Keywords
Oral pigmentation; melanin; hyperpigmentation; gum.
How to Cite
Gingival melanosis, a review of criteria for diagnosis and treatment. (2019). Odontoestomatología, 21(33). https://odon.edu.uy/ojs/index.php/ode/article/view/268
Abstract
Hyperpigmentation of the gingiva is an aesthetic problem for patients with gingival exposure when smiling. The main gingival pigmentation occurs primarily as physiologically response to trauma, chemicals and ultraviolet radiation. In this review, the objective was to perform a bibliographic review on the criteria for the diagnosis and treatment of gingival pigmentation (melanosis). The author explored articles from the PubMed, EMBASE and SciELO databases from 2005 (January) to the present (December 2018). The clinical criteria for diagnosis are based on the severity and extent of the pigmentations on the marginal and adherent gingiva; In this way, the gingival melanosis is more common at the level of the attached gum with shades that vary between light chestnut and dark brown. We concluded that all gingival depigmentation techniques are effective, the differences are in cost, speed healing, comfort and degree of postoperative pain.
References
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10. Janiani P, Bhat PR, Trasad VA, Acharya AB, Thakur SL. Evaluation of the intensity of gingival melanin pigmentation at different age groups in the Indian population: An observational study. J. Indian. Soc. Pedod. Prev. Dent. 2018;36(4):329-33.
11. Tamizi M, Taheri M. Treatment of severe physiologic gingival pigmentation with free gingival autograft. Quintessence. Int. 1996; 27:555 8.
12. Dummett CO, Bolden TE. Post-surgical clinical repigmentation of the gingiva. Oral. Surg. Oral. Med. Oral. Pathol. 1963;16: 353-6.
13. Gupta G.The labial melanotic macule A review of 79 cases. Br. Dent. Dermatologyc. 1964; 136: 772-75.
14. Corteillini P, Bissada NF. Mucogingival conditions in the natural dentition: Narrative review, case definitions, and diagnostic considerations. J Clin Periodontol. 2018;45(Suppl 20):S190–S198.
15. León SM, Faria H, Pérez L. Despigmentación gingival: Procedimiento quirúrgico. Reporte de un caso. Ciencia. odontológica. 2005; 2(2): 127- 32.
16. Rawal SY, Burrell R, Hamidi CS, Kalmar JR, Tatakis DN. Diffuse pigmentation of maxillary attached gingiva: four cases of the cultural practice of gingival tattoo. J. Periodontol. 2007;78 (1):170-6.
17. Abdo JM, Pérez ET, Bernal FS, Dzib JS. Síndrome de Peutz-Jeghers. Rev. Med. Hosp. Gen. Mex. 2005; 68 (2): 99-105
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19. Araki S, Murata K, Ushio K, Sakai R. Dose-response relationship between tobacco consumption and melanin pigmentation in the attached gingiva. Arch. Environ. Health. 1983; 38(6):375-8.
20. Axéll T, Hedin CA. Epidemiologic study of excessive oral melanin pigmentation with special reference to the influence of tobacco habits. Scand. J. Dent. Res. 1982;90 (6): 434-42.
21. Marakoğlu K, Gürsoy UK, Toker HC, Demirer S, Sezer RE, Marakoğlu I. Smoking status and smoke-related gingival melanin pigmentation in army recruitments. Mil. Med. 2007;172(1):110-3.
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24. Laimer J, Henn R, Helten T, Sprung S, Zelger B, Zelger B, Steiner R, Schnabl D, Offermanns V, Bruckmoser E, Huck CW. Amalgam tattoo versus melanocytic neoplasm - Differential diagnosis of dark pigmented oral mucosa lesions using infrared spectroscopy. PLoS. One. 2018;13(11):e0207026.
25. Chavés-Álvarez AJ, Rodríguez-Nevado IM, Argila-Fernández D, Monje-Gil F. Mácula hiperpigmentada en mucosa gingival. Actas. Dermosifiliogr. 2007; 98: 367-8.
26. Owens BM, Johnson WW; Schuman NJ. Oral amalgam pigmentations (tattoos): a retrospective study. Quintessence. Int. 1992; 23: 805-10.
27. Tavares TS, Meirelles DP, de Aguiar MCF, Caldeira PC. Pigmented lesions of the oral mucosa: A cross-sectional study of 458 histopathological specimens. Oral. Dis. 2018; 24(8):1484-91.
28. Hartman LC, Natiella JR, Meenaghan MA. The use of elemental microanalysis in verification of the composition of presumptive amalgam tattoo. J. Oral. Maxillofac. Surg. 1986; 44(8): 628-33.
