Gingivitis

Some drugs can cause an overgrowth (hyperplasia) of gum tissue, so that removing plaque becomes more difficult, and gingivitis often develops. Phenytoin (taken to control seizures), cyclosporine (taken by people who have had organ transplants), and calcium channel blockers such as nifedipine (taken to control blood pressure and heart rhythm abnormalities) can cause such an overgrowth. Also, oral or injectable contraceptives can aggravate gingivitis, as can exposure to lead or bismuth (which is used extensively in cosmetics) or to other heavy metals such as nickel (used in jewelry).

Medical conditions that might cause or worsen gingivitis should be treated or controlled. If people must take a drug that causes gum tissue overgrowth, the excess gum tissue may need to be removed surgically. However, meticulous oral hygiene at home and frequent cleanings by a dentist or dental hygienist may slow the rate of tissue growth and eliminate the need for surgery.

Vitamin deficiencies, in rare cases, can cause gingivitis. Vitamin C deficiency Vitamin C Deficiency In countries with low rates of food insecurity, vitamin C deficiency can occur from a diet low in vitamin C, but severe deficiency (causing scurvy) is uncommon. Not eating enough fresh fruits... read more (scurvy) can lead to inflamed, bleeding gums (see Periodontitis Periodontitis Periodontitis is a severe form of gingivitis, in which the inflammation of the gums extends to the supporting structures of the tooth. Plaque and tartar build up between the teeth and gums and... read more ). Red or purple dots and bruises may appear in the mouth.

Niacin deficiency (pellagra Niacin Deficiency Niacin deficiency (causing pellagra) is uncommon in countries with low rates of food insecurity. Many people with niacin deficiency also have deficiencies of protein, riboflavin (a B vitamin)... read more ) also causes inflamed, bleeding gums and a predisposition to certain mouth infections, such as thrush Candidiasis Candidiasis is a fungal infection caused by several species of the yeast Candida, especially Candida albicans. The most common type of candidiasis is a superficial infection of... read more , or to inflammation of the tongue (glossitis). Additionally, the lips are red and cracked, the tongue is smooth and bright red, and the tongue and lining of the mouth may have sores.

These deficiencies are rare in the United States.

Vitamin C and niacin deficiencies can be treated with vitamin C and niacin supplements, plus a diet that includes more fresh fruits and vegetables.

Pregnancy can worsen mild gingivitis, primarily because of hormonal changes. Some pregnant women may unknowingly contribute to the problem by neglecting oral hygiene because they feel nauseated in the morning (morning sickness) and fatigued. Also during pregnancy, a minor irritation, often the buildup of tartar or a restored tooth with a rough edge, may cause a soft, reddish, lumplike overgrowth of gum tissue, called a pregnancy tumor (pyogenic granuloma Pyogenic Granulomas Pyogenic granulomas are fleshy, moist or crusty, and red or reddish brown slightly raised bumps caused by an increased growth of capillaries (the smallest blood vessels) and swelling of the... read more ). The bloated tissue bleeds easily if injured and may interfere with eating.

If pregnant women are neglecting oral hygiene because of morning sickness and/or fatigue, dentists can suggest ways to keep the teeth and gums clean without making the nausea worse. Gentle brushing without toothpaste, or even salt water rinses after brushing, can help. A bothersome pregnancy tumor can be surgically removed. However, such tumors tend to recur until, and even after, the pregnancy ends.

Menopause can cause desquamative gingivitis, a poorly understood, painful condition that occurs most commonly in postmenopausal women. In this condition, the outer layers of the gums bleed easily and separate from the underlying tissue (desquamate), exposing nerve endings. The outer layers of the gum tissues can be rubbed away with a cotton swab or blown off with a dentist’s air syringe.

If desquamative gingivitis develops during menopause, hormone replacement therapy may help. Otherwise, dentists may prescribe a corticosteroid rinse or a corticosteroid paste that is applied directly to the inflamed areas.

Leukemia Leukemias can cause gingivitis. In fact, gingivitis is the first sign of disease in about 25% of children with leukemia. An infiltration of leukemia cells into the gums causes the gingivitis, and a reduced ability to fight infections worsens it. The gums become swollen, painful, and red and bleed easily. Often, the bleeding continues for several minutes or more because blood does not clot normally in people with leukemia. Less commonly, cancer can form in the gum tissue Mouth and Throat Cancer Mouth and throat cancers are cancers that originate on the lips, the roof, sides, or floor of the mouth, tongue, tonsils, or back of the throat. Mouth and throat cancers may look like open sores... read more .

A person with gingivitis due to leukemia can prevent bleeding by gently wiping the teeth and gums with a gauze pad or sponge instead of brushing and flossing. Dentists can prescribe a chlorhexidine mouth rinse to control plaque and prevent mouth infections. When the leukemia is in remission (when evidence of the cancer disappears), good dental care can restore the gums to health.

Viral infections can cause gingivitis. Acute herpetic gingivostomatitis is a painful viral infection of the gums and other parts of the mouth caused by the herpes virus Herpes Simplex Virus (HSV) Infections Herpes simplex virus infection causes recurring episodes of small, painful, fluid-filled blisters on the skin, mouth, lips (cold sores), eyes, or genitals. This very contagious viral infection... read more . The infection turns the gums bright red and causes many small white or yellow sores to form inside the mouth.

Acute herpetic gingivostomatitis usually gets better in 2 weeks without treatment. Intensive cleaning does not help, so a person should brush gently while the infection is still painful. Dentists may recommend an anesthetic mouth rinse to relieve discomfort while eating and drinking.

Fungal infections can cause gingivitis as well. Fungi commonly grow in the mouth in very small amounts. Use of antibiotics or a change in overall health can increase the number of fungi in the mouth. Thrush Symptoms Candidiasis is infection with the yeast Candida. Candidiasis tends to occur in moist areas of the skin. This skin infection may cause rashes, scaling, itching, and swelling. Doctors examine... read more (candidiasis) is a fungal infection in which the overgrowth of fungi, particularly Candida albicans, forms a white or red patch that irritates the gums. Patches can also coat the tongue and corners of the mouth and leave a bleeding surface if wiped away.

Thrush can be treated with an antifungal drug, such as nystatin, in the form of a mouth rinse or a lozenge designed to dissolve slowly in the mouth. Dentures should be soaked overnight in nystatin solution as well. Good oral hygiene (proper brushing and flossing) and treatment of underlying dental problems, such as ill-fitting dentures, can also help.

Gingivitis can develop in the gums surrounding the crown of an impacted tooth (a tooth that has not fully emerged). In this condition, called pericoronitis, the gum swells over the tooth that has not fully emerged. The flap of gum over the partially emerged tooth can trap fluids, bits of food, and bacteria.

Pericoronitis most commonly occurs around wisdom teeth (3rd molars), particularly the lower wisdom teeth. If the upper wisdom tooth emerges before the lower one, it may bite on this flap, increasing the irritation. Infections can develop and spread to the throat or cheek. The flap disappears once the tooth has fully emerged.

When people have pericoronitis, dentists may flush salt water under the flap of gum to rinse out the debris and bacteria. Sometimes, people are instructed to rinse at home with salt water, hydrogen peroxide, or the antiseptic chlorhexidine. If x-rays show that a lower tooth is not likely to emerge completely, dentists may remove the upper tooth and prescribe antibiotics for a few days before removing the lower one. Sometimes dentists remove the lower tooth immediately.