People who develop gingivitis or other types of gum disease must not have the best oral care habits, right? Not so fast. While the American Dental Association notes that poor oral hygiene can increase your risk of gum disease, it’s also true that gum disease isn’t always linked to a lack of oral hygiene.

In some cases, as the American Academy of Periodontology points out, gum disease can be a sign of systemic disease. So-called strawberry gum disease is one example of gum disease that develops as a result of another condition — in this case, granulomatosis with polyangiitis (GPA).

What Is Granulomatosis With Polyangiitis?

GPA is a type of vasculitis, as the Mayo Clinic explains. Vasculitis is a group of conditions that cause inflammation in the blood vessels. The good news about GPA is that it is pretty rare. One 15-year study from the American College of Rheumatology (ACR) found just 19 cases of GPA between 2000 and 2015 in Latin America. A study published in Rheumatology found 462 cases of GPA in the U.K. between 1997 and 2013. As noted in the latter study, the condition occurs more frequently in individuals between the ages of 55 and 69.

The Mayo Clinic states that the cause of GPA is unknown. The Mayo Clinic points out that the condition doesn’t seem to run in families, and it also isn’t contagious, meaning one person can’t give it to another. However, the Cleveland Clinic does note that it might possibly develop as a result of the immune system damaging the blood vessels and other tissues.

Symptoms of GPA

According to the Cleveland Clinic, GPA most often affects the upper respiratory tract. People may notice symptoms such as a bloody cough, nose bleeds or wheezing and voice changes due to inflammation in the windpipe.

Another potential symptom of GPA is strawberry gum disease, also known as strawberry gingivitis. Like GPA itself, strawberry gingivitis is also pretty rare. One paper published in Head and Neck Pathology states that this condition occurs in about 2% of people with GPA. In addition, a case study published in QJM: An International Journal of Medicine notes that strawberry gingivitis occurs in less than 1% of cases, but that it’s a characteristic sign of GPA.

What Does Strawberry Gingivitis Look Like?

Strawberry gingivitis isn’t the same as the type of gingivitis that develops as a result of poor oral hygiene. Rather, strawberry gum disease (also known as “”hyperplastic granular gingivitis””) causes the gums to become enlarged and nodular, as the study in Head and Neck Pathology notes. The gums will often appear red and sore, and they might bleed easily. A case study published in Modern Rheumatology Case Reports describes gums affected by strawberry gingivitis as having an “”over-ripe strawberry”” appearance.

Strawberry gum disease can look different in different patients. The Head and Neck Pathology study points out that the lesions associated with the issue can occur all over the gums or only in certain areas.

Diagnosing and Treating Strawberry Gum Disease and GPA

Treatment for strawberry gum disease is often different from treatment for other forms of gum disease. The Modern Rheumatology Case Reports study suggests that strawberry gingivitis is usually an early sign of GPA. If you notice bumpy, red or very swollen areas of your gums, you should talk to your dentist or doctor about the issue. They may then screen you for GPA.

The process of diagnosing GPA often involves biopsying the area, performing a physical exam and taking an X-ray of the lungs or other organs to see if there is inflammation, as the Cleveland Clinic notes. About one-third of patients with GPA have lung abnormalities that appear on an X-ray, even if the patient doesn’t have respiratory symptoms.

Treatment for GPA can often be ongoing, although the Mayo Clinic notes that many people recover from it within a few months if the condition is caught early and treated right away. The most common treatments for GPA are corticosteroids and medications that suppress the immune system to reduce the inflammation. Depending on the severity of the condition, you might eventually be weaned off the medications, or you might need to continue taking them to keep your symptoms at bay.

If you’re concerned about the appearance of your gums, your best bet is to get a thorough exam from your dentist. Be sure to keep up with good oral care at home, and see your dentist for regular cleanings to keep your gums healthy.