If you have noticed your gums beginning to swell and grow over the metal brackets of your braces, you are experiencing a phenomenon known as gingival overgrowth, which is also commonly referred to as gingival hyperplasia. While seeing your gum tissue enlarge around your orthodontic hardware can be alarming, this condition is a relatively frequent side effect of treatment with fixed appliances. This gum enlargement is generally manageable and often reversible with focused care and professional oversight. Understanding the root cause of this tissue change is the first step toward correcting the issue and maintaining a healthy smile.
Understanding Gingival Overgrowth
The primary mechanism behind this gum tissue enlargement is an inflammatory response triggered by the accumulation of bacterial plaque, or biofilm, along the gumline. Braces create a complex new environment in the mouth, introducing numerous surfaces, wires, and small gaps where plaque can easily hide and become difficult to remove effectively. This prolonged presence of bacterial toxins irritates the surrounding gum tissue, leading to a defensive swelling as the body attempts to fight the localized infection.
This inflammation is medically termed gingivitis, and the resulting increase in gum size is known as gingival enlargement. The physical presence of the brackets and wires can also contribute by causing minor, ongoing irritation to the soft tissues, which further stimulates the growth response. Furthermore, the continuous, light pressure exerted by orthodontic forces during tooth movement can cause a minor inflammatory reaction within the supporting tissues. While this tissue change can be caused by certain medications or genetic factors, in the context of braces, it is overwhelmingly an inflammatory issue that is reversible once the underlying cause is addressed.
Enhanced Home Care and Hygiene Strategies
Since the issue is fundamentally caused by plaque, the most effective initial strategy is a significant upgrade to your daily oral hygiene routine. Fixed appliances require a modified approach to brushing, often involving a soft-bristled toothbrush used in a modified Bass technique. The brush is held at a 45-degree angle to the tooth and gumline and gently vibrated in small circles. It is necessary to brush both above and below the archwire and brackets to ensure all surfaces are thoroughly cleaned, a process that typically takes longer than a standard two-minute brush.
Flossing is often the most challenging but most important aspect of hygiene with braces, as it targets the plaque between the teeth that a toothbrush cannot reach. Traditional string floss must be carefully guided under the archwire using a specialized tool called a floss threader. Alternatively, specialized orthodontic floss, which features a stiffened end, can simplify this process by eliminating the need for a separate threader. Consistent flossing is paramount, as the interdental areas are prime spots for plaque accumulation that fuels the gum overgrowth.
Many orthodontists recommend incorporating a water flosser, or oral irrigator, into the daily routine to supplement manual cleaning. This device uses a pressurized stream of water to flush out food particles and bacteria trapped around the brackets and under the gumline, often reaching areas difficult for a toothbrush or floss to access. Following your cleaning routine, rinsing with a non-alcohol-based antimicrobial mouthwash may also help reduce the bacterial load in your mouth. This enhanced, diligent home care is the first line of defense and can often significantly reduce the inflammatory swelling within a few weeks.
Professional Treatment and Management Options
If rigorous home care does not fully resolve the gingival enlargement, professional intervention from a dental hygienist, general dentist, or periodontist becomes necessary. The initial professional step is a thorough cleaning, which includes scaling and root planing. This non-surgical procedure removes hardened plaque, known as calculus or tartar, that has formed below the gumline and cannot be removed by the patient’s toothbrush or floss.
Removing the source of chronic irritation through this deep cleaning often allows the inflamed gum tissue to shrink back to a healthier size. If the tissue remains significantly overgrown, or if it has become fibrotic—meaning the tissue has developed a tough, dense texture—a minor surgical procedure may be indicated. This procedure is called a gingivectomy, which involves the precise removal of the excess gum tissue to restore a normal, healthy gum contour.
The gingivectomy can be performed using a traditional scalpel or, increasingly, a soft-tissue dental laser. Laser treatment offers advantages such as less bleeding, minimal discomfort, and faster healing times, and often requires only a topical anesthetic. This procedure is typically done to eliminate the excess tissue that interferes with cleaning or orthodontic movement, but patients must maintain the enhanced home care routine afterward to prevent the overgrowth from recurring.