Gingival Hyperplasia

• Gingival hyperplasia is an overgrowth of gum tissue around the teeth.
• It is also known as:
  • gingival overgrowth,
  • hypertrophic gingivitis or
  • gingival hypertrophy.
• It may be caused due to various conditions, but usually it us symptom of poor oral hygiene or side effect of certain medications. If it isn’t treated, it can affect alignment of teeth and cause gum disease.
• Hyperplasia means increase in number of cells in the gums. Hypertrophy means that the cells in the gums have maintained their number constant, but their size has increased. So, it is preferred not to use either of these two terms but rather choose gingival enlargement as the final diagnosis.
• It is also commonly seen in boxer dogs and brachycephalic breeds.

Classification of Gingival Hyperplasia

Gingival enlargement is classified into 5 groups based on causes. They are:

Inflammatory enlargement

• It can occur as a direct result of inflammation which is caused by plaque buildup on teeth due to food, bacteria or poor oral hygiene.
• The inflammation can make gum tender and red and can trigger bleeding.

Drug induced enlargement

• This occurs as a side effect of various prescribed medication. Gingival overgrowth is most common effect of phenytoin- an antiepileptic drug, termed as ‘phenytoin induced gingival hyperplasia’.
• Other drugs which can cause gingival hyperplasia are:
  • Anticonvulsant drugs including phenobarbital, lamotrigine, ethosuximide and topiramate.
  • Calcium channel blockers like amlodipine, nifedipine and verapamil.
  • Immunosuppressants like cyclosporine.

Enlargement associated with systemic disease or condition

• It may be caused due to physiologic conditions like pregnancy, hormonal imbalances, puberty or vitamin C deficiency.
• Systemic disease which can cause gingival hyperplasia are HIV, diabetes, anemia, Crohn’s disease and lymphoma.
• Benign neoplasm such as fibromas, papilloma and giant cell granulomas and malignant neoplasm such as carcinoma or malignant melanoma can also cause gingival enlargement.

Hereditary gingival fibromatosis

• It is a rare, oral condition that causes slow, progressive gum enlargement. The gingival overgrowth is due to overproduction of collagen.
• In some cases, gums will cover major parts of tooth surface or cover them completely.

False gingival enlargement

• It occurs when there is part of bone or teeth actually detached and cause the modifications.

Symptoms of Gingival Hyperplasia

• The major symptom is actual gingival enlargement. Some other associated symptoms are:
  • Inflammation in affected areas.
  • Tender gums.
  • Plaque buildup on teeth.
  • Bad breath.
  • Teeth might be covered by overgrown tissues.
  • The overgrowth of gum can affect eruption of new teeth and even cause mal-alignment.

Treatment

• Treatment depends on the underlying cause.
• In most of the cases, improved oral hygiene can be first line management in preventing or improving symptoms. However, surgery is required if the cause is medication or any disease.
• The overgrown gums are surgically removed. Different procedures used for this are laser excision, electrosurgery, periodontal flap surgery and gingivectomy.
• If the cause is medication, just stopping the medication cannot reverse the outgrowth. Additional treatment is required.