A Dog's Gums: The Comprehensive Guide

We may think a lot about our dogs' teeth and how important they are to health and happiness. But what about those rosy pink gums that help keep those vital pearly whites in place? A dog's gums are not just there for show, they actually serve as a unique window into the health and condition of a dog at any given time and can be even more important as an indicator for disease than the teeth themselves.

In this article we're going to discuss just about everything you may have ever wondered about dog gums. We'll discuss what normal gums should look and feel like, some different colors of the gums that can be normal or signs of disease, and some other abnormalities, like growths, to look out for.

The Normal Gums

What should a normal, healthy dog's gums look like? They should appear as a nice light pink, kind of like the color of shrimp or a new stick of bubble gum.

The gums are good indicators of several things, which you can assess by just touching and pressing on them lightly with your finger.

The gums should be slightly moist. Gums that feel tacky or even dry can be an indicator of dehydration.

The gums can also be used to assess how good blood perfusion and blood pressure are. When you press lightly on the gums, they should normally blanch to a white color briefly, but return to their normal happy light pink color within 2 seconds. This is what's called the ""capillary refill time,"" or ""CRT"".

We can see a delay in this less-than-2-seconds timing with dogs that are dehydrated, have poor circulation or perfusion, or have lower blood pressure.

So when it comes to normal dog gums, just remember: light pink, moist, and a refill time of less than 2 seconds. Assessing these parameters is actually an integral part of any dog's physical examination when they go to the vet, so even we doctors rely on this information to assess a pup's health. 

Normal Variations in Gum Color

Does your dog have black gums? Or perhaps gums with a mix of pink and black?

Chances are, this is normal. Especially if this has been the case since she was a puppy. There are many breeds, with Chow Chows being the classic one, who have an abundance of the pigment melanin in their mouths.

Melanin is a dark, almost black pigment. In many breeds and especially some mixed breeds, we can see very black lips and gums simply due to the presence of this pigment. In fact, any dog that has a black coat or skin may also have black coloration to the gums as a normal variation.

While pigmentation is not abnormal, it is important to keep a closer eye on these pups as they get into their older years. Cells containing melanin, called melanocytes, can mutate into the very serious cancer called melanoma. We'll cover that more in just a little bit.

Other Gum Colors and What They Mean

In addition to our normal variations on gum color, there are several abnormal colorations to the gums that can be seen. It's very important to be aware of them and what they mean, because it could be one of the first signs that your pet should be examined further by your veterinarian.

Pale Gums

While some dogs may have a lighter or darker pinkness to their gums, having gums that look really pale or white is the sign of a serious health concern.

This occurs for one of two reasons.

First, if a pet is anemic and has sustained substantial blood loss, sometimes internally, the gums will appear pale because they aren't getting good blood perfusion and blood pressure is low.

Second, we can also see pale gums from poor perfusion because of shock to the body. A state of shock can result from severe dehydration, a trauma that was sustained, or something else that has caused a rapid change in pressure or perfusion.

Why does this happen? In a state of shock, the body's blood pressure often drops. In response, the body tightens all of the blood vessels that are farther away from the heart--including vessels in the gums--to try to increase pressure and keep the heart pumping efficiently.

A good example could be a pup that eats something gross outside and develops an acute gastroenteritis with vomiting and diarrhea. All of that fluid loss leads to a state of shock and dehydration where we'll typically see pale, tacky gums with a very delayed refill time.

Pale gums are an important reason to have a pup assessed by a veterinarian as soon as possible.

Injected Gums

Truly injected gums are fortunately uncommon to see, but important to review because of the serious conditions they represent. It can be difficult to tell the difference between severe gingivitis and injected gums, so we'll look to compare, contrast and distinguish the two.

Injected gums will appear as a bright, brick red. While gingivitis tends to occur more along the gumline where the gums meet with the teeth, injected gums will appear bright red everywhere.

Brick red gums are typically the sign of a serious condition. Most often, they are seen during the early phase of heat stroke, while the body is trying to keep its core temperature cool by increasing blood flow to the extremities.

This can also be seen in cases of sepsis, where the body is being affected by a blood-borne infection.

Besides the idea that gingivitis is often more localized to the gumline itself, another way to tell the difference between gingivitis and injected gums is that gingivitis occurs slowly over time, while injected gums often have a more sudden onset.

You also will typically see other very concerning signs if your pup has injected gums. The combination of these should prompt an immediate veterinary visit.

Red or Irritated Gums (Gingivitis)

Not to confuse you with injected gums which we just discussed, gums affected by gingivitis can also have a very bright red and irritated appearance.

However, this is typically a slow, progressive process and is a good reason to have a look at your dog's mouth on a daily basis. Gingivitis most often affects only the gumline, but in more severe cases, can extend to include more of the gum tissue.

