Dark Spots in the Mouth (Oral Pigmented Lesions)

Medically reviewed by Dr. CJ Henley, DMD, general dentist, Jacksonville, FL · Last reviewed October 2026

Dark spots in the mouth usually get noticed by accident: a black spot on the gums in a selfie, a brown dot on the lip while shaving, or a gray patch someone else points out. It's natural to worry. Most of these spots turn out to be harmless, like a bit of old filling material under the gum, a flat freckle, or normal pigment. A few deserve a closer look, and it's not something anyone should judge by eye, including us.

What dark spots in the mouth look like

"Dark spot" covers a lot of ground. Dentists sort them by color, shape, and whether there's one spot or many:

• Gray, blue-gray, or black, flat, one spot: most often an amalgam tattoo, especially on the gums near a filled or removed tooth.
• Brown, flat, small, one spot: often a melanotic macule, which is basically a freckle of the mouth. Common on the lower lip and gums.
• Brown, even, on both sides: normal (physiologic) pigment, very common in people with darker skin. Smoking can cause a similar look on the front gums.
• Dark red, purple, or nearly black, puffy: usually blood. A blood blister after biting your cheek, or a small cluster of veins under the tongue or on the lip.
• Black, hairy-looking coating on top of the tongue: black hairy tongue, which isn't a spot at all. It's a coating that brushes off over time.
• New, growing, uneven, raised, or several colors: needs to be looked at, and often biopsied, to rule out oral melanoma.

We haven't included photos of oral melanoma here on purpose. Early ones often look like an ordinary brown or gray spot, so a photo can give false comfort or needless fear. The chart below shows the features that make us want a biopsy.

Where each type of dark spot shows up

Location is one of the most useful clues. A gray spot on the lower gum beside an old filling is a very different story from a new black patch on the roof of the mouth. The palate and the upper gums deserve extra attention, because that's where oral melanoma and pigmented moles (nevi) most often appear.

What is an amalgam tattoo?

An amalgam tattoo is a flat gray, blue-gray, or black spot caused by tiny particles of silver filling material (amalgam) trapped in the soft tissue. It happens during dental work: a filling is placed or drilled out, a tooth with a silver filling is pulled, or a root canal is sealed, and a few specks get pushed into a scrape in the gum. The tissue heals over them, and they stay put. It's one of the most common reasons for a single black spot on the gums.

• Where: mostly the gums and the tissue over the jawbone, followed by the inner cheek. An amalgam tattoo on the tongue or palate is less common, but possible.
• How it looks: flat, smooth, one color, with edges that can be sharp or a little smoky. Usually under 1 cm.
• How it behaves: painless, doesn't itch, doesn't bleed, and stays the same size. Many people have had one for decades without knowing.
• On an X-ray (radiograph): larger particles show up as small bright specks. Very fine particles may not show at all, so a normal X-ray doesn't rule it out.

Is an amalgam tattoo dangerous? No. It isn't cancer, it doesn't turn into cancer, and the trapped material doesn't harm your health. The only real issue is making sure it actually is an amalgam tattoo. If there's no filling or extraction nearby, nothing shows on an X-ray, or it seems to be changing, we'll recommend a biopsy.

Amalgam tattoo treatment and removal

No treatment is needed. If one sits on the front gums and bothers you when you smile, it can be removed by cutting it out (sometimes with a small gum graft) or, in some cases, with a laser. That's usually done by a periodontist or oral surgeon, and we're glad to talk it through and refer you. Removing it also gives a lab sample, which settles any doubt about what it is.

Melanotic macules and other brown spots

A melanotic macule (also called an oral melanotic macule, or labial melanotic macule when it's on the lip) is a flat, brown to dark brown spot caused by extra melanin in the lining. Think of it as a freckle inside the mouth, though sun isn't the main cause. They're usually under 1 cm, single, and evenly colored. The lower lip and gums are the most common sites, followed by the palate and cheek.

They're the most common melanin spot in the mouth by a wide margin. In one large biopsy study of single brown melanocytic spots, melanotic macules made up about 86% and melanoma well under 1%. Still, an early melanoma can look like a melanotic macule, so many dentists, including us, recommend a biopsy for a new brown spot, a spot on the palate, or one you can't date.

