Green gums are uncommon and typically indicate extrinsic staining or specific pathology. Prompt evaluation is important, as the discoloration can sometimes signal serious underlying conditions.
Causes
- Chromogenic Bacteria: Pseudomonas aeruginosa, Serratia, Flavobacterium produce green pigments (pyoverdine/pyocyanin). Associated with poor hygiene, immunocompromise, or prolonged antibiotic use.
- Medications:
- Minocycline (tetracycline) – blue-green pigmentation of bone, teeth, and mucosa.
- Chlorhexidine (prolonged use) – brown/green stain.
- Chemotherapy agents.
- Oral contraceptives (rare).
- Dental Materials: Amalgam corrosion (greenish), copper-containing restorations, eugenol-based temporaries.
- Systemic Conditions:
- Necrotizing ulcerative gingivitis (NUG) – pseudomembrane may appear greenish.
- Acute leukemia/neutropenia – ulcerative gingivitis with secondary infection.
- Heavy metal exposure (copper, nickel).
- Trauma: Hematoma breakdown (biliverdin) – rare on gingiva.
Evaluation
- History: medications, oral hygiene, systemic health, recent dental work.
- Exam: distribution (localized vs. generalized), bleeding, ulceration, attachment loss.
- Scrape test: chromogenic stain removes with scaling; pigmented tissue does not.
- Culture if infection is suspected.
- Biopsy if neoplastic concern exists.
Treatment
- Professional cleaning: Scaling and root planing remove bacterial biofilm and extrinsic stain.
- Antimicrobial rinses: Chlorhexidine 0.12% (short-term).
- Medication review: Discontinue offending agent if possible.
- Oral hygiene optimization: Electric toothbrush, interdental cleaning.
- Address systemic cause: Hematology referral if leukemia is suspected.
- Laser/abrasion: For persistent intrinsic staining.
See a dentist promptly. Green gums can signal serious underlying conditions.
