Recurring Gum Swelling and Hard Lump: Causes and Solutions

Repeated swelling and pain in the gums with a hard lump?

Hello Doctor: My second lower molar on the right side has deteriorated due to a previous cavity, and the root canal treatment was not completely successful, but the tooth does not hurt, so I ignored it.
Recently, for about one to two months, the gum next to that lower right molar (the one with the cavity) started to swell.
Initially, the swelling occurred on the inner side (the side towards the tongue, with pus), and after it subsided, it shifted to the outer side (the cheek side).
It has been alternating between swelling and subsiding (with a cycle of about 2-3 weeks).
Eventually, it has formed a small lump in the gum area of that decayed molar, which is completely hard and has no pus.
When swollen, it becomes noticeable, and my cheek appears puffy.
Light pressure causes pain, but nothing can be squeezed out (it is hard), and opening my mouth causes slight discomfort.
I do not smoke or chew betel nut, but I often stay up late and lack sleep.
I would like to know if this swelling is due to excessive heat in my body or related to that decayed tooth, or if it could be gingival fibromatosis as mentioned online? What type of clinic should I visit for an examination? Thank you, Doctor.

Xuan Xuan, 10~19 year old female. Ask Date: 2018/12/30

Dr. Huang Tingfang reply Dentistry

Dear Miss Hsuan-Hsuan,
Hello! Regarding your recurrent gum swelling and the presence of a hard lump, it may be due to repeated inflammation, and there could be necrosis of the bone leading to a fibroma.
However, clinical confirmation is necessary.
An X-ray examination is recommended, and if needed, a biopsy should be performed.
Please communicate more with your oral and maxillofacial surgeon.
Thank you! Wishing you safety!
Sincerely,
Dr.
Huang Ting-Fang, Dentistry

Reply Date: 2018/12/30

More Info

Recurring gum swelling and the presence of a hard lump near a tooth can be concerning symptoms that warrant further investigation. Based on your description, it sounds like you may be experiencing a condition related to the tooth that has undergone root canal treatment, particularly since you mentioned that the tooth structure was significantly compromised due to decay.

Possible Causes
1. Periapical Abscess: Even if the tooth does not hurt, a periapical abscess can develop at the root of a tooth that has had previous decay or an incomplete root canal treatment. This can lead to swelling in the gums and the formation of a hard lump. The absence of pus does not rule out an infection; it may simply mean that the infection is chronic.

2. Gingival Fibromatosis: This condition involves the overgrowth of gum tissue, which can lead to swelling and hard lumps. It can be associated with various systemic conditions or may occur idiopathically.

3. Periodontal Disease: Chronic inflammation of the gums can lead to swelling and the formation of lumps. If the underlying tooth is compromised, this can exacerbate the condition.

4. Cyst Formation: A dental cyst can form in response to infection or irritation. These cysts can be hard and may cause swelling in the surrounding gum tissue.

5. Fibroma or Other Benign Growths: Sometimes, benign growths can develop in the gum tissue, leading to localized swelling and hardness.

Recommendations for Management
1. Dental Evaluation: It is crucial to see a dentist or an oral surgeon for a thorough examination. They may perform X-rays to assess the condition of the tooth and surrounding bone. This will help determine if there is an abscess, cyst, or other issues.

2. Possible Treatment Options:
- Root Canal Re-treatment: If the original root canal was not successful, re-treatment may be necessary to remove any remaining infection.

- Surgical Intervention: If a cyst or abscess is present, surgical removal may be required.

- Periodontal Treatment: If periodontal disease is diagnosed, scaling and root planing may be needed to reduce inflammation and promote healing.

3. Oral Hygiene: Maintaining good oral hygiene is essential. Brush twice a day and floss daily to help reduce inflammation and prevent further complications.

4. Lifestyle Modifications: Since you mentioned poor sleep habits, improving your sleep quality and reducing stress can positively impact your overall health and immune response, which may help in managing inflammation.

5. Follow-Up: Regular dental check-ups are important, especially if you have a history of dental issues. This will help catch any problems early before they escalate.

Conclusion
In summary, the recurring gum swelling and hard lump you are experiencing are likely related to the compromised tooth structure and previous dental work. It is essential to seek professional dental care to accurately diagnose the issue and determine the appropriate treatment. Ignoring these symptoms can lead to more severe complications, so prompt action is advisable.

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