You are also more than likely going to see a lot of bad tartar or calculus buildup on the teeth if you're seeing severe gingivitis.

Gingivitis results from bacterial plaque (that filmy, slimy stuff you can feel on your teeth in the morning) sitting in that space between the gums and the teeth, called the gingival sulcus. As that nasty mix of food particles and bacteria sits there, the body's immune system responds to it, leading to localized inflammation in the gum tissue.

If you're seeing progressively worsening gum inflammation, this is usually a sign that your pup will need a dental cleaning, typically performed under anesthesia, with your veterinarian. It's always best to have the teeth examined by your vet first before scheduling a dental, to try to get a good idea of the extent of the problem and if any teeth may require removal.

Blue Gums

The term for blue gums is called ""cyanosis"". More often, they have more of a grey appearance. This is due to a lack of oxygen reaching the tissues and a subsequent build-up of carbon dioxide, which is what leads to the blue/grey color.

There are numerous conditions that can lead to cyanotic gums, both inherited and acquired. There are a number of heart defects dogs can be born with that allow poorly-oxygenated blood to mix with well-oxygenated blood.

We can also classically see cyanosis if there is something obstructing the airways or ability for the lungs to oxygenate the blood. Pneumonia is one classic example. With severe pneumonia, where the lungs are infected and full of fluid, they can't perform oxygen exchange with the blood very well, which allows poorly-oxygenated blood to keep circulating.

Dogs with tracheal collapse, a condition where the trachea is weaker and actually folds in on itself, or dogs with laryngeal paralysis where the tissues that protect the airway during swallowing become paralyzed and actually block the airway, can both develop signs of cyanosis from partial airway obstruction.

Cyanosis is also a concerning thing to see with a dog's gums and a reason for an immediate vet visit. While cyanosis most of the time accompanies conditions of acute respiratory distress, some chronic conditions, like congenital conditions, tracheal collapse, or laryngeal paralysis, may develop more slowly. Another reason to keep a close eye on your pooch's gums often.

Dark or Muddy-Brown Gums

Seeing gums that are more of a grey-brown color is associated with one main condition, called methemoglobinemia.

It's a mouthful to be sure, but important to know, because it can be caused by a dog getting into a bottle of Tylenol, a common household staple.

Hemoglobin is the red pigment in all of our blood cells that helps to transport oxygen through the bloodstream.

Ingestion of sufficient amounts of acetaminophen (Tylenol) leads to hemoglobin being replaced with an abnormal variation called methemoglobin. Methemoglobin cannot carry oxygen, which leads to the dark muddy brown or grey appearance to the gums.

Methemoglobinemia is a very serious life-threatening condition, most commonly caused by Tylenol ingestion. The risk and severity is usually dose-dependent, with small dogs more likely to be affected by a single tablet of Tylenol, whereas it may take more to affect a larger dog.

If you have concern this may have happened to your dog, the best first thing to do is to call the ASPCA Animal Poison Control hotline, where you can be put in touch with a veterinary toxicologist who can advise you on the best course of action for your pup.

Yellow Gums

When the gums take on a yellow appearance, this is called ""icterus"" or ""jaundice"". Icteric gums are caused by the pigment bilirubin building up to high levels in the bloodstream. This is usually the product of an underlying disorder of the liver. This could include an infection, like leptosporosis, end-stage liver failure, or even cancer.

The other cause that leads to bilirubin build-up is when the body attacks its own red blood cells, a condition called immune-mediated hemolytic anemia.

Both situations are considered emergencies and a reason to have your pooch seen by a vet immediately.

Bright Red or Dark Spots or Splotches

If your dog has pretty normal looking gums, but you're noticing the sudden presence of either bright red dots or splotches, or if these have taken on a purple appearance, this is a sign of a concerning condition called petechiation.

Petechiation is a technical term for bruising. We usually see bruising on the gums like this if there is a problem with the body's normal clotting mechanisms, including platelets and other clotting factors manufactured by the liver.

One common scenario where we can see petechiation is with rat poison ingestion. Certain rat poisons interfere with clotting factors produced by the liver, which leads to bruising.

Another situation is if there is platelet loss or destruction. Most often, this is from the body's immune system attacking its own platelets, a term called immune-mediated thrombocytopenia.

Again, if you see something that resembles petechiation or bruising on the gums, your pup needs to be seen as soon as possible to find out the underlying cause and the best way to start treating it. 

Growths on the Gums

Now, we're going to chat about abnormal structure and growths on the gums. Some of these are benign, meaning they are either non-cancerous or at least cannot spread to other parts of the body. But others are malignant, which are far more serious.

Benign Growths

Gingival Hyperplasia

Let's start with a more ""normal"" degree of growth on the gums. Gingival hyperplasia is a technical term for overgrowth of the gums. This is a benign and completely non-cancerous condition, but can lead to a very irregular appearance.

