White, black or pale gums

Pale gums

Healthline says anemia, not enough healthy red blood cells, is a common cause of pale gums, because gum tissue is not getting enough oxygen. It lists low iron, folate or vitamin B-12, excessive bleeding, liver and spleen disorders, hypothyroidism and genetic disorders, with symptoms such as fatigue or weakness, pale or yellowish skin, headaches, cold hands or feet, breathing problems and dizziness. It also lists leukoplakia and menopausal gingivostomatitis as possible causes. It advises talking to a doctor or dentist so underlying causes can be ruled out, since pale gums may indicate a more serious health problem.

White spots or patches on the gums

Healthline lists several causes of white spots on the gums: canker sores, with a white or yellow center and red border that sting; oral thrush, a Candida overgrowth causing creamy white or yellow lesions that may bleed slightly; oral lichen planus, with lacy white patches; and leukoplakia, thick white patches that cannot be scraped off. It says any new white spots on the gums warrant a dental appointment, with prompt attention if they come with pain, a cottony feeling or bleeding that does not resolve within a week.

Leukoplakia

The NHS says leukoplakia is one or more white patches inside the mouth, usually painless, irregular and sometimes slightly raised, with red areas in some, that cannot be rubbed or scraped away, which helps distinguish them from thrush. They often appear on the tongue but can occur on the gums, inner cheeks, and floor or roof of the mouth. The exact cause is unknown, and smoking and chewing tobacco are thought to raise the risk.

The NHS says leukoplakia can, over time, develop into mouth cancer, so any persistent patch should be checked, and that a specialist may perform a biopsy. Healthline says most are harmless, but some are precancerous, particularly speckled types with red areas.

Black or dark spots on the gums

Healthline's page on black gums describes seven causes, most of them harmless: bruises from injury or hard brushing; eruption hematoma, a blood-filled cyst over an erupting tooth, mostly in children; amalgam tattoo, filling particles lodged in gum tissue; blue nevus, a harmless mole; melanotic macule, a freckle-like spot sometimes linked to conditions such as Addison's disease; oral melanoacanthoma, a rare harmless spot; and oral cancer, a less common but serious cause, with tobacco and heavy alcohol as the main risk factors.

The same article says to see a dentist or doctor for a new spot on the gums, a spot that is painful or changes in size, shape or color, frequent unexplained bruising, or any spot with symptoms such as open sores, unusual bleeding, swelling, a chronic sore throat or voice changes. An amalgam tattoo cannot be removed, but is harmless and needs no treatment.

Are black gums normal?

Some people have naturally darker gums, but the sources we read for this guide do not describe natural pigmentation, so we cannot say how to tell it from a problem. A dark area that has always been there is a question for your dentist at a checkup, and a new or changing area should be seen promptly.

White spots on teeth

Healthline's page on white spots on teeth lists diet, with acidic foods and sugar forming acidic plaque that wears down enamel, fluorosis from too much fluoride in developing teeth, enamel hypoplasia, plaque build-up including with braces, and mouth breathing during sleep. It says spots from mouth breathing disappear within a few hours, and does not clearly state whether other types are permanent, but notes that white spots may signal decay so they should be evaluated. Treatments it lists include microabrasion, bleaching (not effective for fluorosis spots), veneers and remineralizing toothpaste. Our guide on cavities explains early white spot decay and its reversal.

Swollen or sore gums

The sources we read for this guide do not cover swollen or hurting gums in detail. The NHS's tooth decay page says to see a dentist if your gums are painful, swollen or bleed when you brush. Our flossing guide covers bleeding gums when cleaning between the teeth.

What your dentist will do

A dentist will look at the area, ask how long it has been there and whether it has changed, and may take X-rays or a biopsy of a patch or spot. Regular checkups mean changes are noticed early, which matters for the rarer serious causes.

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