A dark patch on your gum: amalgam tattoo, smoker's melanosis, or something that needs looking at

Is it normal to have dark gums if you are Middle Eastern, South Asian, African or Mediterranean?

Yes. Even, symmetrical pigmentation that has been there for as long as you can remember is physiological melanin, made by the same cells that colour skin, and it is neither a disease nor a consequence of anything you did. In a South African sample of 430 people, 42% had physiological oral melanin pigmentation, and the gum was the site involved in 73% of cases ^[3]. The usual pattern is a continuous band across the attached gum, symmetrical across the midline, with the thin collar of tissue around the teeth staying pink ^[7]. It does not simply track skin tone: in 100 South Indian adults, gum pigmentation showed no significant association with facial complexion (p = 0.848) ^[6]. If your real question is whether that colour can be changed, that is a separate and purely cosmetic conversation, set out in full on gum depigmentation. The rest of this article is about the other kind of pigment: localised, one-sided, or newer than you are.

What is the grey or blue patch on my gum next to an old silver filling?

That is almost always an amalgam tattoo, meaning microscopic particles of silver filling material embedded in the gum, and it is harmless. The particles arrive during ordinary treatment, when a filling is placed or drilled out or a neighbouring tooth is removed, and nothing has gone wrong when it happens. It reads slate grey or blue-grey rather than brown, it is flat and the tissue over it feels normal, it sits beside or directly opposite a metal restoration (or the place one used to be), and it does not change from one year to the next. Where the particles are large enough they appear as radiopaque flecks on a radiograph, which settles the question without touching the tissue. It is the single most common reason someone arrives worried about a black spot: 53.6% of pigmented lesions in the Brazilian series ^[11] and 18.9% of oral pigmentations found in 1,275 dental patients in Jordan ^[4]. A similar grey mark can follow a childhood pencil-lead injury, which leaves graphite in the tissue the same way ^[12]. No treatment is required: a 2025 review of the literature on treating amalgam tattoo screened 209 publications and analysed 18, all of them concerned with appearance rather than health ^[13]. Replacing the old restoration with composite fillings changes the tooth, not the pigment, because the particles are in the gum. Where the clinical picture is not conclusive, biopsy settles it ^[1].

Why do smokers get dark gums, and will they turn pink again if I quit?

Smoking stimulates the pigment-producing cells in the gum, so melanin accumulates in the tissue, usually as a diffuse brown band across the front gum surfaces. Among 908 army recruits, gingival melanin pigmentation was present in 27.5% of current smokers against 8.6% of never-smokers, and five to nine cigarettes a day appeared enough to produce it ^[9]. In 253 Nigerian adults, pigmented sites were found in 6% of smokers against 0.52% of non-smokers, rising with both amount and duration ^[8]. It is not only cigarettes: among 1,920 dental patients in Yemen, waterpipe smoking was independently associated with oral pigmented lesions (p = 0.004), so shisha and dokha belong in the same conversation ^[5]. On whether the colour returns to pink, the honest answer is that it often lightens gradually over months to years after stopping, though the measured evidence is thinner than the claim, since a photographic analysis of 259 patients found only a weak effect of cessation and only in the youngest age group ^[10]. What is not in doubt is what stopping does for the gum tissue itself, which is assessed and monitored as part of periodontal care.

Can medication or tablets make your gums turn dark?

Some medications can, and the useful clue is the timeline. Minocycline taken long term, antimalarials such as chloroquine and hydroxychloroquine, and some chemotherapy agents are among the recognised culprits, and the pigment appears or deepens after a medication is started or changed rather than having always been there. It is an uncommon cause overall: pigmentation attributed to medication or systemic disease made up 0.52% of oral pigmentations in the Jordanian series ^[4] and 0.3% in the Brazilian one ^[11]. Pigment in the mouth and in the nails often travel together, and dark nail bands alongside oral patches point towards a systemic or drug-related cause rather than a local one ^[14]. Nobody should stop a prescription over the colour of their gums. Take the timeline to the doctor who prescribed it.

When should I worry about a black spot on my gum?

Have it looked at soon, rather than at your next check-up, when the patch is new in adulthood, sits on one side only, has changed in size, shape or colour, has an irregular border, is raised or ulcerated rather than flat, or arrives with symptoms elsewhere in the body. Addison's disease is one reason that last criterion matters: mucocutaneous hyperpigmentation is reported in 92% of patients with the condition, can precede the general manifestations by up to a decade, and pigmentation inside the mouth is sometimes the only visible sign ^[15]. Pigmented spots present since childhood around the lips and in the mouth can point to Peutz-Jeghers syndrome, which has intestinal implications and belongs with a physician ^[14]. Oral melanoma is rare, and it is what every clinician is watching for when a pigmented patch does not behave like the benign ones ^[14]. Where the source of a pigmented lesion cannot be identified confidently from the clinical picture, biopsy is indicated ^[1], and where the pattern points to a systemic cause, the next appointment to make is a medical one.

How can you tell which kind of dark patch you have?

Four features separate them: colour and texture, whether the pigment is symmetrical, when it appeared, and whether it sits beside a restoration.

1. 1

   The history

   When it appeared, whether it has changed, and what medications and habits sit alongside it.

2. 2

   The pattern

   Colour, symmetry, texture, and whether the patch relates to a restoration or an old extraction site.

3. 3

   The radiograph

   A film of the area shows metal particles where they are large enough, which confirms an amalgam tattoo without touching the tissue.

4. 4

   The decision

   A confidently identified benign patch is photographed and reviewed over time; one that cannot be identified is biopsied or assessed medically.

That sequence takes a few minutes and belongs in a comprehensive examination, where soft tissue is recorded rather than glanced at. The conservative principle holds here as it does for teeth: identify the thing first, then decide whether it needs anything at all. Most of these need nothing.