The appearance of gums “coming down” over the teeth during orthodontic treatment signals gingival enlargement, gum overgrowth, or gingival hyperplasia. This condition is an increase in the size of the gum tissue, making the teeth look shorter or more covered than before. While concerning, it is often a manageable side effect of having fixed orthodontic appliances. Understanding the underlying causes and the body’s reaction is the first step toward effective management. The enlargement is primarily an inflammatory response, and while it may be related to the mechanical presence of the braces, it is not an inevitable outcome of tooth movement.
How Braces Create the Environment for Gum Enlargement
Orthodontic appliances, such as brackets and wires, introduce new physical structures that change the oral environment. These fixed devices inherently create more surfaces and crevices where food particles and bacterial plaque easily accumulate. This accumulation is difficult to remove, establishing what dentists refer to as a plaque trap.
The brackets are bonded directly to the tooth surface, creating small ledges and undercuts that are nearly impossible to clean with standard tools. This obstruction significantly compromises thorough oral hygiene, particularly at the gum line where plaque is most damaging.
Furthermore, the physical hardware can cause mild mechanical irritation as it rests against the delicate gum tissue. The constant rubbing from the brackets and wires contributes to a localized inflammatory response. This combination of physical irritation and increased plaque retention makes the gums highly susceptible to inflammation and subsequent overgrowth.
The Biological Mechanism: Inflammation and Swelling
The visible gum overgrowth is primarily a biological reaction to the persistent presence of bacterial plaque biofilm, leading to a condition called gingivitis. When plaque accumulates near the gum line, the bacteria release toxins that irritate the gingival tissue. The body’s immune system responds to this irritation by increasing blood flow to the area, causing redness and swelling.
This chronic inflammatory state prompts the gum tissue to grow larger in volume. Gingival enlargement describes this increase in size, which may stem from an increase in the size of tissue cells (hypertrophy) or an increase in the number of cells (hyperplasia). The body attempts to wall off the source of irritation, resulting in the overgrown appearance.
Often, what appears to be tissue overgrowth is actually a formation of “pseudo-pockets,” where the swollen gum tissue simply covers more of the tooth crown. This localized tissue response is frequently exacerbated during orthodontic treatment because the inflamed, swollen gums are harder to clean, creating a cycle of poor hygiene and increasing enlargement.
Essential Home Care and Prevention Strategies
Since inflammation driven by plaque is the root cause of enlargement, meticulous home care is the most effective prevention and treatment. Brushing must be modified to clean thoroughly around the brackets, wires, and bands. Use a soft-bristled or orthodontic-specific toothbrush with a modified Bass technique, positioning the brush at a forty-five-degree angle toward the gum line and using small, circular motions.
The goal is to clean both above and below the orthodontic wire, focusing on the interface between the bracket and the tooth surface. Brushing should occur a minimum of two times per day for a full two minutes each session.
Flossing is critical for removing plaque from between the teeth. Several tools aid in cleaning around fixed appliances:
- Interdental brushes (proxy brushes) clean tight spaces directly underneath the orthodontic wire and between the brackets.
- Traditional string floss requires an orthodontic floss threader to navigate under the archwire.
- Water flossers use a pressurized stream of water to dislodge plaque and food debris from around the appliance and beneath the gum line.
- Regular use of an antimicrobial or fluoride rinse helps reduce the bacterial load and strengthen the enamel against decay.
When Professional Intervention is Required
While improved hygiene can often reverse mild to moderate gum enlargement, home care alone is not always sufficient, particularly if the tissue has become fibrotic or excessively overgrown. If the swelling persists despite consistent, rigorous oral hygiene for six to eight weeks, professional intervention is necessary.
The initial step involves a professional dental cleaning, which may include scaling and root planing to remove hardened plaque (calculus) from above and below the gum line. Your orthodontist may also need to adjust the appliance to reduce any direct mechanical irritation on the gum tissue.
If the enlargement is severe, persistent, and interferes with oral hygiene or the mechanics of tooth movement, a minor surgical procedure might be considered. This procedure is called a gingivectomy, which involves the removal of the excess gum tissue to restore a healthy, cleanable gum contour.
This surgical option, performed with a scalpel or a dental laser, is reserved as a last resort after all non-surgical methods have been exhausted. Contact your dental professional immediately if you experience excessive pain, persistent bleeding, or signs of a localized infection, such as a pus-filled bump near the gum line.