What is Gingival Hyperplasia?

“Gingival Hyperplasia” refers to the excessive growth of the gum tissue surrounding teeth. While this condition has several causes, it is often a sign of poor oral hygiene or a side effect of specific medications. If left untreated, this oral condition can impact the alignment of your teeth and increase the risk of developing gum disease. Gingival hyperplasia can be resolved by improving oral hygiene habits. In more severe cases, surgical treatment may be necessary.

What Is Gingival Hyperplasia?

Non-inflammatory gingival growth tends to be darker red or purple in color. It can easily bleed and may be either soft or firm and fibrous. Individuals with poor dental hygiene are at a higher risk of experiencing this condition.

Gingival hyperplasia is also referred to as:

  • Gum overgrowth
  • Hypertrophy
  • Hypertrophic gingival inflammation

Symptoms of Gingival Hyperplasia

Gingival hyperplasia can be painful and affect your oral health. One of the common features of this condition is having red, bleeding gums.

What is Gingival Hyperplasia?

What is Gingival Hyperplasia?

Other symptoms associated with gum overgrowth include:

  • Sensitive gums
  • Inflammation
  • Pain
  • Bad breath
  • Formation of plaque on teeth

In more serious cases, excessive gum growth can completely cover the teeth, affecting both hygiene and tooth alignment. If your teeth are covered, cleaning them becomes challenging, increasing the risk of developing gum disease. Developing gum overgrowth at a young age can affect the eruption of teeth or the process where your teeth grow and become visible.

What is Gingival Hyperplasia?

What is Gingival Hyperplasia?

Causes of Gingival Hyperplasia

Gingival hyperplasia is typically caused by inflammation. It can also be drug-related, often as a side effect of prescribed medications. Common medications that can lead to this excessive growth include:

  • Anticonvulsants
  • Immunosuppressants
  • Calcium channel blockers or medications used to treat high blood pressure and other heart-related conditions.

Specific medications that are known to cause gingival hyperplasia include:

  • Nifedipine and other calcium channel blockers
  • Hormonal conditions like pregnancy, puberty
  • Nutritional deficiencies like scurvy (vitamin C deficiency)
  • Medications, mainly cyclosporine, phenytoin, and other anticonvulsants, calcium channel blockers. Rarely, it can be associated with antibiotics, antidepressants, and other drugs. Genetic conditions that are typically present from birth (all are rare conditions): hereditary fibromatosis, I-cell disease, mucopolysaccharidoses, fucosidosis, aspartylglycosaminuria, Pfeiffer syndrome, infantile systemic hyalinosis, and primary amyloidosis. Fabry disease, Cowden syndrome, tuberous sclerosis, and Sturge-Weber angiomatosis can show localized gingival overgrowth, and gingival granular cell tumor.

Gingival hyperplasia can also result from systemic diseases, most commonly polyangiitis, sarcoidosis, Crohn’s disease, neurofibromatosis type 1, primary amyloidosis, Kaposi’s sarcoma, and acromegaly.

Hyperplasia is characterized by the diffuse, relatively avascular smooth or nodular growth of the gingiva and can cover or nearly cover some teeth. Hypertrophic tissue is often excisable. Substitution is made for offending medications, if possible, for uncomfortable drug-induced gingival growths. Proper oral hygiene minimizes recurrences. Squamous cell carcinoma of the oral cavity can also originate from the gingiva and lead to marked gingival enlargement.

What is Gingival Hyperplasia?

What is Gingival Hyperplasia?

This condition typically improves when an individual stops taking the prescribed medication. Other causes can be categorized into groups: inflammatory gingival enlargement, systemic causes, and hereditary gingival fibromatosis.

  1. Inflammatory Gingival Enlargement: Gingival hyperplasia can arise directly as a result of inflammation. Inflammation is often caused by the accumulation of plaque on teeth, which is usually due to poor oral hygiene practices. Inflammation can make the gums appear red and cause bleeding. Proper oral hygiene techniques, such as daily flossing and effective brushing, can improve this condition.
  2. Systemic Causes: Other causes of gingival hyperplasia are more physiological. Pregnancy, hormonal imbalances, and certain illnesses, such as leukemia, can trigger gum growth. Other diseases or conditions that can lead to gum growth or exacerbate it include:
    • HIV
    • Diabetes
    • Anemia
    • Crohn’s disease
    • Lymphoma
    • Vitamin deficiencies

    The condition generally improves once the underlying cause is treated. In the case of pregnancy, gum growth usually resolves after childbirth. Proper oral hygiene can help improve symptoms and reduce the risk of developing this condition.

  3. Hereditary Gingival Fibromatosis: Hereditary gingival fibromatosis (HGF) is a rare oral condition characterized by slow, progressive gum growth. It typically begins in childhood but may not be noticed until adulthood. Gum growth caused by this condition results from excessive collagen production. In some cases, the gums may cover a significant portion or even all of the tooth surfaces.

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Treatment for Gingival Hyperplasia

Treatment depends on the underlying cause. Gingival inflammation can improve with the following measures:

  • Thorough removal of bacterial plaque with comprehensive tooth brushing and flossing
  • Antiseptic mouthwashes like chlorhexidine
  • Ultrasonic therapies
  • Antibiotic courses (e.g., erythromycin or azithromycin) to reduce oral bacterial load
  • Medication changes or discontinuation for drugs known to cause gum overgrowth. Surgical intervention, such as gingivectomy (surgical removal of overgrown gum tissue), may be necessary in severe cases and may need to be repeated if recurrences are common.
What is Gingival Hyperplasia?

What is Gingival Hyperplasia?

Non-surgical approaches, including proper plaque control and discontinuation or replacement of offending medications, represent the initial steps in treatment. Azithromycin has gained significant attention in recent years for its potential to improve gum overgrowth, especially in patients taking cyclosporine A, by eliminating the need to change the medication. Surgical treatment comes into play only when medical therapy fails, but relapses are common, and outcomes typically last for twelve months.

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