Linear Gingival Erythema and HIV

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. Though most cases are associated with human immunodeficiency virus (HIV/AIDS)—this condition used to be called HIV-associated gingivitis—it can also arise in others who have compromised immune systems. 

If untreated, LGE can lead to a more serious gum infection and the loss of tooth and bone, among other issues. Though treatments for other types of gingivitis or periodontitis (gum infection) won’t help, certain dental treatments can.

The condition can also be managed by using special mouthwashes, good oral hygiene habits, and regular dental care.

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

Woman at the dentist.

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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’s typically caused by a fungus, candida, that naturally arises in the gums, though other fungi or bacteria can also cause it. Since the immune system is weakened in these cases, pathogens like this more easily spread, becoming symptomatic and problematic.

LGE often presents like other kinds of gum disease, such as gingivitis and periodontal disease. However, LGE isn’t responsive to standard dental therapies focused on plaque removal, like scaling and root planing. Generally, it’s fungal in origin, whereas most cases of other kinds of gum disease are caused by bacteria.   

Linear Gingival Erythema Symptoms

LGE, especially in its initial stages, can resemble other types of gum disease and infection. This can make it challenging to distinguish. Several signs and symptoms characterize this condition:

  • A horizontal red line, about 2 to 3 millimeters (mm) in width, on the exposed gum
  • Petechiae (tiny red dots on the gums)
  • Lesions (larger red dots that bleed)
  • Persistent bad breath (halitosis)
  • Tenderness or soreness in the gums
  • Loosening or loss of teeth
  • Weakening and degradation of the underlying bone

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

What’s the Connection Between LGE and HIV?

LGE most often arises as an early manifestation of HIV, a sexually transmitted infection (STI) that affects the function of the immune system. As immunity decreases, 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 aside from LGE. Other common issues include:

  • Oral thrush: Also known as oral candidiasis, this infection causes white lesions to develop on the tongue and sides of the mouth.
  • Oral hairy leukoplakia: This condition, also associated with Epstein-Barr virus, arises as white, sometimes hairy lesions, on the side of the tongue.
  • Kaposi sarcoma: This is a cancerous tumor that can develop in the mouth, nose, anus, or genitals. This condition is considered a telltale sign of HIV/AIDS.
  • Herpes simplex: The weakened immunity due to HIV can cause outbreaks of herpes simplex, characterized by the development of lesions and sores in the mouth.
  • Other issues: Canker sores and ulcers in the mouth also commonly arise in HIV cases.

Additional Causes

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

Furthermore, 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 managing the fungus at the root of the infection and maintaining good oral hygiene. Approaches include:

  • Mechanical supragingival debridement: Using a special device, this process removes plaque and biofilms that form on the teeth above the gumline.
  • Oral antimicrobial rinse: You may be prescribed an antimicrobial solution to swish with, such as 0.12% chlorhexidine gluconate. Typically, this is used twice a day for about two weeks.
  • A topical antifungal medication that’s applied directly to affected areas may be prescribed.  

Prevention

Preventing and managing LGE involves keeping up the health of your teeth and controlling the factors that can make the condition worse, including:

  • Good oral hygiene: This means brushing twice a day, for two minutes at a time, and properly flossing every night.
  • Regular dental visits: Regular dental visits are critical for ensuring there are no signs of LGE or other dental issues. They’re a common feature of the management of HIV and other immunocompromising diseases.
  • Keeping up with medications: If you have HIV or AIDS, make sure you’re consistently taking your medications. Let your health provider know if your medications are causing dry mouth or side effects.
  • Hydration: Ensuring you’re drinking enough water and chewing gum may help with dry mouth. Saliva carries white blood cells that fight off fungi and bacteria.

Outlook

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

Like other infections, it can rapidly worsen and progress if left alone. However, with appropriate treatment—not only of the gum infection but of the HIV or other underlying cause—it can be effectively managed.

Summary

Linear gingival erythema (LGE) is a fungal gum infection that arises in cases of compromised immunity. It's a common complication of HIV/AIDS, though other conditions can bring it on. LGE causes lesions, bleeding, and inflammation of the gums. Dental treatments, antimicrobial mouthwashes, and regular dental cleaning treat this condition. Prompt care is critical, as LGE can cause serious dental issues.

A Word From Verywell

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

Linear gingival erythema shouldn’t be taken lightly; it can reflect the health of your immune system and be a sign of worsening overall health. Managing LGE is critical; if you suspect you have the condition or are prone to it, talk to your healthcare provider as soon as possible.

Frequently Asked Questions

  • What is HIV periodontitis?


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

  • Does linear gingival erythema go away?

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

  • How do you diagnose linear gingival erythema?

    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, though cancer and diabetes can also cause it. Typically, it’s identified when the issue persists despite standard dental therapies for gum disease. X-ray imaging may be necessary to assess the health of the underlying bone.

 

4 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Maddi A, Dental Standards of Care Committee of the New York State Department of Health AIDS Institute. Management of periodontal disease.

  2. Gupta K, Singh S, Kannan S. Diagnosis lies in the eyes of 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. MouthHealthy.

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

Additional Reading

By Mark Gurarie
Mark Gurarie is a freelance writer, editor, and adjunct lecturer of writing composition at George Washington University.