Increase in size of gums is known as gums enlargement. Initially term gingival hypertrophy or gingival hyperplasia was used for this condition. Gums may become enlarged from time to time. Various causes can cause enlargement of gums to take place. In case of gingivitis or due to hormonal changes as in pregnancy or puberty or with vitamin C deficiency, gums enlargement can take place. Immunosuppressant drugs like cyclosporine, anticonvulsants like phenytoin, valproate and some other drugs can also cause gingival overgrowth. Gingival enlargement can also occur by stress and diseases such as leukemia, diabetes mellitus, sarcoidosis and some other auto-immune diseases. Treatment of gums enlargement is based on cause and underlying pathologic changes which occur.
Various factors which can cause gums enlargement are:
1. Gingivitis: Gingivitis occurs because of plaque and calculus deposits present around teeth which can lead to swollen and redness of gums. If you are not observing good oral hygiene measures, then gingivitis can occur. If your gums are swollen and red and bleed on brushing, then you might need to visit a dentist. Dentist may perform dental cleaning to remove the deposits from teeth and may even prescribe you an antimicrobial mouth wash. You have to maintain good oral hygiene and brush and floss regularly to avoid deposits around teeth.
2. Drug induced gingival enlargement: Drug induced gums enlargement is rare and can occur because of some drugs like phenytoin, cyclosporine, nifedipine. Non-inflammatory, fibrotic gums enlargement occur because of these drugs.
Gums enlargement caused by anticonvulsants- Anticonvulsant drugs like phenytoin, primidone, valproate, phenobarbital, topiramate can lead to gums enlargement. With phenytoin, gingival enlargement is more on front surface and overgrowth of gums become apparent in first three months after phenytoin dosage and is most rapid in first year. Gums enlargement by phenytoin begins as painless, bead like enlargement and as the gums enlargement progresses, a massive tissue fold is formed and may cover the tooth surface and interfere with occlusion. Phenytoin induced gums enlargement is more severe on front portion of upper and lower jaw.
Phenytoin Induced Gums Enlargement
Gums enlargement caused by immunosuppressants like cyclosporine- Cyclosporine is a drug which is used to prevent organ transplant rejection and to treat diseases of auto-immune origin. In 30% of cases, gingival overgrowth was recorded with cyclosporine. Gums enlargement caused by cyclosporine is similar to that induced with phenytoin. In case of cyclosporine induced gums enlargement, tissue is usually pink, dense and resilient and stippled or granular surface is present.
Gums Enlargement with Cyclosporine Therapy
Gums enlargement caused by calcium channel blockers like nifedipine and verapamil- Calcium channel blockers improve the oxygen supply to heart muscles. With nifedipine, gums enlargement is seen in 20% of cases.
For treatment of drug induced gingival enlargement, oral hygiene instructions are reinforced. You can get dental cleaning and root planning done and can use a mouth wash. Possible drug substitution can also be attempted.
3. Hormonal changes like in pregnancy and puberty: During puberty, altered endocrine disturbances with local factors (Deposits around teeth) causes gums enlargement to take place. It occurs both in males and females in adolescents. Enlargement is seen in both marginal and Interdental papillae and bulbous Interdental papillae occurs in condition. After puberty, the enlargement undergoes spontaneous reduction but doesn’t disappear until the plaque and calculus deposits are removed. Eleven to seventeen years of age showed a high prevalence of gum overgrowth. For treatment of gingival enlargement in puberty, scaling, curettage can be done. You have to follow oral hygiene instructions. In severe cases, surgical procedure is done to treat enlargement of gums.
Gingival Enlargement in Puberty
Altered tissue response that is increased levels of estrogen and progesterone during pregnancy along with local factors lead to gum enlargement. Gum enlargement during pregnancy can either be marginal gum enlargement or pregnancy tumor. Incidence of marginal gum enlargement is 10-70% and it is usually generalized. Pregnancy tumor is tumor like gingival enlargement during pregnancy. It is not a cancerous condition but is an inflammatory response to bacterial plaque and usually occurs after first trimester. To prevent gums swelling, pregnant women should get dental cleaning done and should maintain good oral hygiene.
Severe Gingivitis during Pregnancy
4. Mouth breathing: Mouth breathing can lead to irritation to the gums and can lead to gingival enlargement. A person might be habitual mouth breather or may be having nasal obstruction which can lead to breathing from mouth. Mouth breathing causes enlargement of gums to take place.
5. Inflammatory gum enlargement: Inflammatory gingival enlargement is of 2 types: Acute inflammatory enlargement and chronic inflammatory enlargement.
Acute inflammatory gum enlargement occurs because of bacteria being carried deep into the tissues like embedment of foreign object such as tooth brush or lobster shell fragment into the gums. Acute inflammatory gingival enlargement is painful, rapidly expanding lesion of sudden onset and within 24-48 hours, it becomes fluctuant and pointed out.
Chronic gum enlargement occurs because of prolonged exposure of gums to dental plaque. Chronic gum enlargement can be localized or generalized and is generally papillary or marginal.
Chronic Inflammatory Gums Enlargement
6. Vitamin C deficiency: In case of vitamin C deficiency, gums will become enlarged and red. Vitamin C deficiency causes hemorrhage, collagen degeneration and can lead to edema of the connective tissue. Response of gums to dental plaque is altered in case of vitamin C deficiency which can lead to enlargement of gums. With vitamin C deficiency, marginal gingival enlargement occurs and gums will become bluish red, soft and friable with smooth, shiny surface. Bleeding from gums occur spontaneously or on slight provocation. In case of vitamin C deficiency, you can take citrus fruits or can take multi-vitamin supplements.
7. Stress: If you are very stressed out, then it can lead to enlargement of gums.
8. Diseases: Some diseases like leukemia, diabetes mellitus, sarcoidosis, wegener’s granulomatosis and some auto-immune diseases can cause gums enlargement to take place.
Gum Enlargement in Leukemia
9. Neoplastic gums enlargement or gingival tumor: Benign or malignant tumors of gums can also cause gingival enlargement. Benign tumors of gums such as fibroma, papilloma, peripheral giant cell granuloma, gingival cyst and various malignant tumors of gums such as carcinoma, melanoma, sarcoma etc lead to gums enlargement.