Gingival pigmentation index proposal of a new index with a brief review of current indices

Comparative Assessment of Gingival Depigmentation Using Scalpel Versus Microneedling With Ascorbic Acid: A Randomized Controlled Trial

Background Gingival pigmentation (GP), characterized by the presence of melanin in the gingival tissues, is a common aesthetic concern in dental practice. While it poses no inherent health risks, the visible discoloration may cause psychological distress for individuals seeking optimal dental aesthetics. Understanding the efficacy of various methods is essential for refining treatment strategies and enhancing patient satisfaction in the realm of gingival depigmentation (GD). Aim The objective of the study was to compare the effectiveness of scalpel and microneedling (MN) with ascorbic acid in the treatment of GD. Materials and methods Sixteen patients who had a complaint of GP were included in the study, of whom eight were allocated for depigmentation with a scalpel, and the other eight patients were treated with the MN technique with ascorbic acid. Postoperative wound healing scores were evaluated on the first and seventh days, respectively. The intensity of depigmentation was assessed at baseline, in the first month, and at the end of the third month, respectively. Results The mean Dummett-Gupta Oral Pigmentation Index (DOPI) score at baseline was 2.65±0.16 and 2.61±0.17 in the surgical and microneedling groups with ascorbic acid, respectively. The mean DOPI score at the end of the third month was 1.67±0.39 and 0.87±0.17 in the scalpel and MN with ascorbic acid groups, respectively. There was a statistically significant difference between the scalpel and MN with ascorbic acid groups at the end of the first and third months, respectively, where MN with ascorbic acid showed aesthetically pleasing outcomes. Patients treated with the scalpel technique showed incomplete healing and ulceration on the first and seventh days after the procedure when compared to the MN technique with ascorbic acid. The healing index scores were statistically significant in the MN with ascorbic acid group. Conclusion The MN technique with ascorbic acid is a successful technique for treating GD. It showed aesthetically gratifying outcomes when compared to the conventional surgical technique.

Explaining the colour of natural healthy gingiva

To examine the differences between natural gingival colour in men and women. To determine the degree of predictability of changes in the gingival colour coordinates recorded for healthy gingiva, according to age, long-term medication, frequency of toothbrushing, and smoking habits. The CIELAB colour coordinates were recorded using a spectrophotometer for 360 Caucasian adult participants (aged 18-92 years), in three zones of the healthy attached gingiva of the maxillary central incisor. Regression models were created for each zone and each sex, taking the L*, a* and b* coordinates as dependent variables and age, frequency of toothbrushing, smoking habits (0-non-smoker; 1-smoker) and whether participants were taking long-term medication (0-no; 1-yes) as independent variables. The statistical analysis was conducted with SPSS version 26.0, using multiple regression models. Statistically significant differences between men and women were found only for colour coordinate b*, in all three zones. The only colour coordinate on which the predictor variables had a significant effect was the L* coordinate. In men, age and long-term medication had the greatest effect as predictors (maximum R2 = 0.149). In women, frequency of toothbrushing was the strongest predictor in the predictive models (maximum R2 = 0.099). The colour of gingiva in men contained a larger amount of blue, given that significantly lower values for colour coordinate b* were recorded in men than women, although this difference lacked clinical implications. For both sexes, the regression models produced had a modest predictive capacity. The L* coordinate was the dependent variable that showed the greatest predictability.

Evaluation of Gingival Pigmentation and Related Factors on Former Smokers

Objectives

Gingival pigmentation, the most common etiological factor of which is smoking, is a clinical condition that causes aesthetic complaints. Due to the dose-dependent effect of smoking, gingival pigmentation may present regression following cessation. This cross-sectional study aimed to evaluate gingival pigmentation in former tobacco consumers and compare with current ones.

Material and Methods

A total of 110 people, 70 of whom were current smokers (Group CS) and 40 of whom were former smokers (Group FS), were included in the study. Participants filled out the data collection forms containing questions on demographic features and information related to tobacco consumption. In addition, all individuals were examined with Hedin's melanin index (HMI) to evaluate gingival pigmentation. Statistical significance was set at the P < 0.05 level.

Results

The population consisted of 57.3% male, and the mean age of all participants was 39.43 (SD 12.3) years. The mean duration of tobacco consumption did not differ between groups, whereas the mean HMI score of Group FS was significantly lower (P = 0.001). The correlation analyses showed that while the HMI score of Group CS was in relation to both daily consumption amount and duration of consumption (for both, P < 0.01), the HMI score of Group FS showed a negative association with only time elapsed after cessation (P = 0.000).

