Swollen Gums: Causes and Treatment

What swollen gums look like

Healthy gums are pale pink (or evenly pigmented in darker-skinned people), firm and fit snugly around the teeth. Swollen gums may:

• look red or dark red, shiny and puffy
• bulge between the teeth
• bleed when brushing or flossing
• feel tender or sore
• pull away from the teeth over time

Common causes of swollen gums

Gingivitis

Plaque is a sticky film of bacteria that builds up along the gumline when it is not removed daily. Within days, the gums become inflamed. Gum disease at this early stage, called gingivitis, is very common and fully reversible. Typical signs are red, puffy gums that bleed when you brush, and bad breath.

Periodontitis

Untreated gingivitis can progress to periodontitis, where the infection damages the bone and tissue that hold teeth in place. Gums recede, pockets form between the teeth and gums, and teeth may loosen. This damage is not reversible but can be stopped. Smoking and diabetes greatly increase the risk.

Gum or tooth abscess

A dental abscess is a pocket of pus from a tooth infection or a deep gum pocket. It causes a painful, swollen lump on the gum near one tooth, throbbing pain, a bad taste if it drains, and sometimes fever and facial swelling. It needs dental treatment.

Food trapped under the gum

A popcorn husk or seed caught between the tooth and gum can cause sudden swelling around one tooth. Gentle flossing and warm salt-water rinses usually resolve it.

Wisdom teeth

A partly erupted wisdom tooth can trap food under a flap of gum, causing pericoronitis: swelling, pain, bad taste and difficulty opening the mouth.

Pregnancy

Hormone changes make gums more reactive to plaque. Pregnancy gingivitis affects many pregnant women, typically from the second month. Some develop a "pregnancy tumor", a harmless red lump on the gum that usually shrinks after birth.

Medicines

Some medicines cause the gums to overgrow (gingival enlargement), especially with poor plaque control:

• phenytoin (for seizures)
• calcium channel blockers such as nifedipine and amlodipine
• cyclosporine (an immune suppressant)

Infections

• Herpes gingivostomatitis: in young children, painful swollen gums with mouth ulcers, fever and drooling. See gingivostomatitis.
• Oral thrush: white patches that can affect the gums.
• Acute necrotizing gingivitis: painful, bleeding gums with gray ulcers between the teeth and very bad breath, linked to stress, smoking and poor immunity.

Other causes

• Hormonal changes during puberty, menstrual cycles and with hormonal contraception
• Poorly fitting dentures or braces
• Mouth breathing, which dries the gums
• Sensitivity to toothpaste or mouthwash ingredients

Rare but serious causes

• Leukemia: leukemia cells can infiltrate the gums, causing swelling and bleeding, along with tiredness, bruising and infections.
• Scurvy: severe vitamin C deficiency causes swollen, spongy, bleeding gums, with easy bruising and poor wound healing.

Swollen gum around one tooth

Swelling limited to one tooth usually means food trapped under the gum, a gum or tooth abscess, a cracked tooth, or a wisdom tooth problem. If it is painful, throbbing or does not settle within 1 to 2 days of gentle cleaning and salt-water rinses, see a dentist.

How swollen gums are diagnosed

A dentist will examine your gums, measure the depth of the pockets between teeth and gums with a small probe, check for loose teeth, and often take X-rays to look at bone levels and tooth infections. They will ask about medicines, pregnancy, smoking and general health. If gum changes suggest a blood disorder, your doctor will arrange a blood count.

Treatment for swollen gums

Home care

• Brush twice a day for 2 minutes with a soft-bristled or electric toothbrush and fluoride toothpaste, angling the bristles toward the gumline.
• Clean between your teeth daily with floss or interdental brushes. Bleeding usually lessens within 1 to 2 weeks.
• Rinse with warm salt water (half a teaspoon of salt in a cup of warm water) to soothe sore gums.
• Use an antiseptic mouthwash as directed on the label for a short period if recommended by your dentist.
• Pain relief: acetaminophen (paracetamol) or ibuprofen at the label dose.
• Stop smoking. Smoking worsens gum disease and hides bleeding, delaying diagnosis.
• Stay hydrated and limit sugary snacks and drinks.

Dental treatment

• Professional cleaning (scaling and polishing) removes hardened plaque (tartar).
• Deep cleaning (scaling and root planing) for periodontitis.
• Abscess treatment: drainage, root canal treatment or extraction, with antibiotics if infection is spreading.
• Medicine-related overgrowth: improved oral hygiene, a medicine review with your doctor, and sometimes gum surgery.
• Wisdom tooth problems: cleaning under the gum flap, and sometimes removal.

Prevention

• Brush twice daily and clean between teeth every day.
• See a dentist for checkups and cleanings, usually every 6 to 12 months.
• Control diabetes.
• Don't smoke.
• Eat a diet with enough fruit and vegetables for vitamin C.

Frequently asked questions

What causes swollen gums?

The most common cause is gingivitis, inflammation from plaque bacteria along the gumline. Other causes include gum or tooth abscesses, trapped food, wisdom teeth, pregnancy, certain medicines and mouth infections. Rarely, leukemia or vitamin C deficiency causes swollen gums.

How do I get rid of swollen gums fast?

Brush gently twice daily, floss once a day, and rinse with warm salt water. Swelling from gingivitis usually improves within 1 to 2 weeks. If the swelling is painful, localized to one tooth, or not improving, see a dentist.

Why is my gum swollen around one tooth?

Localized swelling usually means food is trapped under the gum, an abscess is forming, or a wisdom tooth is coming through. If it throbs, has a pimple-like bump, or comes with fever, see a dentist promptly.

Are swollen gums normal during pregnancy?

They are common. Hormonal changes make the gums react more strongly to plaque, causing pregnancy gingivitis. Good brushing and flossing and a dental checkup during pregnancy help. Dental cleanings are safe in pregnancy.

Can swollen gums be a sign of something serious?

Usually not, but they can be. Swollen, bleeding gums with unexplained bruising, tiredness, frequent infections or weight loss should be checked for a blood disorder such as leukemia. Severe gum disease is also linked with diabetes and heart disease.