Gums may appear larger in size in size from time to time. Enlargement of gums can take place because of gingivitis or can occur because of some drugs such as phenytoin, cyclosporine, verapamil, valproate, nifedipine or can occur occur because of mouth breathing. Hormonal changes during pregnancy and puberty along with local factors can also lead to gums overgrowth. Vitamin C deficiency, stress, some diseases like leukemia and sarcoidosis causes gingival enlargement. Treatment of gingival overgrowth is based on cause of gums enlargement and underlying pathological change which has occurred.
Inflammatory gums enlargement is of 2 types: Acute inflammatory gums enlargement and chronic inflammatory gums enlargement.
Acute inflammatory gums enlargement is rapidly expanding gum lesion. Gingival abscess, periodontal abscess, pericoronal abscess leads to acute inflammatory gums enlargement. For treatment of gingival abscess, the cause of abscess that is the foreign objected which is impacted in previously healthy site is removed. In case of tooth with periodontal abscess, prognosis of tooth is seen. If prognosis of tooth is poor, then tooth extraction may also be required. To avoid spread of infection and for pain relief, drainage of abscess is done. Dental scaling and root planning is done after pus drainage. Periodontal gum surgery may also be required. Antibiotics are also given to the patient to control the infection. Pericoronal abscess can occur because of deposits present around soft tissue which is surrounding the partially impacted tooth. For treatment of pericoronal abscess, debridement of area or operculectomy that is surgical removal of flap over partially erupted tooth is done. If pericoronal abscess occurs in relation to wisdom tooth, then tooth extraction may also be required.
Chronic inflammatory gums enlargement can be localized, generalized or can be discrete (Tumor-like). It occurs because of prolonged exposure of gums to dental plaque. For treatment of chronic inflammatory gingival overgrowth, scaling that is dental cleaning and curettage is done. If gums enlargement is very severe, then surgical removal of excess of tissue is done. Gingivectomy or flap operation is done to remove excess of gingival tissue.
Chronic Inflammatory Gums Enlargement
Anticonvulsants like phenytoin, valproate, primidone, Phenobarbital, Calciuym channel blockers like nifedipine and verapamil and immunosuppressant’s like cyclosporine can lead to enlargement of gums. For treatment of drug induced gingival enlargement, oral hygiene instructions are reinforced and scaling and root planning is done. Patient is instructed to brush and floss regularly and to use a mouth wash to remove dental plaque from teeth. If possible, drug substitution should be done. After stoppage of drug therapy, resolution of gingival enlargement will occur in 6-12 months time. If gingival enlargement doesn’t regress, then surgical approach is used. In case of small areas of gums enlargement and no attachment and bone loss, gingivectomy procedure is done. If large areas of enlargement are present and bone defect is present, then periodontal flap surgery will be required.
Drug Induced Gingival Overgrowth
Gum overgrowth can occur during pregnancy because of increased estrogen and progesterone levels along with local factors. Pregnancy accentuates the response to dental plaque and leads to gums enlargement. Scaling, root planning and polishing is done for treatment of gingival enlargement during pregnancy. Expecting mother should maintain good oral hygiene and should brush and floss regularly. Tooth brushing should be done especially after vomiting from morning sickness. Warm saline rinses can be done by pregnant women to reduce the swelling.
Severe Gingivitis during Pregnancy
If there is tumor like gums enlargement present, then surgical excision should be postponed until delivery. If the tumor like enlargement interferes with occlusion and causes disfigurement, then the lesion can be removed surgically.
Altered endocrine disturbance with local factors such as dental plaque leads to enlargement of gums during puberty. Scaling and curettage is done for treatment of gingival enlargement during puberty. Good oral hygiene instructions are reinforced. In case of severe gingival enlargement, surgical removal of gingival overgrowth is done.
Gingival Enlargement in Puberty
Vitamin C deficiency causes bleeding gums, collagen degeneration and edema of gingival connective tissue which will lead to altered response of gums to dental plaque and will lead to enlargement of gums. Citrus fruits or vitamin C supplements should be taken by patient in case of vitamin C deficiency.
Systemic diseases like leukemia, diabetes mellitus, sarcoidosis, wegener’s granulomatosis and some auto-immune diseases can cause gums enlargement to take place. In leukemic patient, rationale of treatment is to remove the local deposits and to control the inflammatory component of enlargement. Enlargement is treated by scaling and root planning. Antibiotics are administered before and after treatment to reduce the risk of infection. Patient is instructed to maintain good oral hygiene.
Gum Enlargement in Leukemia
Cost of scaling and root planning is around $150-$250 per quadrant without dental insurance. Depending on the type of gum surgery which is done, it will cost around $450-$850. Dental insurance will cover 70%-80% cost of procedure. Gingivectomy that is removal of excess of gums tissue will cost around $200-$300 for one tooth and costs $500-$850 per quadrant. Whole mouth gingivectomy will cost around $2000-$4000.
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