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Gingival Hyperplasia

Gingival hyperplasia is a medical condition in which the gums increase in size. This condition is also known as gingival overgrowth, hypertrophic gingivitis or gingival hypertrophy. There are several types available, which will be discussed further down but two of the most important ones are the one induced by different medication and the one associated with inflammatory disorders. Gingival hyperplasia can also be congenital and it is considered to be a rare condition. This condition is often seen in children who are diagnosed with epilepsy but, otherwise, there is no race or sex prevalence.

Before proceeding with the different types, it is important to make the difference between hyperplasia and hypertrophy, as these terms are often used for this condition and they are not quite as similar as one might think. When we say hyperplasia, that means that the cells in the gums have increased in numbers. As for the hypertrophy, it means that the cells in the gums have maintained their number constant but their size has increased. This is why there are specialists who prefer not to use either of these two terms but rather choose gingival enlargement as the final diagnosis.

According to the medical literature, there are five different types of gingival hyperplasia:

Gingival enlargement associated with inflammation
Gingival enlargement induced by medication
Gingival enlargement associated with different medical disorders (systemic involvement)
Gingival enlargement associated with cancer
False gingival enlargement.

Determining the type of gingival enlargement is essential, because each type has its own set of causes. The moment the type has been identified, so will be the causes. Once the cause is identified, the proper treatment can be administered. Because, when it comes to gingival hyperplasia, the treatment depends on the cause.

Gingival Hyperplasia Symptoms

These are the most common symptoms of gingival hyperplasia:

In the majority of the cases, there is no other symptom than the actual gingival enlargement
When gingival hyperplasia is caused by inadequate oral hygiene, the following symptoms can accompany the gingival enlargement:
- Dental plaque builds on the teeth, pushing into the gums
- The gums are tender to the touch
- Inflammation will occur in the affected area
Gums can bleed
Areas that are most affected include the labial gingival mucosa and interdental spaces
If there is also gum overgrowth, then the teeth might be covered by the over-grown tissues
If the gingival enlargement is caused by the administration of different medication, then the patient might experience the following symptoms:
- Gums are firm yet swollen
- They are not tender to the touch
- They have a pink color
- Bleeding does not occur
- Gums can overgrow, covering the crown of the teeth and leading to periodontal disease
- The overgrowth can also affect the eruption of the new teeth and even cause mal-alignment
In case of congenital gingival hyperplasia, the following symptoms might be encountered:
- The inflammation can be only in a part of the gingiva or it can be generalized
- The gums are pink in color and firm to the touch
- Teeth might be covered by the overgrown gums, leading to displacement of new teeth.

Causes of Gingival Hyperplasia

These are the most common causes of gingival hyperplasia:

Medication

Gingival enlargement is encountered in people who are diagnosed with epilepsy and treated with phenytoin
The treatment with phenobarbital can also lead to this problem
Other drugs that can induce such problems are:
- Cyclosporine (immunosuppressant)
- Calcium-channel blocking agents (nifedipine, amlodipine)
There are also certain risk factors that can favor the appearance of drug-induced gingival enlargement:
- Inflammation of the gums (gingivitis)
- Poor oral hygiene
- Excessive dental plaque
- Nickel accumulation
- Proliferation of epithelial cells
- Periodontal disease
- The depth of the periodontal pocket
- Duration and dose of the administered treatment s

Congenital gingival enlargement can have the following causes:

Hereditary transmission
Metabolic disease – fetal valproate syndrome

Chronic inflammation of the gums

This is often present in the person who breathe through their mouths

Systemic causes

Pregnancy
Teenage (reaching puberty)
Vitamin deficiency (especially vitamin C)
Pyogenic granuloma
Leukemia
Granulomatosis
Sarcoidosis
Cancerous growths (benign or malign)

False enlargement of the gingiva occurs when there is a part of bone or teeth actually detached and causing the modifications

Treatment for Gingival hyperplasia

These are the most common courses of treatment and changes recommended for gingival hyperplasia:

Adequate oral hygiene
- Dental plaque removal (thorough, professional dental cleaning)
- Regular teeth brushing (improved technique)
- Constant dental flossing
- Using antiseptic mouthwash
Dental treatments for periodontal disease
- Professional debridement with scaling and root planing
Gingivectomy
- Surgical removal of the excessive gingival tissue
- Often times, the surgical removal of the excessive tissue is performed because of the aesthetic concern rather than for functional purposes
- The gingival enlargement recurs in patients who are of a younger age, those who suffer from chronic gingival inflammation or those who continue to maintain poor oral hygiene
- Daily oral rinses with Chlorhexidine are recommended to prevent recurrences in patients who have undergone surgery for gingival enlargement.
Carbon dioxide laser therapy is also a solution for therapy, providing a very important advantage:
- Reduced change of postoperative bleeding
In the situation of drug-induced gingival enlargement, it is recommended that the treatment with the said medication is stopped or an alternative to the medication is given
- For example, instead of cyclosporin, one can administer tacrolimus. Even though the gingival overgrowth is more reduced in the case of tacrolimus treatments, the toxicity to the renal system is the same in both two cases
- Phenytoin, the drug commonly administered for the treatment of epilepsy, can be easily substituted with another anticonvulsant
Providing adequate treatment for the systemic disease that led to the gingival hyperplasia in the first place
Ultrasonic treatments have also shown promising results when it comes to treating gingival hyperplasia
Antibiotic therapy is recommended in order to prevent or treat secondary infections