Other causes of a brown spot on the gums

• Physiologic (racial) pigmentation. Even, light-to-dark brown color along the gums on both sides, sometimes on the cheeks or tongue too. It's normal, it's usually been there since childhood, and it's more common the darker your skin is.
• Smoker's melanosis. Smoking stimulates pigment cells, often darkening the front of the lower gums. Pipe smokers may see it on the palate or cheeks. It's harmless in itself and often fades over months to a few years after quitting.
• Oral nevus (mole). A brown, gray, or blue spot, often slightly raised and most common on the palate. Moles in the mouth are uncommon and usually get removed for testing because they're hard to tell from early melanoma by looking.

What does oral melanoma look like?

Oral melanoma is a cancer of the pigment cells in the mouth lining. It is rare. Mucosal melanomas of the mouth, nose, and throat together make up less than 1% of all melanomas. It's also serious, because it tends to be found later than skin melanoma, so it's worth knowing the pattern.

• Location: most often the hard palate and the upper gums. In the biopsy study above, 60% of oral melanomas were on the palate.
• Color: brown, black, blue-gray, or a mix. Some have red, purple, or white areas. A few have little or no pigment at all.
• Shape: may start flat with irregular, spreading edges, then thicken, become raised, or form a sore.
• Feel: usually painless early on. Later signs can include bleeding, a loose tooth, or a denture that stops fitting.
• Who gets it: mostly adults over 40. Unlike skin melanoma, it isn't tied to sun exposure.

Some oral melanomas follow a patch of pigment that was there for months or years. That's why a spot that's slowly spreading or changing, especially on the roof of the mouth, should be biopsied rather than watched. Nobody, dentist or physician, can call a dark spot melanoma or "not melanoma" just by looking. A biopsy is the only way to know. Our guide to the signs of oral cancer covers the other warning signs, and an oral cancer screening is part of every exam we do.

Telling dark spots in the mouth apart

Here's how the usual suspects compare. Use it to understand what we look for, not to rule anything out on your own.

Amalgam tattoo vs. melanoma

This is the comparison most people are really asking about. In practice, these are the clues that lean toward an amalgam tattoo:

Other look-alikes have their own pages. A fuzzy dark tongue is covered in black hairy tongue, and blood blisters and other sores are in our mouth ulcers guide. A dark red, bleeding lump on the gums is more often a pyogenic granuloma than a pigment problem.

What causes dark spots on gums and in the mouth?

Dark spots come from one of four sources: material from outside the body, extra melanin, blood, or a growth of pigment cells.

Material from outside the body

• Silver filling particles (amalgam tattoo).
• Graphite from a pencil-point stab, usually on the palate in kids. It looks a lot like an amalgam tattoo.
• Heavy metals such as lead, which can leave a dark line along the gum edge. This is rare today and points to a medical workup.
• Surface stains from coffee, tea, red wine, tobacco, or bismuth (Pepto-Bismol) on the tongue. These sit on the surface and brush or fade away.

Extra melanin

• Normal genetic pigment, melanotic macules, and smoker's melanosis.
• Medications and hormonal or adrenal conditions, covered in the next section.

Blood

• Blood blisters from biting, hot or crunchy food, or dental work.
• Varices: dilated veins under the tongue, common after about age 60.
• Small purple spots (petechiae) or bruises from low platelets or blood thinners.

Pigment-cell growths

• Nevi (moles), and very rarely melanoma.

Near a tooth, between teeth, or after a cleaning

A dark spot on the gums near one tooth is often an amalgam tattoo, a dark filling or crown edge showing through thin gum, or a tooth that has turned gray after its nerve died. A dark spot between teeth is commonly tartar, a stain, or a cavity on the side of a tooth rather than anything in the gum. After a cleaning, a small bruise from the instruments can look purple for a few days, and gums that shrink as they get healthier can reveal dark tartar below the gum line that needs another pass. If a spot near a tooth comes with swelling, a pimple on the gum, or a bad taste, think infection and read about tooth abscesses.

