Swollen gums

Gingival swelling can be classified on the basis of the area covered and the location of the swelling.

Types of gum swelling according to the location:

• Marginal gingival swelling: This type of gum swelling involves marginal gingiva (gingiva which surrounds the teeth)
• Papillary gingival swelling: It involves swelling of the papillary gingiva (triangular-shaped gum tissue located between two teeth)
• Diffuse gingival swelling: When the swelling involves both marginal as well as papillary gingiva

Types of gum swelling according to distribution:

• Localised gingival swelling: If the swelling involves only a few teeth - less than 6
• Generalised gingival swelling: If the swelling involves the whole gum area or gum area of more than 6 teeth

Types of gum swelling according to the onset of swelling:

• Acute gingival swelling: When a gum swelling appears spontaneously like a gingival abscess due to deep caries in the associated tooth
• Chronic gingival swelling: When a gum swelling develops with time and persists like fibrotic gingival swelling

Gum swelling, in itself, is a symptom associated with an underlying oral condition. Patients having swollen gums also experience the following:

• Pain and tenderness in gums
• Gingival overgrowth
• Bleeding of gums on provocation or probing
• Redness and oedema in gingiva

Swollen gums could be because of various causative factors like:

• Gingivitis (inflammation of the gum): Gingivitis is an extremely common disease of dental origin which affects the gum tissues. It is usually caused by plaque and calculus accumulation on the tooth surface and mostly manifests in the form of inflammation or swelling in the gum.
• Periodontitis: It is an aggravated form of gingivitis. When the gingivitis progress and involves the bony tissues beneath the gums it is known as periodontitis.
• Tooth decay: When dental caries spreads to involve the soft tissue like pulp, gingiva and bone, it might cause the gum to swell. Sometimes, a sinus opening (an opening on the gum surface connecting to the infectious site inside the tissue) might also be seen on the gum due to deep bacterial infection or caries.
• Ill-fitting dentures: Ill-fitting dentures irritate the mucosa of the oral cavity where the discrepancy lies, thereby leading to swelling of the local area.
• Poorly fitted dental appliances: Poorly fitted dental implants like crowns or braces may impinge and irritate the gum tissue resulting in swelling. Ill-fitting dental appliances might also leave a sustainable space for plaque accumulation, leading to gingival swelling and gingivitis.
• Pregnancy: Hormonal changes during pregnancy leads to pyogenic granuloma in some women. It appears as skin outgrowths on the gingival tissue which tend to bleed.
• Viral infection: Several viral infections cause ulcers or lesions on gum tissues which may be associated with swelling in the surrounding area.
• Fungal infection: Fungal infections of the oral cavity may also cause the gingiva to swell.
• Malnutrition: Various vitamins and minerals deficiencies are associated with diseases like gingivitis or ulcers which have gum swelling as one of the primary symptoms. Vitamins which can affect gum tissues are vitamin B1, B2, B3, B6 and B12.
• Scurvy: It is a gum disease caused by vitamin C deficiency. One of the oral manifestations of scurvy is gingival swelling.
• Drug reaction: Several drugs may cause the gingiva to swell - leading to a condition called drug-induced gingival enlargement. This type of gum enlargement does not bleed on provocation but are tender and painful to touch. Drugs which might cause gums to swell are anticonvulsants (drugs for seizures), calcium channel blockers (drugs for hypertension) and immunosuppressants.
• Neoplasm: Several gingival neoplastic growths (cancerous growth on gingiva) may appear as gum swelling.
• Cysts: Gingival cysts also appear a gingival swelling.
• Fibroma: Few fibrotic lesions may appear on gingiva as swelling like fibrous epulis (tumour-like outgrowths on gums) or peripheral fibroma (benign gum swelling).
• Granuloma: Some types of granulomatous lesions might also involve gum tissues like peripheral giant cell granuloma.
• Poor oral hygiene: A bad oral hygiene leads to the accumulation of plaque and calculus over time, which is a major causative factor for gingival as well as periodontal diseases.
• Sensitive reaction to mouthwash and toothpaste: Allergic reactions caused by mouthwash or toothpaste can sometimes cause the gums to swell.
• Mouth breathing: People who have a habit of breathing from the mouth may develop gingival swelling or enlargement with time. It has been observed alternate drying and wetting of gums during mouth breathing may make the gingiva to swell up. Mouth breathers often present with red, swollen, edematous and shiny gingiva.

There is no specific tool to diagnose gum swelling. In most cases, patient history and detailed clinical examination help the expert to reach the definitive diagnosis. 

Treatment of gum swelling completely depends on its causative factor. If the underlying condition is eliminated, the inflammation will subside itself. 

The following methods are employed for reducing gum swelling:

Oral prophylaxis or scaling: The first and foremost professional treatment which doctors offer in case of gum swelling is cleaning of the oral cavity to remove any plaque and calculus. Plaque and calculus harbour bacteria which cause infection and gum swelling.

Endodontic treatment: If the swelling in gums is caused by the transmission of infection from pulp to gum tissue, eradication and obliteration of pulpal infection become the first line of treatment. Your dentist will perform a root canal treatment on the concerned tooth to remove the infection. As soon as the teeth enter into a healing stage, the gum swelling starts to recede.

Surgical excision: In several cases of gum swelling such as in pregnancy-related pyogenic granuloma surgical excision is the preferred treatment protocol. Surgical excision involves the targeted removal of the swollen mass or growth that is responsible for swelling. Makes sure to inform your dentist about the stage of pregnancy you are in before undergoing the procedure - most invasive procedures are done in the second trimester of pregnancy and are considered unsafe in the first and third trimester. 

Similarly, in cases of fibrotic growth or benign lesions of gum, your dentist might take a biopsy of the lesion and then remove the mass. Sometimes, the mass is completely excised surgically and then sent for biopsy.

Gingival cysts are also surgically removed by following special techniques for cyst removal.

If there is a nasal blockage caused by a nasal polyp, it can also be removed surgically so that the person can easily breathe from the nose instead of breathing from mouth.

Balanced diet: A balanced diet is recommended if gum swelling is caused by malnutrition or scurvy (vitamin C deficiency). A person suffering from malnutrition-related gingival swelling should eat fruits and vegetables in abundance to replenish the deficient nutrient.

Medications: In cases of severe infection, your doctor might prescribe a few medicines to control microbial growth. The cause of infection is elicited and drugs are given accordingly like antibiotics for bacterial infection, antifungal medicines for candidal infections or antiviral medicines for viral infections. Alternatively, ointments might also be given for localized control of infection.

Alternative drug: For drug-induced gingival enlargement, your doctor might ask you to change the said drug.

Habit breaking appliance and counselling: There are various orthodontic appliances specially designed to promote nasal breathing like an oral screen.

Maintaining good oral hygiene: A good oral hygiene practice will prevent as well as limit the progression of infections and gum swelling. Brush twice daily and floss after every meal. If you have an allergy from a particular toothpaste or mouthwash, stop using them. Finally, try to avoid sticky and sweet foods to prevent dental caries.