Background: Gingival pigmentation presents as a diffuse deep discoloration or as irregularly shaped brown and light brown or black patches, striate, or strands. It is generally agreed that pigmented areas are solely present when melanin granules, synthesized by melanocytes, are transferred to keratinocytes.

Aim: To study the prevalence, extent, and etiology of gingival pigmentation among Riyadh Elm University clinics’ attendees.

Design and Settings: Examinations were done in Riyadh Elm University by four calibrated examiners.

Methods: Patients underwent a Gingival Index examination, followed by an assessment of the presence or absence of gingival pigmentations. If the latter were present, the patient underwent a Hedin’s Melanin Index, a Gingival Melanosis Record, and a Von Luschan Scale examination to evaluate the extent, distribution, and color of the pigmentation.

Statistical analysis: Cohen’s Kappa Test and Chi-Square Test

Results: A total of 139 (80.3%) patients had gingival pigmentation, of which 79 (56.8%) were males. Gingival pigmentations were found in 42 (93.3%) cigarette smokers, 40 (83.3%) hubbly bubbly smokers, and 20 (86.9%) electronic cigarette smokers. Both arches were affected in 102 patients, the canines’ area had the highest incidence of pigmentation (88.9%) while the molars had the least incidence (18.1%). Scores of 2 and 3 on the Hedin’s Index were the highest at 51 and 52 patients respectively. The mean color of the pigmentations on the Von Luschan scale was 21.49 ± 4.59, but it was higher for smokers and patients with severe inflammation.

Conclusions : Gingival pigmentation was more prevalent among all types of smokers—cigarettes, hubbly bubbly, and e-cigarettes compared to non-smokers. More pigmentations were also associated with the higher intake. The major patterns of pigmentation distribution were the short-connected-continuous ribbons and the more-than-two-solitary-papillae.

Keywords: Gingival Pigmentation, Hedin’s Index, Color, Distribution, Smokers