Gingival Hyperplasia (Gums Growing Over Teeth)

What is Gingival Hyperplasia (Gingival Enlargement)?

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). Your gums may be red, soft, shiny, and bleed easily when brushing or flossing. 

Severe gingival overgrowth can completely cover the crown of the tooth. This can lead to periodontal disease (advanced gum disease).

Other names for gingival hyperplasia include:

• Gingival overgrowth
• Gingival enlargement
• Gum enlargement
• Hypertrophic gingivitis

Medical image of a gingival enlargement

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Symptoms of Gingival Hyperplasia

Gingival hyperplasia is often a painful condition that can cause the following:

• Red and/or bleeding gums
• Bad breath
• Plaque buildup on teeth
• Tender/inflamed gums
• Pain

This condition also negatively impacts your oral health standing. If left untreated, your gums can begin to fully cover your teeth, causing poor oral hygiene. This makes your teeth difficult to clean, potentially leading to gum disease and cavities.

In addition, gum tissue overgrowth can shift your teeth out of place. Orthodontic treatment may be necessary if this occurs.

Gingival hyperplasia does not always cause inflammation. Non-inflamed gingival hyperplasia typically causes your gums to turn dark red or purple. The gingival tissues may be firm, fibrous, and bleed easily. This type of gingival enlargement occurs more often in those with poor oral hygiene. 

Gingival Hyperplasia vs. Gingival Hypertrophy

Gingival hyperplasia refers to the increase in the number of cells, while gingival hypertrophy refers to the increase in cell size. 

In other words, hyperplasia occurs when the size of the gingiva increases. Hypertrophy just means an increase in the overall size of the individual cells.

The term gingival enlargement is a more accurate description of the condition. It can be caused by three main issues: inflammation, medication, or systemic disease.

5 Potential Causes of Gingival Hyperplasia

Plaque, calculus, and harmful bacteria in the mouth can cause almost every oral condition. Long-term bad oral hygiene and poor plaque control are common risk factors for gingival hyperplasia.

Gingival enlargement can also be caused by other factors, including: 

1. Drug-Induced Gingival Hyperplasia

Drug-induced gingival overgrowth is linked to: 

• The patient's genetic makeup
• The presence of dental plaque
• Whether they had gingival inflammation before taking medications 

Gingival hyperplasia is a side effect of certain drugs, including:

• Cyclosporine
• Anticonvulsants
• Calcium channel blockers

2. Hormonal 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.

Gingivitis is the inflammation of the gums. It is a minor, reversible form of gum disease that can lead to periodontitis (if left untreated). Good oral hygiene reduces the chance of developing oral conditions during puberty and pregnancy.

3. Genetic Factors

Genetic factors can cause rare types of gingival overgrowth that form during childhood. 

For example, hereditary gingival fibromatosis results in an overproduction of collagen. As a result, the gums enlarge and slowly grow over the teeth.

4. Leukemia

Gingival hyperplasia can indicate acute leukemia if other cancer symptoms are present. Acute leukemia is when a group of blood cancers affects the bone marrow and lymphatic system.

5. Other Health Conditions

Gingival overgrowth can also be caused by other health conditions, including: 

• Systemic diseases, such as sarcoidosis, Crohn'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 C deficiency

Diagnosing Gingival Hyperplasia

Diagnosing gingival hyperplasia begins with a thorough medical history and physical examination. Your doctor will ask about medications you currently take, including prescription and nonprescription drugs.

They'll also look for signs of other conditions that could be causing gingival swelling, such as diabetes, thyroid problems, and vitamin deficiencies.

Your doctor might perform a biopsy to rule out certain types of cancer or pathological conditions. This procedure involves removing a small piece of tissue from the affected area.

If necessary, they may refer you to a periodontist who specializes in treating gum disease.

Gingival Hyperplasia and Gum Disease

Gingival hyperplasia can lead to periodontal disease (if left untreated). Periodontal disease, also called periodontitis or gum disease, is an inflammatory disease that affects the gums, bones, and surrounding tissues. It is caused by plaque buildup below the gum line.

The early stages of gum disease are difficult to notice because people do not feel any pain. However, as the disease progresses, the symptoms will become more obvious.

The most common signs of periodontitis include:

• Red, swollen, or tender gums
• Inflammation around the teeth, which can also extend under the gums
• Bleeding gums, typically while brushing
• Loose or sensitive teeth when consuming hot or cold substances
• Gum recession, which is when the gums pull away from the teeth
• Pus between the gums and teeth
• Sudden teeth misalignment, also called malocclusion
• Lingering bad breath, which may not disappear after brushing
• Poorly fitting dental prosthesis, including partial dentures 

Treatment for Gingival Hyperplasia

Depending on the severity of gingival enlargement, your dentist may recommend one or more of the following treatments: 

Periodontal (Gum) Flap Surgery

Periodontal flap surgery repairs damage caused by periodontal disease (advanced gum disease). It can also treat most cases of gingival hyperplasia.

In general, the surgical removal of excess gum tissue consists of the following steps:

1. Your periodontist administers local anesthesia to numb the treated area
2. A small incision is made into your gums, which separates the gum tissue from your teeth
3. Your gums are carefully folded back to remove the inflamed tissue and calculus on the tooth’s root surface
4. Any remaining debris is flushed out, and the area may be treated with antibiotics, medications, or grafting material
5. Sutures are placed to reposition the gum tissue to reduce the gum “pocket” for proper oral hygiene

Gingivectomy

A gingivectomy is a straightforward procedure that removes excess gum tissue. 

During the surgery, an oral surgeon, a periodontist, or a dentist cuts the overgrown gum tissue. Then they reshape the loose, damaged tissue and remove the “pockets” between your teeth and gums. 

Other Professional Treatments

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

• Scaling and root planing (a deep cleaning) to remove bacteria, plaque, and calculus above and below the gum line
• Ultrasonic treatment to help reduce inflammation
• Prescription mouthwash like chlorhexidine (which has antiseptic properties)
• Antibiotics like azithromycin or erythromycin to help kill bacteria
• Laser excision to remove inflamed gum tissue

Home Treatments

If the condition is mild, you can prevent it from worsening by practicing optimal oral care at home. Tips include: 

• Brushing your teeth twice a day with an extra-soft bristled toothbrush or an electric toothbrush
• Replacing your toothbrush tip every three months
• Flossing daily
• Rinsing with a natural mouthwash
• Visiting your dentist for teeth cleanings twice a year.

After you stop taking the medication(s) that caused gingival hyperplasia or start treatment, it takes 1 to 8 weeks for the lesions to disappear.

Summary

Gingival hyperplasia is a common problem that causes swollen, red, and tender gums. The condition usually goes away after treatment or when the underlying cause is addressed. Professional and at-home treatments can help control symptoms.