Oral Pigmentation Research Articles

Comparative evaluation of the efficacy of BlueM active oxygen gel and Coe-pak dressing on post-operative healing of gingival depigmentation: a study protocol

Introduction Dark colored gingiva is an esthetic concern that cannot be ignored, especially when accompanied by a high lip line or gummy smile. Gingival depigmentation is a periodontal plastic surgical procedure wherein the hyperpigmentation is removed or reduced by various techniques. Protecting the wound from mechanical trauma and stability of the surgical site during the healing process are among the most important advantages of periodontal dressing application after surgery. Aim This study is aimed to comparatively evaluate the effectiveness of reactive oxygen gel species (BlueM gel) and the traditional Coe-Pack dressing on gingival healing and pain after surgical depigmentation. Protocol This split-mouth randomized clinical trial will be conducted on 20 patients aged 18–45 years with maxillary physiologic gingival pigmentation classes (II) (III) and (IV) according to the Dummett–Gupta Oral Pigmentation Index (40 treated sites). The maxilla will be randomly divided into two symmetrical parts—from the right second premolar to the midline and from the midline to the left second premolar—to receive either BlueM gel or Coe- Pack as a dressing after surgical depigmentation with a scalpel. Various indices will be assessed, such as plaque index, papillary bleeding index, pain index, healing index and reepithelization index with toluidine blue, and the follow-up period will be one month. Expected results- A total of 20 patients will be included in this study. Statistically significant differences are expected to show in the pain index and healing index after one, two, three, four, and five days. The BlueM gel group is expected to show a higher significant difference after one, two, three and four weeks in the reepithelization index.

Validity and Reliability of Polarized vs Non-Polarized Digital Images for Measuring Gingival Melanin Pigmentation.

This study aimed to compare the validity and reliability of polarized and non-polarized intraoral photography for the measurement of gingival melanin pigmentation. A case series study was conducted on ten patients scheduled for gingival depigmentation. A total of 976 polarized and non-polarized image samples were collected, capturing two rows above the gingival margin, for analysis. These images were taken both before and one year after the depigmentation procedure. Three independent evaluators assessed the photographs (an orthodontist, a general dentist, and a layperson). The Dummett Oral Pigmentation Index (DOPI) and Gingival Melanosis Record (GMR) indices were used to measure the level of gingival pigmentation. The study found no significant differences between polarized and non-polarized images taken before and after depigmentation. Both methods of imaging received similar scores from the evaluators. The orthodontist identified more pigmented slides than the layperson and the general dentist. Both polarized and non-polarized photographic methods may be used for assessing gingival pigmentation. However, further research is warranted to confirm this finding and examine additional factors.

EVALUATION OF REPIGMENTATION FOLLOWING GINGIVAL DEPIGMENTATION USING LASER TECHNIQUE: A CASE SERIES

The harmony of the smile is not only determined by the shape, position and the color of the teeth but also by the level and color of the gingival tissues. Gingival hyperpigmentation is a major concern for a significant number of patients, as a relevant aesthetic or cosmetic need. Oral melanin pigmentation is considered to be multifactorial and could be related to physiological or even pathological reasons and can be the consequence of a variety of local or systemic factors. The aim of this study is to evaluate the repigmentation followed by gingival depigmentation carried out with a diode laser for 2 to 4 years of follow up. Five patients who were esthetically conscious of their dark gums were selected for this study. After reevaluation mild to moderate pigmentation was noted in all the cases.

Gingival Pigmentation Features in Correlation with Tooth and Skin Shades: A Cross-Sectional Study in a Saudi Population.

