The appearance of gums seeming to cover or “overlap” the teeth is a common dental concern that affects both the look of your smile and overall oral health. This phenomenon is professionally known as gingival enlargement or gingival overgrowth. The excess gum tissue can make teeth look unusually short and creates environments where maintaining cleanliness becomes difficult, often requiring professional intervention.
What is Gingival Overgrowth?
Gingival overgrowth is the abnormal increase in the size of the gum tissue, or gingiva, surrounding the teeth. This enlargement occurs due to an increase in the number of cells (hyperplasia) or an increase in the size of the tissue’s components (hypertrophy). Healthy gum tissue is firm and tightly contoured around the neck of the tooth, but overgrowth causes the tissue to become bulky, puffy, or thick.
The extent of the overgrowth varies significantly, ranging from small, localized swellings to a generalized condition impacting most teeth. In severe cases, the tissue may completely cover the clinical crown of the tooth, which is the visible portion above the gum line.
Plaque and Inflammation as the Primary Cause
The most frequent cause of gingival enlargement is a chronic inflammatory response triggered by the accumulation of bacterial plaque at the gum line. This accumulation leads to gingivitis, where the immune system sends inflammatory cells to fight the bacteria and their toxic byproducts. The chronic presence of these irritants causes the gum tissue to become red, swollen, and prone to bleeding.
This constant inflammation stimulates the gum tissue components to increase in volume. Initially, the swelling is an increase in fluid and inflammatory cells, resulting in a soft, edematous appearance. If poor oral hygiene persists, the tissue can become more fibrotic, developing an excess of collagen fibers, which makes the enlargement firmer.
Managing this type of overgrowth requires removing the source of irritation through professional dental cleaning, known as scaling and root planing, to eliminate plaque and tartar below the gum line. Patients must also adopt stringent oral hygiene practices, including consistent brushing and flossing, to prevent the cycle of inflammation. Addressing the plaque is often enough to cause a partial or complete reversal of the enlargement.
Drug-Induced Gum Enlargement
A distinct cause of gingival overgrowth is the side effect of certain systemic medications, referred to as Drug-Induced Gingival Overgrowth (DIGO). Three major classes of drugs are commonly implicated: anticonvulsants, calcium channel blockers, and immunosuppressants. Examples include phenytoin (for seizures), nifedipine (for blood pressure), and cyclosporine (for transplants).
The drugs interfere with the normal metabolism of gingival fibroblasts, the cells responsible for producing the gum’s connective tissue matrix. This interference can inhibit the activation of collagenase, the enzyme responsible for breaking down old collagen.
The resulting imbalance causes an excessive accumulation of extracellular matrix components, primarily collagen, leading to characteristic firm, pale pink, and non-bleeding tissue enlargement. Patients should never discontinue a prescribed drug on their own, but must inform their physician and dentist so that medication adjustments can be explored. The severity of DIGO is often compounded by dental plaque, making meticulous oral hygiene necessary.
Other Systemic and Hormonal Factors
Gingival enlargement can be influenced by systemic conditions and hormonal fluctuations, which amplify the tissue’s response to local irritants. During periods of hormonal change, such as puberty or pregnancy, increased levels of hormones like estrogen and progesterone affect the gum tissue’s microcirculation. This heightened vascular response makes the gingiva more sensitive to bacterial plaque, resulting in a disproportionately large inflammatory reaction.
In these cases, the generalized enlargement may be characterized by prominent, bulbous interdental papillae that bleed easily. Hormonal change acts as a conditioning factor that exacerbates the inflammation initiated by plaque, rather than causing the overgrowth directly. Other systemic causes include blood disorders like leukemia, or rare genetic conditions such as hereditary gingival fibromatosis.
Hereditary gingival fibromatosis is a slow-growing, generalized enlargement that results in firm, dense, pale pink tissue that can completely cover the teeth. This genetic condition is purely an overproduction of collagen and is not related to inflammation or medication. Management requires controlling the underlying condition or maintaining exceptional oral hygiene to minimize the inflammatory trigger.
Professional Treatments and Management
The treatment for gingival overgrowth depends on identifying and managing the underlying cause. For common inflammatory cases, initial management involves intensive non-surgical therapy, including professional scaling and root planing to thoroughly clean the tooth and root surfaces. This is coupled with rigorous instruction for the patient to improve daily plaque control.
If the overgrowth is caused by medication, the dental team collaborates with the prescribing physician to see if a substitute drug can be used, which may lead to resolution. When the excess tissue is dense, fibrous, severe, or persists after the underlying cause is addressed, surgical intervention becomes necessary.
The primary surgical procedure is a gingivectomy, which is the physical removal of the excess gum tissue to restore a normal contour and allow for effective cleaning. This procedure can be performed using a scalpel, electrosurgery, or a dental laser. A gingivectomy is often combined with a gingivoplasty, which is the reshaping of the remaining gum tissue to create a more natural gum line. Surgical management is followed by a strict maintenance schedule to prevent recurrence.