Blue gingiva: A possible diagnostic pitfall in dark skinned patients

Oral pigmentation is a discoloration of the oral mucosa or gingiva associated with several exogenous and endogenous factors. Oral pigmented lesions can have various etiologies, including drugs, heavy metals, genetics, endocrine disturbance, and inflammation. Gingival tattooing represents a cultural practice prevalent in certain African ethnic groups, resulting in diffuse bluish pigmentation of maxillary alveolar gingiva. Tattoos in the oral region must be distinguished from other form of diffuse, intrinsic or acquired pigmentation of oral mucosa. Herein we describe two patients from Ethiopia presenting a traditional gingival tattoo.