Enlargement of gums is a commonly occurring problem among dental patients nowadays, and refers to overgrowth of the gingival tissues. This condition normally depicts an underlying gingival disease caused by various factors such as inflammation, drugs, or chronic illnesses. The term hyperplasia may not be suitable for this condition, as hyperplasia refers to increase in number of cells of a tissue when observed under a microscope. Since only gingival enlargement is observed on clinical evaluation, the term “gingival enlargement” might be better suited for this condition.
Causes of Gingival Hyperplasia
Gingival hyperplasia has been classified according to its etiology into five major groups:
- Inflammation induced hyperplasia
- Drug induced hyperplasia
- Hyperplasia associated with systemic diseases
- Hyperplasia associated with a cancerous lesion
- False hyperplasia
Inflammation Induced Hyperplasia
Heavy plaque or calculus deposits favor gingival inflammation or gingivitis, hence inflammatory hyperplasia is more common in people with poor oral hygiene. The edema caused by inflammation causes the gums to swell, while the activated inflammatory mediators lead to overgrowth of the gums. Various other factors, such as physical irritation of gums caused improper sub gingival margins of dental restorations, can also cause gingival hyperplasia.
Drug Induced Hyperplasia
Various drugs have been documented in medical literature that can cause excessive gingival enlargement and has been shown to carry a genetic predisposition. Various anticonvulsants such as phenytoin, phenobarbital, lamotrigine, and primidone frequently lead to gingival enlargement. Other drug groups like calcium channel blockers, such as nefidipine, amlodipine, verapamil and immunosuppressants, such as cyclosporine, have been known to cause gingival hyperplasia. It should however be kept in mind that the symptoms are reversed immediately, once the causative drug is discontinued, provided permanent damage has not taken place.
Hyperplasia Associated with Systemic Illnesses
Various systemic illnesses, such as granuomatosis, and several neoplasms, such as leukemia, are known causative agents of gingival enlargement. Apart from that, various metabolic conditions such as vitamin or nutritional deficiencies, and some physiological conditions such as puberty, menstruation and pregnancy can lead to enlarged gums. Symptoms usually fade away with treatment of the illness or end of physiological cycles.
False Gingivitis
This is not an actual gingival enlargement, rather mainly occurs due to a various underlying dental soft tissue or bony lesions.
Management of Gingival Hyperplasia
The first step in management of gingival hyperplasia is to maintain a meticulous oral hygiene. During this period, it is recommended that brushing be performed twice a day using a soft tooth brush, in addition to use of dental floss and a suitable mouthwash. Next, the dentist should consult the general physician of the patient to identify any medication that might by causing gingival enlargement, so that it can be immediately discontinued or replaced with another medication.
In cases of hyperplasia caused by a medical illness, referring the patient to a general physician will help in the diagnosis of any underlying medical condition. Finally, if the dentist sees that the gums are enlarged due to menstruation or pregnancy, the patient should be provided with symptomatic treatment and instructed that it will heal itself once the underlying condition is gone.
If all preventive and medical management strategies fail to treat gingival hyperplasia, a surgical approach known as gingivectomy can be performed. This involves removal of the excessively enlarged gums using a laser or sharp dental tool. Recovery time is surprisingly fast if proper care is taken.
In Conclusion
In most cases, gingival hyperplasia is reversible. However, if the underlying gingival disease progresses to the periodontal region or the alveolar bone, the damage can be even more severe. Hence, gum enlargement, especially that which occurs as a result of inflammation or underlying illness, must not be taken lightly, and immediate treatment should be sought after.
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