What Makes The Gums Grow Scarily Large?

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

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.

Medication

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.

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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.

More Causes And Management Of Gingival Overgrowth

Hereditary Gingival Fibromatosis

 The incidence of this inherited disorder is quite low and becomes evident during childhood in most cases. In some cases, though, gingival overgrowth starts to manifest in adulthood. The gums can be affected throughout the oral cavity or only in a few localized areas. The growth of the gums is slow and constant, eventually covering the entire teeth.

The gums are often firm and non-tender and may not necessarily have a large component of inflammation to them.

Systemic Causes

Sometimes the cause of gingival overgrowth may have more to do with systemic causes than any found locally in the mouth. An example of this is seen in patients suffering from leukemia. The number of immature blood cells increases in leukemia. These cells are frequently ruptured leading to infiltration of cells in the gingival causing overgrowth.

Some people consider pregnancy, puberty, and other hormonal imbalances as examples of gingival enlargement caused by systemic diseases while others disagree since the root cause continues to be plaque.

Management Of Gingival Overgrowth

The first thing that the doctor will do is to take a detailed history, perform a clinical examination and order any necessary tests to pinpoint the cause of gingival overgrowth. In cases where the chief cause is found to be poor oral hygiene and the accumulation of plaque, the focus is on removing the local factors from the teeth to reverse the symptoms.

This involves professional cleaning of the teeth which will be carried out over a series of appointments. In each subsequent appointment, the gums should have shrunk somewhat to reveal more plaque and tartar deposited on the teeth.

The doctor will also advise for come chemical plaque control as well, involving the use of an antibacterial mouthwash and possible a topical antibiotic as well.

This same protocol is followed for all cases of gingival overgrowth since there is always some component of inflammation. Only in the case of leukemia, the systemic disease has to be treated first, since scaling can actually lead to uncontrolled bleeding and even death.

Once the cleaning has been completed, the gums will shrink down to normal in most cases. In drug-induced enlargement and hereditary causes, the overgrowth that remains will have to be removed surgically.

This surgery, also called as gingivectomy, is carried out to remove all the excess gingival tissue from the teeth. For patients that had a very large amount of gingival overgrowth, they may have to undergo more than one surgery until the normal shape and contour is established.

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For patients suffering from hereditary gingival fibromatoses, this procedure will have to be repeated at multiple intervals during life.

Conclusion

Gingival enlargement appears to be much more serious than it is in most cases. The root cause of the entire process is the seemingly insignificant plaque, which if taken care can be removed from the surface of the teeth through simple brushing.

As a patient, you should not waste time in getting to a doctor since there are occasions where it is a symptom of something much more serious lurking underneath.