The present study aimed to observe the anatomical distribution of gingival melanin pigmentation and evaluate its intensity and extent in different age groups and in correlation with skin and tooth shades. The participants of this study were 391 patients attending the Dental University Hospital. The presence of gingival pigmentation was assessed using De Krom's Oral Pigmentation Chart and its intensity was assessed using the Dummett-Gupta Oral Pigmentation Index. Skin colour and tooth shade were measured using the Fitzpatrick scale and the VITA classical shade guide, respectively. Statistical analyses included descriptive statistics and Pearson's Χ2 test for the association between the study variables. The prevalence of gingival pigmentation among the sample size was 74.4%, and pigmentations were present on both arches in 57.6% (n = 224) of the participants. The extent (category 1) was highest when pigmentation was evident in both arches, with category 4 being the least extent. Age and sex did not show a correlation with gingival pigmentation. Gingival pigmentation intensity was mild when pigments were present in one arch (p < 0.00), whereas it was heavy when both arches presented with gingival pigmentation. Medium brown colour and tooth shade A1 were the most common among participants with gingival pigmentation (p < 0.00). The association between gingival pigmentation intensity and extent in relation to skin colour was statistically significant (p < 0.00), as was tooth shade (p < 0.05). Gingival pigmentation is highly prevalent in the Saudi population, with different severity and extent levels. The effect of gingival pigmentation on smile and overall facial aesthetics should be considered when providing dental and cosmetic treatments.

A Case report of Oral Pigmentation - Post-inflammatory or Psoriasiform lesions.

Intraoral pigmentation occurs in various physiologic and pathologic conditions. Many of these are the manifestations of systemic diseases that too dermatologic conditions in specific. Here with reporting a case of intraoral brownish pigmentation in a young adult female who was treated for mild dermal lesions of psoriasis which was reported to be either post inflammatory pigmentation or psoriasiform oral manifestations. The pattern of mucosal pigmentation is nonspecific and there is lack of recent research regarding etiopathogenesis.

Pink Gingiva is it the Needle or the Light!

Objectiv: Gingival depigmentation is an aesthetic periodontal procedure that is carried out to eliminate gingival hyperpigmentation. Numerous depigmentation modalities are used namely surgical scraping, gingival autograft, cryosurgery, electrosurgery, and lasers. Microneddling(MN) is a novel technique that is conservative involving the creation of micro wounds and has been tried for depigmentation. Material and Methods: A 23 yrs old female patient without any systemic conditions reported to the Outpatient Department of Periodontology, Krishnadevaraya College of dental sciences and Hospital, with the chief complaint of dark-colored gums. Depigmentation with micro needling was done in the lower anterior and laser in the upper anterior region. Result: There was a considerable reduction in the oral pigmentation scores (Dummett Oral Pigmentation Index) using both techniques in the first and the fourth week. The Visual Analogue Scale score showed lesser pain in the microneedling area. Conclusion: Depigmentation using microneedling and lasers is effective. Microneedling is a simple, economical, and viable option for the removal of gingival depigmentation.

Case report: drug-induced melanosis in 21-year-old woman treated by gingival depigmentation

Background: Oral pigmentation can be caused by long-term consumption, smoking or physiology. Drug induced melanosis is one of the oral pigmentation caused by long-term medication use. Changes in the color of the oral mucosa can be and provide local or systemic diagnostics, it is necessary to carry out a significant examination and findings from the patient properly.Case Report: The method used is a case report with primary data analysis obtained through anamnesis, as well as intra-oral examinationConclusion: The diagnosis of patients with drug induced melanosis with clinical features found in the gingiva of the maxillary and mandibular anterior teeth, this is because the patient has a history of bronchitis and has been taking antibiotics for a long time. To overcome this pigmentation, the patient underwent OHI and gingival depigmentation treatment and the results showed reduced gingival pigmentation after 1 month postoperatively.

Comparison of Er,Cr:YSGG laser and diode laser in the treatment of gingival melanin pigmentation: a randomized clinical trial.

This investigation has aimed to compare the efficiency of clinical depigmentation and repigmentation rate of erbium chromium-doped: yttrium, scandium, gallium, garnet (Er,Cr:YSGG) and diode lasers during a 1-year follow-up and to evaluate patient satisfaction. Twenty-two participants were divided into Er,Cr:YSGG laser and diode laser groups using computer-aided randomization. Dummett Oral Pigmentation Index (DOPI) and photographic assessment with ImageJ Software version 10.2 were performed at the preoperative period and postoperative 1st month, 6th month, and 12th month. Moreover, the study assessed intra- and postoperative intensities of pain and postoperative patient aesthetic satisfaction using the Visual Analog Scale in both groups. The median values of DOPI did not differ statistically between the groups according to time (p > 0.05). In the Er,Cr:YSGG group, the extension of repigmentation was less as compared to the diode group at 1-year follow-up (p = 0.045). In the Er,Cr:YSGG group, the patients felt less intraoperative pain and discomfort compared to the diode group (p = 0.007). No significant differences were found between the two groups in terms of patient aesthetic satisfaction at the 1st and 12th months. The findings indicate that diode and Er,Cr:YSGG lasers can be used safely in depigmentation treatment, while the Er,Cr:YSGG laser has been shown to have superiorities in pain management and patient comfort parameters. Clinical Trial No.: NCT05304624.

