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Why is my tooth turning black at the gum?

Having a tooth turn black near the gumline can be alarming. However, there are a few potential causes for this that range from benign to serious. In this comprehensive article, we will explore the various reasons you may be experiencing a blackening tooth at the gum and provide an overview of treatment options.

What Does a Black Tooth Mean?

When the tissue at the base of a tooth darkens or turns black, it is known as linear gingival pigmentation. Some potential causes include:

  • Genetics
  • Tobacco use
  • Certain medications
  • Oral piercings
  • Dental trauma
  • Cavities and tooth decay
  • Periodontal disease
  • Dead or necrotic pulp

While a black line near the gumline is primarily an aesthetic concern, it can also be an indication of an underlying dental health issue that needs to be addressed. Proper diagnosis from your dentist is important.

Is Linear Gingival Pigmentation Normal?

Pigmentation in the gums is actually quite common, affecting up to 30% of the population. Linear gingival pigmentation itself is benign and painless. The melanin pigment in gingival tissue usually occurs in adolescence as a result of genetic factors, particularly in those with darker complexions. While this baseline pigmentation is normal, any new black spots or lines appearing later in life warrant an evaluation by your dentist.

Can Smoking Cause Black Lines on Gums?

Long-term tobacco use is one of the most common preventable causes of oral discoloration and dark gums. The nicotine in tobacco can cause melanin cells in the gums to become overactive, leading to excess pigmentation. Smoking is also associated with increased tartar buildup, gum recession, and advanced periodontal disease, which can all influence gum coloration. Avoiding tobacco is the best way to prevent a blackening gumline.

Do Oral Piercings Lead to Darkened Gums?

Oral piercings, especially around the lips and under the tongue, can result in blackened gums. The constant friction from jewelry can irritate the gingival tissue, causing excess melanin production and darkness near the piercing site. An oral piercing can also increase the risk of gum recession, infection, chipped teeth, and other dental concerns. Proper jewelry and oral hygiene are important if you choose to have one.

Can Medications Discolor My Gums?

Certain prescription medications are associated with increased gingival pigmentation, particularly medications containing heavy metals like bismuth, mercury, and lead. Minocycline, an antibiotic, and anti-malarial medications containing quinine are other common culprits. Talk to your dentist or doctor if you notice dark gums after starting a new medication.

Do Mouth Injuries Cause Black Spots on Gums?

Injuries to the soft tissues of the mouth may result in the formation of dark spots or streaks near the damaged site. Canker sores, irritation from an ill-fitting denture or orthodontic wire, accidental biting of the cheek, oral surgery, or other trauma can all potentially lead localized pigmentation as you heal. Using caution while eating and proper oral hygiene can help avoid accidentally injuring your gums.

Can Tooth Decay Turn a Tooth Black?

Advanced tooth decay at the gumline may first appear as a black spot or line near where the enamel meets the root. Cavities that are allowed to progress can compromise tooth structure and irritate the pulp tissue inside. Eventually this can lead to death of the pulp, abscess formation, localized gum recession, and discoloration. Seeking prompt treatment for tooth decay and cavities can help prevent further progression and gumline darkening.

Does Gum Disease Cause Blackening Teeth?

Periodontal (gum) disease is characterized by inflammation and infection of the gingival tissues. When left untreated, the gums can severely recede, exposing more of the tooth root surface. This shrinking back of the gums also concentrates melanin pigmentation near the gumline, causing a dark discoloration. Advanced gum disease also weakens the attachment of the tooth and can lead to loosening or even tooth loss. Practicing good oral hygiene and getting dental cleanings can reduce your risk.

What Does a Black Spot Under a Filling Mean?

Occasionally, you may notice a dark or stained appearance under an existing dental filling, especially along the gumline. This can indicate that the tooth has experienced further decay that is now visible through the transparent filling material. It may also represent deterioration of the filling itself. In some cases, moisture is getting trapped beneath the filling, allowing bacteria to multiply and cause discoloration. Examine any new black spots along your filling edges closely or have your dentist evaluate.

