Variations in gingival pigmentation, presenting as disparate hues within the oral cavity, are not uncommon. This condition, characterized by observable differences in the color of the gum tissue, can manifest due to a variety of underlying factors. An example would be patches of dark brown discoloration alongside areas of the usual pink. This observation requires careful evaluation to determine the root cause.
Understanding the etiology of differential gum coloration is paramount for accurate diagnosis and appropriate treatment. Identifying the underlying reason enables dental professionals to address potentially serious medical or dental issues. This knowledge facilitates the implementation of preventative measures, minimizes potential complications, and ensures optimal oral health. The awareness of conditions that might affect gingival pigmentation has evolved alongside advancements in dental medicine and diagnostic technology.
This exploration will delve into several factors that can contribute to uneven gum coloration. Topics covered include physiological pigmentation, amalgam tattoos, certain medications, and systemic diseases. Furthermore, inflammatory processes and potential neoplastic conditions will be addressed to provide a thorough understanding of the possible causes.
1. Melanin production
Melanin production, or melanogenesis, plays a significant role in determining the natural pigmentation of gingival tissues. Variations in melanin synthesis can lead to noticeable color differences within the gums, presenting as localized darker or lighter patches.
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Genetic Predisposition
Genetic factors heavily influence the number and activity of melanocytes, the cells responsible for melanin production. Individuals with darker complexions often exhibit higher levels of melanocyte activity, resulting in more pronounced gingival pigmentation. This inherent genetic variability can lead to uneven melanin distribution within the gums, contributing to the appearance of multiple colors. Populations of African, Asian, and Mediterranean descent are often reported with this.
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Racial and Ethnic Background
Certain racial and ethnic groups are predisposed to higher melanin production in their gingival tissues. Physiologic melanin pigmentation in these groups can manifest as dark brown or black patches, which may be unevenly distributed. This is a normal physiological variation, but its presentation can create the perception of dissimilar colors within the oral cavity.
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Environmental Factors
While genetics predominantly determine melanin production, environmental factors can influence melanocyte activity. Chronic irritation or inflammation can stimulate melanocytes, leading to localized hyperpigmentation. Smoking, for example, can cause melanin deposition in the gums, resulting in smoker’s melanosis, which may appear as patchy discoloration.
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Hormonal Influences
Hormonal fluctuations can affect melanin production. Conditions such as pregnancy or Addison’s disease, which involve hormonal imbalances, can lead to increased melanin synthesis. This can manifest as diffuse or patchy hyperpigmentation of the gums, resulting in color variations.
In summary, variations in melanin production, stemming from genetic predisposition, racial background, environmental influences, and hormonal factors, significantly contribute to the appearance of multiple colors within the gums. Distinguishing between normal physiologic pigmentation and pathological causes is essential for accurate diagnosis and management.
2. Amalgam Tattoo
An amalgam tattoo represents a localized discoloration of the oral mucosa, specifically the gums, resulting from the accidental implantation of dental amalgam particles into the soft tissues. This phenomenon can contribute to the presentation of uneven coloration within the gingiva.
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Mechanism of Implantation
Amalgam particles, composed of a mixture of metals including mercury, silver, tin, and copper, can enter the gum tissue during dental procedures such as amalgam restorations or extractions. This occurs when small fragments of the amalgam filling are inadvertently forced into the surrounding soft tissues. The implanted particles then elicit a tissue reaction, leading to a visible discoloration.
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Appearance and Location
Amalgam tattoos typically manifest as flat, bluish-gray or black macules within the gums. The size of the discoloration varies, ranging from a few millimeters to larger, more diffuse areas. The most common locations for amalgam tattoos are in the gingiva adjacent to teeth that have been restored with amalgam fillings or in the edentulous areas following tooth extractions where amalgam remnants may have been left behind.
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Microscopic Characteristics
Histologically, amalgam tattoos are characterized by the presence of radiopaque particles within the connective tissue. These particles are often surrounded by a chronic inflammatory infiltrate and may be associated with argyria, a condition resulting from the deposition of silver in tissues. The presence of these particles triggers a foreign body reaction, contributing to the discoloration of the gum tissue.
