The Prevalence and Extent of Physiological and Pathological Gingival Pigmentation in Patients Visiting Riyadh Elm University Clinics

Abstract

Background: Gingival pigmentation presents as a diffuse deep discoloration or as irregularly shaped brown and light brown or black patches, striate, or strands. It is generally agreed that pigmented areas are solely pre-sent when melanin granules, synthesized by melanocytes, are transferred to keratinocytes. Aim: To study the prevalence, extent, and etiology of gingival pigmentation among Riyadh Elm University clin-ics’ attendees. Design and Settings: Examinations were done in Riyadh Elm University by four calibrated examiners. Methods: Patients underwent a Gingival Index examination, followed by an assessment of the presence or ab-sence of gingival pigmentations. If the latter were present, the patient underwent a Hedin’s Melanin Index, a Gingival Melanosis Record, and a Von Luschan Scale examination to evaluate the extent, distribution, and col-or of the pigmentation. Statistical analysis: Cohen’s Kappa Test and Chi-Square Test Results: A total of 139 (80.3%) patients had gingival pigmentation, of which 79 (56.8%) were males. Gingival pigmentations were found in 42 (93.3%) cigarette smokers, 40 (83.3%) hubbly bubbly smokers, and 20 (86.9%) electronic cigarette smokers. Both arches were affected in 102 patients, the canines’ area had the highest incidence of pigmentation (88.9%) while the molars had the least incidence (18.1%). Scores of 2 and 3 on the Hedin’s Index were the highest at 51 and 52 patients respectively. The mean color of the pigmentations on the Von Luschan scale was 21.49 ± 4.59, but it was higher for smokers and patients with severe inflamma-tion. Conclusions : Gingival pigmentation was more prevalent among all types of smokers—cigarettes, hubbly bubbly, and e-cigarettes compared to non-smokers. More pigmentations were also associated with the higher intake. The major patterns of pigmentation distribution were the short-connected-continuous ribbons and the more-than-two-solitary-papillae. Keywords: Gingival Pigmentation, Hedin’s Index, Color, Distribution, Smokers