Gingival Depigmentation Using Microneedling Technique With Topical Vitamin C: A Prospective Case Series.

Introduction Gingival pigmentation is mainly physiological due to the production of melanin. This study aimed to evaluate the effectiveness of a microneedling technique using topical ascorbic acid in treating gingival hyperpigmentation. Methods A case-series study was established, and 16 out of 42 participants enrolled in this study according to the inclusion and exclusion criteria. A microneedling technique was performed using a Dermapen instrument, followed by the topical application of ascorbic acid on the pigmented gingiva. Variations in the Dummett oral pigmentation index (DOPI) and Hedin melanin index (HMI) scores were considered for each patient. A one-month follow-up was conducted on all patients. Results All the reported cases demonstrated noticeable improvement at the end of the sessions. Moreover, seven patients showed complete depigmentation of the gingiva. Analysis using paired T-tests showed a statistically significant lower post-treatment DOPI score with a mean difference of 1.8 ± 0.7, 95% CI: 0.17-1.49. Similarly, the HMI score was lower post-treatment with a mean difference of 3.1 ± 0.7, 95% CI: 2.74-3.50. Conclusions Microneedling combined with topical ascorbic acid is a novel, non-invasive dental technique that can effectively treat gingival hyperpigmentation.

A review of the presentations and treatment of oral pigmentation.

BackgroundOral pigmentation can be either normal or abnormal discolouration of the oral mucosa.&#x0D; Objective: To help clinicians establish a better approach towards the care of patients with pigmented oral lesions and to establish early diagnosis and treatment of such conditions.&#x0D; Data source: Works of literature concerning oral pigmentations, clinical features and treatment were reviewed thoroughly from renowned electronic databases such as PubMed, Medline, Google Scholar, and Cochrane Library and personal clinical experience in managing such conditions. The following words were used for the search: oral pigmentation, aetiology, and clinical presentations.&#x0D; Findings: Oral pigmentation presents in various clinical patterns that can range from just physiologic changes to oral manifestations of systemic diseases and malignancies. Oral pigmentation may be physiological or pathological. Knowledge of the different presentations of oral pigmented lesions is quite crucial to improve and mastering the skill of differential diagnosis, definitive diagnosis and prompt treatment. The deposition of pigments in oral tissues may be due to various etiological factors. It can arise from intrinsic and extrinsic factors and can be physiological or pathological.&#x0D; Conclusion: A good understanding of the various presentations of oral pigmented lesions would aid in the proper diagnosis and treatment of the condition.&#x0D;

Hepatitis C associated oral lesions: A hospital-based retrospective case control study in Egypt

Aim: Investigate the association of hepatitis C virus (HCV) infection on incidence of various oral lesions in a sample of Egyptian population. Materials and Methods: This case control observational retrospective study was conducted on outpatients’ clinics of a University Hospital. The predicted total sample size (n) was 100 with 1:1 ratio by using G*Power (version 3.1.9.79). In which, incidence and frequency of different oral manifestations in 50 HCV patients (cases) were compared to that of 50 healthy individuals(controls). Demographic and clinical data were collected using a structured questionnaire. Frequencies of findings were compared and analyzed using Fisher’s exact test, and regression analysis was performed to ascertain the effects of hepatitis C as well as age, sex and diabetes mellitus on the likelihood of different oral findings. Results: The oral mucosal signs and symptoms were generally more frequent among HCV compared to healthy controls. The frequency was statistically significant higher in HCV patients regarding xerostomia (40%), altered taste (24%) and oral lichen planus (20%), but insignificant regarding atrophic tongue (18%), oral pigmentation (14%) and pallor (10%). The presence of HCV was significantly associated with increased odds of xerostomia (P = 0.028, OR=4.3), oral pigmentations (P = 0.013, OR=12.6) and atrophic tongue (P = 0.039, OR=7.8). While other predictors had no significant effects on any of oral findings. Conclusion: In a hospital-based sample of Egyptian population; Xerostomia, altered taste and oral lichen planus were significantly frequent with HCV infection in comparison to healthy individuals. While xerostomia, oral pigmentations and atrophic tongue were associated with HCV.