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Differential Diagnosis
Differentiating an amalgam tattoo from other pigmented lesions of the oral mucosa is crucial. Conditions such as melanocytic nevi, melanomas, and other forms of focal melanosis can mimic the appearance of an amalgam tattoo. A thorough clinical examination, radiographic evaluation, and, in some cases, a biopsy are necessary to confirm the diagnosis and rule out more serious conditions.
The presence of an amalgam tattoo serves as a distinct cause for variations in gingival pigmentation. Understanding the etiology, appearance, and diagnostic considerations associated with amalgam tattoos is essential for dental professionals to accurately identify and manage this common cause of disparate gum coloration.
3. Medication side-effect
Certain medications can induce alterations in gingival pigmentation, leading to differential coloration of the gums. Drug-induced pigment changes often manifest as localized or diffuse discoloration, contributing to the appearance of multiple colors within the oral cavity. This phenomenon stems from various mechanisms, including direct drug deposition in the tissues, stimulation of melanocyte activity, or drug-induced inflammatory reactions. For example, minocycline, a tetracycline antibiotic, is known to cause bluish-gray discoloration of the skin, mucous membranes, and teeth, and can also affect the gums. Similarly, certain antimalarial drugs, such as chloroquine and hydroxychloroquine, have been associated with increased melanin production, leading to brownish-black pigmentation of the gingiva. The identification of such medication-related effects is critical in the diagnostic process, as discontinuing the offending agent may be necessary to resolve the pigmentation.
The recognition of medication-induced gingival pigmentation is significant not only for diagnostic accuracy but also for patient management. If a medication is suspected as the cause, a comprehensive medication history is essential. Consultation with the prescribing physician might be required to evaluate the necessity of the medication and explore alternative therapies that do not carry the risk of pigmentation. Furthermore, patients should be informed about the potential side effects of their medications, including the possibility of altered gum color, to alleviate unnecessary anxiety and facilitate timely reporting of such changes. In some cases, the pigmentation may persist even after discontinuing the medication, necessitating further interventions such as laser therapy or surgical removal of the affected tissue.
In summary, medication side effects constitute a notable factor in differential gingival coloration. A thorough understanding of the medications known to cause such pigmentation changes, along with a detailed patient history and appropriate diagnostic procedures, is crucial for accurate diagnosis and effective management. The consideration of drug-induced pigmentation ensures comprehensive assessment, prevents misdiagnosis, and facilitates the implementation of suitable treatment strategies, thereby safeguarding oral and overall health.
4. Inflammation
Gingival inflammation, a common manifestation of periodontal disease or local irritations, can significantly contribute to variations in gum coloration. The inflammatory process induces alterations in vascularity, tissue composition, and cellular activity, leading to noticeable color changes that present as disparate hues within the gingiva.
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Increased Vascularity and Erythema
Inflammation triggers vasodilation, increasing blood flow to the affected gingival tissues. This heightened vascularity results in erythema, or redness, which contrasts sharply with areas of healthy, pink gingiva. The presence of intensely red patches alongside normal-colored tissue creates a visually distinct difference in coloration.
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Edema and Tissue Translucency
Inflammation causes edema, or swelling, within the gingival tissues. The increased fluid content makes the tissue more translucent, potentially masking the underlying vascularity and resulting in a paler appearance. This can lead to a mottled appearance, with some areas appearing red due to increased blood flow and others appearing pale due to edema.
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Ulceration and Necrosis
Severe inflammation can lead to ulceration and necrosis of the gingival tissues. Ulcerated areas appear as white or yellowish lesions surrounded by a red, inflamed border. Necrotic tissue may present as dark, discolored patches, creating a striking contrast with the adjacent healthy gingiva.
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Changes in Keratinization
Chronic inflammation can disrupt the normal keratinization process of the gingival epithelium. This disruption can result in areas of leukoplakia (white patches) or altered surface texture, further contributing to variations in color and appearance.