Is a Black Tooth Always Dead?

A tooth that has darkened significantly or turned completely black typically means the pulp tissue inside the tooth is necrotic or “dead.” Without a blood supply, the cells die and the tooth structure begins to decay from the inside out. A dead tooth is a severe dental infection. It requires immediate root canal treatment or extraction to prevent the spread of bacteria and formation of a tooth abscess. Never ignore a blackened tooth, as it likely indicates a serious issue.

When to See a Dentist

While minor gingival pigmentation can be normal, it is important to have any new black spots or lines examined. Darkening near the gumline is often the first noticeable sign of an underlying problem. It is also important to monitor your oral health between dental visits and contact your dentist right away if you notice:

  • Sudden black spots or streaks on one or more teeth
  • Rapid enlargement of pigmented areas
  • Darkening associated with pain, swelling, or bleeding
  • New areas of blackening under an existing dental filling
  • A tooth that has turned partially or completely black

Prompt diagnosis and treatment can help resolve many issues before they become more serious. Even if you had linear gingival pigmentation at a young age, new discoloration appearing later in life deserves investigation.

Diagnosing the Cause of Black Spots on Teeth

During your dental appointment about blackened gums or teeth, your dentist will likely:

  • Ask about your oral hygiene habits and any medications
  • Examine the discolored areas visually and with a dental probe
  • Evaluate your tooth surfaces and check for signs of decay
  • Measure gum recession and pocket depth near affected sites
  • Assess teeth for fractures, infections, or other problems
  • Take dental x-rays to look for issues below the surface

Based on the exam findings and your symptoms, your dentist can determine the most likely cause and recommend appropriate treatment if needed. For blackened gums, basic periodontal therapy is often indicated. Teeth that have turned dark or black may require extraction or root canal treatment.

Gum Discoloration Treatment Options

Treatment for black pigmentation in gums depends on the underlying reason it has appeared. Common approaches may include:

  • Improving oral hygiene: Brushing thoroughly twice daily, flossing, and regular dental cleanings can help remove excess pigmentation from tobacco, tartar, or mild gum disease.
  • Scaling and root planing: Deep cleaning below the gumline to treat periodontal disease and smooth rough root surfaces.
  • Medication adjustment: Working with your doctor to substitute pigment-causing medications when possible.
  • Gum grafting: Surgical replacement of receded gums in areas of severe linear pigmentation.
  • Laser therapy: Advanced light technology to remove dark melanin deposits in the gingiva.

For ornamental piercings causing gum blackening, removing the jewelry completely or replacing with a smaller, better-fitting piece is recommended. Your dentist can advise you on the best approach for your individual situation.

Options for Black Tooth Treatment

Blackened teeth require treatment based on the severity of decay or pulp necrosis:

  • Fillings: Minor decay at the gumline can often be repaired with new composite fillings.
  • Root canal therapy: Endodontic treatment can remove infected pulp and save a functional tooth.
  • Tooth extraction: Severely damaged teeth with non-vital pulps usually require extraction.
  • Dental implant: Extracted teeth can be replaced with a natural-looking dental implant.
  • Dental crowns: Used to restore form and function after root canal treatment.

Restorative and cosmetic options such as professional teeth whitening and dental veneers may also help improve the appearance of stained or discolored teeth.

Home Remedies for Black Spots on Teeth

While home care can’t substitute professional dental treatment, you can use the following remedies to help temporarily improve the appearance of blackened gums or tooth surfaces:

  • Baking soda: Create a paste with water and rub gently on discoloration to help remove stains.
  • Hydrogen peroxide: Use as mouthwash to whiten stained areas, but avoid swallowing.
  • Over-the-counter whitening strips: Apply to the visible tooth surface as directed, but avoid directly touching the gum.
  • Oil pulling: Swish oils like coconut, sesame, or sunflower in the mouth to help reduce staining.
  • Citrus fruits: Rub a lemon wedge or orange peel on stained enamel to help lift surface discoloration.