29. Eley BM, Garrett JR. Tissue reactions to the separate implantation of individual constituent phases of dental amalgam, including assessment by energy dispersive X-ray microanalysis. Biomaterials. 1983; 4(2): 73-80.
30. Mohr W, Gorz E. Association of silver granules with elastic fibers in amalgam reaction of mouth mucosa. HNO. 2001; 49(6):454-7.
31. Hasegawa A, Okagi H. Removing melanogenous pigmentation using 90 percent phenol with 95 percent alcohol. Dent. Outlook. 1973;42: 673-6.
32. Tamizi M, Taheri M. Treatment of severe physiologic gingival pigmentation with free gingival autograft. Quintessence. Int. 1996; 27:555 8.
33. Bergamaschi O, Kon S, Doine AI, Ruben MP. Melanin repigmentation after gingivectomy: A 5-year clinical and transmission electron microscopic study in humans. Int. J. Periodontics. Restorative. Dent. 1993;13: 85-92
34. Pérez-Fernández A. Pigmentaciones melánicas gingivales. Tratamiento mediante mucoabrasión. Cirugía. Plástica. Ibero- Latinoamer. 1977; 3: 57-9.
35. Mesa FL, García MO, López LC, Aneiros CJ, O´Valle RF. Tratamiento de la melanosis gingival mediante mucoabrasión. Estudio inmunohistoquímico en un paciente con pigmentaciones melánicas múltiples. Periodoncia. 2001; 11 (5): 383-90.
36. Murthy MB, Kaur J, Das R.Treatment of gingival hyperpigmentation with rotary abrasive, scalpel, and laser techniques: A case series. J. Indian. Soc. Periodontol. 2012; 16(4): 614-9.
37. Englard S, Seifter S. The biochemical functions of ascorbic acid. Ann. Rev. Nutr. 1986; 6: 365-406.
38. Spencer P, Cobb CM, Wieliczka DM, et al. Change in temperature of subjacent bone during soft tissue laser ablation. J. Periodontol. 1998;69: 1278-82.
39. Goldstein A, White JM, Pick RM. Clinical applications of the Nd:YAG laser. In: Miserendino LJ, Pick RM, eds. Lasers in Dentistry. 1era ed. Chicago: Quintessence Company; 1995. 126p.
40. Hasegawa A, Okagi H. Removing melanogenous pigmentation using 90 percent phenol with 95 percent alcohol. Dent. Outlook. 1973; 42: 673-6.
41. Singh V, Bhat SG, Kumar S, Bhat M. Comparative Evaluation of Gingival Depigmentation by Diode Laser and Cryosurgery Using Tetrafluoroethane: 18-Month Follow-Up. Clin. Adv. Periodontics. 2012; 2: 129-34.
42. Shirazi AS, Moeintaghavi A, Khorakian F, Talebi M. Treatment of gingival physiologic pigmentation in adolescents by liquid nitrogen cryosurgery: 24-month follow-up. Int. J. Periodontics. Restorative. Dent. 2012; 32(4):e142-6.
43. Ahmed SK, George JP, Prabhuji ML, Lazarus F. Cryosurgical Treatment of Gingival Melanin Pigmentation —A 30-Month Follow-Up Case Report. Clin. Adv. Periodontics. 2012; 2:73-8.
44. Grados SP, Castro YR, Bravo FC. Consideraciones clínicas en el tratamiento quirúrgico periodontal. 1era ed. Caracas: AMOLCA; 2014. 165p.
45. Castro RY, Grados PS. Tratamiento de la melanosis gingival y evaluación de la repigmentación melánica. Reevaluación clínica al cabo de 2 años. Rev Clin Periodoncia Implantol Rehabil Oral. 2015; 8(2):139-43.
2. Selvig KA. Structure and function of the periodontium. Dent. Update. 1991; 18: 292–7.
3. Pavlic V, Brkic Z, Marin S, Cicmil S, Gojkov-Vukelic M, Aoki A. Gingival melanin depigmentation by Er:YAG laser: A literature review. J. Cosmet. Laser. Ther. 2018; 20(2): 85-90.
4. Dummett CO. Clinical observation on pigment variations in healthy oral tissues in the Negro. J. Dent. Res. 1945; 24: 7-13.
5. Tal H, Oegiesser D, Tal M. Gingival Despigmentation by Er bium: YAG La ser: Clinical Observations and Patient Responses. J. Periodontol. 2003; 74(11): 1660-7.
