When gums appear to be growing over the teeth, it can be an alarming change that affects both the smile and oral health. This condition is medically known as gingival enlargement, and it requires professional attention. It is characterized by an abnormal increase in the size of the gum tissue surrounding the teeth. Understanding the underlying causes and appropriate management is the first step toward restoring healthy gums and preventing further complications.
Defining Gingival Enlargement
Gingival enlargement is the clinical term for an overgrowth of the gingiva. This condition visually manifests as gums that look puffy, swollen, or excessively prominent, making the teeth appear shorter than they are. The excess tissue is primarily composed of fibrous connective tissue, classified by an increase in the bulk of the gum. In severe cases, the overgrown tissue can completely cover the crowns of the teeth, creating significant aesthetic and functional challenges.
Primary Causes of Gum Overgrowth
Inflammatory Causes
The most frequent cause of gum overgrowth is chronic inflammation in response to poor oral hygiene, which is known as inflammatory gingival enlargement. When bacterial plaque and calculus accumulate on the tooth surfaces, the body’s immune system reacts, causing the gum tissue to become red, tender, and visibly swollen. This type of enlargement often resolves once the irritants are thoroughly removed through professional cleaning and improved daily care.
Drug-Induced Overgrowth
A second major category is drug-induced gingival overgrowth, a side effect linked to certain systemic medications. The three primary classes of drugs responsible are anticonvulsants (e.g., phenytoin), immunosuppressants (e.g., cyclosporine), and calcium channel blockers (e.g., nifedipine and amlodipine). These medications interfere with the metabolism of gingival fibroblasts, the cells responsible for maintaining connective tissue structure, leading to an excessive accumulation of fibrous tissue.
Systemic and Hormonal Factors
Gum enlargement can also be linked to various systemic or hormonal factors. Hormonal fluctuations during pregnancy or puberty can increase the gums’ inflammatory response to plaque, leading to a temporary increase in tissue size. Generalized gum overgrowth can occasionally be a manifestation of systemic diseases, such as leukemia, which causes an infiltration of abnormal cells into the gum tissue. Rare genetic conditions, like hereditary gingival fibromatosis, can also cause a slow, progressive overgrowth of dense, fibrous gum tissue.
How Gum Overgrowth Affects Oral Health
The physical presence of enlarged gum tissue significantly compromises the ability to maintain proper oral hygiene. The overgrown tissue makes it difficult to effectively brush along the gumline or floss, allowing plaque to build up rapidly. This creates an environment where inflammation and enlargement worsen, perpetuating a cycle of tissue growth.
The excessive gum tissue also forms “pseudo-pockets,” deep crevices around the teeth that trap food particles and bacteria. These deep spaces become inaccessible to routine cleaning, accelerating the progression of periodontal disease and increasing the risk of bone loss. Beyond health risks, the condition causes aesthetic concerns, making teeth appear small, and functional issues, including difficulty chewing or occasional pain.
Professional Treatment and Management
Non-Surgical Management
The initial phase of managing gingival enlargement focuses on eliminating the underlying cause, beginning with meticulous plaque control. A dental professional will perform a thorough cleaning, often including scaling and root planing, to remove all bacterial plaque and calculus from above and below the gumline. This non-surgical approach is frequently sufficient to resolve inflammatory enlargement.
Medication Review
For cases linked to medication, the dentist will consult with the prescribing physician to discuss possible drug substitution. It is paramount that a patient never discontinues their medication without medical guidance. Switching to an alternative drug class can often halt the progression of the overgrowth and may lead to a partial or complete resolution. If the causal medication cannot be changed, the treatment plan shifts to managing the tissue growth through ongoing, strict oral hygiene.
Surgical Intervention
When the gum tissue remains excessively enlarged and fibrotic, surgical intervention becomes necessary to remove the excess tissue and re-establish a healthy gum contour. The most common procedure is a gingivectomy, which surgically removes the overgrown tissue to eliminate the deep pseudo-pockets and expose more of the tooth surface. This procedure can be performed using a traditional scalpel or modern dental lasers.
Laser gingivectomy is often favored because it provides a relatively bloodless surgical field, which improves visibility for the clinician. The laser simultaneously cuts and seals the tissue, leading to reduced bleeding during the procedure and potentially faster healing times. Both scalpel and laser techniques are effective at reducing the tissue bulk, but both require a strong commitment to long-term maintenance, including frequent follow-up appointments and diligent home care, to prevent recurrence.