Cancer Chemotherapy-associated Pigmentation of the Oral Mucosa.

Oral adverse events caused by anticancer drugs are diverse, but few reports have examined pigmentation of the oral mucosa. The aim of this study was to clarify the prevalence of oral mucosal pigmentation caused by anticancer drugs. This single-centre retrospective study investigated patients who underwent oral examination in our hospital during cancer chemotherapy for 3 years from April 1, 2019 to March 31, 2021. Inclusion criteria were patients who could be followed-up for ≥3 months after completing chemotherapy with drugs that caused pigmentation. The primary predictive variable was the cancer chemotherapeutic agent used. The primary outcome variable was pigmentation of the oral mucosa. Collected data were statistically analysed using the χ2 test or Fisher's exact test, with the level of significance set at p<0.05. A total of 388 patients were enrolled in the study. Eleven patients (2.8%) showed oral mucosal pigmentation. Drugs causing pigmentation [deposition rate (number of patients with deposits/users)] were TS-1 (combination of tegafur, gimeracil, and oteracil potassium) [12.2% (5/41)], paclitaxel [4.0% (2/50)], gemcitabine [5.0% (1/20)], cyclophosphamide [2.3% (1/42)], carboplatin [1.6% (1/64)], fluorouracil [2.3% (1/43)], and capecitabine [3.4% (1/29)]. Oral pigmentation due to cancer chemotherapy was found in 2.8% of patients. TS-1, carboplatin, cyclophosphamide, capecitabine, fluorouracil, gemcitabine, and paclitaxel caused pigmentation of the oral mucosa. Among these, TS-1 was the most likely to cause pigmentation, affecting 12.2% of users.

Evaluation of the Relationship Between Gingival Pigmentation and Smoking

The abnormal deposition of melanin in the oral mucosa results in melanin pigmentation. The gingiva that has undergone keratinization is most affected. Gingival discoloration may be caused by physiologic or pathological reasons. Melanocytic lesions or melanocytic pigmentations induced by an excessive deposition of melanin in the basal and suprabasal layers of the epithelium are the most common pigmentations of the gingiva. Smoking has been associated to oral melanin pigmentation, particularly in the anterior gingiva. The Fagerstrom Test for Nicotine Dependence is the most used instrument for assessing smoking addiction (FTND). The Fagerstrom Test for Nicotine Dependence (FTND) consists of six questions, with a distinct score assigned to each. Our study comprised 255 individuals over the age of 18 who were smokers, did not use drugs, did not have any systemic illnesses that could contribute to pigmentation, and did not have any active infectious infections. The Hedin scale was used to assess the pigmentation levels of the subjects. The Fagerstrom Test for Nicotine Dependence was used to diagnose the kind of cigarette addiction exhibited by the subjects. Using the Fagerstrom questionnaire, we observed that pigmentation was more common as smoking tendency inreased.

Transepithelial Gingival Depigmentation Using a New Protocol with Q-Switched Nd:YAG: An In Vivo Observational Study.

