Gingival Hyperplasia: Symptoms, Types, Causes and Treatment

Gingival hyperplasia—also known as gingival overgrowth or enlargement—is a condition marked by an abnormal increase in the size of the gums. While it can be a benign and localized issue, it often signals underlying health concerns or medication side effects. In this comprehensive article, we will explore the symptoms, types, causes, and treatments of gingival hyperplasia, helping you recognize its signs and understand the available management strategies.

Symptoms of Gingival Hyperplasia

Gingival hyperplasia can present itself in various ways, making it essential to recognize the symptoms early for timely intervention. While some cases are mild, others can severely impact oral function and aesthetics. Let’s break down the most common signs and what they might mean for your oral and overall health.

Symptom	Description	Impact	Source(s)
Swelling	Enlargement of gum tissue	Functional, aesthetic issues	1 6 7 9 15
Bleeding	Gums bleed easily, especially when touched	Discomfort, risk of infection	1 12 13
Redness	Gums appear more red than usual	Indicator of inflammation	5 15
Firmness	Gums may feel firm or fibrotic	Indicates chronicity	6 7
Granular/Papillary Surface	Gums may look bumpy or uneven	Diagnostic clue	5
Ulceration	Occasional sores or ulcerations on gums	Pain, infection risk	1
Tooth Coverage	Gums may partially or completely cover teeth	Hinders speech, chewing	15

Table 1: Key Symptoms

Swelling and Overgrowth

The most defining symptom of gingival hyperplasia is the visible swelling or overgrowth of the gums. This enlargement may be localized to a small area or generalized, affecting the majority of the gum tissue. The degree of overgrowth can range from slight puffiness to severe cases where the gums cover large portions of the teeth, sometimes impeding normal speech and eating 1 6 7 15.

Bleeding and Redness

Bleeding is a common symptom, especially when the gums are inflamed or ulcerated. Even gentle brushing or chewing can cause bleeding. Redness often accompanies swelling, signaling underlying inflammation or infection 1 12 13 15.

Texture Changes

In some cases, the surface of the gums becomes granular, papillary, or uneven. This is especially noted in localized juvenile spongiotic gingival hyperplasia, where the gums may have a granular or slightly papillary appearance 5.

Firmness and Fibrosis

Chronic forms of gingival hyperplasia may result in a firm, fibrotic texture. This is common in hereditary conditions or longstanding cases, distinguishing them from the softer, more inflamed gums seen in acute or drug-induced forms 6 7.

Ulceration and Sores

Occasionally, ulcerations or sores may appear on the overgrown gum tissue, particularly in cases associated with systemic diseases such as leukemia 1. Ulceration increases the risk of pain and secondary infections.

Functional Impact

As the gums enlarge, they may partially or completely cover the teeth, leading to difficulties with speech, mastication (chewing), and maintaining oral hygiene. This can further exacerbate inflammation and infection risk 15.

Types of Gingival Hyperplasia

Gingival hyperplasia is not a one-size-fits-all condition. It can be categorized based on its cause, extent, and clinical appearance. Understanding the different types helps guide diagnosis and management strategies.

Type	Key Features	Typical Demographics	Source(s)
Inflammatory	Red, swollen, often bleeds	All ages	2 3 6 15
Drug-induced	Firm, fibrous, linked to medication	Patients on certain drugs	9 10 11 12 13 15
Hereditary (HGF)	Generalized, fibrotic, familial	Often children/teens	6 7 16
Syndromic	Part of a genetic syndrome	Variable	7 8
Reactive (e.g., Pyogenic Granuloma)	Localized, exophytic, often in females	Children, young adults	2 3 4 5
Idiopathic	Unknown cause, fibrotic	Any age	6 16

Table 2: Main Types of Gingival Hyperplasia

Inflammatory Gingival Hyperplasia

Triggered by chronic irritation, plaque, or poor oral hygiene, this form is characterized by red, swollen, and friable gum tissue. It can often be reversed with improved dental care and removal of irritants 2 3 6 15.

