The condition where gums appear to cover too much of the teeth is clinically known as gingival enlargement or gingival hyperplasia. This overgrowth of gum tissue is a common concern that goes beyond aesthetics. It can interfere with proper oral hygiene and lead to more serious health issues. Understanding why this enlargement occurs is the first step toward effective management, whether the cause is related to inflammation, medication, or genetic factors.
Primary Causes of Excessive Gum Coverage
The most frequent reason for gum tissue to swell and cover the teeth is chronic inflammation resulting from poor oral hygiene. When dental plaque is not adequately removed, it hardens into calculus or tartar, which causes gingivitis. This inflammation results in tissue edema and an infiltration of immune cells, causing the gums to appear red, puffy, and enlarged. This inflammatory enlargement is often soft, bleeds easily, and is reversible with professional cleaning and improved home care.
A significant cause is the side effect of certain systemic medications, known as drug-induced gingival overgrowth (DIGO). The three main classes of drugs implicated are anticonvulsants (e.g., phenytoin), immunosuppressants (e.g., cyclosporine), and certain calcium channel blockers (e.g., nifedipine). These medications alter the metabolism of cells in the gum tissue, specifically fibroblasts, leading to the excessive production and accumulation of extracellular matrix proteins like collagen. Unlike inflammatory enlargement, DIGO tissue is typically firm, pale pink, and fibrotic, often presenting within a few months of starting the medication.
Beyond inflammation and medication, excessive gum coverage can be influenced by developmental or systemic factors. Hormonal fluctuations during puberty or pregnancy can increase the gingival tissue’s inflammatory response to plaque, leading to temporary enlargement. A rare genetic condition called hereditary gingival fibromatosis causes a slow, progressive, and dense overgrowth of the gums, often starting in childhood. Certain systemic diseases, such as leukemia, can also manifest as gingival enlargement due to the infiltration of abnormal cells into the gum tissue.
Non-Surgical and Hygiene-Based Solutions
The initial approach to treating excessive gum coverage, especially when inflammation is a factor, involves professional deep cleaning. This procedure, known as scaling and root planing (SRP), is a non-surgical therapy performed below the gumline. Scaling removes accumulated plaque and hard calculus from the tooth surfaces and the pocket between the gum and tooth. Root planing involves smoothing the root surfaces to remove toxins and create a clean surface that encourages the gums to reattach, reducing the depth of the pockets. This deep cleaning eliminates the bacterial irritants that drive the inflammatory component of the enlargement. Following SRP, more frequent professional cleanings, often every three to four months, are recommended to maintain gum health.
Improved home care is fundamental to resolving and preventing recurrence of gingival enlargement. This involves meticulous brushing twice a day with a soft-bristled brush, angled at 45 degrees toward the gumline to disrupt plaque effectively. Daily flossing or use of interdental cleaners is necessary to remove trapped bacteria that contribute to inflammation. Specialized products like antimicrobial mouthwashes containing chlorhexidine may also be recommended temporarily to reduce the bacterial load and aid in healing.
For cases of drug-induced overgrowth, the most effective non-surgical solution involves collaboration between the dentist and the prescribing physician. Patients should never discontinue medication independently. A consultation may allow the physician to substitute the causative drug with an alternative that has a lower risk of gum overgrowth, such as replacing cyclosporine with tacrolimus. If substitution is successful, the gum enlargement may partially or completely resolve over several weeks. If the medication cannot be changed, aggressive plaque control is necessary to minimize the inflammatory component, which can worsen the drug’s effect on the gums.
Surgical and Advanced Procedures
When conservative treatments fail to resolve the gum overgrowth, or when the underlying cause is developmental, surgical options provide definitive treatment. The least invasive surgical option is a gingivectomy, which involves the surgical removal of excess soft gum tissue to expose more of the natural tooth structure. This procedure is indicated for cases where the enlargement is due only to excess gum tissue, such as severe drug-induced or inflammatory cases that have not responded to deep cleaning.
A gingivectomy is performed under local anesthetic using a scalpel or, increasingly, a specialized dental laser. Laser therapy minimizes bleeding and discomfort, as the laser cauterizes the tissue as it cuts, often eliminating the need for sutures and promoting faster healing. The procedure sculpts the gum line to create a more balanced appearance, and recovery is generally rapid.
For aesthetic correction of a “gummy smile,” or when the underlying bone structure is a factor, a more comprehensive procedure called esthetic crown lengthening is necessary. This procedure removes excess gum tissue and involves reshaping the bone around the tooth roots, known as osseous recontouring. Reshaping the bone establishes the correct biological width—the space required between the tooth root and the edge of the restoration—to prevent the gum tissue from growing back.
The crown lengthening procedure is more involved than a gingivectomy and is often necessary when the teeth are naturally short or have not fully erupted. Following any surgical intervention, diligent post-procedure care is required, including careful cleaning and follow-up appointments, to ensure proper healing and prevent the recurrence of tissue overgrowth. In cases of chronic drug-induced enlargement, the condition can still recur, making long-term professional maintenance and excellent oral hygiene necessary.