Gingival enlargement

What is gingival enlargement?

Gingival enlargement refers to excessive growth of the gums, and may also be known as gingival hyperplasia or hypertrophy.

What are the possible causes?

In many cases the cause is unknown. The affected tissue may be inflamed (gingivitis), in which case the gums are red, soft, shiny and bleed easily. Gingivitis may be localised or generalised.

Specific causes of gingivitis include:

• Poor dental hygiene resulting in bacterial plaque, gingivitis and periodontitis
• Smoking, mouth breathing and overcrowded teeth
• Systemic diseases especially diabetes, HIV infection

Non-inflamed gingival enlargement tends to be a darker red or purple. It may be soft, which bleeds easily, or firm and fibrous. It is also more likely to occur in those with poor dental hygiene. Causes include:

• Hormonal states: pregnancy, puberty;
• Nutritional deficiency: scurvy (vitamin C deficiency);
• Medications, most often ciclosporin, phenytoin and other anticonvulsants, calcium channel blockers. Uncommonly, it may be due to antibiotics, antidepressants and other medications.
• Genetic conditions, often present at birth (all rare conditions): hereditary fibromatosis, I-cell disease, mucopolysaccharidoses, fucosidosis, aspartyl glycosaminuria, Pfeiffer syndrome, infantile systemic hyalinosis and primary amyloidosis. Localised gingival enlargement may be seen in Fabry disease, Cowden syndrome, tuberous sclerosis, Sturge-Weber angiomatosis and gingival granular cell tumour.
• Blood conditions such as acute leukaemia, lymphoma or aplastic anaemia;
• Systemic diseases most often granulomatosis with polyangiitis, sarcoidosis, Crohn disease, Type 1 neurofibromatosis, primary amyloidosis, Kaposi sarcoma and acromegaly.

What are the symptoms?

Gingival enlargement may cause discomfort, interfere with speech or chewing, result in halitosis (bad odour to the breath) and it may look unsightly.

What is the treatment for gingival hyperplasia?

The treatment depends on the underlying cause. Gingivitis may improve with the following measures:

• Removal of bacterial plaque by thorough tooth brushing and flossing
• Antiseptic mouthwashes such as chlorhexidine
• Ultrasonic treatments
• Courses of antibiotics to reduce oral bacterial load (e.g. erythromycin or azithromycin)

Drugs that are known to cause gingival enlargement should be discontinued. Gingivectomy (surgical removal of the overgrown gum tissue) may be necessary for severe cases and may be repeated if necessary.