Gingival melanin hyperpigmentation is a para-physiological condition that may have a negative impact on smile esthetics. In the present study, the use of the Q-Switched Nd:YAG laser, according to a defined protocol, was proposed to treat Gingival Melanin Hyperpigmentation with a transepithelial approach. A total of 10 Patients with different grades of gingival hyperpigmentation were treated with Q-Switched Nd:YAG in one to four laser sessions without local anesthesia. The grade of depigmentation was evaluated by comparing Oral Pigmentation Index (OPI) and Melanin Pigmentation Index (MPI) at baseline and three weeks after the laser session. Additionally, oral discomfort rated by the Numeric Rating Scale (NRS) was recorded one, three, and five days after the procedure. Complete depigmentation was achieved in all cases. Patients reported no-little discomfort (NRS 0 to 3) during the laser session that lasted a maximum of five days. No major complications were reported, and no recurrences were observed at least after one year of follow-up. In addition, patients were available to be re-treated if necessary. These findings suggested that the Q-Switched Nd:YAG could be an effective and well-tolerated approach in the treatment of gingival melanin hyperpigmentation.

Evaluation of Carbon Dioxide Laser-Assisted Treatment for Gingival Melanin Hyperpigmentation.

Smile aesthetics has a vital role to play in an individual's life and one of the factors affecting the beauty of the smile is gingival color. A gingival color change or gingival hyperpigmentation causes an unesthetic smile line, especially in patients with a gummy smile, which is also known as a black gummy smile. Numerous gingival depigmentation methods have been performed successfully for ablating gingival melanin pigmented epithelium. Thus, the aim of this study is to evaluate the treatment efficacy of gingival hyperpigmentation by using a carbon dioxide (CO2) laser. A cross-sectional descriptive study was carried out with 38 patients at a hospital in Vietnam. Ponnaiyan classification and the Hedin melanin index were used to assess the distribution and extent of gingival pigmentation in the study. Pain assessment was performed using the Visual Analog Scale (VAS) to evaluate the intensity of pain during the laser treatment. In addition, clinical evaluation (i.e., wound healing) of each treatment procedure was conducted using the three level Dummett-Gupta Oral Pigmentation Index (DOPI) assessment. This study showed that less pain was experienced by patients treated by CO2 laser; the rates of no pain, mild pain and moderate pain after treatment were, respectively, 21%, 76% and 2.6%; there was 100% complete epithelization after 1 week. The DOPI rates for turning from a DOPI score of 1, 2 or 3 to a DOPI score of 0 after a 12-week treatment were 87.5%, 76.9% and 24%, respectively. Using a CO2 laser for gingival melanin pigmentation treatment is a safe and effective procedure.

Pigmented Lesions of the Oral Cavity: A Review

The term “pigmentation of oral mucosa” is applied to a wide range of lesions or conditions featuring a change of color of oral tissues. Common causes of mucosal coloration including petechiae, purpura, ecchymoses, hematomas, vascular tumors and exogenous substances are not true pigmented lesions. In contrast, melanin which is synthesized by melanocytes, is a true pigment and usually imparts a brown, blue or black appearance of the mucosa. Oral pigmentation affects about 3% of the total population and most likely in those with dark skin, more prevalent in females than males during the 3rd or 4th decade of life. In this review, we are describing the oral manifestation and dental considerations associated with common pigmented disorders which will allow the practitioner to have a holistic approach in diagnosis and management of these patients.

Oral and Systemic Manifestations in Leprosy a Hospital Based Study with Literature Review.

Leprosy is a chronic granulomatous disease of the peripheral nerve and muscle of upper respiratory tract. Consequence to the neighbouring primary site, oral lesions have been seen in 20-60% of patients with leprosy mainly lepromatous leprosy. The lepromatous nodules may be infective and may lead to the spread of disease and hence require proper diagnosis. To assess oral lesion in leprosy patients. To assess the disease and the occurrence of oral lesion according to age and gender. To detect any primary lesion in oral cavity and compare these lesions in duration to study. One hundred patients with leprosy were examined and their oral manifestations were recorded. It was found that 70 (70%) leprosy patients showed oral manifestations. Eighteen (25%) had chronic generalized periodontitis, 9 (12.8%) cases of oral melanosis, 7 (10%) atrophy of papillae and loss of taste sensation each, 6 (8.5%) complained of aphthous and candidiasis each, 5 (7.14%) depigmentation and 4 (5.71%) smokers palate, oral submucous fibrosis and fissured tongue. Our clinical findings are in conjugation with previous studies; however, as per the review of literature, this is the first study worldwide where we have examined 100 cases of leprosy which has not been documented till date. We suggest that the lesser incidence of oral lesions is observed recently compared to older reports because of more effective present treatment which is initiated earlier.

