Gingival Enlargement

Quite simply put, gingival enlargement is the increase in size of the gums, or gingiva. Gingival enlargement is common when gum disease is present, though it can be caused by any of several different factors. Traditionally, clinicians have referred to gingival enlargement as gingival hyperplasia and gingival hypertrophy. However, both hyperplasia and hypertrophy are specific pathologies that can only be accurately determined with microscopic tissue analysis, and, while either condition may be present, the overarching condition is now broadly referred to as gingival enlargement. Treatment for gingival enlargement is directly connected to its cause. These causes are classified into five general categories, which are referred to as: inflammatory enlargement, drug-induced enlargement, enlargement associated with systemic diseases or conditions, neoplastic enlargement, and false enlargement.

The most common cause of gingival enlargement is chronic inflammation. Chronic inflammation of the gingiva is most often caused by infection due to extended exposure to bacterial plaque, and it is treated with periodontal therapies including dental scaling and root planing. Risk factors for inflammatory gingival enlargement include insufficient oral hygiene, tactile irritation of the gingiva, and surface dehydration caused by mouth breathing.

Drug-induced gingival enlargement, sometimes called drug-influenced gingival overgrowth, is often associated with three separate classes of drugs. It is estimated that as many as half of all cases of drug-induced gingival enlargement is related to phenytoin, an anticonvulsant. Calcium channel blockers and certain immunosuppressants are also related to drug-induced gingival enlargement. It is unclear whether the drugs themselves cause inflammation, or whether inflammation must already be present for drug-induced enlargement to occur; either way, discontinuing the drug is often effective in resolving the gingival enlargement, and, when the drug must be used, improved oral hygiene may reduce gingival enlargement.

Systemic diseases and conditions that may develop into gingival enlargement, along with possibly manifesting as other oral symptoms, include hormonal fluctuations that appear during puberty or pregnancy, vitamin C deficiency, leukemia, granulomatous diseases, and neoplasms, which may be benign or malignant. The subcategory of neoplastic gingival enlargement is therefore included in this larger category. False gingival enlargements are also categorized as enlargements that appear due to an underlying condition; in this case, the gingival enlargement is an external manifestation of an underlying lesion in the bone or tissue that is applying pressure to the gum tissue and causing it to increase in size.

Regardless of the cause of gingival enlargement, the first goal in management is to remove all irritants from the teeth and gums. This is ideally achieved through rigorous oral hygiene, both at home and in the dentist’s office, to thoroughly remove bacterial plaque and dental calculus. To remove accumulated plaque and calculus below the gumline, a dentist or dental hygienist uses clinical tools to scrape or vibrate hardened buildup from the surfaces of the teeth; this clinical treatment, called dental scaling and root planing, combined with effective home hygiene habits, may be sufficient treatment for gingival enlargement. When gingival enlargement includes fibers that don’t respond favorably to dental scaling and root planing, these enlarged excess tissues may be surgically removed; this procedure of removing excess gum tissue is called gingivectomy.