Linear Gingival Erythema and HIV: Symptoms, Treatment

Linear Gingival Erythema and HIV: Symptoms, Treatment

Linear gingival erythema (LGE) is a type of gum infection (gingivitis) that causes lesions and bleeding in the mouth. It presents as a distinctive red line on the gums. Although most cases are associated with human immunodeficiency virus (HIV AIDS)—this condition used to be called HIV-associated gingivitis—can also arise in other people who have compromised immune systems.

If left untreated, LGE can lead to a more serious gum infection and tooth and bone loss, among other problems. Although treatments for other types of gingivitis or periodontitis (gum infection) will not help, certain dental treatments may.

The condition can also be managed through the use of special mouth rinses, good oral hygiene habits, and regular dental care.

This article provides an overview of LGE, including its symptoms, its relationship to HIV, how it is treated, and what the outlook is for those living with the condition.

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What is linear gingival erythema?

Linear gingival erythema (LGE) is an infection, inflammation and bleeding of the gums that arises in cases of compromised immunity, especially HIV. It is usually caused by a fungus, candida, which arises naturally in the gums, although other fungi or bacteria can also cause it. Since the immune system is weakened in these cases, pathogens like this spread more easily, becoming symptomatic and problematic.

LGE often presents as other types of gum disease, such as gingivitis and periodontal disease. However, LGE does not respond to standard dental therapies focused on license plate removal, such as scaling and root planing. Generally, it is fungal in origin, while most cases of other types of gum disease are caused by bacteria.

Symptoms of linear gingival erythema

LGE, especially in its early stages, can resemble other types of gum disease and infection. This can make the distinction difficult. Several signs and symptoms characterize this condition:

  • A horizontal red line, about 2 to 3 millimeters (mm) wide, on the exposed gum
  • Petechiae (small red spots on the gums)
  • Lesions (larger red dots that bleed)
  • Persistent bad breath (halitosis)
  • Sensitivity or pain in the gums
  • loosening or loss of teeth
  • Weakening and degradation of the underlying bone.

If left untreated, LGE can progress to a more serious infection called necrotizing ulcerative periodontitis. This causes the death and loss of the gum tissue that supports the teeth, destabilizing and loosening them.

What is the connection between LGE and HIV?

LGE most often arises as an early manifestation of HIV, a sexually transmitted infection (STI) that affects immune system function. As immunity declines, the body becomes more susceptible to other opportunistic pathogens, including the fungi that cause linear gingival erythema.

LGE is the most common oral complication of HIV/AIDS; however, this chronic disease can cause a number of other dental problems in addition to LGE. Other common problems include:

  • oral thrush: Also know as oral thrushthis infection causes white lesions to develop on the tongue and sides of the mouth.
  • furry oral leukoplakia: This condition, also associated with Epstein-Barr virusIt arises as white, sometimes hairy, lesions on the side of the tongue.
  • Kaposi’s sarcoma: This is a cancerous growth that can develop in the mouth, nose, anus, or genitals. This condition is considered a telltale sign of HIV/AIDS.
  • herpes simplex: Weakened immunity due to HIV can cause outbreaks of herpes simplexcharacterized by the development of lesions and sores in the mouth.
  • Other issues: thrush and mouth ulcers also commonly arise in HIV cases.

additional causes

While most cases of LGE are caused by HIV, this condition also arises due to other diseases that affect the immune system. These include:

In addition, the risk increases with:

  • Smoking or tobacco use
  • wearing dentures
  • Taking antibiotics or corticosteroids

How is linear gingival erythema treated?

Treatments for linear gingival erythema focus on controlling the fungus at the root of the infection and maintaining good oral hygiene. Approaches include:

  • Supragingival mechanical debridement: Using a special device, this process removes plaque and biofilms that form on the teeth above the gum line.
  • antimicrobial mouthwash: An antimicrobial swish solution, such as 0.12% chlorhexidine gluconate, may be prescribed. Usually this is used twice a day for about two weeks.
  • A topical antifungal medication that is applied directly to the affected areas may be prescribed.

