Gingival Hyperplasia Treatment Options and Steps

Gingival hyperplasia, or gum overgrowth, can cause discomfort, hinder oral hygiene, and affect appearance. It may result from medication use, underlying health conditions, or poor oral care. Addressing this condition is essential to prevent complications like infection and periodontal disease.

Treatment options vary based on severity and cause.

Medication Review And Adjustments

Certain prescription drugs contribute to gingival hyperplasia, particularly calcium channel blockers (e.g., nifedipine, amlodipine), anticonvulsants (e.g., phenytoin), and immunosuppressants (e.g., cyclosporine). These medications can stimulate excessive fibroblast proliferation, leading to gum thickening. Reviewing and modifying medication is a primary step in managing drug-induced cases. Substituting or adjusting the dosage of the offending drug may reduce gum enlargement. For instance, switching from nifedipine to amlodipine or from cyclosporine to tacrolimus has been associated with a lower risk of overgrowth.

Collaboration between dental and medical professionals is necessary when considering medication changes. Physicians must balance the benefits of a drug with its oral side effects. When substitution isn’t an option, dose reduction may be explored. Research in the Journal of Clinical Periodontology suggests lower dosages of phenytoin correlate with reduced gingival hyperplasia. However, patients should never alter their medication without medical supervision, as abrupt changes can have serious consequences, particularly for those managing epilepsy, hypertension, or organ transplant rejection.

Adjunctive strategies may help mitigate gum overgrowth. Studies suggest folic acid supplementation may reduce gingival inflammation associated with phenytoin use, and topical folate application may improve tissue integrity. Additionally, systemic or topical azithromycin has been explored for its potential to modulate fibroblast activity and reduce tissue proliferation, though further research is needed. These approaches are not universally effective but may provide benefits when combined with other management strategies.

Oral Hygiene Support

Maintaining meticulous oral hygiene is key to managing gingival hyperplasia and preventing further overgrowth. Plaque buildup exacerbates inflammation, worsening the condition and increasing the risk of gingivitis and periodontal disease. A study in the Journal of Periodontology found that individuals with drug-induced gingival hyperplasia who followed strict oral hygiene had significantly lower inflammation scores.

Brushing technique plays a critical role. A soft-bristled toothbrush is recommended to prevent mechanical trauma to enlarged gums. The modified Bass technique—angling bristles at 45 degrees toward the gumline and using gentle, circular motions—effectively removes plaque without irritating the tissue. Electric toothbrushes with oscillating heads may further improve plaque removal and reduce gingival inflammation, as noted in Clinical Oral Investigations.

Flossing is equally important, as gingival hyperplasia can create deepened pockets where plaque accumulates. Traditional floss may be difficult to maneuver around enlarged gums, making interdental brushes or water flossers more practical. A study in The International Journal of Dental Hygiene found that water flossers reduced bleeding on probing by 56% compared to conventional floss. Antimicrobial mouth rinses containing chlorhexidine or cetylpyridinium chloride can further aid in bacterial control, though prolonged chlorhexidine use should be monitored due to potential staining and taste alteration.

Professional cleanings help remove plaque and calculus deposits that daily hygiene cannot address. Scaling and root planing may be necessary if gingival pockets deepen. A study in The Journal of Clinical Periodontology found that patients with gingival hyperplasia who received regular cleanings had reduced gingival thickness and lower inflammatory markers over six months.

Tissue Removal Approaches

When gingival hyperplasia persists despite medication adjustments and rigorous oral hygiene, surgical intervention may be necessary to restore normal gum contours. Several techniques are available, each suited to different severities of overgrowth.

Gingivectomy

A gingivectomy involves excising overgrown gum tissue to reshape the gingival margin and reduce pocket depth. This procedure is effective for localized overgrowth that does not involve underlying bone structures. Performed under local anesthesia, excess tissue is removed using a scalpel or specialized surgical instruments.

Healing typically takes one to two weeks, with mild discomfort and sensitivity during recovery. A study in The International Journal of Periodontics & Restorative Dentistry found that gingivectomy significantly improved periodontal health in patients with drug-induced gingival hyperplasia. However, recurrence is possible, especially if the underlying cause remains. To minimize regrowth, patients should maintain strict oral hygiene and attend regular dental follow-ups.

Laser Reshaping

Laser-assisted gingival contouring offers a minimally invasive alternative to traditional surgery. Diode, CO₂, or erbium lasers remove excess gum tissue while cauterizing blood vessels, reducing bleeding and discomfort. This technique allows for precise tissue removal, making it particularly useful for mild to moderate overgrowth.

Healing times are shorter than conventional gingivectomy, with minimal swelling and faster recovery. A clinical trial in Lasers in Medical Science reported that laser gingivectomy resulted in lower pain scores and quicker healing compared to scalpel-based procedures. Additionally, lasers’ bactericidal properties may reduce the risk of postoperative infection. However, laser treatment may not be suitable for severe cases requiring extensive tissue removal and can be costlier due to specialized equipment.

Electro Surgery

Electrosurgery uses high-frequency electrical currents to excise overgrown gingival tissue while coagulating blood vessels, minimizing bleeding. This method is especially beneficial for patients with excessive vascularization in the gums. Performed under local anesthesia, electrosurgery allows for precise tissue removal with minimal trauma to surrounding structures.

A study in The Journal of Oral and Maxillofacial Surgery found that electrosurgery produced similar clinical outcomes to traditional gingivectomy, with reduced intraoperative bleeding and shorter procedure times. However, improper technique can lead to thermal damage to adjacent tissues. Healing is generally similar to laser reshaping, with mild discomfort and swelling resolving within a few days. While effective, electrosurgery is not always the preferred choice for extensive overgrowth, as deeper tissue penetration may be required in severe cases.

Professional Dental Guidance

Managing gingival hyperplasia requires ongoing professional oversight to tailor treatment and monitor changes over time. Dentists and periodontists assess severity through clinical evaluation, probing depths, and imaging techniques like digital radiographs to determine whether soft tissue alterations involve underlying bone.

Regular monitoring is crucial, as subtle changes in gum architecture can indicate progression before symptoms become pronounced. Periodontal charting helps track tissue response over successive visits, allowing for early intervention if regrowth occurs. After surgical procedures, follow-ups ensure proper healing and assess whether additional contouring is necessary. This proactive approach minimizes complications such as uneven gum regrowth or excessive scar tissue formation.