Certain breeds, with Boxer Dogs and Bulldogs being the most classic, are prone to gingival hyperplasia. Their gums look very lumpy and bumpy. Sometimes, the teeth appear to be enveloped and nearly hidden by overenthusiastic gum tissue.

While it is a benign condition in itself, gingival hyperplasia can contribute to some health concerns. The main one is that all of those extra pockets and swellings of gum tissue around the teeth add to far more plaque and tartar accumulation around the teeth.

For this reason, many dogs with gingival hyperplasia may need dental cleanings at the vet more often. Brushing as a preventative measure is still a good idea, but most toothbrushes will be unable to really get down into those deep crevices and pockets that gingival hyperplasia creates.

Sometimes, with enough overgrowth of the gums we can see issues where some teeth are actually poking and traumatizing the gums, leading to bleeding, swelling, and pain. In cases like this, depending on the severity, it may be necessary either to extract the offending tooth, or have a veterinary dentist do some cosmetic work on the tooth or teeth to shorten and smooth them over.

While you can in theory cut away or remove some of the overgrown gum tissue instead, it is almost always simply going to grow back, not providing a good long-term solution.

Papillomas

If I had to choose a type of gum growth that was my favorite, I would probably choose papillomas. Why? Because in most cases they are simple benign growths that tend to go away on their own.

Papillomas in dogs are caused by canine papillomaviruses, and most classically occur before 2 years of age. I most often see them in dogs between 1 and 2 years of age.

You can think of papillomas almost like the chicken pox for those of you who remember the time before the chicken pox vaccine, when we all got the chicken pox at some point as a young kid, but once you got it and recovered, you couldn't get it again.

Young dogs acquire papillomas after exposure to another dog that has them. But typically, after the pup's immune system mounts a response, the papillomas will go away on their own after 2-3 months and it is extraordinarily rare to ever see them again. It is also extremely rare to see any middle-aged or older dog get them.

Most pups will have at most, half a dozen of the small pea-sized pink or white wart-like growths. If this is the case and there is no issue with eating or signs of oral pain, there is usually no primary treatment required.

But on rare occasions, usually in pups with some degree of immune system suppression or compromise, we can see dozens of papillomas, and this can interfere with a pup's normal day to day.

If you see papillomas in your younger pooch's mouth, it's always best to still have them assessed by your vet to ensure that's what they are and not something else. Most of the time, these can be confirmed visually in conjunction with a pup's young age, and monitoring for the next 2-3 months for self-resolution will be recommended.

Uncommonly, your vet may wish to biopsy one or more to verify a papilloma, especially if your pup acquired one or more at an older age. Also, depending on the number or severity of them, some veterinarians may elect to manually rupture or surgically remove the warty growths.

Epulis

An epulis is a benign tumor that appears as a localized overgrowth of gum tissue. Most usually look like a little mushroom cap or ball of gum tissue that appears very much out of place with the rest of the gums.

These are the fourth most common type of gum tissue growth and most often form as the result of trauma or irritation to an area of the gums, which can occur due to poor occlusion of the teeth. They are most often seen in brachycephalic breeds, like Boxer Dogs and Bulldogs. As mentioned these breeds also most often have gingival hyperplasia, which could be a contributing risk factor.

Epuli, or epulides, as they are called in plural form, can also have involvement with the ligament that holds a tooth in place with the jaw. This is important for expectations, as we'll soon discuss.

There are three different types of epuli that have different degrees of severity.

The first is called a fibromatous epulis. These are the simplest form and the least concerning. Small ones less than 1 centimeter often cause no problems within the mouth, but occasionally you can have an adjacent tooth traumatizing it, leading to bleeding and irritation.

The second type is called an ossifying epulis. These appear very similar to our first type, but they differ in terms of their inner tissue make-up. Ossifying epuli contain bone-forming cells called osteoblasts. These are more likely to be connected to the ligament structures holding a tooth in place.

The third type of epulis is a very concerning type called an Acanthomatous ameloblastoma. These behave far more like aggressive tumors and usually look different from our first two epuli. These often have more of an irregular, cauliflower-like appearance and may also look ulcerated.

Acanthomatous ameloblastoma, while technically benign (which means it cannot spread to other organs or tissues of the body) is usually very locally invasive, involving the bone of the jaw and displacing teeth.

Treatment for epuli depends on what the type is. Often, for the more simple and small ones, your vet may only elect to cut it away during an anesthetic dental procedure, as long as x-rays of the mouth otherwise appear normal.

The only way to know what type of epulis is present is to send it out for analysis by a veterinary pathologist as a biopsy. This can help set expectations for the chance of regrowth.

