Gingival Hyperplasia: Causes, Medication Risks & Treatment Options

What is Gingival Hyperplasia?

Gingival hyperplasia, also referred to as gingival enlargement, is the overgrowth of gum tissue around your teeth. The affected gum tissue often becomes inflamed, which is a symptom of gingivitis (mild gum disease). If this is the case, your gums may be red, soft, shiny, and bleed easily when brushing or flossing. 

In severe cases of gingival enlargement, the gum tissue can completely cover teeth crowns, leading to periodontal disease (advanced gum disease).

However, gingival hyperplasia does not always cause inflammation. Non-inflamed gingival hyperplasia typically causes your gums to turn dark red or purple. Additionally, the gum tissue may be firm, fibrous, and bleed easily. Further, this type of gingival enlargement occurs more often in those with poor oral hygiene. 

Causes of Gingival Enlargement

Plaque, calculus, and harmful bacteria in the mouth can provoke almost every oral condition. Long-term bad oral hygiene and poor plaque control are common risk factors of gingival hyperplasia. However, the condition can also be caused by other factors, including: 

Drugs That Cause Gingival Hyperplasia

Drug-induced gingival hyperplasia is linked to the patient's genetic makeup, the presence of dental plaque, and whether they had gingival inflammation prior to taking medications. Gingival hyperplasia is a side effect of certain drugs, including:

• Cyclosporine — cyclosporine is an immunosuppressant that prevents organ rejection after a heart, kidney, or liver transplant. In addition, this drug can also treat dry eyes, rheumatoid arthritis, and psoriasis.
• Anticonvulsants — phenytoin, diltiazem, valproate, felbamate, phenobarbital, and erythromycin are anticonvulsants that control seizures. These drugs reduce the production of collagen in your body, which can lead to gingival overgrowth.
• Calcium Channel Blockers — nifedipine, verapamil, and amlodipine are common calcium channel blockers that relax the heart muscles and blood vessels. These drugs commonly treat angina (chest pain), hypertension, irregular heartbeats, and high blood pressure. They can cause an overgrowth of the connective tissue matrix, resulting in gingival hyperplasia. 

Hormone Imbalances

Hormonal changes that occur during puberty and pregnancy can cause gingival hyperplasia. This is because a sudden boost in hormones can increase inflammation in the body. As a result, you are at a higher risk of developing gingivitis and other gum related issues. Gingivitis is characterized as the inflammation of the gums. It is a minor, reversible form of gum disease that can lead to periodontitis (severe gum disease) if left untreated. Although, practicing good oral hygiene reduces the chance of developing serious oral conditions during these stages of life.

Genetic Factors

Rare types of gingival overgrowth that form during childhood may be due to genetic factors. For example, hereditary gingival fibromatosis results in an overproduction of collagen. As a result, the gums become enlarged and slowly begin to grow over your tooth surfaces.

Leukemia

Gingival hyperplasia is associated with acute leukemia, which is a group of blood cancers that affect the bone marrow and lymphatic system.

Other Health Conditions

Hormonal imbalances, genetics, blood cancers, poor oral hygiene, and certain medications can all lead to gingival hyperplasia. However, gingival overgrowth can also be attributed to other health conditions, including: 

• Systemic diseases, such as sarcoidosis, Chron's disease, neurofibromatosis, Kaposi sarcoma, acromegaly, amyloidosis, and granulomatosis with polyangiitis.
• Zimmerman-Laband Syndrome
• Cowden’s Syndrome 
• Blood disorders and certain cancers, such as lymphoma, leukemia, and anemia
• Human Immunodeficiency Virus (HIV)
• Diabetes
• Vitamin deficiencies (e.g., vitamin C deficiency)

Gingival Hyperplasia Treatment

There are a few different treatment options available for gingival overgrowth. These options include, but are not limited to, periodontal flap surgery, a gingivectomy, and laser treatment. Depending on the severity of gingival enlargement, your dentist may recommend one or more of the following treatments: 

Flap Surgery

Periodontal flap surgery repairs damage caused by periodontal disease (advanced gum disease). Although, it can also treat most cases of gingival hyperplasia. During the surgery, your periodontist administers local anesthesia to numb the treated area. Then they make a small incision into the gums, which separates the gum tissue from your teeth. Lastly, the dentist gently folds back your gums, carefully removes the inflamed tissue, and flushes out any remaining debris.

Gingivectomy

A gingivectomy is a straightforward procedure that involves the removal of excess gum tissue. During the surgery, your oral surgeon cuts the overgrown gum tissue out of your mouth. Then they reshape the loose, damaged tissue and remove the “pockets” between your teeth and gums. 

Other Treatments

Other common treatment options include electrosurgery and laser excision. Both of these procedures involve the removal of inflamed gum tissue. In addition, if you have gingival enlargement and gingivitis, your dentist may recommend:

• A deep cleaning (scaling and root planing), which removes any bacteria, plaque, and calculus below the gum line.
• An ultrasonic treatment (to help reduce inflammation).
• A prescription mouthwash, such as chlorhexidine (antiseptic properties). 
• Antibiotics, such as azithromycin or erythromycin, to help kill bacteria.