In summary, inflammation plays a pivotal role in the development of disparate gingival coloration. The interplay of increased vascularity, edema, ulceration, and alterations in keratinization contributes to a complex mosaic of colors within the gingiva. Recognizing the signs of inflammation and addressing the underlying causes are essential for restoring healthy gingival color and preventing further progression of periodontal disease.
5. Systemic disease
Systemic diseases, by their nature, affect multiple organ systems and can manifest with oral signs and symptoms, including alterations in gingival pigmentation. Variations in gum coloration can serve as a clinical indicator of underlying systemic health conditions, necessitating a thorough evaluation to identify potential systemic involvement.
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Hematologic Disorders
Hematologic disorders, such as leukemia and anemia, can significantly impact gingival appearance. Leukemia, characterized by the abnormal proliferation of white blood cells, can cause gingival enlargement, bleeding, and pallor due to infiltration of leukemic cells into the gum tissue. Anemia, resulting from a deficiency in red blood cells or hemoglobin, often leads to pale gingiva. These conditions can cause disparate coloration, with areas of pallor contrasting with areas of inflammation or bleeding.
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Endocrine Disorders
Endocrine disorders, particularly those involving hormonal imbalances, can influence gingival pigmentation. Addison’s disease, characterized by adrenal insufficiency, leads to increased melanin production, resulting in diffuse or patchy hyperpigmentation of the oral mucosa, including the gums. Conversely, conditions like hypopituitarism can cause decreased pigmentation. These hormonal fluctuations can lead to uneven distribution of melanin, resulting in variations in gum color.
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Autoimmune Diseases
Autoimmune diseases, such as lichen planus and pemphigus vulgaris, can manifest with oral lesions that affect the gingiva. Lichen planus can present as white, lacy patches (Wickham’s striae) or erosive lesions, while pemphigus vulgaris is characterized by blistering and ulceration of the mucous membranes. These lesions can create areas of discoloration, contrasting with the surrounding healthy tissue, resulting in a non-uniform appearance.
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Nutritional Deficiencies
Nutritional deficiencies, particularly deficiencies in vitamins and minerals, can impact the health of the gingiva. Vitamin C deficiency (scurvy) can cause gingival inflammation, bleeding, and ulceration. Iron deficiency can lead to pallor of the oral mucosa. These deficiencies can lead to variations in gum color, with inflamed or pale areas contrasting with normal-colored tissue.
In conclusion, a range of systemic diseases can manifest with alterations in gingival pigmentation, leading to disparate coloration. The recognition of these oral manifestations is crucial for early detection and management of underlying systemic conditions. Dental professionals play a pivotal role in identifying potential systemic involvement and referring patients for appropriate medical evaluation, ensuring comprehensive care and improved health outcomes.
6. Smoking
Tobacco use, specifically smoking, exerts a significant influence on gingival pigmentation, frequently resulting in uneven coloration. This effect, known as smoker’s melanosis, is characterized by an increased deposition of melanin within the gingival tissues. The degree and pattern of pigmentation vary, often presenting as brown or black patches that contrast with the normal pink hue of the gums. This uneven distribution of melanin creates a disparate color appearance. The stimulation of melanocytes by components within tobacco smoke, such as nicotine and benzopyrenes, leads to increased melanin production. The severity and extent of melanosis correlate with the duration and intensity of smoking habits. For example, a long-term smoker may exhibit extensive, dark brown pigmentation across the entire gingiva, whereas a lighter smoker may present with more localized or subtle discoloration.
The practical significance of understanding the connection between smoking and differential gum coloration lies in its implications for oral health assessment and patient counseling. Dental professionals can use the presence of smoker’s melanosis as an indicator of tobacco use, even if the patient is not forthcoming about their smoking habits. The visual evidence can serve as a powerful tool for motivating smoking cessation. It’s also important to differentiate smoker’s melanosis from other causes of gingival pigmentation, such as amalgam tattoos or systemic diseases, to ensure appropriate diagnosis and treatment. Moreover, the presence of smoker’s melanosis can mask underlying inflammatory conditions, making it more challenging to assess the true state of periodontal health.
