Gum Overgrowth

• Clinical Definition: Proliferative gingival tissue grows over the enamel of the teeth creating pseudopockets.

• Drivers: Systemically affecting medications (anticonvulsants, calcium channel blockers, immunosuppressive agents), long-term plaque buildup, hormone imbalances, genetic disposition.

• Warning Signs That Require Immediate Attention: Unprovoked gingival hemorrhage, extreme pain, malodor, inability to chew or eat properly or rapid enlargement of tissue obscuring multiple teeth.

• Treatment Options: Scaling/root planing, treatment/adjustment of offending systemically acting medication(s); Laser Gingivectomy; Surgical Recontouring

Gingival hyperplasia is characterized by both functional disturbances, along with both sensory and visual changes; most notably as follows:

• Physical / Visual Changes: Patients will often see their gums are visibly swollen; some have a bulging appearance while others simply hang down and over the bottom third of their teeth. If these tissues get large enough they can even cover one-half or more of the tooth's enamel surface.

• Changes in Color & Texture: As the tissue becomes inflamed it transforms from a normal stippled coral-pink color to a deep red/magenta or sometimes a pale, fibrous-looking nodule-shaped mass.

• Tactile / Sensory & Physical Symptoms: The texture of the gums themselves become abnormal either being too soft (spongy) or too hard to the touch. Some patients experience tenderness when they brush or floss their teeth normally.

• Functional Effects: Due to swelling and inflammation patients may be prone to persistent bad breath (halitosis); develop an unusual sensation of an altered "bite"; and may trap food particles locally in areas where the swelling has caused significant displacement.

If you are concerned about possible complications associated with your gingival hyperplasia, seek immediate attention from a dentist if you notice:

• Hemorrhaging Spontaneously: Bleeding continuously from the gums without touching them mechanically through brushing or flossing.

• Discharging Purulent Fluid: A pus-like substance is draining from under the swollen gum margin indicating that there is an active infection or abscess forming in the area.

• Trauma From Mastication: Your swollen gums are so large that they continue to impede chewing and cause new painful ulcerated wounds each time you attempt to chew on something.

• Tooth Movement / Destruction Of Alveolar Bone: Progressive loss of support for your teeth due to continuous destructive forces at work on the alveolar bone beneath the gum.

The main reason for gingival overgrowth is caused by three major clinical reasons:

• Drug Induced (Drug Induced Gingival Overgrowth - DIGO): Certain drugs that are given to treat various medical conditions such as epilepsy, hypertension and after transplant stimulate the fibroblast cells of the extra-cellular matrix to produce excessive amounts of collagen.

• Tissue Inflammation: The development of persistent bacterial biofilm on the surface of teeth will cause chronic inflammation of the area which results in the retention of fluids and swelling of both the free and attached gingiva.

• Estrogen Progesterone Imbalance: During periods of increased levels of estrogen and progesterone such as pregnancy and puberty, there is an increase in tissue response to small amounts of bacteria found in dental plaque.

There are several systemic risk factors and lifestyle choices that make people more vulnerable to developing gingival overgrowth:

• Systemic Health & Therapy: Without targeted oral care, individuals who continuously take heart medications, seizure medications or immunosuppressant therapy have an increased risk for developing this condition.

• Dental Care Habits: Individuals who do not regularly remove dental plaque and debris may experience accelerated growth of their gums surrounding orthodontic appliances.

• Dietary Practices: Consuming diets high in sugar, refined carbohydrates and frequently eating sweet foods and drinks can also contribute to the rapid buildup of biofilm. Additionally consuming sour food/drink such as pickled mangoes (manga achar) increases the rate at which your teeth erode.

• Smoking or Chewing Substances: Frequent chewing of betel nut (paan or areca nut) or smoking is commonly practiced locally. This habit puts continuous pressure and/or damage to the periodontal tissue through constant friction from the chewed substance.

The first step is to perform an in-home examination that has no risk for you.

• Prepare and Inspect: Take a clean, well-lit mirror and wash your hands thoroughly. Stand in front of the mirror and use your fingertips to carefully pull your upper lip back.

• Observe the Gum Margin: Look closely at the gum-tooth contact area to see if the soft tissue is either rounded, folded inward toward your tongue, or extends too far down on your teeth.

• Palpate the Tissue: Lightly touch the tissue with the end of a clean finger. The feeling should be smooth and tender. If it feels thickened, hard, and lumpy then it may be abnormal.

• Log Findings: Record the places around your teeth where food typically becomes stuck and how much of the enamel is covered with soft tissue.

Warning: Don’t use anything with points like tooth picks or sharp edges, such as metal, because they can harm your mouth.

To determine if you have gingival overgrowth, dental professionals will follow these standardized steps:

• Periodontal Probing: A special instrument called a periodontal probe is used to measure the depth of each pocket. Any reading greater than 3 mm indicates a pocket or pseudopocket is present.

• Digital Radiography (X-Rays): Intraoral periapical (IOPA) x-rays and panographic x-rays are taken to determine if the overgrowth of tissue is limited to the soft tissues surrounding your teeth, or if there is bone loss associated with the tissue growth.

