Swollen gums are almost always a sign of inflammation, and the most common trigger is plaque buildup along the gum line. About 4 in 10 U.S. adults over 30 have some level of gum disease, and that number jumps to 60% for adults 65 and older. But plaque isn’t the only culprit. Hormonal shifts, certain medications, nutritional gaps, and infections can all cause your gums to puff up, bleed, or feel tender.
Plaque Buildup and Early Gum Disease
The single most common reason for swollen gums is gingivitis, the earliest stage of gum disease. Plaque, a sticky film loaded with bacteria, constantly forms on your teeth. When it isn’t removed through daily brushing and flossing, those bacteria irritate the gum tissue and trigger inflammation. Your gums may look redder than usual, feel puffy, or bleed when you brush. At this stage, no permanent damage has occurred, and the swelling is reversible with better oral hygiene.
If plaque sits long enough, it hardens into tartar, a calcified deposit that you can’t remove with a toothbrush. Tartar below the gum line is especially problematic because it creates a sheltered space for bacteria to thrive. Left untreated, gingivitis can progress to periodontitis, where the infection spreads deeper and starts breaking down the bone and connective tissue anchoring your teeth. At that point, gums may recede, pockets form between the gums and teeth, teeth become sensitive or loose, and in severe cases, teeth can fall out.
Hormonal Changes
Pregnancy is one of the most well-known hormonal triggers for gum swelling. Rising levels of estrogen and progesterone increase blood flow to the gums, making them more sensitive and more reactive to plaque. Even a small amount of plaque that previously caused no problems can suddenly produce noticeable inflammation, soreness, and bleeding. Symptoms can appear as early as the first trimester, though they tend to peak during the second or third trimester and usually resolve after delivery.
Puberty, menstruation, and menopause can produce similar effects. Any period of significant hormonal fluctuation can temporarily change how your gums respond to the bacteria already in your mouth.
Medications That Cause Gum Overgrowth
Certain prescription drugs can cause your gum tissue to physically enlarge, a condition called gingival overgrowth. Three classes of medication are the primary offenders:
- Seizure medications. Phenytoin is the most common cause. Roughly half of the approximately 2 million people taking it develop some degree of gum overgrowth. Other seizure drugs like carbamazepine and valproic acid carry a lower but real risk.
- Blood pressure medications (calcium channel blockers). Nifedipine leads the list, with about 38% of users affected. Diltiazem causes overgrowth in roughly 20% of users, and amlodipine in about 3%.
- Immune-suppressing drugs. Cyclosporine, commonly used after organ transplants, causes gum overgrowth in 13% to 85% of patients, with the wide range partly explained by many of those patients also taking calcium channel blockers.
If you’ve noticed your gums growing over your teeth since starting a new medication, bring it up with your prescriber. Switching to a different drug in the same class can sometimes resolve the problem.
Vitamin C Deficiency
A severe lack of vitamin C for at least three months can lead to scurvy, which causes swollen, bleeding gums that may turn purple and spongy. This is rare in developed countries but does still occur, particularly in people with extremely limited diets, those with alcohol use disorders, or older adults who eat very little fresh food.
Adults need 75 to 90 mg of vitamin C daily (smokers should add another 35 mg). A single orange or a cup of strawberries covers that easily. If scurvy is caught early, supplementation reverses most symptoms, though severe gum damage can be permanent.
Localized Infections and Abscesses
When swelling is concentrated in one specific spot rather than spread across your gums, an abscess is a likely cause. A dental abscess is a pocket of pus caused by a bacterial infection, often originating from a deep cavity, a cracked tooth, or advanced gum disease. The swelling may appear as a distinct bump on the gum, and you might notice a foul taste in your mouth, throbbing pain, or sensitivity to hot and cold.
An abscess won’t resolve on its own and requires professional treatment. If the swelling is severe enough to make chewing, breathing, or closing your mouth difficult, that’s a sign the infection may be spreading and needs urgent care.
What Happens Beyond Your Mouth
Chronic gum inflammation doesn’t stay confined to your gums. When periodontal pockets bleed, bacteria from dental plaque can enter the bloodstream. This triggers a body-wide inflammatory response. People with periodontal disease carry higher circulating levels of several inflammatory markers, including C-reactive protein, which is independently linked to cardiovascular risk. According to a scientific statement from the American Heart Association, the bacteria can also reach blood vessel walls directly, potentially contributing to the buildup of arterial plaque. The connection doesn’t prove that gum disease causes heart attacks, but the biological pathways are well documented and taken seriously.
The relationship also runs in the other direction with diabetes. Poorly controlled blood sugar makes gum disease worse, and active gum infections make blood sugar harder to control, creating a cycle that compounds both conditions.
Professional Treatment
For gingivitis, a professional cleaning to remove tartar is often enough to let the gums heal. For periodontitis, the standard treatment is scaling and root planing, sometimes called a deep cleaning. Your dentist or hygienist numbs your gums with local anesthetic, then uses hand instruments or ultrasonic tools to scrape away plaque and tartar both above and below the gum line. They also smooth the tooth roots so gum tissue can reattach more easily. Antibiotics may be placed directly around the roots or prescribed as pills.
The procedure takes one to two hours and may be split across two appointments. Most people return to normal activities the same day, though gums can feel sore for a couple of days afterward.
Managing Swollen Gums at Home
While you’re waiting for a dental appointment, or alongside professional treatment, a few things can help reduce discomfort. A warm saltwater rinse (half a teaspoon of salt dissolved in 8 ounces of warm water) helps draw out minor infection and soothes inflamed tissue. Using it two to four times per week is a reasonable frequency. Brush gently with a soft-bristled toothbrush twice a day, and don’t skip flossing just because your gums bleed. Bleeding during flossing is a sign of inflammation, not a reason to stop. For most people, consistent flossing reduces that bleeding within a week or two.
Signs That Need Prompt Attention
Most gum swelling responds well to improved hygiene and a dental visit, but certain patterns deserve faster action. Swelling concentrated in a single bump-like area often signals an abscess. Significant bleeding when eating or brushing, gums so tender that you can’t eat or clean your teeth properly, or swelling severe enough to interfere with closing your mouth or breathing all warrant a call to your dentist that day rather than scheduling a routine appointment weeks out.