Gum tissue appearing to grow or swell between the teeth is a common concern that can be alarming to notice. This phenomenon is professionally known as gingival enlargement or gingival overgrowth, representing an increase in the size of the gum tissue surrounding the teeth. This tissue change is a relatively frequent dental condition caused by several factors, ranging from local irritants to systemic issues. Understanding the underlying cause is important for effective resolution, and a dental professional must properly diagnose the specific condition.
Defining Interdental Gum Overgrowth
The tissue that fills the space between two adjacent teeth is called the interdental papilla, and this specific area is often affected by the overgrowth. When this tissue expands, it is generally termed gingival enlargement, a broad clinical description for the increased volume of the gums. More specific scientific terms include gingival hyperplasia (an increase in the number of cells) and gingival hypertrophy (an increase in the size of individual cells).
Regardless of the precise cellular mechanism, the result is an accumulation of excess fibrous connective tissue, which can partially or fully obscure the crowns of the teeth. This overgrowth can be localized or generalized across the entire mouth, and its texture may vary depending on the cause. This tissue proliferation creates spaces that are difficult to clean, which can then lead to further dental complications.
Causes Related to Dental Hygiene and Inflammation
The most frequent reason for this overgrowth, especially when the tissue appears red, soft, and bleeds easily, is chronic inflammation caused by poor oral hygiene. When dental plaque—a sticky film of bacteria and food debris—is not adequately removed, it accumulates near the gum line and mineralizes into calculus, or tartar. The presence of these irritants triggers an inflammatory response in the gums, known as gingivitis.
This sustained inflammation leads to a localized immune reaction, stimulating the proliferation of the underlying fibrous connective tissue, causing the visible enlargement of the interdental papilla. Inadequate brushing and infrequent flossing allow the bacterial biofilm to remain undisturbed, continuously feeding this inflammatory cycle and exacerbating the tissue swelling.
The tissue expansion can create a false pocket around the tooth, making it even harder to clean and encouraging further plaque buildup. Because this type of enlargement is directly correlated with the presence of plaque, it is often reversible once meticulous oral hygiene is re-established and all local irritants are removed.
Causes Related to Medications and Health Conditions
Gingival enlargement can also be a side effect of certain systemic medications, a condition referred to as Drug-Induced Gingival Enlargement (DGE). Three main classes of drugs are commonly implicated: anticonvulsants, immunosuppressants, and calcium channel blockers. For example, the anti-seizure medication phenytoin is known to cause gingival overgrowth in many users.
Immunosuppressants such as cyclosporine, often prescribed after organ transplantation, and calcium channel blockers like nifedipine and amlodipine, used to manage blood pressure, also trigger tissue proliferation. The cellular mechanism involves these drugs interfering with the metabolism of gingival fibroblasts, the cells responsible for producing connective tissue. This interference inhibits the function of enzymes necessary to break down old collagen, leading to an excessive accumulation of extracellular matrix material.
Beyond medication, several systemic health conditions and hormonal fluctuations can also contribute to localized gum growth. Hormonal changes during puberty or pregnancy can increase the gum’s inflammatory response to plaque, leading to noticeable enlargement. Furthermore, certain systemic diseases, including leukemia, HIV, and some genetic syndromes, can manifest as gingival overgrowth, often requiring a medical evaluation to determine the underlying cause.
Treatment and Management Options
The first step in managing gingival enlargement is always to address any underlying inflammation through comprehensive non-surgical periodontal therapy. This treatment involves professional scaling and root planing, which removes the plaque and calculus from above and below the gum line to eliminate the primary bacterial irritants. Meticulous daily oral hygiene, including proper brushing and flossing techniques, must be adopted to prevent recurrence of the inflammatory cycle.
Drug-Induced Management
For cases of drug-induced enlargement, management often requires a collaborative approach between the dentist and the prescribing physician. The treatment may involve adjusting the dosage of the medication or switching to an alternative drug that is less likely to cause the side effect. However, even after a medication change, the existing overgrown tissue may not fully shrink and might require further intervention.
Surgical Intervention
When the enlargement is severe, fibrotic, or does not resolve after conservative and medical management, surgical intervention becomes necessary. The most common procedure is a gingivectomy, which involves the precise removal of the excess gum tissue using a scalpel or dental laser to re-establish a normal gum contour. This reshaping procedure eliminates the tissue overgrowth, making it easier to maintain oral hygiene and reducing the risk of further dental complications.