Diffuse pigmentation of maxillary attached gingiva: four cases of the cultural practice of gingival tattoo.

Background: Gingival pigmentation is a common finding, may be of endogenous or exogenous origin, and can have diagnostic significance. Diffuse gingival pigmentation may be physiologic in nature or can be due to environmental factors, drugs, endocrine disorders, or genetic conditions. We present four cases of diffuse gingival pigmentation due to traditional gingival tattooing and review the literature on this practice.

Methods: Four black females (aged 19 to 56 years) of West African origin (Mauritania and Senegal), representing three different ethnic groups (Fulani, Mandinka, and Soninke) presented with various chief complaints. All exhibited diffuse pigmentation of the maxillary vestibular gingiva extending to the second premolar areas, without any associated radiographic abnormalities. The color ranged from intense blue gray to light gray or grayish pink. One case was biopsied for histopathologic evaluation.

Results: Questioning revealed that the women had had one or more sessions of traditional gingival tattooing. In one case, the procedure was performed in a dental office. The color range appeared to depend on the time that elapsed since the last procedure. The biopsy exhibited dense fibrous connective tissue containing aggregates of foreign material consistent with a foreign body tattoo.

Conclusions: Gingival tattooing, a cultural practice prevalent in certain African ethnic groups, results in diffuse pigmentation. Outside of Africa, it may be misinterpreted as racial pigmentation or pose a diagnostic puzzle. The color and distribution pattern of diffuse gingival pigmentation often are quite suggestive, and the clinical diagnosis should be confirmed by patient history. In selected cases, biopsy may be necessary to exclude other diagnostic considerations.