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Gingival overgrowth — also called gingival enlargement, gingival hyperplasia or gingival hypertrophy— refers to a condition where the gums grow abnormally large. Patients notice a swelling in their gums that may be limited to a certain area of the mouth or may, in fact, be affecting the entire mouth.
This condition can be pretty scary and can pose a serious aesthetic problem for affected individuals. These are the most likely causes of gingival overgrowth.
Inflammation is the most common source of gingival overgrowth, even though, in most cases it is quite mild. The root cause behind the appearance of this inflammation is the presence of plaque on the surface of the teeth.
Plaque, which a soft adherent mixture of bacteria found in the mouth, turns disease causing over a period of time if not removed from the tooth. Part of the reaction that takes place in inflammation is a swelling of the gums. Patients describe them as being soft, spongy and prone to bleeding.
The response to this plaque varies from person to person and even within the same individual, this response is different at different times. Women who are experiencing hormonal changes as seen during their period of menstruation, pregnancy or even puberty will see an exaggerated response to plaque.
In some cases, the gums can swell up and grow to cover large parts of the teeth. This makes more plaque accumulation likely and continues to worsen until treated. The spread of this overgrowth is more in the upper jaw and is more likely to be worse in the front teeth.
Patients who are on certain classes of drugs can develop something that is called drug induced gingival overgrowth. There are three main classes of drugs that are implicated here: Phenytoin, a drug used in the treatment of epilepsy; Nifedipine, a drug used in the treatment of high blood pressure and Cyclosporine, an immunosuppressive drug that is used to treat autoimmune diseases.
Researchers have been struggling to find a common link between three drugs that are used in different conditions and have completely different modes of action. Even though a few compelling theories have been put up in recent times, the exact reason is still unknown.
The kind of overgrowth that is seen in cases of drug induced gingival enlargement is quite distinctive. The degree of enlargement is massive and often the entire teeth will get covered by the gums. The gums are usually more fibrous in texture than that seen in inflammation. Cyclosporin has a slightly different clinical presentation to the others with a lot more bleeding occurring in patients.
Secondary inflammation on top of the drug-induced gingival overgrowth can confuse the clinical picture somewhat.
It is important to remember that the drugs only modify the response of the body to plaque, thus, the basic cause of overgrowth still rests with the plaque. In experimental animals that were raise in a germ-free environment, no response was seen to the drugs in the absence of plaque.