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Gingival hyperplasia; Gum overgrowth; Gingivzal enlargement; Causes; Symptoms; Diagnosis; Treatment

Gingival hyperplasia is a condition in which the gingival tissues (gums) become enlarged due to an overgrowth of the cells that make up the gum tissue [1]. This condition may occur as a result of various factors, ranging from drug-induced effects to systemic conditions or poor oral hygiene [2,3]. Gingival hyperplasia can be localized or generalized, affecting either a small section of the gums or the entire gingival area [4]. Although the condition is often non-threatening, it can lead to complications such as difficulty in maintaining oral hygiene, pain, bleeding, and even tooth mobility in severe cases [5,6]. Recognizing and addressing gingival hyperplasia early is essential to prevent potential oral health issues and improve the quality of life for affected individuals.

Types of gingival hyperplasia

Gingival hyperplasia can manifest in different forms, based on its extent and underlying cause. The main classifications are:

This type affects only a small, specific area of the gums and is often associated with localized factors, such as poor oral hygiene, dental appliances (e.g., braces), or injury.

This form involves the widespread enlargement of the gums and is usually linked to systemic causes or drug-induced reactions.

A rarer type of gingival overgrowth that can run in families. It is typically congenital and may require surgical management for aesthetic or functional reasons.

Causes of gingival hyperplasia

One of the most common causes of gingival hyperplasia is the use of certain medications, particularly anticonvulsants, immunosuppressants, and calcium channel blockers [7]. Used to control seizures, phenytoin is known to cause gingival overgrowth in up to 50% of patients.

A drug prescribed to prevent organ rejection after transplants can also lead to gum enlargement.

Used to treat high blood pressure and heart conditions, these medications have been linked to gingival hyperplasia in some patients.

Drug-induced gingival hyperplasia typically begins within three months of starting the medication, and the condition may worsen with prolonged use [8]. The enlargement is often seen in the anterior (front) part of the mouth, especially in the upper and lower gums.

Systemic diseases and conditions

Some systemic health conditions can lead to gingival hyperplasia, including:

Pregnancy, puberty, and menstrual cycles can cause fluctuations in hormone levels, leading to gingival enlargement.

Certain forms of leukemia can result in gum overgrowth, as the abnormal growth of white blood cells infiltrates the gums.

Conditions like diabetes or certain autoimmune diseases may increase the risk of gingival hyperplasia due to altered immune responses or reduced healing capacity.

Symptoms of gingival hyperplasia

The symptoms of gingival hyperplasia vary depending on the severity of the condition. Common symptoms include:

The gums appear enlarged, particularly around the teeth.

The gums may bleed easily when brushing or flossing, especially if inflammation is present.

The enlarged gums can make it more difficult to brush and floss effectively, increasing the risk of plaque buildup and further gum disease.

In some cases, the enlarged gums may become sensitive or painful.

The difficulty in cleaning the teeth and gums can result in the accumulation of bacteria and food debris, which may lead to foul-smelling breath.

In severe cases, the gum overgrowth can cause the teeth to become loose due to the inflammation and pressure on the tooth roots.

Diagnosis and treatment

A dentist or periodontist can diagnose gingival hyperplasia through a clinical examination and patient history. In many cases, the doctor will inquire about the patient’s medical history, including any medications they are taking and whether they have any systemic conditions that could contribute to gum overgrowth [9]. Additionally, a thorough oral examination will help determine the extent of the gum enlargement and rule out other possible conditions, such as gum infections or malignancies.

In some cases, further diagnostic tests, including blood tests or biopsies, may be necessary to determine the underlying cause, particularly if systemic diseases are suspected [10].

The treatment of gingival hyperplasia depends on its underlying cause and severity. In most cases, the condition can be managed through changes in medication, improved oral hygiene, or surgical intervention.

Medications and lifestyle adjustments

If the cause of gingival hyperplasia is drug-induced, switching medications (under a doctor’s guidance) or adjusting the dosage may resolve the condition. For instance, substituting phenytoin with another anticonvulsant drug may alleviate the overgrowth.

Regular brushing, flossing, and professional dental cleanings are essential to reduce plaque buildup, which exacerbates the condition.

For more severe cases of gingival hyperplasia, particularly those that do not respond to conservative treatments, surgical intervention may be required. Surgical options include:

A surgical procedure to remove excess gum tissue and reshape the gums.

A surgical procedure that involves reshaping the gums for aesthetic purposes or to improve oral function.

Other treatments

Deep cleaning procedures that help remove plaque and tartar buildup beneath the gum line.

In some cases, laser surgery can be used to remove excess gum tissue with minimal discomfort and faster recovery.

Preventing gingival hyperplasia is largely dependent on addressing its underlying causes. Maintaining good oral hygiene is essential for preventing plaque-induced gum enlargement. For individuals on medications known to cause gingival overgrowth, regular dental checkups and prompt action by adjusting the medication (in consultation with a healthcare provider) can help prevent or manage the condition.

Conclusion

Gingival hyperplasia is a condition that can affect both the aesthetics and functionality of the oral cavity. It is most commonly caused by medications, but it can also be linked to systemic conditions or poor oral hygiene. Early diagnosis and appropriate treatment are essential for managing gingival hyperplasia effectively. With proper care, the condition can be managed, and in many cases, reversible treatments are available to restore the health and appearance of the gums. Regular dental visits and improved oral hygiene practices remain crucial for preventing this condition and maintaining overall oral health.

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