• Medical History Review: Evaluate your medical history including all medications you currently take (such as those for cardiovascular disease), diet, and other potential factors that could contribute to the development of gingival overgrowth.

• Biopsy: Only in rare cases, such as when a single side of your face develops significantly more quickly than normal or does not respond to treatment; a biopsy may need to be performed to confirm that your gingival overgrowth is benign or not cancerous.

Dealing with periodontitis involves removing the source of inflammation, addressing any underlying issues that are contributing to your problem, and returning your gums back to their normal shape and function:

• Non-Surgical Debridement: Using ultrasonic cleaning equipment and debriding all surfaces of your teeth with the goal of removing sub-gingival calculus and bacteria endotoxins from around your roots.

• Physician Collaboration: Working closely with your medical doctor to replace medication which could be causing your gum disease (such as replacing amlodipine with another blood pressure medicine).

• Laser Gingivectomy: A precise method of using laser technology to remove excessive gum tissue, while providing instant hemostasis, little to no pain after surgery, and a fast recovery time.

• Electrosurgery / Surgical Flap: In cases where there is a lot of hard fibrous tissue present, such as grade 3 cases that require the bone level to be corrected, a traditional scalpel is used to remove the tissue and/or an electrocautery device can also be used.

The cost of treatment varies based on the degree of involvement and type of technology used in the area you live in Kerala:

Note: Cosmetic contouring procedures would typically be considered "out-of-pocket" expenses. However, if you have a medical necessity for your procedure due to extreme pain or significant functional loss, then some limited coverage might be available through select private health insurance plans or employee medical benefit programs.

• General Dentist: Capable of treating mild inflammation (Grade 1) through simple dental cleaning and oral hygiene counseling.

• A Periodontist: Gum Disease Expert needed to perform surgery on Grades 2 & 3; Laser Gingivectomy; Complex Flap Repairs.

• Emergency (Within 24 hours): Uncontrollable bleeding; Acute Pain; Signs of Systemic Infection (Fever, Facial Swelling); Unable to Chew.

• Scheduling (Within 1–2 weeks): Moderate Tissue Growth affecting Smile Appearance; Chronic Halitosis; Chronic Bleeding while Brushing Daily.

1. How much does laser gum resection cost in Kerala?

The price range for laser gum sculpting (gingivectomy) in Kerala typically varies between ₹3,500 – ₹8,000 per quadrant depending on where the clinic is located, how experienced the practitioner is and what technology they are using.

2. Is my blood pressure medication causing my gums to grow over my teeth?

Yes. Some calcium channel blockers commonly used for high blood pressure like amlodipine or nifedipine can cause gum tissue to become overly stimulated leading to growth above teeth in susceptible individuals if there is also an accumulation of plaque.

3. Are overgrown gums likely to regrow after surgical removal?

It is likely that the gums will regrow unless all of the underlying causes have been addressed. However, maintaining excellent oral hygiene habits, attending regular scale & polish appointments and modifying any contributing medications dramatically reduces the likelihood of recurrence.

• Gingivitis: Gingivitis is a mild inflammation of the gingiva. Gingivitis can be reversible if you brush your teeth at least once daily for at least two minutes. The condition is caused when plaque forms on the tooth surface. If left untreated, it may lead to periodontitis which causes deep structural damage to the bone and attaching structures that support the teeth.

• Periodontitis: Periodontitis is a destructive infection process that involves both hard and soft tissues surrounding the teeth and results in the loss of these supportive structures over time. This disease progresses as an infectious agent develops within pseudopocket spaces created during the initial stages of periodontal disease progression.

• Pregnancy Tumors / Pyogenic Granulomas: Pregnancy tumors or pyogenic granulomas are benign, rapidly growing lesions found on the gums that develop due to excessive blood flow in response to hormonal fluctuations. These lesions have no relationship with pregnancy and occur frequently in children and young adults.

• Hyperplastic Reactions: Hyperplastic reactions can be seen where orthodontic appliances place brackets and bands on the surfaces of teeth. Bracket friction along with poor oral hygiene contribute to irritation that leads to inflammation of the gingival margin, which creates an environment for hyperplastic growth to occur.

• Orthodontics: Realigns crooked teeth so that they do not create tight interproximal areas and therefore facilitate the cleaning of the area under and between them.

• Nightguards & Occlusal Splints: Protect the new contours of your gum line and teeth by preventing the forces generated by clenching and grinding from causing further injury.

• Supportive Periodontal Therapy (SPT): Requires that patients see their dentist regularly (every three to six months), so that their progress toward healing and regaining health to their supporting tissues will be evaluated.

Gingival enlargement can be easily managed as a structural problem if you get to it quickly, are clinically diagnosed by an expert, and receive specific treatment. In this day in age, there are laser treatments that can remove extra gingiva (tissue) accurately and leave little down time for you after the procedure. The best long term results will depend on your ability to maintain perfect oral hygiene habits for yourself, manage all of your chronic medical conditions (and their medications) under the care of your primary care provider, and have scheduled appointments with your Periodontist for regular check-ups.