A smile can make or break a person's entire look. We normally associate how pleasant or esthetic a smile is with the color, size and arrangement of the teeth. Without doubt, these are extremely important, however, they alone are not enough. The gums too play a vital but often overlooked role in the appearance of the smile.
The natural color of the gums is considered to be "coral pink", and that is what most people free from gum disease have. However, there are some who have gums that are darker than normal due to the abnormal deposition of melanin (the tanning pigment).
Why Are Some People's Gums Darker Than Others?
The cells that produce melanin are present in everybody’s gums, however due to reasons ranging from tobacco use, certain medications like anti-malarial medication and antidepressant drugs, hormonal disturbances, genetic conditions like Albright’s syndrome/Peutz-Jeghers syndrome or even without any cause at all, these cells can become overactive and produce more melanin than is considered normal.
It is important to remember here that dark gums do not indicate a medical problem as such. If the patient has no other systemic symptom other than dark gums then no medical treatment is required.
The issue that arises for the patient is esthetic in nature.
The options available to patients who would like to get their gums treated and made lighter are all surgical. There are a number of different techniques that are used, with each having some pros and cons, but the patient must have realistic expectations before choosing any of these procedures. None of them are permanent and it is almost certain that the color of the gums will return to the starting point over a variable length of time.
The procedure is absolutely safe and if done properly does not cause any harm to any of the surrounding structures. Thus, the patients do have the option of getting it done multiple times.
This is probably the most convenient and cost effective method for the patient although it requires the doctor to have a high level of skill. The idea is to use a sharp surgical blade to remove the thin top layer of the gingival.
This is the layer that has all the accumulated melanin pigment and so the top layer that reforms after healing is pink again. Unfortunately, the melanin-producing cells are found in the bottom layers of the gingival and cannot be altered by this method. This is why the gums return to their genetically and physiologically set color over a period of time.
There are several disadvantages of this method. The first is that there is a lot of bleeding involved. There is a risk of injury to the underlying bone if the incisions run deeper than intended. A small risk of leaving behind small islands of pigmented gingiva is always present.
The raw gingival at the end of the procedure requires the application of an uncomfortable periodontal pack for at least a week after surgery.
More Treatment Options For Gingival Pigmentation
This method involves the use of a rotary bur, like the kind used to prepare cavities, for the removal of the of the top layer of the gums. The time taken to complete the depigmentation via this method is probably the least and it is also pretty forgiving to the doctor.
Bleeding is still a disadvantage with this method as is the excessive amount of trauma when compared to a scalpel. Doctors should take care to use a large sized bur otherwise the smaller sized bur will cause uneven pitting to occur on the surface of the gums and not abrade it as intended.
Cryosurgery for the purposes of removal of the pigmented layer of gingival was extremely popular before it was replaced by better methods on a large scale. It will be hard to find practitioners that practice this method because of its associated and well-documented disadvantages.
The method involved the use of liquid nitrogen to freeze the top layer of the gingival that would then over the course of a week necrose and fall off. It was frequently necessary to perform this procedure in two sittings, with the second one to remove any areas that may have been left behind.
The procedure was effective and painless but there was no way control the depth of penetration of the cold. Thus, patients would frequently develop recession or damage to the underlying bone as collateral damage.
The advent of lasers has made this technique mostly irrelevant.
This is by far the best method that can be used for the removal of pigmentation from the gingival and make it lighter in appearance. There is no blood during the procedure, the wound that is left behind is sterile and thus does not need a periodontal dressing, and it is extremely easy for the doctor to perform the procedure using this method.
The only problem is that the laser has a fixed depth of penetration depending upon the kind of laser it is and the intensity at which it is being used. This makes it difficult to alter the depth in areas of the gingival that may not be as thick.
Patients are quite satisfied since they find it quite comfortable to go through the procedure without any noise, blood, pain or a bulky dressing afterward.
The cost of getting the procedure done using a laser is considerably higher than with other methods while the result may not be that different.
The color of the gingiva varies from person to person, similar to how the color of the skin varies. It is possible to make the gingival lighter for some time, however, it is bound to return to its original color in the long run.
No one can predict the exact time frame in which this return to the original pigmentation levels will happen or guarantee that any one method is going to work better than all others. The final decision as to what procedure is to be followed should be made on the advice of your doctor based on a clinical examination and previous experience.