COM April 2005

This is an otherwise healthy 17-year-old white male who has had two years of treatment with minocycline for acne. He was referred by his general dentist, Dr. Robert Stockton, for evaluation of discolored oral mucosa, especially in the gingiva and palate. His skin, including his face, showed no evidence of pigmentation.

Figure 1. This clinical photograph represents the band-like grayish blue pigmentation of the maxillary anterior gingiva.

His past medical history is non-contributory. The patient is in excellent health and is on no other medications. There is no history of tobacco use.

The patient presented with diffuse mandibular and maxillary gingival bluish discoloration involving the attached and non-attached mucosa. It was also visible on the palate. The clinical concern was only esthetic; the patient did not complain of any pain and there was no evidence of swelling, infection, or acute changes. The teeth were slightly tan, but did not show evidence of the bluish discoloration. There was no evidence of any radiographic changes.

The gingival discoloration in minocycline patients usually represents a reflection of the discoloration of the underlying bone and the apical one third of the roots. Therefore a soft tissue biopsy will not reveal changes that can be definitively identified under the microscope. For that reason, there is no need for a biopsy.