6. Roshna T, Nandakumar K. Anterior esthetic gingival depigmentation and crown lengthening: report of a case. J. Contemp. Dent. Pract. 2005; 6(3): 139-47.
7. Duarte A. Cirugía Periodontal Preprotésica y Estética. 1era ed. Bogotá: Santos Editora; 2004. 225p.
8. Huaman EV. Características clínicas de melanosis gingival en pacientes del curso de periodoncia de la escuela de Estomatología de la Universidad Nacional de Trujillo. [Tesis de bachiller]. [Trujillo]. Facultad de Estomatología, Universidad Nacional de Trujillo; 2013. 54p.
9. Ipek H, Kirtiloglu T, Diraman E, Acikgoz G. A comparison of gingival depigmentation by Er:YAG laser and Kirkland knife: osmotic pressure and visual analog scale. J. Cosmet. Laser. Ther. 2018:1-4.
10. Janiani P, Bhat PR, Trasad VA, Acharya AB, Thakur SL. Evaluation of the intensity of gingival melanin pigmentation at different age groups in the Indian population: An observational study. J. Indian. Soc. Pedod. Prev. Dent. 2018;36(4):329-33.
11. Tamizi M, Taheri M. Treatment of severe physiologic gingival pigmentation with free gingival autograft. Quintessence. Int. 1996; 27:555 8.
12. Dummett CO, Bolden TE. Post-surgical clinical repigmentation of the gingiva. Oral. Surg. Oral. Med. Oral. Pathol. 1963;16: 353-6.
13. Gupta G.The labial melanotic macule A review of 79 cases. Br. Dent. Dermatologyc. 1964; 136: 772-75.
14. Corteillini P, Bissada NF. Mucogingival conditions in the natural dentition: Narrative review, case definitions, and diagnostic considerations. J Clin Periodontol. 2018;45(Suppl 20):S190–S198.
15. León SM, Faria H, Pérez L. Despigmentación gingival: Procedimiento quirúrgico. Reporte de un caso. Ciencia. odontológica. 2005; 2(2): 127- 32.
16. Rawal SY, Burrell R, Hamidi CS, Kalmar JR, Tatakis DN. Diffuse pigmentation of maxillary attached gingiva: four cases of the cultural practice of gingival tattoo. J. Periodontol. 2007;78 (1):170-6.
17. Abdo JM, Pérez ET, Bernal FS, Dzib JS. Síndrome de Peutz-Jeghers. Rev. Med. Hosp. Gen. Mex. 2005; 68 (2): 99-105
18. Kato T, Mizutani S, Takiuchi H, Sugiyama S, Hanioka T, Naito T. Gingival Pigmentation Affected by Smoking among Different Age Groups: A Quantitative Analysis of Gingival Pigmentation Using Clinical Oral Photographs. Int. J. Environ. Res. Public. Health. 2017;14(8). pii: E880. doi: 10.3390/ijerph14080880
19. Araki S, Murata K, Ushio K, Sakai R. Dose-response relationship between tobacco consumption and melanin pigmentation in the attached gingiva. Arch. Environ. Health. 1983; 38(6):375-8.
20. Axéll T, Hedin CA. Epidemiologic study of excessive oral melanin pigmentation with special reference to the influence of tobacco habits. Scand. J. Dent. Res. 1982;90 (6): 434-42.
21. Marakoğlu K, Gürsoy UK, Toker HC, Demirer S, Sezer RE, Marakoğlu I. Smoking status and smoke-related gingival melanin pigmentation in army recruitments. Mil. Med. 2007;172(1):110-3.
22. Hanioka T, Tanaka K, Ojima M, Yuuki K. Association of melanin pigmentation in the gingiva of children with parents who smoke. Pediatrics. 2005;116(2):e186-90.
23. Sridharan S, Ganiger K, Satyanarayana A, Rahul A, Shetty S.Effect of environmental tobacco smoke from smoker parents on gingival pigmentation in children and young adults: a cross-sectional study. J. Periodontol. 2011;82 (7):956-62.
24. Laimer J, Henn R, Helten T, Sprung S, Zelger B, Zelger B, Steiner R, Schnabl D, Offermanns V, Bruckmoser E, Huck CW. Amalgam tattoo versus melanocytic neoplasm - Differential diagnosis of dark pigmented oral mucosa lesions using infrared spectroscopy. PLoS. One. 2018;13(11):e0207026.
