Swollen gums are quite common, and symptoms can appear in a variety of forms:

• Swollen, red, smooth and shiny gums;
• Gum pain on contact with food or when brushing teeth;
• Bleeding gums;
• Gingival recession;
• Ulcers with white or yellow centers;
• Hard lump under the gum.

The causes of pain in the gums or tissues of the mouth are very varied, and can easily be confused with dental pain. They may be specific to one area or generalized to the whole mouth.

SWELLING AROUND A BROKEN, DECAYED OR DEVITALIZED TOOTH

If a lump appears around a tooth that has been damaged by decay or has had a major filling in the past, there’s a strong likelihood that an infection has set in (dental abscess). In this case, the tooth is dead and contains bacteria and toxins that irritate the surrounding tissues. The tooth is then painful to the pressure and does not react to cold or heat, although in the past it may have been painful. This swelling may fluctuate over time. It can be more or less pronounced, and pus can sometimes be seen draining from it when pressure is applied to the bump. This pus evacuation route is called a fistula. It’s usually located in the mouth, around the periphery of the diseased tooth. However, in the presence of a major infection, the fistula can sometimes make its way into the skin, causing a visible lesion on the chin or cheek.

GONFLEMENT OU BOSSE SUR LES GENCIVES

Often, the appearance of the lump is preceded by severe pain. This is due to an inflammation called pulpitis. Pulpitis can cause severe pain when cold, hot or touched. Irreversible pulpitis, where the nerve of the tooth is damaged, potentially leading to tooth necrosis, causes severe pain that may persist for a long time. This pain may disappear or diminish when a lump appears on the gum (dental abscess).

SWELLING NEAR A PREVIOUSLY DEVITALIZED TOOTH

If the tooth has been devitalized in the past and a lump appears, it’s because, despite root canal treatment, toxins and bacteria may still be present in the hollow parts of the tooth. Fracture of a devitalized tooth can also lead to localized infection.

SWOLLEN GUMS BEHIND WISDOM TEETH

Another frequent cause of swelling in the mouth is pericoronitis. This is swelling of the gums surrounding erupting teeth (most often the lower wisdom teeth). This occurs when the erupting tooth creates an opening in the gum where food debris and bacteria can lodge. Pericoronitis sometimes resolves once the tooth has erupted, but it is often necessary to intervene to treat the infection.

SWELLING AROUND ONE OR MORE TEETH (PERIODONTAL PROBLEM)

When the swelling is located around the coronal portion of a tooth (the part visible in the mouth), it may be due to an infection originating in the structures that support the tooth, rather than the tooth itself. This is known as periodontitis. This condition may be localized to one or a few teeth, or may affect several teeth in the mouth. Periodontitis occurs when deposits of tartar or food debris encourage the accumulation of bacteria under the gums. The gums then become reddish and tend to bleed. This condition develops relatively slowly, although it can also progress rapidly. In the early stages of periodontal disease, there is usually no pain. Teeth react normally to cold and heat. However, as periodontitis progresses, teeth may begin to loosen, leading to increased sensitivity. In the absence of appropriate treatment, the alveolar bone deteriorates and teeth become loose.

SWOLLEN GUMS IN PREGNANT WOMEN

Due to hormonal factors, the gums of pregnant women are at greater risk of swelling and bleeding. These conditions often resolve once pregnancy is over, but it’s best to consult a dentist to see if treatment is required.

HARD BUMP AT BASE OF UPPER TEETH OR ON TONGUE SIDE OF LOWER TEETH (TORI)

If you see hard bumps on the gums facing the cheeks at the top and the tongue at the bottom, these may well be bony growths (tori). Tori are usually seen in patients who grind or clench their teeth. These bumps are very hard because they are made of bone. Bone apposition is a physiological reaction to protect the body. Indeed, in the presence of strong forces, the body consolidates the bone supporting the teeth in order to solidify them. On the other hand, the presence of such growths does not protect the tooth, but merely reinforces the tooth’s support. As a result, teeth are at risk of excessive wear or even fracture in the presence of these extreme forces.

OTHER CAUSES OF SWELLING OR PAIN

Although less common, there are many other causes of swelling or pain in the mouth. There may be a cyst or tumour (benign or cancerous). Oral cancers are more frequently found on the floor of the mouth or on the lateral edges of the tongue. In the presence of swelling accompanied by persistent ulceration, it is important to consult a dentist, who will examine the lesions. Other inflammatory conditions can also create lesions in the mouth, such as lichen planus and Crohn’s disease or other autoimmune diseases. Some medications have the side-effect of causing lichenoid lesions or the proliferation of fungi such as Candida Albicans (steroids used in pump therapy for asthma can have this effect). Redness can also result from burning or irritation caused by certain foods. Certain viral diseases, such as oral herpes or hand-foot-and-mouth disease, can also lead to oral lesions (vesicles which, once ruptured, give way to ulceration).

When plaque bacteria enter your gums, they cause an infection. The body reacts to these foreign bodies by attacking the bacteria, resulting in swelling. In all cases, swelling should not be neglected. If it’s mild, the solutions are simple (mouthwash or gum massage).

If it persists, it may be indicative of more serious problems such as gingivitis or periodontitis. In these cases, it’s usually best to consult your dentist without delay.

Sometimes, swollen gums are indicative of a more serious disorder, accompanied by other symptoms such as..:

• difficulty swallowing;
• difficulty breathing;
• high fever (over 38.5°C);
• severe bleeding from the gums.

In the presence of these symptoms, it is advisable to consult a dentist as soon as possible.