Noticing gums seemingly growing over teeth can be concerning. This physical change is a relatively common dental condition, ranging from mild swelling to significant overgrowth. While it affects the appearance of the smile, it also poses a risk to long-term oral health by creating pockets where bacteria can thrive. Fortunately, the condition is treatable once a dental professional identifies the underlying cause.
Understanding Gum Overgrowth
The clinical term for gums growing over teeth is gingival enlargement, sometimes called gingival hyperplasia. This condition involves an increase in the size of the fibrous gum tissue, causing it to cover a larger portion of the tooth crown than is typical. The term enlargement is preferred because hyperplasia (increased cell number) and hypertrophy (increased cell size) are strictly microscopic diagnoses.
When gum tissue increases in size, it creates deep crevices around the teeth that are difficult to clean effectively. This accumulation of bacterial plaque within the gum line can lead to secondary issues, including gingivitis and periodontal disease. In severe cases, the excess tissue can cover the teeth completely, affecting chewing function, speech, and tooth alignment.
Causes Linked to Inflammation and Systemic Health
The most frequent reason for gingival enlargement is chronic inflammation triggered by insufficient oral hygiene. When bacterial plaque and calculus accumulate on the teeth, the gingiva reacts with an inflammatory response. This response results in tissue edema and an infiltration of inflammatory cells, causing the gums to appear soft, red, swollen, and prone to bleeding. This inflammatory enlargement is often reversible by establishing meticulous oral hygiene and undergoing professional cleaning to remove the source of irritation.
Hormonal fluctuations in the body can also predispose an individual to this issue, even with moderate plaque levels. Changes associated with puberty, pregnancy, and menopause increase the gums’ susceptibility to inflammation and subsequent enlargement. These “conditioned enlargements” typically lessen once the hormonal state stabilizes, such as after a pregnancy concludes.
In rarer instances, the overgrowth is a symptom of an underlying systemic medical condition or a genetic disorder. Certain blood disorders, such as acute leukemia, can manifest as diffuse gingival enlargement. Hereditary gingival fibromatosis is a rare genetic condition that results in a slow, progressive, and firm enlargement of the gum tissue, often starting in childhood.
Medication-Induced Gum Enlargement
A common cause of gum overgrowth is the use of certain prescription medications, known as drug-induced gingival enlargement (DIGO). This side effect results in enlargement that is often firm, pale pink, and non-tender, contrasting with the soft, red texture of inflammatory overgrowth.
The three main categories of drugs known to cause this adverse reaction are anticonvulsants, immunosuppressants, and calcium channel blockers. For example, the anticonvulsant phenytoin, used to manage seizure disorders, is frequently cited as a cause. Immunosuppressants, particularly cyclosporine, are prescribed to organ transplant recipients and trigger significant gingival changes. Calcium channel blockers, such as nifedipine and amlodipine, are widely used to treat high blood pressure and also carry a risk.
The underlying mechanism involves gingival fibroblasts, the cells responsible for producing connective tissue. The medication interferes with fibroblast metabolism, leading to an overproduction of proteins like collagen and inhibiting the body’s ability to break down this accumulated tissue.
The result is a net increase in gum tissue volume, which is often more pronounced where plaque-induced inflammation is present. Management involves communication between the dentist and the prescribing physician to potentially reduce the dosage or substitute the medication with an alternative drug, such as tacrolimus instead of cyclosporine.
Diagnosis and Treatment Options
Determining the appropriate course of action begins with a comprehensive diagnostic process by a dental professional. The dentist reviews the patient’s medical history, focusing on systemic diseases and current medications. A clinical examination involves measuring the depth of the gum pockets and assessing the tissue’s texture, color, and tendency to bleed. X-rays evaluate the underlying bone structure, and in rare instances, a biopsy or blood studies may be necessary to exclude serious systemic conditions like leukemia. Treatment is always tailored to the specific underlying cause.
If the enlargement is caused by inflammation from plaque, the first line of treatment is non-surgical. This involves professional cleaning, known as scaling and root planing, which is a deep cleaning procedure that removes plaque and tartar from below the gum line. Patients must also be instructed on meticulous home care, as improved brushing and flossing techniques are necessary to prevent recurrence.
When non-surgical management is insufficient or the overgrowth is severe, surgical intervention is necessary to remove the excess tissue. The most common procedure is a gingivectomy, which involves the surgical excision and contouring of the overgrown gum tissue. A gingivoplasty may also be performed to reshape the remaining gum line aesthetically, making the teeth appear longer and creating an environment that is easier to keep clean. Following any treatment, ongoing maintenance and regular professional appointments are important to monitor the gums and prevent the condition from returning, especially if the patient continues taking an inducing medication.