25. Chavés-Álvarez AJ, Rodríguez-Nevado IM, Argila-Fernández D, Monje-Gil F. Mácula hiperpigmentada en mucosa gingival. Actas. Dermosifiliogr. 2007; 98: 367-8.
26. Owens BM, Johnson WW; Schuman NJ. Oral amalgam pigmentations (tattoos): a retrospective study. Quintessence. Int. 1992; 23: 805-10.
27. Tavares TS, Meirelles DP, de Aguiar MCF, Caldeira PC. Pigmented lesions of the oral mucosa: A cross-sectional study of 458 histopathological specimens. Oral. Dis. 2018; 24(8):1484-91.
28. Hartman LC, Natiella JR, Meenaghan MA. The use of elemental microanalysis in verification of the composition of presumptive amalgam tattoo. J. Oral. Maxillofac. Surg. 1986; 44(8): 628-33.
29. Eley BM, Garrett JR. Tissue reactions to the separate implantation of individual constituent phases of dental amalgam, including assessment by energy dispersive X-ray microanalysis. Biomaterials. 1983; 4(2): 73-80.
30. Mohr W, Gorz E. Association of silver granules with elastic fibers in amalgam reaction of mouth mucosa. HNO. 2001; 49(6):454-7.
31. Hasegawa A, Okagi H. Removing melanogenous pigmentation using 90 percent phenol with 95 percent alcohol. Dent. Outlook. 1973;42: 673-6.
32. Tamizi M, Taheri M. Treatment of severe physiologic gingival pigmentation with free gingival autograft. Quintessence. Int. 1996; 27:555 8.
33. Bergamaschi O, Kon S, Doine AI, Ruben MP. Melanin repigmentation after gingivectomy: A 5-year clinical and transmission electron microscopic study in humans. Int. J. Periodontics. Restorative. Dent. 1993;13: 85-92
34. Pérez-Fernández A. Pigmentaciones melánicas gingivales. Tratamiento mediante mucoabrasión. Cirugía. Plástica. Ibero- Latinoamer. 1977; 3: 57-9.
35. Mesa FL, García MO, López LC, Aneiros CJ, O´Valle RF. Tratamiento de la melanosis gingival mediante mucoabrasión. Estudio inmunohistoquímico en un paciente con pigmentaciones melánicas múltiples. Periodoncia. 2001; 11 (5): 383-90.
36. Murthy MB, Kaur J, Das R.Treatment of gingival hyperpigmentation with rotary abrasive, scalpel, and laser techniques: A case series. J. Indian. Soc. Periodontol. 2012; 16(4): 614-9.
37. Englard S, Seifter S. The biochemical functions of ascorbic acid. Ann. Rev. Nutr. 1986; 6: 365-406.
38. Spencer P, Cobb CM, Wieliczka DM, et al. Change in temperature of subjacent bone during soft tissue laser ablation. J. Periodontol. 1998;69: 1278-82.
39. Goldstein A, White JM, Pick RM. Clinical applications of the Nd:YAG laser. In: Miserendino LJ, Pick RM, eds. Lasers in Dentistry. 1era ed. Chicago: Quintessence Company; 1995. 126p.
40. Hasegawa A, Okagi H. Removing melanogenous pigmentation using 90 percent phenol with 95 percent alcohol. Dent. Outlook. 1973; 42: 673-6.
41. Singh V, Bhat SG, Kumar S, Bhat M. Comparative Evaluation of Gingival Depigmentation by Diode Laser and Cryosurgery Using Tetrafluoroethane: 18-Month Follow-Up. Clin. Adv. Periodontics. 2012; 2: 129-34.
42. Shirazi AS, Moeintaghavi A, Khorakian F, Talebi M. Treatment of gingival physiologic pigmentation in adolescents by liquid nitrogen cryosurgery: 24-month follow-up. Int. J. Periodontics. Restorative. Dent. 2012; 32(4):e142-6.
43. Ahmed SK, George JP, Prabhuji ML, Lazarus F. Cryosurgical Treatment of Gingival Melanin Pigmentation —A 30-Month Follow-Up Case Report. Clin. Adv. Periodontics. 2012; 2:73-8.
44. Grados SP, Castro YR, Bravo FC. Consideraciones clínicas en el tratamiento quirúrgico periodontal. 1era ed. Caracas: AMOLCA; 2014. 165p.
45. Castro RY, Grados PS. Tratamiento de la melanosis gingival y evaluación de la repigmentación melánica. Reevaluación clínica al cabo de 2 años. Rev Clin Periodoncia Implantol Rehabil Oral. 2015; 8(2):139-43.