Prevalence and pattern of physiologic oral pigmentation in a Pakistani population

Document Type : Original Article

Authors

1 Oral Diagnostic Sciences Department, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia

2 slamic International Dental College, Riphah International University, Islamabad, Pakistan

3 Periodontology Department, Islamic International Dental College, Riphah International University, Islamabad, Pakistan

4 Oral Medicine Department, Islamic International Dental College, Riphah International University, Islamabad, Pakistan

Abstract

Background: Excessive melanin deposition in the oral cavity without any systemic disease or other known cause is known as hyperpigmentation or physiologic pigmentation. The site and intensity of pigmentation of the oral mucosa varies in different populations, and it is especially common in individuals with darker skin tones. This study aimed to determine the prevalence of physiologic oral pigmentation in a Pakistani population and its association with age, sex, and skin tone.
Methods: This was a cross-sectional observational study of 386 consenting individuals aged between 18 and 75 years attending a dental college over two months. Individuals with pathologic pigmentation were excluded based on their history and clinical examination. All participants underwent a comprehensive oral examination to document the sites and intensity of pigmentation, and skin tone was classified according to the Fitzpatrick phototype classifications III, IV, and V. The chi-squared test or Fisher’s exact test was used in the analysis.
Results: Nearly sixty percent of the population had some pigmentation within the oral cavity. The most common site of pigmentation was the attached gingiva. Oral pigmentation was significantly associated with darker skin tone and older age but not sex.
Conclusion: Oral pigmentation is present in about sixty percent of the Pakistani population and is associated with darker skin tones.