Drug-Induced Gingival Hyperplasia

Certain medications are notorious for causing gum overgrowth. The most common culprits include anticonvulsants (phenytoin), immunosuppressants (cyclosporine), and calcium channel blockers (nifedipine). The tissue is often firm and fibrotic, and the overgrowth typically resolves or diminishes upon discontinuation or substitution of the offending drug 9 10 11 12 13 15.

Hereditary Gingival Fibromatosis (HGF)

This rare, inherited condition is marked by slow, progressive, and generalized overgrowth of the gums. The tissue is usually firm and fibrous. HGF can occur as an isolated finding or as part of a syndrome with other systemic abnormalities 6 7 16.

Syndromic Gingival Hyperplasia

Some genetic syndromes, such as those involving FAM20A mutations, present with gingival hyperplasia alongside other features like enamel hypoplasia (amelogenesis imperfecta) 8. These cases require multidisciplinary management.

Reactive Lesions

These include localized growths like pyogenic granuloma, peripheral giant cell granuloma, and fibrous hyperplasia. They often arise in response to chronic irritation or trauma and may be more common in specific age groups or genders 2 3 4 5.

Idiopathic Gingival Hyperplasia

In some cases, no specific cause can be identified. These cases are termed idiopathic and typically present as fibrotic overgrowths that may require surgical intervention 6 16.

Causes of Gingival Hyperplasia

The underlying causes of gingival hyperplasia are diverse, ranging from local irritants to systemic diseases and genetic mutations. Identifying the cause is crucial for effective treatment and prevention of recurrence.

Cause	Description	Example/Trigger	Source(s)
Poor Oral Hygiene	Accumulation of plaque and calculus	Inflammatory hyperplasia	2 3 6 15
Medications	Specific drugs induce tissue overgrowth	Phenytoin, cyclosporine, nifedipine	9 10 11 12 13 15
Systemic Disease	Underlying health conditions	Leukemia, vitamin C deficiency	1 6
Hereditary Factors	Genetic predisposition	Hereditary gingival fibromatosis	6 7
Syndromic Associations	Part of broader genetic syndromes	AI-gingival hyperplasia syndrome	7 8
Hormonal Changes	Fluctuations influence gum tissue	Puberty, pregnancy, menopause	4 6
Idiopathic	Unknown, not linked to known causes	-	6 16
Local Trauma/Irritation	Mechanical or chemical injury	Faulty restorations, appliances	2 3 4 5

Table 3: Major Causes of Gingival Hyperplasia

Poor Oral Hygiene and Chronic Inflammation

The most common cause is persistent inflammation from plaque and tartar buildup. This chronic irritation stimulates the gums to proliferate as a protective response. The condition can be reversed with proper oral hygiene and professional cleaning 2 3 6 15.

Medication-Induced Overgrowth

• Phenytoin: An anticonvulsant, well-known for causing gingival hyperplasia in a significant percentage of users.
• Cyclosporine: An immunosuppressant used in transplant patients; can cause gingival overgrowth, sometimes compounded by poor oral hygiene 12 13 14 15.
• Calcium Channel Blockers (e.g., Nifedipine): Used for cardiac conditions, these drugs are associated with gingival hyperplasia similar in presentation to that caused by phenytoin 9 10 11 15.

The exact mechanism varies, but alterations in calcium metabolism, fibroblast function, and inflammatory mediators are implicated 11.

Systemic Diseases

• Leukemia: Gingival hyperplasia can be an early sign of some leukemias, often accompanied by bleeding, ulceration, and systemic symptoms such as fatigue and weight loss 1.
• Vitamin C Deficiency: Scurvy can lead to swollen, bleeding gums due to impaired collagen synthesis 6.

