches gradually appear on your gums and grow darker over time5 

Severe Gum Disease

Acute necrotizing ulcerative gingivitis (trench mouth) is a severe form of gum disease. It can cause the gumline around your teeth to appear black or dark gray.

The color change is gum tissue dying due to infection. Necrotizing ulcerative gingivitis is caused by a bacterial infection in the gum tissue around the teeth—usually due to poor oral hygiene.6 

This severe form of gingivitis can also cause symptoms like:6

• Fever 
• Vomiting
• Fatigue
• Painful gums
• Bleeding gums
• Ulcers along the gum line
• Halitosis (bad breath)

Amalgam Tattoo

Amalgam tattoos are black, blue, or gray patches that form above a tooth that was recently filled. The black areas may look like clusters or a single spot up to 1 centimeter wide.2

This discoloration occurs after silver dental filling materials, or amalgam, accidentally embeds into the gum line. The metal particles in the gum over time, which can cause more discoloration.1  

Amalgam tattoos don't typically require removal because they don't create health risks. However, they are often removed for cosmetic reasons.  

Medications

Certain medications can cause most gums to turn black, purple, or dark brown. Drug-induced black gums are typically caused by drugs that can increase melanin.

Medication can also damage the middle layer of skin (the dermis) and deposit iron in the area, causing a black pigment. People with drug-induced black gums may find that their lips start to darken in color.5

Medications that can cause black gums include:1 

• Minocycline: An antibiotic used to treat bacterial infections
• Chlorpromazine: An antipsychotic medication used to treat mental health conditions like schizophrenia and bipolar disorder
• Ketoconazole: An imidazole antifungal used to treat fungal infections
• Chloroquine and quinine: Antimalarial medications
• Bleomycin and cyclophosphamide: Chemotherapy drugs
• Zidovudine: An antiretroviral used to manage HIV-1)

Addison's Disease

Black gums and darkening of other mucus membranes in the mouth may be symptoms of a rare condition called Addison's disease.1 Addison's disease is caused by damaged adrenal glands that can't make enough cortisol and aldosterone hormones.

If left untreated, the condition can keep the body from functioning correctly and eventually lead to death. Hormonal medication can manage the condition and help people live healthy lives.7 

Addison's disease is typically caused by an autoimmune disease that makes the immune system mistakenly attack the adrenal glands. Tuberculosis infections, human immunodeficiency virus (HIV), and cancer can also increase the risk of Addison's disease.89 

Other symptoms of Addison's disease include:98

• Unexpected or sudden weight loss
• Muscle weakness
• Chronic (long-lasting) fatigue 
• Loss of appetite
• Abdominal pain
• Hypotension (low blood pressure)
• Hypoglycemia (low blood sugar)
• Darkening of scars, skin folds, elbows, knees, knuckles, and toes
• Darkening of the interior lining of the cheeks 

Peutz-Jeghers Syndrome

Peutz-Jeghers syndrome (PJS) is a rare condition caused by a gene mutation that forms non-cancerous growths in areas of the digestive tract. However, it can increase your risk of digestive tract, pancreatic, cervix, ovarian, and breast cancer.10 

People with PJS often develop small, dark spots on the gums and mouth as children. These tiny black areas usually fade with age. 

Other symptoms of PJS that typically appear during childhood and adolescence include:10

• Dark spots on the hands and feet
• Dark spots around the eyes, nostrils, and anus
• Recurrent bowel obstructions
• Chronic bleeding
• Abdominal pain

When Should You See a Dentist?

Contact a dentist if you notice any gradual gum changes that form black patches, lines, or spots, or if a black patch or spot suddenly appears on your gums. They may refer you to a periodontist—a dentist who specializes in gum-related diseases. 

Other gum-related symptoms to watch for include:11

• Inflamed or swollen gums
• Bleeding gums
• Changing spots on the gums4
• Loose teeth
• Tooth pain
• Halitosis
  
  You may need to seek emergency dental care if you have a cracked tooth, severe pain, bleeding, or fever.12

etting a Diagnosis

A dentist will diagnose the underlying cause of your black gums by performing an oral exam. This can help them determine color variations, discoloration shapes, and affected gum areas.

They will ask you about your dental history, medical history, medications, and current symptoms—as well as if you smoke.131
If lesions are causing black gums, a dentist might examine the lesion and do a biopsy. During the biopsy, they will numb the area and surgically remove a small sample of gum tissue. This sample will be examined under a microscope for abnormalities.14

A dentist may also take X-rays to identify bone health issues or look for metal filling material under your gum line.113

What Treatment Looks Like

Treatment for black gums depends on the root cause. Black gums that cause pain, dental issues, or increase your risk of cancer need treatment.

Treatment is not necessary if black gums are caused by your natural melanin content. However, cosmetic treatments are available if you're not happy with the color of your gums. 

Black gum treatments include:1  

• Scalpel gingivectomy: Discolored gum tissue and the underlying connective tissue layer are surgically removed using a scalpel.
• Bur abrasion: A tool with a medium grit bur is spun at high speeds to sand off black gum tissue.  
• Electrosurgery: Electrical currents are applied to discolored gum tissue to destroy tissue.
• Radiosurgery: A type of electrosurgery that uses radio frequency energy to destroy discolored gum tissue—while also clotting blood to minimize bleeding.
• Cryosurgery: Black gum areas are frozen with liquid nitrogen to destroy discolored tissue.  
• Laser ablation: Lasers are targeted into discolored gum tissue, which absorbs lasers easily to destroy discolored cells.
• Chemical methods: Chemicals like phenol and alcohol are applied to dark gum areas to burn and destroy pigmentation.
• Gingival grafts: Discolored gum tissue is replaced with a skin graph using tissue from the roof of your mouth.  

A dentist will prescribe an antibiotic if a gum infection is causing black gums.

You may also need a gingivectomy to remove dead or infected tissue. If the infection has damaged your gum line, a gingivoplasty can surgically reshape gum tissue around your teeth.6

How Can You Prevent Black Gums?

You can help prevent black gums caused by oral hygiene habits and smoking by taking care of your teeth.

Ineffective brushing can cause bacterial and food build-up (plaque) to decay and discolor your teeth. Plaque that's not removed hardens into tartar, which increases your risk of gum bleeding, infection, and discoloration.15

Only dental professionals can remove tartar build-up, which is partially why regular dental cleanings are so important. A dentist can also help prevent tooth decay and other mouth-related side effects caused by medications and underlying health conditions.15

Oral hygiene tips that can help prevent black gums include the following:1115

• Brush your teeth twice a day to remove plaque and avoid build-up.
• Floss regularly—or using a dentist-approved water flosser or floss pick—to remove plaque between teeth.
• Avoid smoking, which discolors teeth and increases the risk of gum disease.
• Limit sugary drinks and sweets that encourage plaque build-up.
• Use toothpaste and drinking water that contains fluoride to protect against tooth decay.