The phenomenon often described as “gums growing over teeth” is medically termed gingival enlargement or gingival hyperplasia. This condition involves an increase in the size of the gingiva, the tissue that surrounds the teeth, resulting in the gums covering a greater portion of the tooth crown. Enlargement is caused by either inflammatory swelling or the proliferation of gum tissue cells. Understanding the underlying cause is necessary, as treatment depends entirely on whether the enlargement is due to bacterial irritation, medication side effects, or a systemic health issue.
The Role of Plaque and Inflammation
The most frequent reason for gum overgrowth is a chronic inflammatory response triggered by the accumulation of bacterial plaque at the gumline. Plaque is a sticky film of bacteria that, if not regularly removed, irritates the gum tissue, leading to gingivitis. Gingivitis manifests as swollen, red, and often bleeding gums. The body responds to bacterial toxins by increasing blood flow and fluid (edema), causing the initial soft swelling.
With prolonged exposure to plaque, chronic irritation stimulates the proliferation of cells, leading to a hyperplastic overgrowth that is more fibrous. This chronic inflammatory enlargement is often reversible by removing the source of irritation. Improved home care and professional cleanings, which remove hardened plaque or calculus, can cause the inflamed tissue to shrink back to a normal size. However, significant fibrotic changes may prevent full resolution, creating a cycle where enlarged tissue makes proper cleaning difficult.
Medication Side Effects
A cause of gum overgrowth is a side effect from certain prescription medications, known as drug-induced gingival overgrowth (DIGO). This enlargement is typically firm, pale pink, and less prone to bleeding than inflammatory overgrowth. The mechanism involves the medication interfering with the normal metabolism of gingival fibroblasts, the cells responsible for maintaining the connective tissue of the gums.
Three main classes of drugs cause this adverse effect by altering the balance between collagen production and breakdown. Anticonvulsants, such as Phenytoin, were the first class linked to this condition, affecting approximately 50% of users. Immunosuppressants, primarily Cyclosporine, used to prevent organ transplant rejection, affect around 30% of patients.
The third class is Calcium Channel Blockers, like Nifedipine and Amlodipine, prescribed for high blood pressure. These drugs inhibit the activation of collagenase, the enzyme responsible for breaking down old connective tissue. The resulting excessive accumulation of collagen leads to the dense, fibrotic enlargement of the gum tissue. The severity of DIGO is highly variable and is influenced by the drug dosage and the patient’s existing level of dental plaque.
Systemic Conditions and Genetic Predisposition
Gum overgrowth can also be a manifestation of internal physiological changes or underlying systemic diseases. Hormonal fluctuations are a common example, particularly the temporary enlargement seen during pregnancy and puberty. Increased levels of sex hormones exaggerate the gum tissue’s inflammatory response to small amounts of bacterial plaque, leading to increased swelling and vascularity.
Underlying systemic diseases can cause gingival enlargement through the infiltration of abnormal cells into the gum tissue. Leukemia, a cancer of the blood-forming tissues, can present with soft, boggy gum overgrowth caused by the infiltration of malignant white blood cells. Nutritional deficiencies, such as a lack of Vitamin C (scurvy), can also contribute to severe inflammatory gum changes.
In rare instances, the cause is purely genetic, known as Hereditary Gingival Fibromatosis (HGF). This condition is a slow, progressive, and benign enlargement present from childhood, often appearing with the eruption of permanent teeth. HGF results from a mutation that leads to an uncontrolled proliferation of fibroblasts and excessive collagen deposition. Unlike other forms, this overgrowth is firm, pale pink, non-inflammatory, and often requires surgical intervention due to its dense, fibrous nature.
Professional Treatment Options
The approach to managing gingival enlargement is tailored to the specific cause identified by the dental professional. For cases driven by plaque and inflammation, the initial treatment is non-surgical and involves thorough professional cleaning. This procedure, known as scaling and root planing, removes the plaque and calculus below the gumline to eliminate the source of irritation.
If the overgrowth is medication-induced, the most effective long-term solution involves collaboration between the dentist and the prescribing physician. The patient may be switched to an alternative medication that does not cause the side effect, provided the medical condition allows it. Maintaining meticulous oral hygiene remains necessary, as the presence of plaque significantly worsens drug-induced overgrowth.
For severe overgrowth that is fibrotic, persistent despite hygiene improvements, or caused by hereditary factors, surgical intervention is often required. The definitive procedure is a gingivectomy, which involves the surgical removal of the excess gum tissue to restore the normal contour and allow for effective cleaning. While effective, the condition can sometimes recur, necessitating repeated surgical procedures over time.