Conclusions

Considering the limitations of this study, the outcomes revealed a dose- and a time-dependent relation of gingival pigmentation in smokers. However, gingival pigmentation in former tobacco consumers was negatively correlated only with time elapsed after cessation.

Management of gingival hyperpigmentation induced by increased ferritin level in a HbS-β+ thalassemia patient using diode laser

Diode lasers can be employed for the treatment of gingival hyperpigmentation in HbS-β+ thalassemia patients due to the advantages that lasers provide including good hemostatic effect and less postoperative complications.

Gingival Pigmentation Removal With a High-Power Diode Laser in Non-contact Mode: A Proposed Technique With Two Years of Follow-Up

This case report describes the efficacy and advantages of using a high-power diode laser in non-contact mode to remove racial melanin pigmentation from the oral mucosa in an aesthetically sensible area to reduce thermal damage and promote better postoperative results. In the presented case, the lesion was removed under local anesthesia in a single session using high-power diode equipment with circular movements over the lesion (10 seconds maximum for each irradiation cycle, with 30 seconds for thermal relaxation, for a total of two cycles), maintaining an average distance of 2-3 mm from the target tissue without fiber activation (continuous wave, 2 W, delivered by quartz fiber with 300 µ). The patient did not report immediate postoperative pain; however, analgesic use was recorded during the first day after the surgical procedure. The biological response and cosmetic results were satisfactory, with proper lesion removal and adequate cicatrization observed during a two-year follow-up period, without complications or compromise of periodontal tissue esthetics.

Reconnoitering the Association of Gingival Melanin Pigmentation With Skin Color, Age, and Sex in Pre-School Children of Hazaribag: A Cross-Sectional Study

Introduction The purpose of this study was to compare and evaluate the association of gingival melanin pigmentation with age, sex, and skin tone in pre-school children of Hazaribag, Jharkhand, India. Materials and methods The study included 310 children aged 3 to 6 years, who were divided according to skin color into the following: group I: Fair, group II: wheatish, group III: brown; and group IV: dark. The children were selected using a census method where all participants fulfilling inclusion criteria were selected from the outpatient department of the Department of Pediatric and Preventive Dentistry, Hazaribag College of Dental Sciences and Hospital, Hazaribag. The subjects were further grouped into different age groups of 3-4 years, 4-5 years, 5-6 years, and 6 years. Subjects were examined in natural daylight, and gingival melanin pigmentation was assessed using the Dummett-Gupta Pigmentation Index. The scoring was done for each arch segment. These categorical data were analyzed using the chi-square test. Results Gingival pigmentation was found to increase with increasing age, whereas female subjects showed less pigmentation than males. Majority of the children had wheatish complexion, and a significant positive correlation was found between skin tone and gingival pigmentation; the darker the skin tone, the darker was the gingival pigmentation. Anatomically, greater pigmentation was found in the anterior than posterior region of arches. Greater pigmentation was found in the labial than lingual region; greater pigmentation was also reported in the mandible than maxilla. Conclusion There was a positive correlation of gingival melanin pigmentation with age, sex, and skin tone in pre-school children. Clinical significance The association of gingival pigmentation with skin color had been documented, but very few studies have been published on adults and children on this subject. However, there is no study that evaluates the association of gingival melanin pigmentation with age, sex, and skin tone of children of pre-school age.

Development and validation of an occlusal cant index

Background

Occlusal cant (OC) is a malocclusion trait lacking indexing or classification that describes the extent and severity of tilt in the occlusal plane. The aims of this study were to develop an occlusal cant index (OCI) based on the degree of OC detection among orthodontists and laypeople and to validate the newly developed OCI by a panel of experts using content validity.

Methods

The ability to perceive OC was assessed in 134 participants (orthodontists = 67 and laypeople = 67). A frontal photograph of a model with an ideal smile with 0° of OC was obtained and manipulated to create various degrees of OC from 1–5° at the right and left sides. A set of 11 electronic photographs was displayed to the participants. The participants were asked to report whether they detected an OC in each photograph. The collected data was used as a baseline to develop an OCI. Then, a content validation of the OCI was performed using a questionnaire provided to a panel of experts comprising ten orthodontists.

Results

The OCI was designed based on the threshold of OC detection. In both orthodontists and laypeople, the accuracy of OC detection increased as the amount of tilt increased. The threshold point of OC detection in orthodontists was at 2°, while in laypeople it was at 4°. There was a significant difference between orthodontists and laypeople in their ability to detect OC at 2–3° of tilt. The content validity index (CVI) showed excellent validity between the item-level CVI and the scale-level CVI of the OCI.

