Gingival overgrowth, also known as gingival hyperplasia, is a common condition where the gum tissue surrounding the teeth enlarges abnormally. This excess tissue can make the teeth appear shorter and may interfere with proper oral hygiene. While the condition can be concerning, it is manageable with several effective prevention and treatment strategies available. Understanding the underlying reasons for this overgrowth is the first step toward finding a solution.
Understanding Why Gums Overgrow
The enlargement of gum tissue is categorized into three main etiologies: drug-induced, inflammatory, and systemic or hereditary factors. The most prevalent form is drug-induced gingival hyperplasia (DIGH), an adverse effect of certain systemic medications. These include anticonvulsants (phenytoin), immunosuppressants (cyclosporine), and calcium channel blockers (nifedipine).
The mechanism behind DIGH involves the drug altering the metabolism of gingival fibroblasts, the cells responsible for maintaining connective tissue. These drugs inhibit calcium ion influx, which interferes with collagen degradation. This leads to an excessive accumulation of collagen, resulting in tissue proliferation and the characteristic firm, fibrous enlargement.
Overgrowth can also be caused by an inflammatory response triggered by poor oral hygiene. Plaque accumulation causes chronic inflammation (gingivitis or periodontitis). This persistent inflammation leads to swelling, making the tissue appear red, soft, and prone to bleeding, distinguishing it from the firm tissue seen in drug-induced cases.
Finally, systemic and hereditary factors also play a role. Hormonal fluctuations during pregnancy or puberty can increase the inflammatory response to plaque. Certain systemic diseases, including leukemia, or rare genetic conditions such as hereditary gingival fibromatosis, can also cause generalized gum overgrowth.
Daily Strategies for Prevention and Management
Effective management begins with a dedicated home care routine, as bacterial plaque acts as a cofactor in nearly all forms of the condition. Patients should adopt the Modified Bass technique, positioning a soft-bristled toothbrush at a 45-degree angle to the tooth surface. This technique uses short, vibratory strokes to disrupt and remove the bacterial biofilm from the gingival sulcus, the critical area for initiating inflammation.
Interdental cleaning with floss or specialized brushes is equally important to remove plaque from between the teeth. For temporary control of inflammation, a prescription chlorhexidine mouthwash may be recommended as an adjunct to mechanical cleaning. Chlorhexidine should be limited to short-term use (30 days or less), as prolonged application can cause side effects like tooth staining and increased calculus formation.
If the overgrowth is suspected to be drug-induced, consulting the prescribing physician is the first step. The physician may substitute the problematic medication with an alternative drug that lacks gingival side effects. This modification, where medically feasible, is often the most direct way to stop progression and encourage tissue recession.
Professional Maintenance
Patients with existing gum overgrowth or those taking causative medications require more frequent professional maintenance than the standard six-month interval. To manage persistent inflammation and prevent plaque hardening into calculus, a cleaning schedule of every three to four months is often recommended. These frequent visits allow the dental team to meticulously remove irritants, reducing the inflammatory component that fuels tissue growth.
Clinical Treatments for Gum Reduction
When rigorous home care and medication adjustments are insufficient, dental professionals use clinical treatments to reduce the enlarged gum tissue. The first step for inflammatory overgrowth is often scaling and root planing (SRP), a non-surgical deep cleaning procedure. This involves meticulously removing plaque and hardened calculus from the tooth surface and below the gumline.
During root planing, the root surfaces are smoothed to eliminate rough areas where bacteria accumulate, helping the gum tissue reattach. SRP is effective for reducing inflammation-driven enlargement. If the tissue remains enlarged due to fibrous, non-inflammatory causes or if the overgrowth is severe, a surgical procedure called a gingivectomy is performed.
A gingivectomy involves the physical removal and contouring of excess gum tissue to expose more of the natural tooth crown. This can be accomplished using a scalpel, electrosurgery, or a dental laser. Laser excision offers advantages like precise tissue sculpting and immediate hemostasis (less bleeding), which improves visibility and contributes to faster healing.
Following any surgical reduction, maintaining impeccable oral hygiene and adhering to a strict maintenance schedule is necessary to prevent the relapse of the overgrowth.