If there is evidence that the epulis is more aggressive, may involve the tissues surrounding the associated tooth, or if x-rays of the mouth show abnormalities, a vet may elect to take a more aggressive approach to the epulis by removing it as well as the associated tooth, and scraping out the tooth socket to ensure no epulis tissue remains behind.

If an epulis is removed in a simple manner, but then regrows in the same place, this may also be the necessary approach to prevent any further regrowth.

If your vet suspects an acanthomatous ameloblastoma however, or if a biopsy sample proves this to be the case, a far more aggressive approach is needed. Most often, the bone of the jaw itself requires removal, as these tumors invade and destroy the bone itself.

If such an aggressive measure is required, this is most often done by a board certified veterinary dentist or surgeon. It may come as a surprise, but most dogs that require some surgical removal of the jaw actually do extremely well.

Malignant Growths

We're now going to review the top three most common tumors of the mouth which unfortunately, happen to be malignant (if you remember, the benign epulis growth is the fourth most common).

If a growth is malignant, this means that cells from the tumor can actually leave the tumor itself, travel through the bloodstream, and set up shop in another part of the body. When you hear the word ""metastasis"" or ""metastatic spread"", this is what is being referred to.

Malignant Melanoma

Melanoma is the most common tumor of the mouth in a dog, and unfortunately it's not a great one to have.

If you recall the early discussion about gum pigmentation and dogs that have dark or black gums, you'll remember I said you always want to monitor those areas carefully.

This is because these black-pigmented areas contain melanocytes, which can mutate into cancerous cells.

There is a less common form of melanoma called ""amelanotic melanoma"" where the pigmentation is not present, but these tend to be in the minority, and any dog with these dark or black gums are at the highest level of risk.

Melanoma can occur anywhere along the gumline, but in my experience most often occurs in the middle to back part of the mouth behind the canines.

Signs of melanoma can include bleeding from the mouth, especially from just a certain location. Pup parents also may notice a swelling of the lips or cheek, where the gum tumor is actually pushing the lips and cheek outwards. These pups usually also have difficulty eating as the tumor grows.

Catching melanoma early is extremely important, so if you notice any early signs of swelling or bleeding in and around the mouth, have it looked at by your vet as soon as possible.

Treatment of melanoma usually involves surgical removal of the tumor, often involving the associated teeth and sometimes jaw bone as well.

This is usually followed up by chemotherapy or radiation. The most successful treatment following surgery is with what is termed the melanoma ""vaccine"". With early timing and successful therapy, many dogs with oral melanoma can still live with a good quality of life for several months to over a year. But unfortunately, metastatic spread, usually to the lungs, inevitably happens.

Squamous Cell Carcinoma

Squamous cell carcinoma, or ""SCC"" for short, is the second most common tumor of a dog's mouth.

Because squamous cells are the simple skin cells that line every outer surface of our bodies and mouths, this cancer can appear nearly anywhere and in any breed of dog.

While on the skin it can appear as more of an actual growth, it can take on a different appearance in the mouth. It can appear as a defined growth, but may also appear more as an area of ulcerated and irritated tissue.

Typically, this tissue will appear far more severe than just gingivitis and will be prone to bleeding.

Success with SCC also requires early detection, as it does continue to enlarge and spread, and can metastasize. It also depends on the location. SCC tumors that are located more in the front of the mouth are easier to remove surgically and are less prone to metastasize compared to tumors in the back of the mouth or under the tongue.

Surgical removal followed by radiation therapy is considered the best method to address SCC, and with complete early removal, prognosis can be pretty good. There is plenty of evidence that non-steroidal anti-inflammatory drugs like carprofen can significantly slow down progression of the tumor as well, while also bringing some relief to the pain they cause. Thus starting a dog with SCC on an NSAID may be initially recommended by your vet while making further treatment decisions.

Fibrosarcoma

Fibrosarcoma is the third most common but unfortunately, is the least amenable to treatment unless it is caught very early.

This is a tumor of connective tissues within the mouth. In addition to the risk for metastatic spread, these tumors tend to grow rapidly and are very locally invasive, sometimes even growing into the nasal cavity.

The only way to address them is with early surgical removal, trying to get the whole tumor out. They do not respond well to chemotherapy or radiation, and as a result, they have a high rate of recurrence. 

Staying on Guard for the Gums

You probably didn't know there was so much to know about dog gums! But hopefully, with this comprehensive guide, you can see the value of keeping a close eye on your pup's gums both for the gums' sake, as well as for the more complete health of your pup.

Make the habit of checking your dog's mouth on a daily basis. This helps to recognize problems early in an area that is often mostly hidden from view. And if you're not sure if what you're seeing is abnormal, or if you have seen any swelling, bleeding, or difficulty chewing food, make sure to have your veterinarian take a look for you.