In summary, smoking is a prominent factor contributing to uneven gingival pigmentation. Smoker’s melanosis, characterized by increased melanin deposition, results in brown or black patches that contrast with the normal gum color. Recognizing this association is crucial for accurate oral health assessment, patient education regarding the detrimental effects of tobacco, and differentiating this condition from other causes of gum discoloration. Addressing smoking habits is essential not only for improving gingival aesthetics but also for promoting overall oral and systemic well-being.
7. Addison’s disease
Addison’s disease, or primary adrenal insufficiency, directly impacts gingival pigmentation and may result in uneven gum coloration. This condition involves the inadequate production of cortisol and aldosterone by the adrenal glands, triggering a cascade of physiological changes that affect melanin deposition in various tissues, including the gums.
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Hyperpigmentation Mechanism
The primary mechanism linking Addison’s disease to altered gum color is the elevated level of adrenocorticotropic hormone (ACTH). In response to diminished cortisol production, the pituitary gland secretes increased amounts of ACTH. ACTH shares a precursor molecule with melanocyte-stimulating hormone (MSH). Elevated ACTH levels stimulate melanocytes, leading to increased melanin synthesis and deposition in the skin and mucous membranes, including the gingiva. This manifests as areas of hyperpigmentation.
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Clinical Presentation in Gums
In the oral cavity, Addison’s disease typically presents as diffuse or patchy brown or black pigmentation on the gums. The pigmentation may be localized or widespread, creating a mottled or uneven appearance. These pigmented areas are often observed on the buccal mucosa, tongue, and lips in addition to the gingiva. The appearance can be quite striking, with sharply defined borders between the normal and hyperpigmented tissues. This distinct coloration is a significant diagnostic clue.
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Diagnostic Significance
The presence of unusual hyperpigmentation in the gums should prompt clinicians to consider Addison’s disease, particularly if accompanied by other suggestive symptoms such as fatigue, weight loss, muscle weakness, and low blood pressure. A thorough medical history and physical examination are essential, followed by diagnostic testing, including ACTH stimulation tests and measurement of serum cortisol levels. Early diagnosis and treatment are critical to prevent adrenal crisis, a life-threatening complication of Addison’s disease.
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Differential Diagnosis
It is important to differentiate the gingival hyperpigmentation associated with Addison’s disease from other causes of oral pigmentation, such as physiologic pigmentation, drug-induced pigmentation, and amalgam tattoos. Addison’s disease typically presents with more widespread pigmentation and is often accompanied by systemic symptoms. A comprehensive clinical evaluation and appropriate diagnostic testing are necessary to establish an accurate diagnosis.
The relationship between Addison’s disease and altered gum coloration underscores the importance of considering systemic conditions in the evaluation of oral manifestations. Gingival hyperpigmentation can serve as an early indicator of Addison’s disease, facilitating timely diagnosis and treatment. Therefore, dental professionals must be vigilant in recognizing these oral signs and collaborating with medical colleagues to ensure optimal patient care.
8. Oral cancer
Oral cancer can manifest as localized changes in gingival pigmentation, contributing to the phenomenon of disparate gum coloration. The development of cancerous lesions within the oral cavity may disrupt the normal vascularity and tissue composition, leading to observable differences in color. For example, a squamous cell carcinoma, a common type of oral cancer, can present as a white or red patch (leukoplakia or erythroplakia, respectively) on the gums, distinctly contrasting with the surrounding healthy pink tissue. This atypical coloration should raise suspicion and prompt further investigation.
