Gingival enlargement, also known as gingival hyperplasia or overgrowth, is a common condition where the gum tissue surrounding the teeth increases in size. This overgrowth can range from mild swelling to severe cases where the gums cover a significant portion of the tooth crowns. Enlarged gums interfere with proper oral hygiene, increasing the risk of periodontal disease and causing discomfort during eating. Understanding the underlying causes is the first step toward effective management, as treatment is tailored to the source of the growth.
Why Gums Become Enlarged
Gingival enlargement results from various biological processes, broadly categorized into three main origins. The most frequent cause is inflammatory enlargement, which occurs when bacterial plaque accumulates on the teeth and along the gumline. This buildup triggers a chronic inflammatory response, known as gingivitis, causing the gums to become red, soft, and swollen. If this irritant is not removed through daily cleaning and professional care, the persistent inflammation can lead to fibrous tissue changes and continued swelling.
A second cause is a reaction to certain systemic medications, termed drug-induced gingival overgrowth. This side effect is associated with three classes of drugs: anticonvulsants, immunosuppressants, and calcium channel blockers. For example, phenytoin and cyclosporine can induce this reaction. These medications alter the function of gingival fibroblasts, the cells responsible for producing connective tissue, resulting in an excessive accumulation of tissue within the gums.
The third category includes systemic or hormonal factors that can contribute to gum tissue growth. Hormonal fluctuations, such as those experienced during pregnancy or puberty, can make the gums more susceptible to inflammation even with minimal plaque accumulation. Certain underlying systemic diseases, most notably leukemia, can also cause the gums to enlarge due to the infiltration of leukemic cells into the tissue. In these cases, the gum enlargement serves as a visible symptom of a broader health condition requiring medical attention.
Professional Treatments to Reduce Gum Size
For cases driven primarily by inflammation, non-surgical management is the first line of defense. This involves a professional deep cleaning procedure known as scaling and root planing, which meticulously removes plaque and hardened calculus from both above and below the gumline. Eliminating these bacterial irritants often allows the inflamed tissue to shrink significantly, sometimes resolving the enlargement entirely without further intervention.
When the enlargement is linked to medication, the approach involves coordination between the dental specialist and the prescribing physician. Patients should never stop taking a prescribed drug on their own, but a consultation may allow for a change in medication or a dosage adjustment. Substituting the causative drug with an alternative can often lead to a reduction in the gum overgrowth. If drug substitution is not possible due to the patient’s medical needs, other treatments are pursued to manage the side effect.
If non-surgical efforts or medication changes fail to resolve the issue, or if the enlargement is fibrotic and firm, surgical intervention is necessary to remove the excess tissue. The most common procedure is a gingivectomy, which is the surgical excision of the overgrown gum tissue to restore a normal contour and depth around the teeth. This procedure is typically performed by a periodontist under local anesthesia.
In a traditional gingivectomy, the surgeon uses a scalpel to precisely trim away the excess gum tissue. An increasingly common alternative is the use of a dental laser, which offers a less invasive method for tissue removal and contouring. Laser treatment cauterizes the tissue as it cuts, often resulting in less bleeding and a faster recovery time compared to the traditional scalpel method. The primary goal of the surgery is to create an anatomy that allows the patient to effectively clean their teeth and maintain long-term gum health.
Preventing Future Gum Enlargement
Preventing recurrence requires a commitment to long-term maintenance, as many causative factors can persist. The most significant factor in prevention is maintaining a meticulous home care routine. This involves brushing twice daily with the correct technique, ensuring the bristles reach the gumline, and flossing or using interdental brushes once a day to remove plaque from between the teeth.
Regular professional care is also a necessary part of maintenance, often requiring cleanings more frequently than the standard six-month interval. These appointments allow the dental team to monitor the gum tissue for early signs of recurrence and remove any plaque or calculus buildup. Monitoring and managing any systemic health conditions is also important for reducing the risk of recurrence. If the original cause was related to a hormonal fluctuation or a systemic disease, keeping the underlying condition controlled helps to minimize the body’s inflammatory response. Patients taking medications known to cause overgrowth must be vigilant and report any changes in their gums immediately to ensure results are sustained.