Gingival Enlargement

Gingival enlargement, which simply means an increase in the size of the gums, is a common effect of gum disease. Gingival enlargement may be a direct effect of inflammation, or it may be a side effect of medication; treatment depends on the cause of the enlargement. Historically, the terms gingival hyperplasia and gingival hypertrophy have been used to describe gingival enlargement, but this terminology is overly specific and requires microscopic analysis to diagnose. Hyperplasia is characterized by an increase in the number of cells, while hypertrophy is characterized by an increase in the size of each individual cell, and neither of these causes can be determined without a clinical evaluation. Therefore, gingival enlargement is more universally applied to any increase in the size of the gingiva.

Gingival enlargement, which has many possible causes, is classified by cause. These classifications are inflammatory enlargement, drug-induced enlargement, enlargement associated with systemic conditions, neoplastic enlargement, and false enlargement. Inflammatory enlargement is the most common classification. When chronic inflammatory gingival enlargement is present, the gum tissue is soft and discolored due to edema and infection that results from prolonged exposure to plaque. Treatment for inflammatory enlargement is the same as treatment for periodontitis and focuses primarily on dental scaling and root planing. Risk factors for inflammatory gingival enlargement usually include poor oral hygiene and may include physical irritation of the gingiva by ill-fitting restorations or by orthodontic appliances. Both gingivitis and inflammatory gingival enlargement have also been seen in mouth breathers, though the cause for this is not definitively known.

Drug-induced gingival enlargement may also be referred to as drug-influenced gingival enlargement. This classification of gingival enlargement is attributed to three different types of drugs. The most common drug-induced gingival inflammation arises as a common side effect of phenytoin and certain other anticonvulsants, with about 50% of cases arising from these medications. The immunosuppressant cyclosporin is connected to about 30% of drug-induced gingival inflammation, with the remainder of cases connected to calcium channel blockers that are used to reduce blood pressure. Not all patients who use these medications experience drug-induced gingival inflammation, which is believed to be associated both with a patient’s genetic predisposition and to underlying inflammation that may be present. While improved oral hygiene can reduce the severity of inflammation, discontinuing the use of the drug will often provide complete resolution.

Several systemic conditions and diseases may induce gingival enlargement. Conditions that can contribute to gingival enlargement include pregnancy, puberty, and vitamin C deficiency. Diseases that may cause enlargement include leukemia, granulomatous diseases, and both malignant and benign neoplasms. Because this latter type of enlargement is caused by a growth beneath the gums, rather than as a side effect of a condition or disease, these are more specifically known as neoplastic enlargement. When enlargement arises because of an underlying lesion in the bone or the tissue that is not connected to systemic disease, this is known as false enlargement; the tissue itself is only enlarged because of the protuberance beneath it. In all cases, treatment includes hygienic measures that may include dental scaling and root planing and that aim to manage the amount of plaque on the teeth and under the gums. When enlarged gingival tissues do not respond to these treatments, it may be necessary to surgically remove the excess tissue with a procedure called a gingivectomy.