Swollen, painful gums: causes, what to do and when to see a dentist

Swollen and painful gums: what it usually means

A swollen, painful gum almost always signals inflammation or infection of the tissues around a tooth. The most common causes are plaque-related gingivitis, an abscess at the root tip or in the gum, infection around a wisdom tooth, and food trapped under the gum line. The swelling will not settle for good unless its cause is treated, so you should see a dentist, quickly if the pain is severe or your cheek is swelling.

Before the examination, two questions help you get your bearings:

• Where is the swelling? Around one tooth, at the very back behind the last molar, or along all the gums.
• What is the pain like? Throbbing in time with your pulse, a dull ache, or no real pain but red gums that bleed.

A throbbing pain with a localised swelling suggests a collection of pus. Red, puffy gums that bleed everywhere without sharp pain point more towards gum disease.

Swelling around one tooth: abscess, trapped food, cracked tooth

When one specific area is swollen, the dentist first looks for a local cause:

• A dental abscess: deep decay or an old injury has infected the pulp, and the infection drains out through the root tip. The tooth hurts when you bite, may feel "high", and the gum swells over the root.
• A periodontal abscess: it starts in a deep pocket between gum and tooth in someone with periodontitis. The tooth is often still alive but slightly loose.
• Food impaction: a fish bone, a popcorn husk or a meat fibre pushed under the gum can cause very painful inflammation within hours. A loose contact between two teeth or an overhanging filling makes this trap more likely.
• A cracked tooth: a crack running towards the root can keep a local infection going, with swelling that keeps returning to the same spot.
• Around a crown or implant: excess cement, a poorly fitting crown or inflammation around an implant produce the same picture.

The signs of an abscess and how urgent it is are covered in our article on dental abscess.

Swollen gum near a wisdom tooth: pericoronitis

A swollen gum right at the back of the mouth, behind the last molar, in a teenager or young adult, first suggests pericoronitis. The wisdom tooth has only partly come through and is covered by a flap of gum under which plaque and food collect without being cleaned away.

Typical signs:

• pain deep in the jaw, sometimes spreading to the ear or throat;
• red, puffy gum over the tooth, often marked where the upper tooth bites into it;
• difficulty opening your mouth or swallowing;
• a bad taste and bad breath on that side.

Immediate treatment consists of cleaning and irrigating under the flap, sometimes smoothing a cusp of the upper tooth that keeps biting the gum. Antibiotics are only prescribed if the infection spreads or comes with a fever. Once the flare-up has settled, the decision to keep or remove the tooth depends on space, position and how often the episodes recur.

Swollen gums all over: gingivitis, periodontitis, hormones

When the swelling affects all the gums, a single tooth is rarely to blame:

• Gingivitis: plaque left along the teeth irritates the gum, which becomes red, puffy and shiny and bleeds when brushed. It is reversible with scaling and better daily cleaning.
• Periodontitis: the inflammation has reached the bone, pockets form and abscesses may flare up. It requires in-depth gum treatment.
• Hormonal changes: pregnancy, puberty and some contraceptives amplify the gum's reaction to plaque. During pregnancy, a small red lump that bleeds easily, known as a pregnancy epulis, can form between two teeth.
• Certain medicines: some anti-epileptic drugs, immunosuppressants and calcium channel blockers used for high blood pressure can cause gum overgrowth. Never stop them without asking the doctor who prescribed them.
• A viral infection, such as a first herpes infection in a child, causes very inflamed gums with small blisters and fever.

More rarely, very swollen gums that bleed on their own, together with tiredness or unusual bruising, call for a medical check-up. If bleeding is your main symptom, our article on bleeding gums goes further.

A lump on the gum or a white gum: what you might notice

Some appearances are particularly worrying and deserve an explanation:

• A small pimple on the gum that releases a bad-tasting fluid and then comes back: this is often a sinus tract (fistula), the drainage outlet of a chronic infection at a root tip. The pain may have gone, but the infection remains and needs treating.
• A firm, painless pink lump: it may be a reactive growth caused by chronic irritation (tartar, the edge of a denture) or a normal bony bump called a torus. The dentist tells them apart on examination.
• A white gum around a tooth: after a burn from very hot food, a tablet left against the gum or a whitening product, the lining can turn white and then heal within days. White patches that wipe off suggest thrush; lacy white lines suggest oral lichen planus.
• A mouth ulcer: a small, round, white or yellowish sore with a red border, very painful, which usually heals on its own.

A simple rule: any sore, lump or white patch that has not healed within two weeks should be shown to a dentist without further delay.

What to do in the meantime, and when it is urgent

While you wait for your appointment, a few measures ease the discomfort without hiding the problem:

• gently pass floss or an interdental brush between the teeth in the area to dislodge any trapped food;
• rinse with warm salt water several times a day;
• keep brushing with a soft brush, without avoiding the area;
• take your usual painkiller, following the leaflet and your own contraindications;
• apply something cold to the cheek if it swells, never heat.

Avoid lancing the swelling yourself, putting aspirin or alcohol on the gum, or taking antibiotics left over from a previous course.

See someone the same day if your cheek swells and spreads towards the eye or neck, if you have a fever, or if opening your mouth, swallowing or breathing becomes difficult. These signs can mean a spreading infection and sometimes require a hospital emergency department.

Diagnosis and treatment in Agdal

Treatment depends entirely on the cause, which is why the examination matters. The dentist asks when the swelling started, which medicines you take and whether you might be pregnant, then examines the gum, tests the tooth concerned, measures pocket depths with a probe and takes an X-ray to see the root and bone.

Depending on the diagnosis, treatment can range from simply cleaning the area to draining an abscess, root canal treatment, in-depth gum therapy or, less often, an extraction.

At German Dental Clinic in Agdal, digital radiography helps pinpoint the source of the swelling quickly so the options can be explained to you. If you are in Rabat and a swollen gum is causing you pain, you can book an appointment or call the practice for a prompt consultation.