If you’ve visited your dentist recently, chances are they’ve reminded you about the importance of maintaining healthy gums. The gums provide an essential barrier between oral bacteria and the bloodstream and serve as the foundation for strong teeth [1].
Unfortunately, the gum tissue is sensitive and vulnerable to irritation and inflammation. Swollen gums, formally termed “gingival swelling,” are the main symptom of gingivitis (gum disease), which is a common oral health issue. Gingival swelling may result in irritated, sensitive, or painful gums which bleed more easily when brushing or flossing your teeth [2]. Such a condition is not only unpleasant, but may lead to loose teeth and susceptibility to infection by oral bacteria [2]. Understanding the causes of swollen gums can allow one to take effective preventative measures against gingivitis and maintain good oral health.
Common causes of swollen gums
What causes swollen gums?
Swollen gums may occur for several reasons, including:
- Gingivitis: the most common cause of gingival swelling is gingivitis, or gum disease. Gingivitis is caused by poor oral hygiene and a build-up of plaque on the gum line and teeth [2]. If plaque remains on the teeth for more than a few days, it becomes tartar, a hardened form of plaque that can't be removed with flossing and brushing alone. Tartar provides a breeding ground for oral bacteria, which feed off of the sugars and minerals in the deposits [3]. This can lead to tooth decay, inflammation, and gum disease.
- Periodontitis: periodontitis occurs due to inflammation of the periodontium, a type of soft tissue which contains the gingiva as well as the bones responsible for keeping teeth firmly anchored [4]. Periodontitis often results from unresolved gingivitis and is a more severe form of gum disease.
- Hormonal changes: changes in hormones such as estrogen and progesterone can impact blood flow to the gums, leading to swelling, redness, or bleeding. High estrogen levels, which occur during female puberty, pregnancy, and certain phases of the menstrual cycle, increase blood flow to the gingiva and therefore may cause swelling and increased bleeding [5].
- Medications: Certain medications such as Amlodipine, a calcium channel blocker used for hypertension, can cause severe gingival swelling and enlargement [6].
Swollen gums and cancer
It's important to note that there are many other more common causes of gingival swelling. However, swollen gums can potentially be a sign of cancer.
Oral cancer is a type of carcinoma that occurs due to uncontrolled proliferation of squamous cells, the flat cells lining body surfaces and cavities such as the mouth and throat [7]. While oral cancer primarily affects the mouth, tongue, and lips, cancerous cells can spread into deeper tissue and potentially metastasize to other body sites [8].
Signs and symptoms of oral cancer
Persistent swollen gums and canker sores can be signs of oral cancer. Along with gingival swelling, other symptoms of oral cancer include [9]:
- Changes in the appearance or color of the gums
- Persistent mouth sores
- A painful lump or growth inside the mouth
- Difficulty chewing or swallowing
- Chronic sore throat
- Unexplainable bleeding or numbness in the mouth
Causes and risk factors of oral cancer
Like most cancers, oral cancer results due to DNA mutations which permit unrestrained cell proliferation and spread. Such mutations occur randomly and do not have a singular cause; however, there are various factors associated with increased risk of oral cancer.
Risk factors for oral cancer include [10, 9]:
- Tobacco use
- Heavy alcohol consumption
- Excessive UV exposure to the lips
- Human papillomavirus (HPV) infection
- Immunodeficiency
- Periodontitis
When to see a dentist or a doctor
If you experience persistent swollen gums, painful sores, bleeding, or numbness in the mouth for over 2 weeks, you should schedule an appointment with your dentist and/or doctor to investigate your symptoms. If differential diagnoses such as gum infection, medication side effects, or hormonal changes are ruled out, further testing may be recommended [9].
Conclusion
Swollen gums can result from a variety of factors, including poor oral hygiene, gum diseases like gingivitis or periodontitis, medication side effects, or hormonal imbalances. However, in some cases, swollen gums can indicate a more serious medical issue such as oral cancer. Although most cases of gingival swelling are not due to cancer, it is worth seeing your dentist and/or doctor if you experience painful swelling, bleeding, discoloration, canker sores, and/or numbness for over 2 weeks. To protect against oral cancer, it is advisable to avoid tobacco, heavy alcohol use, maintain good oral hygiene, and use an SPF-containing lip balm when exposed to sun for prolonged periods. Though oral cancer can be serious, it can be guarded against by regular visits to your dentist and maintenance of good oral health.