Gum swelling
Gum swelling may result from one of two mechanisms: an increase in the size of existing gum cells (hypertrophy) or an increase in their number (hyperplasia). This common sign may involve one or many papillae—the triangular bits of gum between adjacent teeth. Occasionally, the gums swell markedly, obscuring the teeth altogether. Usually, the swelling is most prominent on the labia and bucca.
Gum swelling usually results from the effects of phenytoin; less commonly, from nutritional deficiency or certain systemic disorders. Physiologic gum swelling and bleeding may occur during the first and second trimesters of pregnancy when hormonal changes make the gums highly vascular; even slight irritation causes swelling and gives the papillae a characteristic raspberry hue (pregnancy epulis). Irritating dentures may also cause swelling associated with red, soft, movable masses on the gums.
History and physical examination
After ruling out pregnancy or the use of phenytoin or similar prescription drugs as the cause of gum swelling, take a history. Have the patient fully describe the swelling. Has he had it before? Is it localized or generalized? Find out when the swelling began, and ask about any aggravating or alleviating factors. Is the swelling painful? Then explore the patient’s medical history, focusing on major illnesses, bleeding disorders, and pregnancies. Also check his dental history. Does he wear dentures? If so, are they new? Ask about use of alcohol and tobacco, which are gum irritants. Then have the patient describe his diet to evaluate nutritional status. Ask about his intake of citrus fruits and vegetables.
Next, inspect the patient’s mouth in a good light. If he wears dentures, ask him to remove them before you begin. As you examine the gums, characterize their color and texture, and note any ulcers, lesions, masses, lumps, or debris-filled pockets around the teeth. Then inspect the teeth for discoloration, obvious decay, and looseness.
Medical causes
Crohn’s disease
Granular or cobblestone gum swelling occurs in this disorder, which is characterized by cramping abdominal pain and diarrhea. In acute Crohn’s disease, the patient may also have nausea, fever, tachycardia, abdominal tenderness and guarding, hyperactive bowel sounds, and abdominal distention. Chronic effects include anorexia, weight loss, a palpable lower quadrant mass, perianal lesions, skin lesions (erythema nodosum), arthritis, and occasionally constipation.
Fibrous hyperplasia (idiopathic)
In this disorder, the gums become diffusely enlarged and may even cover the teeth. Large, firm, painless masses of fibrous tissue that form on the gums may prevent tooth eruption and cause lip protrusion and difficulty chewing.
Leukemia
Gum swelling is commonly an early sign, especially in acute monocytic, lymphocytic, or myelocytic leukemia. Usually, the swelling is localized and accompanied by necrosis. The tender gums appear blue and glossy and bleed easily.
Acute leukemia also causes severe prostration, high fever, and signs of abnormal bleeding, such as ecchymosis and prolonged menses. Sometimes it produces dyspnea, tachycardia, palpitations, and abdominal or bone pain. Late effects may include confusion, headache, vomiting, seizures, papilledema, and nuchal rigidity. In chronic leukemia, signs and symptoms develop insidiously and may include malaise, pallor, low-grade fever, chills, minor bleeding tendencies, and enlarged tonsils, lymph nodes, and spleen.
Vitamin C deficiency (scurvy)
In this deficiency, the gums are spongy, tender, and edematous, and the papillae appear red or purple. The gums bleed easily, and inspection may reveal pockets filled with clotted blood around loose teeth. Associated findings include anorexia, pallor, dry mouth, scaly dermatitis, weakness, lethargy, insomnia, and signs of abnormal bleeding, such as myalgia and arthralgia (possibly with swelling), from hemorrhage into joints and muscles. Occasionally, psychological changes, such as depression and hysteria, occur.
Other causes
Drugs
Gum swelling is a common side effect of the anticonvulsant phenytoin. Cyclosporine, a drug used to prevent rejection of transplanted organs, also produces this sign in about 15% of patients.
Special considerations
When performing mouth care, avoid using lemon-glycerin swabs, which can irritate the gums. Instead, use a soft-bristled toothbrush or one that’s padded with sponge or gauze. For phenytoin-induced swelling, expect to substitute another anticonvulsant, such as carbamazepine, and prepare the patient for surgery. Because gum swelling may affect the patient’s appearance, offer emotional support and reassure him that swelling usually resolves with treatment.
Pediatric pointers
Gum swelling in children commonly results from nutritional deficiency. It may also accompany phenytoin therapy; in fact, drug-induced gum swelling is more common in children than in adults. Fortunately, this dramatic swelling is usually painless and limited to one or two papillae. Gum swelling may also result from idiopathic fibrous hyperplasia and from inflammatory gum hyperplasia, which is especially common in pubertal girls.
Good nutrition and oral hygiene help control gum swelling in children, so encourage parents to make brushing as much fun as possible.
Geriatric pointers
Always ask an elderly patient if he wears dentures and, if so, whether they’re new. Also ask him when he last visited the dentist. If dentures are causing gum inflammation, the patient may require a new set. Always evaluate oral hygiene in older patients, especially bedridden ones who can’t perform self-care.
Patient counseling
To prevent further swelling, teach the patient the basics of good nutrition. Remind him to eat foods high in vitamin C, such as fresh fruits and vegetables, daily. Also, encourage him to avoid gum irritants, such as commercial mouthwashes, alcohol, and tobacco. Advise him to see a periodontist at least once every 6 months.
Book Source Details
- Book Title: Professional Guide to Signs & Symptoms (Fifth Edition)
- Author(s): Springhouse
- Year of Publication: 2006
- Copyright Details: Professional Guide to Signs & Symptoms (Fifth Edition), Copyright © 2006 Lippincott Williams & Wilkins.
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Copyright Details: Professional Guide to Signs & Symptoms (Fifth Edition), Copyright © 2008 Williams & Wilkins.
More About Causes of Enlarged testicle
» Next page: Inguinal/Femoral Swelling (Field Guide to Bedside Diagnosis)
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