Medications and medical conditions that darken the mouth

Sometimes pigment spread across several areas is a clue to something going on elsewhere in the body. You'll find more on these in our autoimmune and systemic disease guide.

Drug pigmentation

• Hydroxychloroquine (Plaquenil) and related antimalarials, used for lupus, rheumatoid arthritis, and other conditions, can cause a blue-gray to black patch on the hard palate after long-term use. It's harmless, but it's worth having us document it. People taking it for lupus often see us for other mouth symptoms too.
• Minocycline (Minocin, Solodyn), an antibiotic taken long term for acne or rosacea, can turn the gums or palate blue-gray. It can also stain the jawbone or the roots of teeth, and that shows through thin gum as a gray color.
• Other drugs linked to oral pigment include some cancer drugs (such as imatinib), some HIV medications, and hormone therapies.

Drug pigment usually lightens slowly once the medicine is stopped, though it may not disappear completely. Don't stop a prescribed medicine because of a spot in your mouth. Tell us and your prescriber. In most cases the medicine is worth far more than the cosmetic change.

Addison's disease pigmentation

Addison's disease (primary adrenal insufficiency) can cause patchy brown or bluish-brown pigment on the gums, cheeks, tongue, or lips. It sometimes shows up in the mouth early, along with darkening skin (especially in skin creases and scars), fatigue, weight loss, salt craving, and dizziness when standing. Dentists can notice these signs, but we don't diagnose Addison's. A physician does, with blood tests for cortisol and ACTH and a stimulation test. If your mouth and symptoms fit the picture, we'll send you to your doctor with our notes. The pigment often fades somewhat once treatment starts.

Other medical causes

• Peutz-Jeghers syndrome: a genetic condition with many small brown freckles on the lips and inside the mouth, starting in childhood, plus intestinal polyps.
• Kaposi sarcoma: red, purple, or brown patches, often on the palate, in people with advanced HIV or other immune suppression. See our page on HIV and the mouth.
• Hemochromatosis (iron overload) and some hormonal changes can also darken the mouth lining.

Symptoms: a black spot in the mouth with no pain

Most dark spots in the mouth cause no symptoms at all. That's true of amalgam tattoos, melanotic macules, and normal pigment, but also of early melanoma. So "it doesn't hurt" isn't a reason to ignore a spot, and "it hurts" isn't a reason to panic. Pain usually points to a blood blister, an injury, or an infection.

Things worth noting and telling us about:

• When you first noticed it, and whether anyone has ever mentioned it at a dental visit
• Whether it has changed in size, shape, or color
• Bleeding, a raised area, or a sore in the middle of it
• Other dark spots, darkening skin, or new medicines
• Nearby fillings, crowns, root canals, or extractions

Do dark spots on gums go away?

It depends on the cause:

If a dark red or purple spot hasn't faded in 2 weeks, it isn't a simple blood blister, and we'd like to see it.

What to do about a dark spot in your mouth at home

There's nothing to put on a pigment spot to make it fade. What helps is a clear record, so we can tell whether it's changing.

1. Take a good photo. Use daylight or your phone's flashlight, get close, and include a tooth or a ruler for scale. Save it with the date.
2. Note what's nearby. Is there a silver filling, a crown, or a gap where a tooth was pulled? Does the spot match on both sides?
3. Feel it gently with a clean finger. Flat or raised? Soft and squishy (often a blood blister or vein) or firm?
4. Give a blood blister 1 to 2 weeks. Don't pop it. Rinse with warm salt water and avoid hot, sharp foods. It should break and heal.
5. Book a visit for anything else. A new spot that isn't a blood blister, or any spot on the palate or upper gums, shouldn't just be watched at home. Bring your photos.

