Gingival hyperplasia (GH) is a common dental condition characterized by an overgrowth of gum tissue around the teeth. This excess tissue can make the gums appear puffy, swollen, and sometimes cover a significant portion of the tooth crown, making the teeth look smaller. GH is a highly treatable condition that can often be resolved with professional intervention. Successful treatment depends entirely on accurately identifying and addressing the underlying cause of the tissue proliferation.
Identifying the Underlying Cause
Managing gingival hyperplasia requires determining the specific cause, as treatment is cause-dependent. Causes fall into three major categories: inflammation, certain medications, and systemic factors. Inflammation-induced enlargement is the most frequent, typically resulting from bacterial plaque accumulation along the gumline due to insufficient oral hygiene. Unremoved plaque triggers a chronic inflammatory response, causing the gum tissue to swell and increase in volume.
Drug-induced gingival overgrowth is another common cause, associated with medications that alter gum tissue cell metabolism. Implicated drugs include anticonvulsants, such as phenytoin, which causes overgrowth in roughly half of patients. Calcium channel blockers (like nifedipine and amlodipine) and the immunosuppressant cyclosporine also stimulate tissue growth. Systemic and hormonal changes also play a role, including conditions like leukemia, certain vitamin deficiencies, and hormonal fluctuations during pregnancy. Addressing the underlying systemic issue is necessary for long-term resolution.
Conservative and Non-Surgical Treatment
For many cases, the first line of treatment is conservative and non-surgical, aiming to eliminate inflammation. This approach focuses on intensive professional cleaning and improved at-home oral hygiene protocols. Professional procedures often include scaling and root planing, a deep cleaning that removes hardened plaque and tartar from below the gumline.
Patients receive instruction on meticulous brushing and flossing, often supplemented with prescription antiseptic mouth rinses containing agents like chlorhexidine to reduce the bacterial load. If medication is the cause, the most effective non-surgical fix involves consulting the prescribing physician to discuss an alternative drug or dose adjustment. Replacing the offending medication with a substitute, such as switching from cyclosporine to tacrolimus, often leads to significant tissue regression without the need for surgical removal.
Surgical Removal of Excess Tissue
When conservative methods fail, or when the tissue is too extensive and fibrotic, surgical intervention is necessary to restore the normal gum contour. The most common procedure is a gingivectomy, which involves excising the excess gum tissue to expose the tooth structure and create a healthy gum architecture. This procedure is performed under local anesthesia using a traditional scalpel, electrosurgery, or specialized lasers.
Laser contouring, often referred to as laser gingivectomy, has become a preferred method because it offers a minimally invasive alternative that often results in reduced bleeding and faster healing times. High-level diode or CO2 lasers precisely vaporize the excess tissue. The thermal properties of the laser promote hemostasis, which means less blood loss during the procedure. Regardless of the tool used, the surgical goal is to reshape the gumline to a natural, functional level, eliminating the pockets that trap bacteria and impede cleaning.
Post-Treatment Maintenance and Prevention
Successfully treating gingival hyperplasia requires a continuous approach to prevent recurrence. Long-term success is linked to maintaining a meticulous oral hygiene regimen tailored to individual risk factors. This includes brushing twice daily and flossing once, often utilizing tools like interdental brushes or water flossers to clean difficult areas.
Patients who continue taking causative medication or have an unresolvable systemic condition require enhanced vigilance. A personalized recall schedule is established, often requiring professional cleanings and check-ups every three to four months instead of the standard six. This continuous monitoring and professional plaque removal manage the inflammatory component, ensuring the gum contour remains healthy and stable.