Overview

Swollen gums are a common health complaint, and can be a cause for concern when the cause is unclear. Inflammation of this sensitive tissue can occur due to infection, irritation, hormonal changes, certain nutrient deficiencies, or as a side effect of medication. Good oral health is crucial to general wellbeing and swollen gums may indicate dental issues or underlying health issues, which should not be ignored. Here we will talk you through how to recognise and alleviate swollen gums, avoid habits that cause it, and when to seek dental or medical advice.

Importance of healthy gums

Your gums are an important connective tissue which protects your jawbone and keeps your teeth in place. Where your gums and teeth meet, there is something called the ‘periodontal membrane’ that holds your teeth tightly in place against your gums and contains many blood vessels and nerve endings.

Your gums require regular cleaning and good oral hygiene to stay healthy. When your gums are in good health, they are pink or light-brown, firm to the touch, and won’t bleed or cause pain easily.

Signs of swollen gums

If they appear swollen, red, soft to the touch, and bleed or hurt during eating, brushing or throughout the day, then this indicates problems with your gum health. Other symptoms that may accompany swollen gums are receding gums or bad breath (known as ‘halitosis’).

If not properly cared for, swollen gums can be one of the first symptoms indicating you may be at risk of cavities, or more serious gum infections known as gingivitis and periodontitis. They can also indicate other underlying conditions, nutrient deficiencies or reactions to medication. Altogether, your oral health can impact your general well-being, such as your heart, lungs, and even mental health.

Causes of swollen gums

Bacterial infections

Plaque buildup and tartar

A common cause of swollen gums is infection due to poor oral hygiene. Your dental hygiene regimen should include:

• Brushing twice a day
• Daily flossing
• Avoiding sugary food and drinks
• Getting regular dental check-ups

If this routine is not followed, your teeth and gums will gradually accumulate something known as plaque. Plaque is a film of bacteria that appears on your teeth, feeding on sugars and starches left from the food or drinks you’ve consumed. If it is not removed regularly by cleaning, the bacteria in this plaque can harden to form a substance called tartar which will need to be removed by a dentist.

The plaque will continue to build up and produce acids that damage the enamel of your teeth and gum tissue, making you susceptible to cavities and infection.

Gingivitis 

Gingivitis is one of the most common causes of swollen gums and is an infection of the soft tissue in the gums. Although it can usually be treated, if left unchecked, it can develop into more severe forms of progressive gum disease.

Untreated gingivitis can develop into periodontitis as deep gaps form between the teeth and gums in the periodontal membrane. Periodontitis is a deeper infection of the gums that can spread into the jawbone, causing bone loss.

Another severe form of gingivitis is necrotising ulcerative gingivitis, also known as ‘Trench Mouth’. This is where the infection spreads to soft tissue rather than the bone. This can cause cells in the tissue to die (necrosis) and leave crater-like sores in the gums.¹

Causes of gingivitis

Whilst poor dental hygiene is one of the leading causes of swollen gums, a number of other underlying health issues can cause swelling or increase the risk of gum disease.

Hormonal changes

Hormonal changes can also cause gum swelling. Oestrogen and other hormones that fluctuate during puberty, menstruation, pregnancy, and menopause may increase blood flow to the gums and change the way gum tissue reacts to dental plaque. This can sometimes lead to gingivitis.

Fortunately, these symptoms are usually temporary and typically subside after puberty, pregnancy or the menstrual cycle has finished. As the increased sensitivity of the gums is a reaction to plaque during these hormonal cycles, maintaining good oral hygiene can minimise plaque formation and reduce gum swelling.

Changes in hormone levels during menstruation are permanent, and alongside the natural reduction in bone density that occurs during ageing, might make the gums more susceptible to periodontal disease in later life. Oral contraceptives work by changing hormone levels, and may also increase the risk of gum disease.²

Medication side effects

Oral contraceptives are not the only medications that can cause gum swelling. Technically referred to as ‘drug-induced gingival overgrowth’, different drugs may cause swelling in different ways. A wide range of drugs can cause this, such as:

• Anticonvulsants
• Calcium-channel blockers
• Immunosuppressants 

Medications that cause dry mouth as a side effect can also increase plaque buildup. However, the risk and severity of gum disease as a side effect may be associated with the degree of plaque buildup, meaning good oral hygiene can help minimise this.³

Diabetes and autoimmune disease

Some health conditions, seemingly unrelated to the mouth, may cause swollen gums.

