The perception that one’s gums are “too big” is a common concern that dentists refer to as gingival enlargement or gingival overgrowth. This condition involves an increase in the size of the gum tissue surrounding the teeth. It can range from localized swelling around a single tooth to generalized overgrowth across the entire mouth. While the appearance of enlarged gums can be concerning, it is often a symptom of an underlying issue that can be diagnosed and treated effectively.
Distinguishing True Enlargement from a Gummy Smile
It is important to differentiate between a true increase in gum tissue volume, known as gingival hyperplasia, and what is commonly called a “gummy smile.” True enlargement is a pathological increase in the actual size of the gingiva, causing the gums to appear puffy or bulky.
A gummy smile, or excessive gingival display, is a structural issue where the gums look prominent due to factors like a shorter upper lip, teeth covered by excess normal gum tissue, or a vertically long upper jawbone. In these cases, the gum tissue is simply more visible due to the proportions of the mouth and face, not necessarily enlarged.
The Role of Plaque and Inflammation
The most frequent cause of true gum enlargement is chronic inflammation, known as inflammatory gingival enlargement. This is a direct response to the accumulation of dental plaque, a sticky film of bacteria, on the teeth and at the gum line. When plaque is not removed, the body’s immune system activates an inflammatory response to fight the bacterial invasion.
This immune reaction causes the gum tissue to become red, tender, and swollen, a state called gingivitis. If the inflammation persists, the gum tissue can begin to proliferate, leading to visible overgrowth. This enlargement is highly reversible, often resolving completely once meticulous oral hygiene is adopted and a professional dental cleaning removes hardened plaque (calculus).
The chronic presence of bacteria triggers the release of inflammatory mediators, which stimulate the growth of connective tissue within the gums. This tissue proliferation can create a pocket around the tooth, making it more difficult to clean and trapping more bacteria. This cycle can cause the gingival enlargement to worsen over time, emphasizing the need for consistent plaque control.
Medications and Underlying Health Conditions
Beyond plaque accumulation, systemic factors, including certain medications and underlying medical conditions, can directly trigger gingival overgrowth. This drug-induced gingival enlargement (DGE) occurs when specific compounds interfere with the normal metabolism of gum tissue cells. The excess tissue in DGE is typically firm, pale pink, and less prone to bleeding than enlargement caused by plaque inflammation.
Three main classes of medications are most frequently implicated in DGE: anticonvulsants (like phenytoin, used for seizures), immunosuppressants (like cyclosporine, used for organ transplants), and calcium channel blockers (like nifedipine, used for high blood pressure). These drugs disrupt the ability of gingival fibroblasts to break down collagen, leading to an excessive buildup of the extracellular matrix and subsequent tissue growth.
Systemic diseases and hormonal changes can also contribute to gum enlargement. Hormonal fluctuations during pregnancy and puberty can exaggerate the inflammatory response to plaque, leading to temporary swelling. More serious conditions, such as leukemia, can manifest in the gums as enlarged, sometimes purplish, tissue. Hereditary gingival fibromatosis is a rare genetic disorder that causes a slow, progressive overgrowth of dense, pale gum tissue, often starting in childhood.
Treatment Options for Excess Gum Tissue
The approach to treating excess gum tissue depends entirely on identifying the underlying cause. For inflammatory enlargement resulting from plaque, the initial and most effective non-surgical management involves professional deep cleaning and improvement in daily oral hygiene. This step often allows the swollen tissue to regress naturally.
If the enlargement is linked to a medication, consulting with the prescribing physician to adjust the dosage or switch to an alternative drug is the first course of action. Discontinuing or changing the medication can often lead to a partial or complete resolution of the overgrowth. If the medication cannot be changed, or if the tissue remains significantly enlarged, surgical removal may be necessary.
Surgical treatment for true gingival enlargement is typically performed by a periodontist. A procedure called a gingivectomy involves the precise removal of the excess gum tissue, often using a scalpel or a laser, to expose more of the natural tooth crown. When the goal is to reshape the gums for a more aesthetically pleasing appearance, the procedure is referred to as a gingivoplasty. For a gummy smile caused by structural issues, specialized procedures such as orthodontic treatment, lip repositioning surgery, or orthognathic surgery to reposition the jawbone may be required.