Gingival Hyperplasia

Gingival hyperplasia, also known as gum enlargement or hypertrophy, is an abnormal overgrowth of gum tissues surrounding teeth. The causes of this condition may range from poor oral hygiene or a side effect of some medications to systemic causes. If the enlarged gingiva is left untreated, it can affect your teeth alignment and cause teeth shifting. Also, it increases the risk of developing gum disease. Gingival hyperplasia can usually be treated by improving oral hygiene habits. In more serious cases, your dentist may recommend surgical treatment to remove the overgrown gums.

Signs & Symptoms of Gingival Hyperplasia

Gingival hyperplasia is characterized by abnormal overgrowth of the gum tissues. This overgrowth can have different causes, but they have a very similar appearance, which is bright red gingival overgrowth that bleeds easily. It can cause pain and affect your oral health. Signs and symptoms of gingival enlargement include:

  • Overgrowth and enlargement of gum tissues
  • Gums easily bleed
  • Pain
  • Red gums
  • Inflammation and the swelling of gums
  • Bad breath

In severe cases of gingival overgrowth, gums can completely cover teeth, making it difficult to brush or floss teeth, which can lead to the development of periodontitis, an advanced stage of gum disease.

Causes of Gingival Hyperplasia

Gingival overgrowth can occur due to several causes, which can be categorized into groups:

  • Inflammatory gingival hyperplasia.
  • Drug-induced gingival hyperplasia
  • Systemic diseases or conditions.
  • Hereditary gingival fibromatosis.

Inflammatory Gingival Hyperplasia

Inflammatory gingival hyperplasia can be chronic or acute. The chronic form occurs as an inflammatory response to the dental plaque. Plaque bacteria decompose food debris and produce toxins that irritate gums, causing them to swell and bleed.

This form of gingival overgrowth is usually associated with poor oral hygiene. The inflammatory hyperplasia can be localized or generalized. The affected gums become red, swollen, tender to the touch, and bleed easily.

This condition can usually be treated by good oral hygiene practices and periodontal cleaning at the dental office.

The accumulation of dental plaque on teeth surfaces is the main cause of inflammatory gingival hyperplasia. Several factors can increase the chances of plaque accumulation and retention and promote inflammatory gingival enlargement, including:

  • Poor oral hygiene.
  • Improper tooth fillings.
  • ill-fitting dentures.
  • Orthodontic appliances.
  • Mouth breathing.

Inflammatory gingival enlargement and gingivitis can often be seen in mouth breathers because mouth breathing can dry out your mouth, which promotes bacterial growth. Gingivitis is a reversible condition that can be treated by improving oral hygiene, professional teeth cleaning, and treating the underlying cause.

The acute form of gingival hyperplasia includes periodontal abscesses, which cause a localized painful area of purulent discharge.

Drug-induced Gingival Hyperplasia

Gingival hyperplasia may occur as a side effect of some medications, for example:

  • Anticonvulsants (valproic acid, phenytoin, ethosuximide, methsuximide).
  • Immunosuppressants (cyclosporine)
  • Calcium channel blockers, which are used to treat high blood pressure (nifedipine, felodipine, amlodipine, diltiazem)

In most cases, drug-induced gingival enlargement resolves by discontinuing medications. Consult your doctor if you suspect your medication is affecting your oral health. They can change the dose or change the medication.

Abnormal overgrowth of gingival tissues
Gingival hyperplasia is an overgrowth of gum tissues surrounding teeth. Image by Lesion under CC Attribution-Share Alike 3.0 Unported

Systemic Diseases or Conditions

Gingival hyperplasia can be associated with systemic diseases or conditions such as:

  • Hormonal changes during pregnancy and puberty
  • Vitamin deficiency
  • Diabetes mellitus
  • Anemia
  • Lymphoma
  • Leukemia
  • Human Immunodeficiency Viruses (HIV)
  • Crohn’s disease

In this case, gingival hyperplasia is usually treated by treating the underlying cause. In the case of pregnancy, the abnormal gums overgrowth usually disappears once the baby has been delivered.

Improving your oral hygiene habits can improve the symptoms and reduce the risk of developing gingival enlargement.

Hereditary Gingival Fibromatosis

Hereditary gingival fibromatosis (HGF) is a rare condition that is characterized by a benign gingival overgrowth. It usually begins in childhood during the transition from primary to permanent teeth. In some cases, the gums may cover major parts of the teeth surfaces or cover them completely, which can interfere with teeth eruption and function and cause aesthetic problems.

Complications of Gingival Hyperplasia

  • Aesthetic problems, which can have a negative psychological effect.
  • Interfere with oral hygiene practices, which can increase the risk of periodontal disease and dental caries.
  • Prevent the eruption of permanent teeth.
  • Interfere with teeth function (cutting and chewing of food).
  • Teeth shifting and misalignment.

Treatment Options for Gingival Hyperplasia

For gingival hyperplasia, treatment options vary based on the cause and severity of the condition, but they generally fall into two main categories: non-surgical and surgical methods.

Non-surgical methods

  • Improved Oral Hygiene: This is the first line of defense against gingival enlargement. Keeping the oral cavity clean through regular brushing and flossing can significantly reduce gum swelling.
  • Medication Adjustment: In cases where medication is the cause of gingival hyperplasia, consulting with your healthcare provider to modify or change the medication can help manage the condition.
  • Scaling and Root Planing: This deep cleaning of teeth removes plaque and tartar from below the gum line. This treatment can be essential in controlling and preventing gingival enlargement.

Surgical methods

  • Gingivectomy / Gingivoplasty: Gingivectomy is a surgical procedure that involves the removal of excess or overgrown gum tissue, while gingivoplasty is a surgical procedure that reshapes the gums to provide a more natural and aesthetically pleasing appearance. Gingivectomy and gingivoplasty are performed using a scalpel, electro-surgical device, or laser.
  • Flap Surgery: In severe cases of gingival enlargement, a periodontist may recommend flap surgery. The flap surgery procedure involves lifting the gum tissue away from the teeth so that a more effective scaling and root planing procedure can be completed. This is often done in combination with gingivectomy and gingivoplasty to remove excess gum tissue.

Gingival Hyperplasia – Conclusion

Gingival hyperplasia is an overgrowth of gum tissue that can cause cosmetic and functional problems. It can occur due to various reasons, including poor oral hygiene, medication, genetics, or systemic disease.

The treatment depends on the cause and severity of the gingival enlargement. Several treatment options are available, ranging from non-surgical methods like improved oral hygiene and medication adjustment to surgical procedures, including gingivectomy, gingivoplasty, and flap surgery.

Consulting with a periodontist is the best way to determine an appropriate treatment plan for gingival enlargement. With early diagnosis and treatment, it can be managed effectively.

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