The significance of recognizing oral cancer as a potential etiology for uneven gum pigmentation lies in the need for early detection and intervention. The presence of a non-healing ulcer, an area of induration, or an unusual color change in the gums warrants prompt referral to an oral surgeon or other qualified healthcare professional for biopsy and histopathological examination. Delay in diagnosis and treatment can significantly impact prognosis and survival rates. A practical example is the identification of a dark, irregularly shaped lesion on the gums that, upon biopsy, reveals to be melanoma, a less common but highly aggressive form of oral cancer. Early detection allows for surgical excision and adjuvant therapies, improving the chances of successful treatment.
In summary, oral cancer is a critical consideration in the differential diagnosis of disparate gingival coloration. The presence of suspicious lesions, such as leukoplakia, erythroplakia, or non-healing ulcers, should prompt immediate evaluation. Understanding this connection emphasizes the importance of regular oral cancer screenings and patient education regarding self-examination. Early detection and prompt treatment are paramount to improving outcomes and reducing morbidity and mortality associated with oral malignancies.
9. Vascular anomalies
Vascular anomalies in the gingiva can manifest as localized color changes, contributing to the overall presentation of disparate gum coloration. These anomalies encompass a spectrum of conditions, ranging from benign vascular proliferations to more complex malformations involving blood vessels. The etiology of vascular anomalies varies, including congenital factors, trauma, and developmental aberrations. The color changes observed are directly related to the abnormal presence and concentration of blood vessels within the gingival tissues.
Common examples of vascular anomalies affecting the gums include hemangiomas, pyogenic granulomas, and varicosities. Hemangiomas are benign tumors composed of blood vessels, typically appearing as raised, reddish-blue lesions. Pyogenic granulomas, although not true granulomas, are rapidly growing vascular proliferations that often occur in response to local irritation or trauma, presenting as red or purple nodules. Varicosities, or dilated veins, can appear as bluish, tortuous vessels near the surface of the gums. The presence of these distinct vascular lesions creates a noticeable contrast with the surrounding healthy gingival tissue, leading to an uneven appearance. Accurate diagnosis often requires clinical examination and, in some cases, imaging or biopsy to rule out other conditions.
Understanding the role of vascular anomalies in causing uneven gum coloration is critical for appropriate clinical management. While many vascular anomalies are benign and may not require treatment, others may necessitate intervention due to aesthetic concerns, bleeding tendencies, or functional impairment. Treatment options range from conservative measures such as observation and oral hygiene improvements to more invasive procedures like surgical excision, laser therapy, or sclerotherapy. Accurate diagnosis, coupled with appropriate management strategies, ensures optimal outcomes for patients presenting with gingival color variations related to vascular abnormalities.
Frequently Asked Questions About Differential Gingival Pigmentation
The following section addresses common inquiries regarding variations in gum coloration, providing concise and informative answers to enhance understanding of this condition.
Question 1: What are the primary reasons for gums exhibiting disparate colors?
Gums may appear in two or more colors due to various factors, including physiological melanin pigmentation, amalgam tattoos, medication side effects, inflammation, systemic diseases, smoking-related melanosis, and, in rare cases, oral cancer or vascular anomalies.
Question 2: Is uneven gum coloration always a cause for concern?
While differential gum pigmentation is often benign, it can indicate underlying medical or dental issues. Therefore, a thorough evaluation by a dental professional is necessary to determine the etiology and rule out any serious conditions.
Question 3: How does smoking impact gum color?
Smoking can lead to smoker’s melanosis, characterized by increased melanin deposition in the gums. This results in brown or black patches that contrast with the normal pink color, creating an uneven appearance.
Question 4: Can medications cause changes in gum pigmentation?
Yes, certain medications, such as minocycline and some antimalarial drugs, can induce changes in gum pigmentation. These changes may manifest as bluish-gray or brownish-black discoloration, contributing to differential coloration.
Question 5: What role does inflammation play in altering gum color?
Gingival inflammation, often associated with periodontal disease, can cause increased blood flow and erythema (redness). In some cases, it can also lead to edema (swelling), making the tissue more translucent and altering its color. Severe inflammation may result in ulceration and necrosis, further contributing to variations in gum appearance.