Conclusion

The OCI was developed and implemented for diagnostic, communication, and research purposes. The index showed strong evidence supporting content validity.

Gingival pigmentation: Concurrent assessment of distribution, intensity, and extent in a black population

OBJECTIVE

To evaluate prevalence, distribution, intensity and extent of physiologic gingival melanin pigmentation (GMP) in black individuals.

MATERIALS AND METHODS

For this cross-sectional study, GMP was evaluated on digital images by three calibrated examiners, according to de Krom (distribution), DOPI (intensity) and Melanin Index (extent) classifications. Descriptive statistics, Wilcoxon, Mann-Whitney, Kruskal-Wallis, Two-way ANOVA, chi square, and K-means cluster analysis were used.

RESULTS

Seventy participants were recruited. The most prevalent GMP categories were: de Krom category 2 (34.3%), DOPI heavy intensity (57.2%), and Melanin index Degree IV (50%). Significant inter-group differences were found for age (p < 0.05) but not gender (p > 0.05). Significant correspondence/overlap was observed between classifications (p > 0.05). Three GMP clusters were identified: Cluster 1 (27%; n = 19) had mild asymmetric and interspersed pigmentation; Cluster 2 (46%; n = 32) had heavy pigmentation in one long continuous ribbon, with pink marginal gingiva; and Cluster 3 (27%; n = 19) had heavy pigmentation in one long continuous ribbon, symmetric, and uniform.

CONCLUSIONS

There may be overlap among GMP classification systems. In black individuals, the predominant GMP presentation is one of a broad zone of heavily pigmented attached gingiva, in a continuous strip from central incisors to canines, symmetrical across the midline, and with pink free marginal gingiva.

CLINICAL RELEVANCE

This is the first study to analyze distribution, intensity, and extent of gingival melanin pigmentation in the same population and to integrate the various classification systems through cluster analysis. The novel findings provide a foundation for patient assessment and counseling and for future studies.

Pigmented Oral Lesions: A Multicenter Study

Objectives  The aim of this study was to determine the prevalence and clinical features of pigmented oral lesions from Thailand.

Materials and Methods  Biopsy records of the Department of Oral Pathology, Chulalongkorn University, Department of Oral Diagnosis, KhonKaen University, Department of Oral Biology and Oral Diagnostic Sciences, Chiangmai University, Department of Stomatology, Prince of Songkla University, and Rangsit University were reviewed for oral pigmented lesions diagnosed during 1999 to 2019. Demographic data were culled from the biopsy records. Ages of the patients were subdivided into 10-year intervals. Locations of the lesions were classified as gingiva, labial/buccal mucosa, palate, floor of the mouth, tongue, as well as the combination of sites. Data were analyzed by descriptive statistics using SPSS version 20.0.

Results  Of the 47,175 accessioned cases, 241 cases (0.51%) were diagnosed in the category of pigmented oral lesions. The age of the patients ranged from 1 month to 88 years with the mean ± standard deviation = 38.74 ± 20.96 years. Regarding gender, 172 patients (71.37%) with pigmented lesions were females, while 69 patients (28.63%) were males. The female-to-male ratio was 2.49:1. The majority of the pigmented lesions were encountered at the gingiva (29.88%) followed by labial/buccal mucosa (26.97%), palate (14.94%), lip (10.79%), alveolar mucosa (9.54%), and others (7.88%), respectively. The three most common pigmented oral lesions in the present study were nevus (39.83%), followed by melanotic macule (28.63%) and amalgam tattoo (17.43%), respectively.

Conclusions  The most common pigmented oral lesion in the present study is nevus. Demographic data of the patients in the present study are in accordance with previous studies with minor differences. Even though pigmented lesions of the oral cavity constitute a small portion of the oral pathology biopsies, accurate diagnosis is important since there is an overlap in clinical appearance of benign pigmented lesions and melanoma.

Laser-Assisted Depigmentation-An Introspection of the Science, Techniques, and Perceptions

Background: 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. This pigmentation varies individually across races or age groups and is without any gender predilection. Evidence gleaned from literature is presented from case–control studies and from the authors’ own research work in prospective, split-mouth, double-blinded, clinical trials comparing treatment modalities in effecting depigmentation. Methods: A systematic review of published articles, using suitable assay criteria, was carried out to formulate a consensus on laser-assisted modalities. A total of 295 published sources were subject to critical analysis and resulted in six papers that were subject to data scrutiny. Additionally, evidence is presented on clinical protocols and treatment outcomes. Results: Analysis of randomized clinical studies identified the use of two laser wavelength groups—near infrared diode and erbium group of mid-infrared lasers. Several areas of analysis were examined, and inconsistent degrees of significance were obtained to establish which laser group was optimal and if they were any better than scalpel depigmentation. Conclusion: A definitive conclusion is wanting as studies with scientific and standardized protocols of evaluation are yet to provide a take on comparative assessments between different techniques of depigmentation.

