Why are my gums sore and red?

Severe Gingivitis

The answer is probably Gingivitis. Gingivitis, also known as inflammation of the gums, is a disease of the soft tissues surrounding and supporting the teeth.

It is a bacterial infection caused by microbes in plaque which is allowed to settle and grow around the gum edges.

One of the most significant signs of gingivitis is bleeding from the gums. This is not normal, and is an inevitable indication of disease. It might be noticed on the toothbrush following brushing, in the toothpaste on spitting out, or even on biting into some fibrous foods, eg. apples. In severe cases, the gums might bleed spontaneously, particularly during the night when blood may be found on the pillow.

Most gingivitis is of the chronic type: it is generally painless, has slow onset and is most easily detected by bleeding. Most gums are pink in colour, although they are sometimes pigmented, especially in dark skinned people.

When diseased, the gums look red and may be swollen and loose at the margin where the tooth emerges. There may even be some tenderness if the inflammation is severe.

Who is susceptible to gingivitis? Almost anyone, particularly if their cleaning is inadequate. In between the teeth is a very common area for gingivitis to occur if dental floss is not used daily, and also on the tongue side of the teeth because this is a harder area to reach with the toothbrush.

Some people are unusually susceptible: eg. during hormonal changes as in young people during puberty - the so-called "puberty gingivitis", and during pregnancy. Smoking makes people more prone to gum infection from plaque. Other risk factors are stress and general disease, particularly poorly-controlled diabetes.

Gingivitis can occur in acute form. The best known is ANUG (Acute Necrotising Ulcerative Gingivitis) formerly known as "Vincent's Infection".

This condition is extremely painful, is identified by ulcers at the gum edge, mostly in the peak of the gum between teeth. There is a strong, characteristic smell from the mouth. ANUG happens because of poor oral hygiene, smoking, stress, poor eating habits or a combination of a number of these factors.

ANUG can be effectively treated by mouthwashes and/or antibiotics, but is likely to return if the same conditions continue. ANUG is most commonly seen today in association with HIV (AIDS) infection.

The other acute form of gingivitis that is reasonably common is Acute Herpetic Gingivo Stomatitis (AHGS). This is a primary form of infection by the Herpes Simplex virus.

It is essentially an oral infection although there is some crossover between this infection and HSV-2 which is associated with genital herpes. AHGS usually occurs in young children, but can happen in adults.

It is acutely painful and there may be ulceration in all areas of the gums, palate, cheek lining, tongue and throat. The infection is self-limiting, lasting between 10 days and 2 weeks, but the pain can be relieved by analgesics. Dehydration must be avoided by frequent fluid intake.

It is likely to be followed intermittently by the secondary form, cold sores on the lips. In some people the primary form occurs without symptoms, so that cold sores are the only known signs.

If left untreated, Gingivitis may progress to Periodontitis, in which the disease spreads along and around the root of the tooth, destroying the bone attachment, and eventually leading to tooth loosening and loss.