Gums growing over braces is a common occurrence known as gingival hyperplasia, or gum overgrowth. This condition involves the enlargement of gum tissue and is frequently observed in individuals undergoing orthodontic treatment with fixed appliances. The swelling represents an inflammatory reaction by the gum tissue to localized irritants in the mouth. While the appearance can be concerning, this tissue response is often temporary and can be managed effectively through specific hygiene practices and professional care.
Understanding the Causes of Gum Overgrowth with Braces
The primary driver of gingival overgrowth during orthodontic treatment is the inflammatory response to bacterial plaque retention. Brackets, wires, and bands create numerous surfaces where food particles and bacteria accumulate, making removal difficult. This buildup of plaque and hardened calculus along the gumline leads to gingivitis, causing the gums to swell as a defense mechanism. This results in an overreaction of the gum cells, leading to visible enlargement of the tissue surrounding the teeth.
The mechanical presence of the orthodontic appliance itself can also contribute to the issue. The physical contact of the braces with the gum tissue can cause low-level, chronic irritation, stimulating the tissue to grow. This mechanical factor, combined with inadequate plaque control, creates an environment ripe for tissue proliferation.
While the main cause is localized inflammation, certain systemic factors can also increase a person’s susceptibility. Hormonal fluctuations, such as those experienced during puberty or pregnancy, can heighten the gum tissues’ sensitivity to plaque, leading to a more pronounced inflammatory response. Additionally, some individuals taking specific medications, such as certain anti-seizure drugs or immunosuppressants, may be more prone to this type of gum enlargement. For most orthodontic patients, however, the condition is directly tied to the challenges of maintaining hygiene around the fixed appliance.
Essential At-Home Management and Prevention
Addressing gum overgrowth begins with establishing an exceptionally meticulous and targeted oral hygiene regimen. Brushing must be done with a soft-bristled or orthodontic toothbrush after every meal, focusing on cleaning the surfaces above and below the brackets. Using the modified Bass technique, where bristles are angled toward the gumline at a 45-degree angle, helps dislodge bacteria from the bracket margins and the gum sulcus. Special attention should be given to the areas where the gum tissue meets the brace components to physically disrupt the plaque film.
Flossing is paramount, but the hardware of the braces requires specialized tools to navigate. Traditional floss requires a floss threader to pass beneath the main archwire, ensuring the sides of the teeth and the gumline are cleaned daily. Water flossers, or oral irrigators, offer a highly effective alternative, using a pressurized stream of water to flush out food debris and bacteria from around the brackets and under the gumline. Combining both mechanical flossing and water irrigation provides the most comprehensive approach to plaque removal.
Incorporating specific rinsing agents supports mechanical cleaning efforts. Rinsing with warm salt water several times a day helps soothe inflamed gum tissue and reduce swelling. For persistent inflammation, a dental professional may recommend a prescription antimicrobial mouthwash containing chlorhexidine, which effectively kills bacteria and reduces plaque. Consistent use of these products manages the bacterial load that fuels the inflammatory growth cycle.
Dietary choices play an important supporting role in prevention and management. Foods that are sticky, chewy, or high in refined sugar should be limited, as they easily become trapped in the braces and provide a food source for plaque-forming bacteria. Increasing water intake throughout the day helps to naturally rinse the mouth and promote saliva production, which neutralizes acids and aids in the self-cleansing process. By controlling the factors that promote plaque formation, patients can significantly reduce the severity of the gum overgrowth.
Professional Treatment Options for Resolution
When at-home care is insufficient to resolve the overgrowth, professional intervention becomes necessary, starting with deep cleaning procedures. Scaling and root planing (SRP) is a non-surgical procedure performed by a dentist or periodontist to remove hardened plaque and calculus (tartar) from both above and below the gumline. This process thoroughly cleanses the root surfaces of the teeth, eliminating the primary source of the inflammatory stimulus.
Following a thorough cleaning, the orthodontist will examine the appliance for any localized issues. Sharp wires, ill-fitting bands, or rough bracket edges can cause trauma, leading to localized gum irritation and growth. Adjusting or smoothing these components removes the mechanical irritant, allowing the gum tissue to calm down and potentially shrink back naturally once the inflammation is controlled. For many patients, improved hygiene combined with SRP and appliance adjustment is enough to reverse the condition.
In more severe and persistent cases, surgical removal of the excess tissue, known as a gingivectomy, may be required. This procedure involves carefully trimming away the overgrown gum tissue to restore a healthy and functional gum contour. The procedure is often performed using a traditional scalpel or a soft-tissue laser. A gingivoplasty, which focuses on reshaping the remaining tissue, may also be done simultaneously to create an aesthetically pleasing gumline.
The timing of a gingivectomy is often strategic within the overall orthodontic plan. It is recommended to control the underlying inflammation through meticulous hygiene and professional cleaning before considering surgery. The procedure may be performed during treatment if the tissue severely obstructs tooth movement, or it may be reserved for the final stage to ensure a stable aesthetic result. Consulting with both the orthodontist and a periodontist is necessary to determine the most appropriate treatment sequence.