Question 6: What systemic diseases are associated with changes in gum pigmentation?
Several systemic diseases can affect gum color. Examples include Addison’s disease (leading to hyperpigmentation), anemia (causing pallor), and leukemia (resulting in enlargement, bleeding, and pallor). Autoimmune diseases like lichen planus can also cause lesions that alter gum appearance.
Understanding the potential causes of differential gum pigmentation is essential for maintaining oral health. Any unexplained changes in gum color should be promptly evaluated by a qualified dental professional.
The next section will outline steps to promote optimal gingival health and preventive measures.
Maintaining Optimal Gingival Health
Achieving and maintaining optimal gingival health is paramount in preventing and managing conditions that contribute to uneven gum coloration. Consistent adherence to evidence-based practices is essential for preserving the integrity and aesthetic appearance of the gums.
Tip 1: Practice Meticulous Oral Hygiene: Regular and thorough oral hygiene practices are foundational for gingival health. This includes brushing at least twice daily with fluoride toothpaste, using a soft-bristled toothbrush to avoid trauma. Employ interdental cleaning aids such as dental floss or interdental brushes daily to remove plaque and debris from between teeth, areas often missed by brushing alone. Proper plaque control minimizes inflammation and reduces the risk of gingival discoloration associated with periodontal disease.
Tip 2: Attend Regular Dental Check-ups and Cleanings: Routine dental examinations and professional cleanings are essential for detecting and addressing early signs of gingival disease. Dental professionals can identify subtle changes in gum color, texture, and contour that may indicate underlying problems. Scaling and root planing, performed during professional cleanings, remove hardened plaque (calculus) and smooth root surfaces, preventing the accumulation of bacteria and reducing inflammation.
Tip 3: Adopt a Balanced Diet: A nutrient-rich diet supports overall oral health and strengthens gingival tissues. Ensure adequate intake of vitamins and minerals, particularly Vitamin C, which is crucial for collagen formation and wound healing. Limit the consumption of sugary and processed foods, as these contribute to plaque formation and increase the risk of gingivitis and associated color changes.
Tip 4: Abstain From Tobacco Use: Smoking and other forms of tobacco use are significant risk factors for gingival discoloration and periodontal disease. Tobacco smoke irritates and inflames gingival tissues, leading to increased melanin production and smoker’s melanosis. Quitting tobacco use can improve gingival health and reduce the likelihood of uneven pigmentation.
Tip 5: Manage Systemic Health Conditions: Systemic diseases, such as diabetes and autoimmune disorders, can impact gingival health and pigmentation. Effective management of these conditions, through medication, lifestyle modifications, and regular medical check-ups, helps to minimize their impact on the oral cavity. Maintain open communication with both dental and medical providers to ensure coordinated care.
Tip 6: Avoid Irritants: Minimize exposure to potential gingival irritants, such as harsh mouthwashes, abrasive toothpastes, and ill-fitting dental appliances. These irritants can cause inflammation and discoloration. Opt for gentle, fluoride-containing mouthwashes and toothpastes, and ensure that dental appliances are properly fitted and maintained.
Consistent implementation of these tips promotes a healthy gingival environment, reducing the risk of uneven gum coloration and supporting long-term oral health and aesthetics.
The concluding section will recap key points and emphasize the importance of professional evaluation.
Gingival Discoloration
This examination of the factors influencing gingival pigmentation has demonstrated the multifaceted nature of the condition often described as “why are my gums two different colors.” It encompasses physiological variations, localized irritations, systemic conditions, and potentially neoplastic processes. The presence of disparate coloration can serve as a crucial indicator of underlying health issues, warranting careful consideration by both patients and clinicians.
Given the diverse etiologies, self-diagnosis is ill-advised. Instances of uneven gum color necessitate professional evaluation to ensure accurate diagnosis and timely intervention. Prioritizing regular dental examinations and prompt attention to oral changes remain essential for safeguarding overall health and well-being. Continued research and awareness are vital to further refine diagnostic approaches and improve patient outcomes.
