Excess gum tissue growing over the surfaces of the teeth is medically termed gingival enlargement or gingival overgrowth. This condition is a noticeable change, often making teeth look shorter and creating pockets that are difficult to clean. Gingival enlargement is a symptom with several distinct underlying causes, ranging from poor hygiene to systemic health factors. Understanding this growth requires professional assessment.
The Primary Cause: Inflammation from Plaque
The most frequent reason for localized gum tissue overgrowth is a prolonged inflammatory response triggered by the accumulation of dental plaque. Plaque is a sticky biofilm composed of bacteria and food debris that constantly forms on the teeth, especially in areas difficult to reach with a toothbrush and floss. When this plaque is not removed effectively, the bacteria release toxins that irritate the gingival tissues, initiating an immune reaction called gingivitis. This inflammation causes the gums to become red, swollen, and prone to bleeding easily.
The body’s defense against this bacterial irritation leads to both fluid accumulation (edema) and a proliferation of tissue cells (hyperplasia). This enlargement is often most evident in the interdental papilla, the small triangular piece of gum tissue between adjacent teeth. If the plaque remains and hardens into tartar (calculus), the irritation becomes chronic, perpetuating the cycle of inflammation and tissue growth. Fortunately, this type of enlargement is reversible; eliminating the plaque and calculus through diligent home care and professional cleanings typically causes the excess tissue to shrink.
Medications That Stimulate Gum Tissue Growth
A second major category of gingival enlargement is a side effect caused by certain systemic medications, known as drug-induced gingival overgrowth (DIGO). This form of enlargement is not primarily due to inflammation, though plaque can certainly worsen the condition. Instead, it results from the drug’s effect on the metabolic processes of gingival fibroblasts, the cells responsible for producing connective tissue in the gums. The medication interferes with the body’s natural ability to break down older collagen, leading to an excessive accumulation of extracellular matrix material and subsequent tissue buildup.
Three main classes of drugs are most often implicated in causing this reaction. These include anticonvulsants (e.g., phenytoin for seizures) and immunosuppressants (e.g., cyclosporine for transplant rejection). The third group is calcium channel blockers (e.g., nifedipine and amlodipine), used to treat high blood pressure and heart conditions. Since these medications manage serious health issues, patients should never discontinue or alter their dosage without first consulting the prescribing physician to explore substitution options.
Systemic Conditions and Hormonal Influences
Gingival enlargement can also signal internal physiological changes or the presence of a systemic disease, often by exaggerating the tissue’s response to minimal plaque levels. Hormonal fluctuations are a common example, particularly during life stages such as puberty, pregnancy, or the menstrual cycle. Elevated levels of progesterone and estrogen increase blood flow to the gums, making the tissue more sensitive to bacterial toxins and prone to swelling, a condition often called pregnancy gingivitis. This heightened vascularity leads to an overgrowth that is typically soft, reddish-blue, and bleeds easily.
Certain medical conditions can also manifest as gum tissue enlargement. For instance, poorly controlled diabetes can impair the immune system and healing process, intensifying the inflammatory response to plaque. Rarely, the overgrowth can be an early sign of serious blood disorders, such as acute leukemia. In these cases, the enlargement is due to the infiltration of leukemic cells into the gingival connective tissue, not inflammation alone. Addressing the underlying systemic condition is necessary before the gum tissue can return to a healthy state.
Treatment Options and Long-Term Care
Resolving gingival enlargement begins with identifying the specific cause, as treatment is highly dependent on the underlying factor. For enlargement primarily caused by plaque, a professional procedure called scaling and root planing is the first step. This deep cleaning removes hardened calculus and bacterial toxins from below the gumline, often allowing the swollen tissue to shrink significantly. Following this, meticulous home care, including proper brushing and flossing, is necessary to prevent recurrence.
If the overgrowth is medication-induced, the most effective solution is substituting the causative drug with an alternative, requiring collaboration between the dentist and the patient’s physician. For example, a calcium channel blocker may be replaced with a different class of antihypertensive medication. When drug substitution is not possible or the enlarged tissue is fibrotic and does not shrink, surgical removal, known as gingivectomy, becomes necessary. This procedure reshapes the gumline to a normal contour, eliminating excess tissue and the deep pockets that harbor plaque, though recurrence remains possible if the underlying cause persists.