Normal and Abnormal

Appearance of the Gingiva:

Stippling and Pigmentation
What is Stippling?
 STIPPLING
 Small depressions or “pits” in the
epithelium of healthy attached gingiva
(bound to underlying alveolar bone)
 Has an orange-peel appearance.
 Consequence of rete pegs/ridges, which
are deep epithelial projections into the
underlying connective tissue.
 If the gingiva appears smooth, clinically,
this does not neccesarily indicate
pathology.
STIPPLING in healthy
gingiva
 How does Stippling appear
Clinically & Histologically?
Attached
Free gingiva* gingiva

* Free gingiva is not

stippled
Stippled
Appearanc
 A= Stippling of e
gingiva
 B= Keratin layer
 Causes of Altered Stippled
Gingiva
 Any condition that enlarges the attached
gingiva will cause stippling to disappear!

 Causes of Gingival Enlargement:

 Inflammation (e.g. gingivitis)
 Drug-induced (e.g. Ca2+ channel blockers,
anticonvulsants)
 Conditioned enlargement (e.g., pregnancy,
puberty, Vit C deficiency, pyogenic granulomas)
 Systemic disease (e.g., leukemia,
granulomatous diseases, neoplasms)
 Bony/dental tissue lesions
Examples of Gingival
Enlargement
GINGIVAL PIGMENTATION
& Dark Patches
 Gingival Pigmentation
 Gingival pigmentation results from
melanin granules, which are produced by
melanoblasts. The degree of pigmentation
depends on melanoblastic activity.
 Variations in gingival color may be
correlated with the racial diversity of an
individual or may be a reflection of
pathologic influences.
 How Does Gingival Colour
Differ Between Races?
 The colour of the gingiva generally matches
the skin colour of the person.
 High levels of oral melanin pigmentation are
normally observed in:
 Africans/decendants of Africans (gums appear
dark/close to black)
 Hispanics (gums vary from light pink to dark brown)
 East Asians (gums appear coral pink to light brown)
 People with fair skin (Caucasians) will not
demonstrate overt tissue pigmentation; thus
their gums appear pink.
 Hyperpigmentation
 Hyperpigmentation of the gingiva is caused
by excessive melanin deposition by the
melanocytes mainly located in the basal and
suprabasal cell layers of the epithelium.
 Melanin increases with exposure to the sun;
thus, individuals with darker complexions and
those who spend a lot of time outdoors tend
to have darker gums (e.g., children with a
high smile line).
 Hyperpigmentation is observed in the gingiva
closest to the teeth, often as dark patches;
the portion hidden under the lips usually
appear pink.
 How Does Hyperpigmentation
Affect Individuals?
 Hyperpigmentation is not commonly an
indication of a medical problem!
 It is considered a genetic trait in some
populations; medically, it is known as racial or
physiological gingival pigmentation.
 The effects may be esthetic problems and
embarassment, especially if the pigmentation is
visible during speech and smiling.
 What Can Be Done to Alter
Hyperpigmentation?

 The gingiva can be de-pigmented!

 Yes, the “blackness” of the gums is superficial
and can removed.
 Removal of Dark Patches
 Various de-pigmentation techniques can be
employed.
 The most popular one is the surgical removal of
the undesired pigmentation:
 Done under local anesthesia
 Only the outer layer of gum epithelium is removed,
with a layer of the underlying connective tissue;
healing via secondary intention is allowed
 The new epithelium that forms is devoid of melanin
 Immediate results are evident on the day of the
procedure
De-pigmentation of Gingiva
 Pathological Influences in
Gingival Pigmentation
 These include:
 hypoadrenocorticism (Addison's disease)
 Nevi (pigmented birthmarks)
 Depositions of heavy metals