Clinical Characterization of Gingival Pigmentation in Indian Adults: A Study on Distribution, Intensity, and Extent – A Cross-Sectional Study

Abstract

Background: Gingival pigmentation, a physiologic condition primarily attributed to melanin deposition, significantly impacts smile esthetics. It is more frequently observed in individuals with darker skin tones, yet limited data exists on the detailed clinical presentation of this pigmentation in Indian adults.

Objective: To evaluate and correlate the distribution, intensity, and extent of gingival melanin pigmentation in Indian adults with darker skin tones using standardized classification systems.

Materials and Methods: This cross-sectional study included 80 dark-skinned Indian adults aged 18–60. Standardized intraoral photographs of the maxillary anterior gingiva were assessed by three calibrated examiners. Gingival pigmentation was classified based on de Krom (distribution), DOPI (intensity), and Melanin Index (extent) systems. Statistical analyses including Chi-square, Kruskal–Wallis, and k-means clustering were applied.

Results: Category 1 pigmentation (De Krom) was most common (37.5%), followed by Categories 2 (22.5%) and 3 (20%). Heavy pigmentation (DOPI) was seen in 36.3% of participants, while 46.3% showed Degree IV pigmentation (Melanin Index), indicating extensive gingival involvement.

Conclusion: Gingival pigmentation is a universal trait among dark-skinned Indian adults. A symmetrical, continuous, darkly pigmented ribbon across the attached gingiva was the predominant pattern. There was considerable overlap among classification systems, supporting the need for a unified, practical clinical index. Age influenced pigmentation extent, while gender did not.