The appearance of “big gums” is a common concern, clinically referred to as gingival overgrowth or gingival hypertrophy. For many people, the issue is not tissue overgrowth but an excessive gingival display, frequently called a “gummy smile.” This occurs when more than four millimeters of gum tissue is visible when smiling. While these conditions affect confidence and aesthetics, they often point to underlying health issues requiring professional attention. Fortunately, a range of fixes exists, from non-invasive changes to minor surgical procedures, aimed at restoring a balanced and healthy appearance to the gums and teeth.
Understanding the Underlying Causes
Proper diagnosis is the first step toward effective treatment, as the causes for enlarged gum tissue are varied. One frequent cause is inflammatory gingival enlargement, stemming directly from dental plaque accumulation. This plaque-induced inflammation, or gingivitis, causes the gum tissue, particularly between the teeth, to become red, soft, and swollen. This chronic inflammatory lesion is directly related to poor oral hygiene practices.
Another cause is drug-induced gingival enlargement (DIGO), a side effect of certain systemic medications. The main classes of drugs known to cause this condition are anticonvulsants (e.g., phenytoin), immunosuppressants (e.g., cyclosporine), and calcium channel blockers (e.g., nifedipine and amlodipine). These medications alter the metabolism of gingival fibroblasts, leading to excessive tissue proliferation. The resulting enlargement tends to be firm, pale pink, and less prone to bleeding than inflammatory overgrowth.
In some cases, enlargement relates to structural or systemic factors beyond inflammation or medication. Hereditary gingival fibromatosis is a rare genetic disorder causing slow, non-tender, generalized overgrowth, often presenting in childhood. Systemic conditions like hormonal fluctuations during pregnancy or diseases such as leukemia can also manifest as gingival enlargement. Furthermore, an excessive gingival display can be caused by skeletal issues, such as vertical maxillary excess, or a hypermobile upper lip that rises too high when smiling.
Home Care and Non-Invasive Management
Managing gingival overgrowth, especially the inflammatory type, requires adopting meticulous oral hygiene practices. Consistent brushing and daily flossing are necessary to physically remove the dental plaque that drives inflammation and enlargement. Patients are instructed on proper brushing techniques to ensure the gum line is thoroughly cleaned without causing trauma.
Professional intervention begins with non-surgical periodontal therapy, including scaling and root planing. This deep cleaning removes hardened plaque (calculus) and toxins from below the gum line, eliminating irritants that fuel chronic inflammation. For inflammatory enlargement caused solely by plaque, this non-surgical approach can often completely resolve the issue and reduce the need for surgery.
If medication is the suspected cause, a consultation with the prescribing physician and dentist is warranted to review the drug regimen. Simply discontinuing the causative drug can lead to a rapid reduction in the enlargement, even in long-standing cases. If the medication cannot be stopped, a healthcare provider may substitute it with an alternative drug from the same class that is less likely to cause gingival enlargement.
Professional and Surgical Solutions
When non-invasive measures fail or the cause is structural, various surgical treatments are available. The most common procedure for removing excess soft tissue is a gingivectomy. This procedure is performed by a periodontist using traditional instruments or a laser, which offers less bleeding and faster healing. A gingivectomy is often the treatment of choice for tissue enlarged due to chronic inflammation or medication, provided the underlying bone level is normal.
Another procedure is aesthetic crown lengthening, performed when teeth appear too short due to excess gum covering the natural tooth structure. This treatment involves reshaping both the gum tissue and the underlying bone to expose more of the tooth crown. Crown lengthening is distinct from a gingivectomy because addressing the bone level prevents gum tissue from growing back over the teeth.
For excessive gingival display rooted in the lip or jaw structure, specialized treatments are used. Lip repositioning surgery is designed for patients whose upper lip rises too high when smiling. The procedure involves removing a strip of tissue from the inside of the lip and suturing the lip down to a lower position. This physically limits the amount of gum visible during a full smile.
Orthodontic and restorative approaches often combine with surgery. Orthodontic treatment moves over-erupted teeth that contribute to excessive gum display. Restorative procedures, such as veneers or crowns, reshape the teeth after gum surgery, improving proportion and balance. In severe cases of jaw misalignment, such as vertical maxillary excess, orthognathic surgery may be required to reposition the upper jaw.
Post-Treatment Care and Long-Term Prevention
Following any surgical procedure to correct big gums, diligent post-operative care is required for optimal healing. Patients are advised to rest and limit strenuous physical activity for the first few days to minimize bleeding. Minor bleeding and slight swelling are expected during the first 24 to 48 hours and can be managed with a cold compress applied to the outside of the jaw.
Pain management usually involves non-aspirin medication, taken as directed by the dental surgeon. The diet should be restricted to soft, cool foods like soups and yogurt for the first week. Hard, crunchy, or spicy foods must be avoided as they can irritate the surgical site.
Oral hygiene in the surgical area must be performed gently to keep the site clean without dislodging healing tissue or sutures. An antibacterial mouthwash, often a chlorhexidine rinse, may be prescribed for use twice daily, along with careful brushing of the teeth in the area. Patients must attend all scheduled follow-up appointments, typically within the first two weeks, so the periodontist can monitor healing and remove any sutures.
Long-term prevention hinges on maintaining exceptional oral hygiene and adhering to a regular periodontal maintenance schedule. Since recurrence is often linked to dental plaque, consistent brushing and flossing are paramount. For patients whose enlargement was drug-induced, maintaining quarterly professional cleanings is recommended to control plaque levels and mitigate the risk of recurrence.