What Is Gingival Hyperplasia?

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Gingival hyperplasia is a condition of the mouth involving overgrowth of the gingiva (the gum tissue) surrounding the teeth. Once the condition begins, it creates a cycle of difficulty performing good oral hygiene, leading to higher risk (and possibly more severe symptoms) of overgrowth.

Sometimes the condition is referred to as gingival overgrowth, gum enlargement, hypertrophy, hypertrophic gingivitis or gingival hyperplasia symptoms.

Gingival hyperplasia
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Gingival Hyperplasia Symptoms

Symptoms of gingival hyperplasia may include:

  • Swollen overgrowth of the gingivae
  • Gums that bleed easily
  • Bright red colored tissue in the overgrowth area (can be round in appearance)
  • Pain
  • Bad breath
  • Plaque accumulation

The overgrowth area is usually located in the front of the mouth (surrounding the front teeth) but can be located between the teeth and cheeks.

A 2015 study published by the journal Histopathology describes gingival hyperplasia as "a small papillary or velvety bright red gingival overgrowth that bleeds easily." 

Causes

Gingival hyperplasia can result from various underlying causes, including:

  • Inflammation from poor oral hygiene
  • Bacteria and plaque buildup (which may be severe)
  • Inflammation from an ill-fitting dental appliance (such as a partial denture or orthodontic braces)
  • Hormonal imbalances (including changes during pregnancy or puberty)
  • Certain types of cancer (including leukemia)
  • A benign or malignant lesion (present when there is localized overgrowth/hyperplasia)
  • Vitamin C deficiency
  • Some types of systemic (entire body involvement) medical disorders
  • Certain types of medications

The correct underlying cause of gingival hyperplasia must be identified before proper treatment can be administered; the treatment may vary from one cause to another.

Drug-Induced Gingival Hyperplasia

The drugs that have been most associated with gingival hyperplasia fall into three categories—anti-seizure medications, immunosuppressant medications used in transplant patients, and calcium channel blockers used to treat various cardiovascular conditions (such as high blood pressure).

Drugs That Can Induce Gingival Hyperplasia
Anticonvulsants Immunosuppressants Calcium Channel Blockers
Amlodipine Cyclosporine Diltiazem
Ethosuximide Nitrendipine Felodipine
Ethotoin Sirolimus Nifedipine
Lamotrigine Tacrolimus Verapamil
Mephenytoin    
Phenobarbital    
Phenytoin    
Pyrimidinone    
Topiramate    

If you take any medications that have been linked with gingival hyperplasia, it’s important to observe carefully for any signs and symptoms of gum inflammation.

According to a 2013 study, published by the Indian Society of Periodontology, gum inflammation may be the first indication that a person (particularly one who is taking certain medications) will develop gum overgrowth/hyperplasia.

Be sure to report any signs of inflammation (such as redness or swelling) to your dentist as well as to your physician. A dentist can provide treatment to help lower the risk of the development of gingival hyperplasia, as well as being able to treat existing symptoms.

Your physician may be able to switch your prescription to a type of medication that is less likely to cause gingival hyperplasia.

Studies

The incidence of gingival hyperplasia is very high when a person takes specific medications, as shown by various studies.

Phenytoin

According to a report published in Pediatric Nephrology, of the approximately 2 million study participants taking phenytoin (an anticonvulsant medication, given for seizures), about half will have the development of some degree of gingival overgrowth (hyperplasia).” 

Cyclosporine

Cyclosporine, a drug commonly given to transplant patients to prevent the body from rejecting transplanted organs, has been known to cause gingival hyperplasia in approximately 13 to 85% of those taking the drug.

The percentage range is so wide because other factors that can adversely influence accurate results in studies, such as the fact that transplant patients usually take a myriad of different drugs at one time (including other medications that may increase the risk of gingival hyperplasia, like calcium channel blockers).

Nifedipine

Nifedipine is a type of calcium channel blocker given for high blood pressure. It has been the most closely linked drug (in its class) causing gingival hyperplasia. In fact, studies reported an incidence of 38% of those taking nifedipine who developed the condition. Other calcium channel blockers are also known to cause gingival hyperplasia.

Typically the symptoms begin in approximately one to three months after a person starts taking the medication. The higher the dosage, the more likely gingival hyperplasia occurs in animal studies, but this has not yet been confirmed in adult studies.

Some experts theorize that plaque accumulation and lack of proper oral hygiene are likely to increase the severity of this type of gingival hyperplasia.

Risk Factors

There are several risk factors that were identified according to a 2013 study, for gingival hyperplasia, these include:

  • Age
  • Predisposition (being hereditarily predisposed or prone to a disease)
  • Presence of preexisting plaque
  • The relationship between certain drugs and gum tissue

Diagnosis

Depending on the symptoms and the underlying cause of gingival hyperplasia, your healthcare provider may perform various diagnostic measures and tests, these may include:

  • A thorough exam and history will be done to identify possible drug causes, hormonal influences, and more. The appearance and the location of the overgrowth area can provide vital diagnostic information.
  • A biopsy to rule out pathological conditions (such as localized cancer) may be performed.
  • Blood studies may be necessary in rare instances to diagnose underlying medical conditions.

Usually a thorough examination and history suffice to provide enough information to diagnose the underlying cause of gingival hyperlasia, but on rare occasions, lab tests and other diagnostic measures are performed.

Treatment

The correct diagnosis of gingival hyperplasia (identifying the underlying cause) is vital to effective treatment. Treatment options may include:

  • Periodontal cleaning and scaling (to remove plaque and other irritants causing inflammation): Frequent cleanings such as every three months may be required to resolve the condition.
  • Surgical removal with a laser or scalpel, to remove the tissue involved in the overgrowth/hyperplasia: If the underlying cause of gingival hyperplasia is not addressed, surgical removal could be required on numerous occasions.
  • A night guard appliance to limit the regrowth of tissue after surgical removal of the overgrowth tissue
  • A consultation with a medical physician to stop or change medications causing the overgrowth: A change in medication will not treat the existing overgrowth. Further treatment will more than likely be required.

Never discontinue taking any prescription medications without first consulting with your healthcare provider.

A Word From Verywell

Gingival hyperplasia can result in overgrowth of the gum tissue that can end up being severe enough to cover (or partially cover) the teeth. This can make good oral hygiene (brushing and flossing) nearly impossible.

Prevention measures include good oral hygiene measures at home, regular dental exams and cleanings, and getting prompt and effective treatment when signs of inflammation or tissue overgrowth are first noticed.

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  2. Agrawal AA. Gingival enlargements: Differential diagnosis and review of literature. World J Clin Cases. 2015;3(9):779-88. doi:10.12998/wjcc.v3.i9.779 

  3. Bharti V, Bansal C. Drug-induced gingival overgrowth: The nemesis of gingiva unravelled. J Indian Soc Periodontol. 2013;17(2):182-7. doi:10.4103/0972-124X.113066 

  4. Bokenkamp A, Bohnhorst B, Bêler C, Albere N, Offner G, Brodehl J. Nifedipine aggravates cyclosporine A-induced gingival hyperplasia. Pediatr Nephrol. 1994; 8: 181-185. doi:10.1007/BF00865474