Genetic and Syndromic Causes

• Hereditary Gingival Fibromatosis: Inherited in an autosomal dominant or recessive pattern, marked by slow, progressive overgrowth 6 7.
• Syndromic Forms: Certain genetic syndromes, such as those involving FAM20A mutations, combine gingival hyperplasia with enamel defects and other systemic findings 8.

Hormonal Changes

Periods of hormonal fluctuation, such as puberty, pregnancy, or menopause, can predispose individuals to gingival hyperplasia, especially in the presence of local irritants 4 6.

Idiopathic and Local Factors

In rare cases, no specific cause can be pinpointed (idiopathic). Local trauma, such as from dental appliances or ill-fitting restorations, can also trigger localized overgrowths 2 3 4 5 6 16.

Treatment of Gingival Hyperplasia

Treating gingival hyperplasia involves a tailored approach based on the underlying cause, severity, and patient needs. Timely intervention can restore oral health, function, and aesthetics.

Treatment	Approach/Details	When Used	Source(s)
Improved Oral Hygiene	Brushing, flossing, professional cleaning	Inflammatory, all cases	14 15
Medication Adjustment	Change or discontinue causative drugs	Drug-induced cases	9 10 11 12 13 15
Antibiotic Therapy	Azithromycin for cyclosporine cases	Cyclosporine-induced cases	12 13
Periodontal Therapy	Scaling, curettage, root planing	All types, especially inflammatory	14 15
Surgical Removal	Gingivectomy, flap surgery	Severe, fibrotic, hereditary	7 16
Management of Underlying Disease	Treat systemic condition	Leukemia, vitamin C deficiency	1 6
Multidisciplinary Approach	Collaboration with other specialists	Syndromic, severe cases	8 16

Table 4: Main Treatment Options

Oral Hygiene and Non-Surgical Therapy

The first line of treatment is always improving plaque control through regular brushing, flossing, and professional dental cleaning. In many mild cases, this is sufficient to reverse the overgrowth 14 15.

Medication Review and Substitution

If the hyperplasia is drug-induced, consulting with the prescribing physician to substitute or discontinue the offending medication is critical. Not all drugs have alternatives, so this must be approached carefully 9 10 11 12 13 15.

Antibiotic Therapy

Short courses of azithromycin have been shown to significantly reduce cyclosporine-induced gingival hyperplasia, especially when initiated early. This can sometimes eliminate the need for surgical intervention 12 13.

Periodontal Therapy

Scaling, root planing, and curettage help remove local irritants and reduce inflammation, often resulting in partial or complete resolution of the hyperplasia. Regular follow-up is important to prevent recurrence 14 15.

Surgical Management

For severe or fibrotic cases—such as hereditary forms or when non-surgical methods fail—surgical removal (gingivectomy or flap surgery) is necessary. This restores normal gum contours and function. In cases like hereditary gingival fibromatosis, surgery may need to be repeated periodically 7 16.

Management of Underlying Disease

When systemic diseases like leukemia or vitamin C deficiency are the cause, addressing the primary disease is essential. The gum overgrowth often resolves with successful treatment of the underlying condition 1 6.

Multidisciplinary Approach

Some cases, especially syndromic or severe hereditary forms, require coordination between periodontists, physicians, geneticists, and even orthodontists for comprehensive management 8 16.

Conclusion

Gingival hyperplasia is a multifaceted condition with varied presentations, causes, and treatments. Early recognition and targeted management can prevent complications and restore oral health. Here’s a quick summary of what we’ve covered:

• Symptoms: Range from swelling, bleeding, and redness to functional impairment and tissue changes.
• Types: Include inflammatory, drug-induced, hereditary, syndromic, reactive, and idiopathic forms.
• Causes: Encompass poor oral hygiene, medications, systemic diseases, genetic factors, hormonal changes, and local trauma.
• Treatment: Focuses on improving oral hygiene, adjusting medications, antibiotic therapy, periodontal and surgical interventions, and addressing systemic causes.

If you notice changes in your gum health, prompt consultation with dental and medical professionals ensures accurate diagnosis and effective treatment.