One example is in individuals with type 2 diabetes, where the rate of dental health issues is about 3 times that of people who are non-diabetic. Type 1 diabetes also increases the risk of oral health problems.

Inflammatory bowel disease (IBD), particularly Crohn's disease, can cause swelling of the gums amongst other oral symptoms like sores.⁴

Nutritional deficiencies

Vitamins and minerals are essential in maintaining good oral health and preventing gum disease. Examples include:

• Magnesium
• Vitamin C
• Calcium
• Zinc 

These nutrients in particular are vital in promoting bone health, enamel formation, boosting the immune system or having an antioxidant effect.^5,6,7,8

Smoking and vaping

One of the major risks of smoking is susceptibility to gum disease, with some estimates placing the likelihood of gum disease in smokers to be twice that of non-smokers. The risk will increase depending on the number of cigarettes smoked and the duration of the smoking habit. It is thought that this is due to the harmful impact of smoking on the immune system and the ability of gum tissue to recover. 

Other tobacco products such as chewing tobacco have the same negative effect on gum health. Tobacco alternatives such as electronic cigarettes should also be avoided, as these too are associated with increased gum sensitivity and are thought to increase the risk of gum disease.⁹

Fitting retainers and dental implants

Another cause of gingivitis can actually stem from dental treatments. Although less common, the use of retainers that fit poorly and obstruct regular flossing and brushing can allow plaque buildup. Additionally, retainers that rub against the gums can cause soreness and bleeding, creating an entry point for bacteria that can cause gum disease.¹⁰

Treatment options for swollen gums

For healthy gums, prevention is better than cure – especially for individuals at increased risk due to existing health conditions or hormonal changes. Avoiding plaque buildup can prevent gingivitis. Brushing twice daily for at least two minutes, flossing daily, and using mouthwash or saline can help remove bacteria in hard-to-reach spots, such as between your teeth and around your rear molars.

It is also important to avoid habits like smoking or using e-cigarettes that may damage your gums and leave them vulnerable to infection. A balanced diet can help avoid the nutrient deficiencies that are associated with poor gum health.

Home treatment

Whilst it is important to see your dentist regularly, many home treatments can help alleviate and reverse symptoms of gum disease, such as temporary sensitivity and bleeding around the gums.

Natural remedies such as triphala and aloe vera found in herbal mouthwashes may be used in place of alcohol or chlorhexidine-based mouthwashes. These herbal remedies may be more suitable for individuals with sensitive gums and have been shown to effectively relieve pain, and inflammation to help prevent infection.¹¹

Another traditional method of promoting gum health is oil pulling. This involves swishing a small amount of edible oils (e.g., coconut, sunflower, sesame) and spitting it out before brushing. This practice has been shown to be beneficial in a number of small studies. However, as with other traditional methods, these treatments may support gum health but are not a replacement for dental or medical care.¹²

When to seek professional help

If swollen gums persist, symptoms worsen or keep recurring with no obvious cause, it is time to see a dentist.

Professional diagnosis and treatment

A dentist or doctor will likely start by examining the general health of your gums, inspecting for bleeding, soreness, and other symptoms that might indicate gingivitis. You may be referred to a dentist, who may perform periodontal probing. This is a procedure where a small metal probe is inserted to measure the depth of any gaps between the teeth and gums, indicating the extent of gum disease.

You may also have a radiograph (such as an x-ray) taken of your jaw to assess potential damage to the root of your teeth or jawbone.

Medical treatments

One of the most common treatments given by dentists for gingivitis is to clean tartar from the teeth using various instruments. Removing this tartar can allow the gums to heal and recover. In severe gum infections, antibiotics may be prescribed.

If the gingivitis has progressed into a more severe infection, treatments include tooth removal, or in very advanced cases, surgery.¹³

Summary

Swollen gums can be caused by a number of factors. The direct cause of inflammation and soreness is usually an infection caused by plaque and tartar buildup. However, other factors that may exacerbate swelling include dental treatments, medication, hormones, diet, and pre-existing health conditions.

Whilst gingivitis can usually be remedied easily, it is important to act on any symptoms quickly to prevent it from worsening into more serious dental health issues. In most cases, following good dental hygiene practices and avoiding harmful lifestyle choices can protect your gums and avoid painful swelling.