Prevention

Prevention and management of LGE involves maintaining the health of your teeth and managing factors that can worsen the condition, including:

  • good oral hygiene: This means brushing your teeth twice a day, for two minutes each time, and flossing correctly every night.
  • Regular visits to the dentist: Regular visits to the dentist are essential to ensure there are no signs of LGE or other dental problems. They are a common feature of the management of HIV and other immunocompromised diseases.
  • Keep up with medications: If you have HIV or AIDS, be sure to take your medicines. Tell your health care provider if your medications cause dry mouth or side effects.
  • Hydration: Making sure you drink enough water and chewing gum can help with dry mouth. Saliva carries white blood cells that fight fungus and bacteria.

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LGE is considered a serious complication of HIV, making treatment and management of the condition critical.

Like other infections, it can get worse and progress quickly if left alone. However, with proper treatment, not only the gum infection but also the HIV or other underlying cause can be managed effectively.

Summary

Linear gingival erythema (LGE) is a fungal infection of the gums that arises in cases of compromised immunity. It is a common complication of HIV/AIDS, although other conditions can cause it. LGE causes lesions, bleeding and inflammation of the gums. Dental treatments, antimicrobial mouth rinses, and regular dental cleaning treat this condition. Prompt attention is critical, as LGE can cause serious dental problems.

A word from Verywell

If you’re living with HIV, cancer, or another immune-compromising condition, your oral health is an important part of the equation.

Linear gingival erythema should not be taken lightly; it can reflect the health of your immune system and be a sign of worsening general health. LGE management is essential; if you suspect you have the condition or are prone to it, talk to your health care provider as soon as possible.

Frequent questions

  • What is HIV periodontitis?

    HIV periodontitis refers to a chronic infection of the gums that arises as a complication of the human immunodeficiency virus (HIV/AIDS). Because this virus impairs immune function, it is easier for viruses, bacteria, or fungi in the mouth to spread and cause injury, bleeding, inflammation, and loss of tissue, teeth, and bone. Types of HIV periodontitis include linear gingival erythema and necrotizing ulcerative periodontitis (NUP), among others.

  • Does linear gingival erythema disappear?

    Generally, linear gingival erythema (LGE) can be reversible with consistent and appropriate dental treatment and good oral hygiene. However, if left untreated or allowed to progress, this fungal infection of the gums can progress to necrotizing ulcerative periodontitis (UNP), a more serious infection. The latter, in which there is gum tissue and bone loss, may be less responsive to treatment.

  • How is linear gingival erythema diagnosed?

    Linear gingival erythema (LGE) can be difficult to diagnose because it shares many features with severe gingivitis (gum disease). LGE is suspected when you have compromised immunity. It often accompanies HIV/AIDS, although cancer and diabetes can also cause it. It is usually identified when the problem persists despite standard dental therapies for gum disease. X-ray images may be necessary to assess the health of the underlying bone.

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts in our articles. Read our editorial process to learn more about how we check facts and keep our content accurate, reliable, and trustworthy.

  1. Maddi A, New York State Department of Health AIDS Institute Dental Care Standards Committee. Management of periodontal disease.

  2. Gupta K, Singh S, Kannan S. The diagnosis is in the eyes of the beholder: linear gingival erythema in a non-HIV pediatric patient. J Indian Acad Oral Med Radiol 2019;31:397-400. doi:10.4103/jiaomr.jiaomr_125_19

  3. American Dental Association. HIV/AIDS and dental health. Healthy Mouth.

  4. Centers for Disease Control and Prevention. candida infections of the mouth, throat, and esophagus.

further reading


By Mark Gurarie

Mark Gurarie is a freelance writer, editor, and adjunct professor of copywriting at George Washington University.

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