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In this article we will explore the various causes of gingival hyperplasia, as well as the treatments available for its effective management.
What is gingival hyperplasia
Gingival hyperplasia is the uncontrolled increase in the number of cells in the gums, which results in a large part of the teeth being covered by the gums, preventing proper chewing and sometimes correct alignment of the teeth.
The most common symptoms of hyperplasia, also known as gingival hypertrophy, are:
- Oversized and swollen gums.
- Halitosis.
- Sharp pain when brushing teeth.
- Difficulty chewing and articulating words.
Hyperplasia has been found to occur more frequently in young men, especially if they neglect or perform poor daily oral hygiene. Although the presence of dental biofilm is not always a sufficient cause for hyperplasia to occur, it is undoubtedly a factor that could aggravate this oral condition.
In addition to causing problems and discomfort when eating, gingival hyperplasia is a major obstacle to the social life of those who suffer from it, as they may have difficulty smiling, speaking or eating in public.
Causes of gingival hyperplasia
Among the causes that aggravate gingival hyperplasia is poor oral hygiene that leads to the accumulation of dental biofilm above and below the gums. In the act of fighting the infection caused by the biofilm, the gums enlarge to the point of bleeding. These accumulations can then aggravate pre-existing oral health conditions that contribute to the hyperplastic state.
If it occurs in children between 5 and 12 years of age, that is, during the period of tooth replacement, the eruption of the permanent teeth may be delayed or occur in a disorderly manner, in addition to the possibility of causing crowding or inclusions.
Hyperplasia can also arise due to pregnancy, as a consequence of the hormonal changes to which the pregnant woman is normally subjected. In these cases, the hyperplasia usually subsides spontaneously at the end of the pregnancy as hormone levels rebalance.
Gingival hyperplasia can also occur in the presence of diseases that strongly affect the immune system, such as:
- HIV infection.
- Crohn's disease.
When the gingival inflammatory condition is caused by one of these situations, regression of the hyperplasia itself will be observed as the condition is treated and improves. Therefore, in these cases it is necessary to act on the causes external to the oral cavity.
Certain pharmaceutical compounds such as cyclosporine, nifedipine and phenytoin have also been identified as molecules directly responsible for the appearance of gingival hyperplasia. Once drugs containing these molecules are discontinued, the gingiva decreases in volume and stabilizes.
Symptoms of gingival hyperplasia
The gingival tissue is enlarged, interdental growths occur, and it is possible that the growth is upward and covers both the inner and outer surfaces of the teeth.
Pain appears, the type and intensity of which may vary, reddening of the gingival tissue, bleeding, etc. In addition to having difficulty in carrying out normal tooth care, it may be difficult to chew and a constant feeling of discomfort may be felt due to the presence of the abnormal mass in the mouth.
Poor hygiene resulting from the inability to maintain proper tooth care leads to an increase in bacterial concentration. This, in turn, can cause periodontitis.
Treatment of gingival hyperplasia
Treatments for gingival hyperplasia are aimed at reducing the patient's discomfort by reducing the swollen gums.
If the hyperplasia is drug-induced, the modality of intervention consists of medical control, with the reduction or interruption of the drug causing the enlargement and its substitution with an equivalent one. To evaluate this possibility, it is necessary for the dentist to consult with the physician who prescribed the drug in question.
After that, it is necessary to wait 6 to 12 months for the gums to return to their normal size. In the meantime, the patient should be advised on the importance of oral hygiene and dental biofilm control, as well as instructed on the best ways and means to keep the oral cavity clean despite gingival hyperplasia.
Inflammation should be treated separately by non-surgical therapy. This involves biofilm control, either by home oral hygiene or professional tartar removal, in addition to periodontal treatments and therapies according to the stage of inflammation.
If non-surgical therapy is insufficient, the dentist may resort to gingivectomy or mucogingival plastic surgery. The operation usually has no particular contraindications, and shows good success when using special techniques such as laser, which reduces local bleeding. However, gingivectomy should only be resorted to in the presence of recurrences or severe and persistent enlargement that does not heal.
Even after gingivectomy, and in any case in all phases of the treatment of gingival hyperplasia, as well as for the prevention of its development, it is essential to emphasize the importance of dental biofilm control and daily oral hygiene.