Assessment of gingival thickness in multi-ethnic subjects with different gingival pigmentation levels.

Assessment of the thickness of gingival tissues using the probe visibility test is regarded as the method of choice during routine examinations. However, the probe visibility test has not been validated for patients with gingival pigmentation and its accuracy in populations with physiological gingival pigmentation is yet unknown. This study aims to evaluate different methods for the clinical assessment of gingival thickness in participants with varying levels of gingival pigmentation. Buccal mucosa of the maxillary right central incisor teeth of 171 participants was evaluated using four methods, which were direct measurements using calliper, transgingival probing method using an endodontic probe, and probe visibility method using Colorvue biotype probe (CBP) and UNC-15 probe. The pigmentation of the gingiva was assessed using the Dummett-Gupta oral pigmentation lesion index. The average gingival thickness of the selected population was 1.22 ± 0.38 mm with a distribution of 70% thick and 30% thin gingiva. Transgingival and calliper methods showed good agreement and significant correlation (r= 0.229; p= .003). Visual assessment using CBP and UNC-15 probe showed poor agreement with the direct measurement methods. Gingival pigmentation significantly affected the probe visibility assessment, reducing the visibility of both the CBP (odds ratio [OR]=4.00; 95% confidence interval [CI], 1.83-8.74) and UNC-15 probe (OR=1.84; 95% CI, 1.05-3.23) while controlling for thickness of the gingiva. The probe visibility method using either CBP or the UNC-15 probe is affected by the degree of gingival pigmentation. Direct measurements using either a calliper or transgingival probing are recommended as methods to measure the gingival thickness in populations with gingival pigmentation.

Oral Manifestations of Systemic Lupus Erythematosus: A Systematic Review.

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that is characterized by clinical heterogeneity and irregularities in its course. The etiology and pathogenesis of this pathology are not well-understood, so there is difficulty in establishing a diagnosis and treatment plan with certainty. The aim of this systematic review is to present a qualitative synthesis of studies referring to the oral manifestations of systemic lupus erythematosus (SLE). This systematic review was performed following the PRISMA guideline. On this basis, a search for articles was performed in the PubMed, Web of Science, and Scopus databases on 19 November 2021 and updated on 15 February 2022. We chose articles published between 2012 and 2022 that analyzed the oral manifestations of SLE patients. The quality of all these studies was analyzed following the STROBE scale. A total of 15 articles were included in this study after selection. The selected articles were cross-sectional, case–control, and cohort studies. The most frequently associated oral manifestations with SLE were oral ulcers, hyposalivation, pigmentations, glossodynia, cleft tongue, cheilitis, arthritis, and secondary Sjögren’s syndrome. However, despite the importance of the perception of these oral manifestations in the early diagnosis of SLE, there are still not enough studies about them.

Identifying Gingival Pigmentation Patterns and Skin Color and Its Co-relation With Serum Ferritin Levels in Thalassemic Patients

Background: Patients with β-thalassemia major (β-TM), a genetic issue due to hemoglobin (Hb) synthesis disorder, require life-long erythrocyte transfusion. The purpose of this study is to evaluate and compare gingival pigmentation and skin color with serum ferritin levels of patients with β-TM, using the Dummett's oral pigmentation index (DOPI) and Fitzpatrick skin scale, respectively.Methods: A total of 100 patients were monitored at a thalassemia care center. Each patient's gingival pigmentation and skin color were matched with DOPI and the skin scale under natural light. Serum ferritin levels, the interval of blood transfusions, and iron chelation medications were studied. A gingival pigmentation score and skin color type were compared with the serum ferritin.Results: A significant correlation was found between age, serum ferritin, pigmentation score, and skin color, which means as serum ferritin level increases, gingival pigmentation score increases, and skin color darkens.Conclusion: This study evaluated the correlation between gingival pigmentation and skin color with serum ferritin levels and established gingival pigmentation as a sign of iron deposition in β-TM patients. This is the simplest and least invasive method for evaluating serum ferritin level parameters in β-TM patients.