Keywords

Main Subjects


1. Rosebush MS, Briody AN, Cordell KG. Black and brown:
non-neoplastic pigmentation of the oral mucosa. Head Neck
Pathol. 2019;13(1):47-55. doi: 10.1007/s12105-018-0980-9.
2. Rakhewar PS, Patil HP, Thorat M. Identification of gingival
pigmentation patterns and its correlation with skin color,
gender and gingival phenotype in an Indian population. Indian
J Multidiscip Dent. 2016;6(2):87-92. doi: 10.4103/2229-
6360.197763.
3. Shahna N, Suchetha A, Sapna N, Darshan BM, Apoorva SM.
Gingival pigmentation: a review of literature. Int J Appl Dent
Sci. 2019;5(2):83-91.
4. Gul M, Hameed MH, Nazeer MR, Ghafoor R, Khan FR. Most
effective method for the management of physiologic gingival
hyperpigmentation: a systematic review and meta-analysis. J
Indian Soc Periodontol. 2019;23(3):203-15. doi: 10.4103/jisp.
jisp_555_18.
5. Feller L, Masilana A, Khammissa RA, Altini M, Jadwat Y,
Lemmer J. Melanin: the biophysiology of oral melanocytes and
physiological oral pigmentation. Head Face Med. 2014;10:8.
doi: 10.1186/1746-160x-10-8.
6. Larocca CA, Kundu RV, Vashi NA. Physiologic pigmentation:
molecular mechanisms and clinical diversity. Pigment Int.
2014;1(2):44-51. doi: 10.4103/2349-5847.147039.
7. Radhakrishnan S, Santhosh K, Anbuselvan GJ, Kanthasamy G.
A focal intrinsic physiologic pigmentation of tongue. J Pharm
Bioallied Sci. 2021;13(Suppl 1):S878-80. doi: 10.4103/jpbs.
JPBS_745_20.
8. Sbirkova T, Kisselov S, Cholakova R, Pechalova P,
Konstantinova D. Focal oral pigmentation on the gingiva
of mandible-a case report. J IMAB. 2018;24(4):2193-5. doi:
10.5272/jimab.2018244.2193.
9. Farid H, Shinwari MS, Khan FR, Tanwir F. Journey from black
to pink gums: management of melanin induced physiological
gingival hyper pigmentation. J Ayub Med Coll Abbottabad.
2017;29(1):132-8.
10. Sreeja C, Ramakrishnan K, Vijayalakshmi D, Devi M, Aesha
I, Vijayabanu B. Oral pigmentation: a review. J Pharm
Bioallied Sci. 2015;7(Suppl 2):S403-8. doi: 10.4103/0975-
7406.163471.
11. Hassona Y, Sawair F, Al-Karadsheh O, Scully C. Prevalence
and clinical features of pigmented oral lesions. Int J Dermatol.
2016;55(9):1005-13. doi: 10.1111/ijd.13133.
12. Longo BC, Rocha TTC, Santin GC, Tatakis DN, Silva CO.
Gingival pigmentation: concurrent assessment of distribution,
intensity, and extent in a black population. J Esthet Restor
Dent. 2022;34(6):897-906. doi: 10.1111/jerd.12846.
13. Chan IL, Cohen S, da Cunha MG, Maluf LC. Characteristics and
management of Asian skin. Int J Dermatol. 2019;58(2):131-
43. doi: 10.1111/ijd.14153.
14. Rotbeh A, Kazeminia M, Kalantari M, Rajati F. Global
prevalence of oral pigmentation and its related factors:
a systematic review and meta-analysis. J Stomatol Oral
Maxillofac Surg. 2022;123(5):e411-24. doi: 10.1016/j.
jormas.2022.01.009.
15. Li Z, Yao Y, Yu Y, Shi J, Liu Y, Tao Y, et al. Prevalence and
associated factors of passive smoking among women in
Jilin province, China: a cross-sectional study. Int J Environ
Res Public Health. 2015;12(11):13970-80. doi: 10.3390/
ijerph121113970.
16. Alhajj MN, Alhajj WA. Prevalence of melanin pigmentation
in a Yemeni population and its relation to some risk factors.
Braz Dent Sci. 2020;23(2):1-9. doi: 10.14295/bds.2020.
v23i2.1906.
17. Nik-Azis NM, Razali M, Goh V, Ahmad Shuhaimi NN, Mohd
Nazrin NA. Assessment of gingival thickness in multi-ethnic
subjects with different gingival pigmentation levels. J Clin
Periodontol. 2023;50(1):80-9. doi: 10.1111/jcpe.13723.
18. Shahzad A, Kiyani A, Paiker S. Prevalence of oral anomalies
and pathologies in the Pakistani population–a cross sectional
study. J Pak Dent Assoc. 2018;27(1):13-7. doi: 10.25301/
jpda.271.13.
19. Ponnaiyan D, Jegadeesan V, Perumal G, Anusha A. Correlating
skin color with gingival pigmentation patterns in South
Indians - a cross sectional study. Oral Health Dent Manag.
2014;13(1):132-6.
20. 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. doi:
10.4103/jisppd.Jisppd_192_17.
21. Verma J, Ahuja A, Ahuja V, Thosar NR. Reconnoitering the
association of gingival melanin pigmentation with skin color,
age, and sex in pre-school children of Hazaribagh: a crosssectional
study. Cureus. 2022;14(10):e30699. doi: 10.7759/
cureus.30699.
22. Masilana A, Khammissa RA, Lemmer J, Feller L. Oral
medicine case book 66: physiological/racial oral melanin
hyperpigmentation. S Afr Dent J. 2015;70(1):28-9.
23. Packyanathan JS, Lavanya G. Evaluation of gingival melanin
pigmentation in pediatric population-an observational study.
J Family Med Prim Care. 2019;8(8):2623-7. doi: 10.4103/
jfmpc.jfmpc_332_19.
24. Kang HY, Lee JW, Papaccio F, Bellei B, Picardo M. Alterations
of the pigmentation system in the aging process. Pigment
Cell Melanoma Res. 2021;34(4):800-13. doi: 10.1111/
pcmr.12994.
25. van Wyk CW. Mouth pigmentation patterns in a group of
healthy South African Bantu. S Afr Med J. 1970;44(7):177-80.
doi: 10.10520/aja20785135_32794.
26. Koppolu P, Almutairi H, Yousef SA, Ansary N, Noushad
M, Vishal MB, et al. Relationship of skin complexion with
gingival tissue color and hyperpigmentation. A multi-ethnic
comparative study. BMC Oral Health. 2024;24(1):451. doi:
10.1186/s12903-024-04189-7.
27. Jem S. Oral pigmentation and ethnicity. J Dermatol Dis.
2023;10(3):405. doi: 10.37421/2684-4281.2023.10.405.
28. Lin JY, Fisher DE. Melanocyte biology and skin pigmentation.
Nature. 2007;445(7130):843-50. doi: 10.1038/nature05660.
29. Visscher MO. Skin color and pigmentation in ethnic skin.
Facial Plast Surg Clin North Am. 2017;25(1):119-25. doi:
10.1016/j.fsc.2016.08.011.
30. Masilana A, Khammissa RAG, Lemmer J, Feller L. Physiological
oral melanin pigmentation in a South African sample: A
clinical study. J Investig Clin Dent. 2017;8(4):e12258. doi:
10.1111/jicd.12258.
31. Brown T. Oral pigmentation in the aborigines of Kalumburu,
north-west Australia. Arch Oral Biol. 1964;9:555-64. doi:
10.1016/0003-9969(64)90019-6.
32. Gorsky M, Buchner A, Fundoianu-Dayan D, Aviv I. Physiologic
pigmentation of the gingiva in Israeli Jews of different ethnic
origin. Oral Surg Oral Med Oral Pathol. 1984;58(4):506-9.
doi: 10.1016/0030-4220(84)90352-9.
33. Moravej-Salehi E, Moravej-Salehi E, Hajifattahi F. Relationship
of gingival pigmentation with passive smoking in women.
Tanaffos. 2015;14(2):107-14.
34. Rashidi Maybodi F, Ghafourifard R, Mohammad Taheri
M, Golvardi Yazdi R. Characteristic factors affecting oral
pigmentation in passive smoker children. J Dent (Shiraz).
2020;21(2):127-31. doi: 10.30476/dentjods.2019.81785.0.