Over-the-counter products and dark spots

No over-the-counter product removes pigment from inside the mouth. A few things help with related problems:

What a dentist can do about dark spots in the mouth

Most of the time, a visit for a dark spot ends with good news and a photo in your chart. Here's what we do:

• Take a careful history. When it appeared, your medications, smoking, past dental work, and any other symptoms.
• Look at the whole mouth, not just the spot, as part of a comprehensive exam and screening of the head and neck.
• Press on it. Spots filled with blood, like varices, blanch under pressure. Pigment doesn't.
• Take an X-ray when an amalgam tattoo is likely. With digital imaging, metal particles in the tissue often show up as bright specks.
• Photograph and measure it so there's a baseline to compare against at your next visit.
• Biopsy it or refer you for a biopsy if it's new, changing, on the palate, or doesn't fit a harmless pattern. A pathologist looks at the tissue under a microscope. Our oral medicine and diagnosis page explains how that works.
• Coordinate with your physician when the pattern suggests a medication effect or a condition like Addison's disease.
• Refer for removal if an amalgam tattoo or harmless spot bothers you cosmetically.

If a biopsy ever shows melanoma, care moves to a head and neck cancer team. We stay involved with your dental care before, during, and after treatment, as described on our head and neck cancer dental care page, but we don't replace your oncology team.

Can you prevent dark spots in the mouth?

Most can't be prevented, and most don't need to be. A few things help:

• Don't smoke. Quitting lets smoker's melanosis fade and lowers your risk of oral cancer in general.
• Tell us about long-term medicines like hydroxychloroquine or minocycline, so we can track any palate or gum changes over time.
• Keep up regular exams. A spot we've already photographed and recorded is much easier to judge later.
• Look at your own mouth once a month, including the roof of your mouth and under your tongue. The oral cancer signs page linked above has a step-by-step self-exam.
• Brush your tongue to keep surface staining and hairy tongue from building up.

Dark spots in kids, pregnancy, dentures, and cancer treatment

Babies and kids (teething)

A bluish or purple dome on a baby's or child's gum right where a tooth is coming in is usually an eruption cyst or eruption hematoma, a small fluid- or blood-filled sac over the tooth. It usually goes away on its own once the tooth breaks through. Call us if it's large, painful, or still there after several weeks. Other dark spots in kids are often graphite from a pencil stab, a bruise from a fall, or normal pigment. Multiple brown freckles on a child's lips are worth mentioning to your pediatrician. For teething pain, use cold teething rings and avoid benzocaine gels under age 2.

Pregnancy

Pregnancy hormones can darken skin pigment, and some people notice their gum color deepen a bit. A new dark red or purple lump on the gums during pregnancy is usually a pyogenic granuloma rather than a pigment spot. Any truly new dark spot should still be looked at, and exams are safe during pregnancy.

Denture wearers

The palate is the most common place for oral melanoma, and an upper denture covers it most of the day. Take your denture out once a month and look at the whole roof of your mouth and your gums in good light. If your dentures suddenly stop fitting, have it checked.

Chemotherapy, radiation, and weakened immunity

Some chemotherapy drugs darken the gums, tongue, or nails. Low platelet counts during treatment can cause purple spots and blood blisters, and those need a call to your oncology team the same day. Kaposi sarcoma is a concern with weakened immunity. See our pages on leukemia and the mouth and HIV for more.

When to see a dentist about a dark spot in your mouth

Dark spots in the mouth FAQ

Related conditions

Sources

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2. Buchner A, Hansen LS. Amalgam pigmentation (amalgam tattoo) of the oral mucosa: a clinicopathologic study of 268 cases. Oral Surg Oral Med Oral Pathol. 1980;49(2):139–147.
3. Hicks MJ, Flaitz CM. Oral mucosal melanoma: epidemiology and pathobiology. Oral Oncol. 2000;36(2):152–169.
4. Tosios KI, Kalogirou EM, Sklavounou A. Drug-associated hyperpigmentation of the oral mucosa: report of four cases. Oral Surg Oral Med Oral Pathol Oral Radiol. 2018;125(3):e54–e66.
5. Abati S, Sandri GF, Finotello L, Polizzi E. Differential diagnosis of pigmented lesions in the oral mucosa: a clinical based overview and narrative review. Cancers (Basel). 2024;16(13):2487.
6. U.S. Food and Drug Administration. Risk of serious and potentially fatal blood disorder prompts FDA action on oral over-the-counter benzocaine products. 2018.

This page is for general education and isn't a diagnosis. Every mouth is different. If you have a sore you're worried about, see your dentist or physician. Photos marked Wikimedia Commons are used under their listed licenses and may have been cropped or resized.