However, always see your dentist for an evaluation if black spots are severe, painful, or worsening despite remedies. Persistent discoloration likely indicates a more significant problem needing professional care.

Preventing Black Spots on Gums and Teeth

Practicing good preventive oral care and getting routine dental cleanings can help reduce your risk of gum and tooth discoloration:

  • Brush thoroughly twice a day and floss daily.
  • Visit your dentist every 6 months for exams and professional cleanings.
  • Avoid tobacco products and limit staining foods/beverages.
  • Inspect your mouth regularly and report changes to your dentist.
  • Wear a mouthguard during contact sports to prevent dental trauma.
  • Get dental injuries, fillings, implants, etc. checked annually.

When to Seek Emergency Dental Care

In some cases, blackening gums or teeth may represent a dental emergency requiring urgent treatment. Seek emergency care if you experience:

  • Severe tooth or gum pain
  • Swelling in the mouth or jaw
  • Bleeding that won’t stop
  • Sudden tooth looseness or damage
  • Difficulty breathing or swallowing
  • Fever and chills

A discolored tooth accompanied by severe pain or swelling is often indicative of a tooth abscess, which can quickly become very serious. In such cases, emergency root canal treatment or extraction is needed to relieve the infection. Leaving a dental abscess untreated can potentially progress to sepsis, hospitalization, or even life-threatening complications.

Cost of Treatment for Black Spots on Gums and Teeth

The cost to treat blackened gums and teeth can vary significantly based on the required procedures. Typical fees may include:

Procedure Average Cost
Routine dental exam $50 – $100
Teeth cleaning $70 – $200
Periodontal disease treatment $500 – $6,000
Tooth-colored fillings $100 – $300 per filling
Porcelain veneers $900 – $2,500 per tooth
Teeth whitening $200 – $1,000
Root canal treatment $300 – $2,000 per canal
Tooth extraction $75 – $300 per tooth
Dental implant $1,500 – $6,000 per implant

More complex cases with advanced procedures, surgery, multiple affected teeth, or cosmetic restoration needs tend to fall on the higher end of the cost range. Dental insurance can offset the expenses significantly. Discuss the available treatment options and costs with your dentist.

Questions to Ask Your Dentist About Black Spots

If you notice new black spots or staining on your gums or teeth, talking with your dentist can provide insight into the cause and best treatment options. Ask:

  • What is the most likely cause of this new pigmentation based on my symptoms and dental history?
  • Do you recommend any additional testing or imaging to diagnose the problem?
  • Is the discoloration indicative of an underlying condition like gum disease or tooth decay?
  • What is the prognosis if the blackened areas are left untreated?
  • What treatment options do you recommend, and what are the risks and benefits of each?
  • What will happen if I choose to wait and monitor the condition?
  • What can I do at home on a daily basis to help improve or prevent more discoloration?

Early evaluation and open communication with your dental provider can ensure any black spots or lines on your gums and teeth are properly addressed before they threaten your dental and overall health.

The Takeaway

Noticing your gums or teeth beginning to blacken or darken can certainly be unsettling and raise concerns. However, there are many potential causes – some harmless, and others indicating disease. The most important step is to have it properly evaluated by your dentist to determine the exact reason pigmentation has appeared.

With conditions like smoking, oral piercings, and minor gum recession, improving daily oral hygiene is often the main treatment. But more serious causes like advanced decay, pulp death, or severe periodontal disease may require significant dental intervention to save the tooth and prevent worsening infection.

If you notice any unusual black spots, your best course is to seek prompt professional assessment. Early diagnosis of the underlying problem allows appropriate treatment to stop progression and help restore the health and appearance of your smile.