Safety and efficacy of parenteral glutathione as a promising skin lightening agent: A controlled assessor blinded pharmacohistologic and ultrastructural study in an animal model

Hyperpigmentation was induced in the skin of experimental animals using UVB at 6 J/cm² three times a week for three consecutive weeks. Subsequently, glutathione was injected intraperitoneally in the experimental animals at doses of 10, 20, and 40 mg/kg body weight three times a week for three consecutive weeks. At the end of the experiment, blood samples and lung, kidney, liver, and skin tissue specimens were collected from animals for hematological, biochemical, histological, and electron microscopy examination. Glutathione at 40 mg/kg body weight/day reduced skin hyperpigmentation significantly, except at low doses. The skin lightening effect assessed by a chromameter was dose-dependent. There were no statistically significant differences among the mean values of AST, ALT, creatinine, BUN, and CBC counts across the four groups. Lung, kidney, and liver tissue specimens did not show any histological toxic changes. The number of melanin granules was significantly lower in the group treated with the highest dose of glutathione compared to that in the control. Electron microscopy proved that glutathione at 20 and 40 mg/kg body weight/day was able to reduce the number of melanized cells significantly compared to that in the control. Parenteral glutathione was effective as a skin lightening agent and did not provoke any toxic effects in the employed animal model. The limitation of the study was conducted in guinea pigs and was of short-term duration.

Gingival melanin depigmentation by Er:YAG laser: A literature review

Laser ablation is recently suggested as a most effective and reliable technique for depigmentation of melanin hyperpigmented gingiva. To date, different lasers have been used for gingival depigmentation (CO₂, diode, Nd:YAG, Er:YAG and Er,Cr:YSGG lasers). The use of Er:YAG laser for depigmentation of melanin hyperpigmented gingiva has gained increasing importance in recent years. The purpose of this study was to report removal of gingival melanin pigmentation using an Er:YAG laser in a literature review. The main outcomes, such as improvement of signs (clinical parameters of bleeding, erythema, swelling and wound healing), symptoms (pain) and melanin recurrence/repigmentation were measured. The literature demonstrated that depigmentation of gingival melanin pigmentation can be performed safely and effectively by Er:YAG laser resulting in healing and an esthetically significant improvement of gingival discoloration. Thus, Er:YAG laser seems to be safe and useful in melanin depigmentation procedure. However, the main issue in giving the final conclusion of the optimal Er:YAG laser use in melanin depigmentation is that, to date, studies are offering completely discrepant Er:YAG laser procedure protocols (complex settings of laser parameters), and different criteria for the assessment of depigmentation and repigmentation (recurrence), thus hampering the comparison of the results. Therefore, further studies are necessary to give an optimal recommendation on the use of Er:YAG laser in gingival melanin hyperpigmentation.

Measurement of Reduced Gingival Melanosis after Smoking Cessation: A Novel Analysis of Gingival Pigmentation Using Clinical Oral Photographs

Background: Due to moisture and the anatomical complexity of the oral mucosa, it is difficult to measure the extent of gingival melanosis in an optical manner. Therefore, we developed a new quantitative method using clinical oral photographs and compared the extent of gingival melanosis before and after smoking cessation. Methods: A new analysis method, which we named the gingival melanosis record (GMR), is a quantitative analysis method using clinical oral photographs. We obtained 659 clinical photographs from 263 patients from 16 general dental offices in Japan. Standardized measuring sites were automatically spotted on the screen, and the presence of gingival melanosis was determined at the measuring sites. We assessed the validity of the GMR with the previously reported Hedin’s classification using Spearman’s rank correlation and intraclass correlation coefficients. Results: The GMR showed a significant association with Hedin’s classification (p < 0.01, correlation coefficient = 0.94). The GMR also showed excellent reproducibility of the substantial repeated agreement intraclass correlation coefficients (ICC) (1,1) and ICC (2,1), p > 0.61). The longitudinal loss of gingival melanosis was confirmed by a change in the GMR among patients who successfully achieved smoking cessation for a mean of 4.5 years. Conclusion: The GMR is an effective method to assess gingival melanosis. The loss of gingival melanosis after smoking cessation can be objectively confirmed with the use of the GMR.