Assessment of Parameters Influencing Physiologic Gingival Pigmentation Using a Novel Classification System

Abstract

Background: Depigmentation has become an important treatment modality among the general population due to the growing esthetic concern about the pigmentation. Previous studies have not considered parameters such as anatomical distribution of gingiva, intensity of pigmentation, and skin color in their classification systems. The purpose of this study was to assess physiologic gingival pigmentation in individuals based on certain gingival parameters and their correlation with skin color for better treatment strategies using a new classification system. Methods: The study was carried out in Ragas Dental College using a cross-sectional design. A total of 112 female dental students were examined for skin color and gingival parameters. The facial gingiva of upper anterior teeth was assessed for gingival phenotype, intensity and distribution of pigmentation. Descriptive statistics were used to describe the data and the associations between variables were done using chi-square test (P < 0.05). Results: It was found that skin color has a significant association with the intensity of pigmentation (P = 0.0001). In both dark and fair skinned individuals, Class II pigmentation (47%, 23.2%) with thick phenotype (62.5%, 35%) was most prevalent. Dark-skinned individuals were also found to have a generalized distribution of melanin pigmentation (19%) with high intensity of pigmentation (28.5%) predominantly. Fair-skinned individuals had a patchy distribution of melanin pigmentation with low intensity of pigmentation (37%). Conclusions: The association of skin color with various parameters affecting gingival pigmentation can help in determining the depigmentation treatment strategies. *Correspondence to Saumya John, Tel: +914692645210 Email: drsaumyajohn85@ gmail.com Background Gingiva is a soft tissue that covers the alveolar process of the jaws and the cervical portion of the teeth. The color of the healthy gingiva is determined by numerous factors. The most important factors include degree of keratinization, epithelial thickness, oxygenation of blood, number and size of blood vessels, and the amount of pigments in the tissue (1). Carotene, melanin, reduced hemoglobin, and oxyhemoglobin are the main pigments contributing to the normal color of the gingiva, among which melanin is the most important factor (2-4). Melanocytes in the epithelial basal cell layer convert tyrosine to melanin using enzyme tyrosinase, which is then stored in the basal cells in the form of melanosomes. It can also be found in the keratinocytes of gingival epithelium (2). Becker et al showed that melanocytes are present in Assessment of Parameters Influencing Physiologic Gingival Pigmentation Using a Novel Classification System Received Dec. 6 2019 Accepted Dec. 22 2019 ePublished Dec. 3