Gingival Hyperplasia: Causes, Symptoms & Treatment

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 teeth crowns, leading to periodontal disease (advanced gum disease).

Other names for gingival hyperplasia include:

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

Symptoms of Gingival Hyperplasia

Gingival hyperplasia is often a painful condition that can cause red and/or bleeding gums. Other symptoms of gingival enlargement include bad breath, plaque buildup on teeth, and tender/inflamed gums.

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 make your teeth move 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. 

What is the Difference Between Gingival Hyperplasia and 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 Causes of Gingival Enlargement

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 of 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, 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. This drug can also treat dry eyes, rheumatoid arthritis, and psoriasis.
• Anticonvulsants — phenytoin, diltiazem, valproate, felbamate, and phenobarbital 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. 

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

Rare types of gingival overgrowth that form during childhood can be caused by 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 teeth.

4. Leukemia

Gingival hyperplasia can be a sign of acute leukemia, a group of blood cancers that affect the bone marrow and lymphatic system, if other symptoms of leukemia are present.

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

How to Tell if You Have 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 at first 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
• Partial dentures that do not fit properly anymore

Gingival Hyperplasia Treatment

There are a few different treatment options available for gingival overgrowth. These include, but are not limited to, periodontal flap surgery, a gingivectomy, and laser gum treatment.

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.
4. Any remaining debris is flushed out.

Gingivectomy

A gingivectomy is a straightforward procedure that involves the removal of excess gum tissue. During the surgery, an oral surgeon cuts the overgrown gum tissue out of the 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. If you have gingival enlargement and gingivitis, your dentist may recommend:

• Scaling and root planing (a deep cleaning) to remove bacteria, plaque, and calculus 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

Common Questions and Answers

Here are some frequently asked questions about gingival enlargement: