Gingival hyperplasia is a growth of the gums. It belongs to the group of periodontal diseases.
What is gingival hyperplasia?
Gingival hyperplasia is a growth of the gums. It is classified in the group of periodontal diseases (periodontopathies). The term gingival hyperplasia is composed of the Latin terms “gingiva” (gums) and “hyperplasia” (excessive formation of cells). Another name is gingival hypertrophy. However, the term is considered imprecise. Thus, the term hyperplasia refers to an increased number of cells. The designation hypertrophy is used in connection with an increased size of individual cells. Both factors can only be determined histologically. Gingival hyperplasia can be localized to individual teeth, or it can appear on the entire gum. In localized gingival hyperplasia, the growths take the form of a hemisphere. There is a connection to the gums through a tissue stalk. Doctors also refer to this form as epulis. Gingival hyperplasia can also affect some breeds of dogs.
Causes
The causes for the development of gingival hyperplasia vary. It is not uncommon for no specific cause for gingival hyperplasia to be identified at all. In some cases, it is also hereditary. In most cases, the occurrence of gingival hyperplasia is caused by the use of certain medications. This often involves preparations such as cyclosporin A. This drug is used, among other things, in organ transplantation. But also calcium channel blockers, which are dissolved in the context of epilepsy, or phenytoin are among the possible triggers. Gum proliferation is then an undesirable side effect of permanent drug treatment. Other drugs that may be responsible for triggering gingival hyperplasia include nifedipine, valproate, and diltiazem. Nifedipine, phenytoin, and cyclosporine A in particular have a marked affinity for gingival connective tissue cells. Thus, they may be responsible for cell proliferation. Another possible cause of gingival proliferation is deficiency symptoms such as a lack of vitamin C or hormonal changes in the course of pregnancy. Gingival hyperplasia is exacerbated by inadequate dental hygiene, which leads to the formation of dental plaque. Also causative for growths of the gums can be inflammation and chemical or mechanical irritation.
Symptoms, complaints and signs
The extent of gingival hyperplasia varies from patient to patient. In addition to localized discomfort in individual teeth, symptoms in the entire gums are also possible. As a rule, however, gingival hyperplasia is painless and appears as a rough growth on the tissue. The coloration of the gums varies between pink and dark red. In some cases, patients suffer from bleeding gums. Likewise, ossification is within the realm of possibility internally. If gingival hyperplasia occurs during pregnancy, edema (water retention), bad breath and pain may also occur. In the case of extensive gingival overgrowth, it is not uncommon for bite injuries to take place on the teeth of the opposite jaw. A bacterial infection then threatens a painful inflammation. Bleeding gums when brushing teeth are also not uncommon. If the gingival hyperplasia is progestin- or estrogen-induced, the proliferation usually turns out to be more extensive than if it is caused by phenytoin.
Diagnosis and course
An experienced dentist can usually diagnose gingival hyperplasia at first glance. To find out the cause of the gingival overgrowth, the dentist will conduct an interview with the patient. In addition, the extent of the periodontal disease is determined. A tissue examination with the aid of a microscope is also considered useful. Idiopathic gingival hyperplasia, the cause of which cannot be clearly determined, progresses only slowly. It can already occur in childhood or during the mixed dentition. As a result, there is a risk of problems with the eruption of teeth. If the growths are not treated dentally, it is possible that they cover the crown of the tooth. In addition to negative esthetic effects, there is also a risk of obstruction and displacement of teeth.If it is gingival hyperplasia caused by taking medication, it usually goes away on its own when the triggering drug is discontinued.
Complications
The complications and complaints of gingival hyperplasia turn out relatively differently, but always lead to symptoms in the mouth area. Extremely severe growths occur on the gums. The gums can change color and usually turn dark red or pink. It is not uncommon for patients to suffer from severe bleeding of the gums due to gingival hyperplasia. An unpleasant bad breath also occurs. The gums themselves are painful and inflammations can develop on the teeth or on the tooth root itself. These inflammations also lead to severe pain and discomfort. The quality of life of the affected person is enormously reduced. A normal intake of food and liquids is no longer possible, so that it is not uncommon for underweight or dehydration to occur. The inflammation in the oral cavity can also spread to other regions. Often, the pain also spreads from the teeth to the head or ears, causing unpleasant discomfort in these areas as well. In most cases, gingival hyperplasia can be treated well. If inflammation has occurred, this can also be treated by a dentist. Life expectancy is not altered by the disease.
When should you go to the doctor?
If the affected person suffers from swelling or growths in the mouth, a doctor should be consulted. If there are changes in the gums, there are often serious diseases that need to be examined and treated. If there is pain in the mouth, abnormalities of the gums or bleeding in the mouth, a doctor should be consulted. If gingival hyperplasia causes problems with existing dentures or existing tooth corrections, a visit to the doctor is necessary. If teeth loosen or shift, a visit to the doctor is necessary as soon as possible to avoid further complications. If there are changes in phonation, speech ambiguities or if the patient refuses to speak due to the complaints, a doctor should be consulted. If the symptoms increase, a doctor should be contacted immediately. If there is a refusal to take in food and fluids, there is a severe health risk. If the behavior leads to weight loss or a feeling of dryness inside the body, a doctor must be consulted immediately. If bite wounds can be seen in the mouth or felt with the tongue, this is a worrisome condition. Consultation with a physician is necessary to initiate clarification of the cause. The formation of an unpleasant mouth odor is considered a natural warning sign that should be investigated. Discoloration of the gums is also unusual and should be checked by a physician.
Treatment and therapy
If gingival hyperplasia does not regress after discontinuation of the medication or has other causes, treatment must be sought from a dentist. Due to numerous recurrences, treatment of gingival hyperplasia is considered a major challenge for dentists. Treatment can be conservative or surgical. An important role in non-surgical therapy is played by the patient’s oral hygiene. According to studies, the risk of gingival hyperplasia can be significantly reduced by maintaining a high standard of oral hygiene, which can be achieved by professional gum cleaning in addition to home care. In addition, esthetics will benefit. However, if medication has to be taken in the long term or if the case is severe, a surgical procedure is required in which the dentist removes the gingival overgrowth with a scalpel. The patient is given a local anesthetic. Surgical removal of gingival hyperplasia is called gingivectomy in dentistry. In this procedure, the dentist cuts out part of the gum to correct the growth. Generally, the prognosis of gingival hyperplasia is considered positive.
Outlook and prognosis
The prognosis of gingival hyperplasia is tied to the cause of the disorder. Generally, it is considered favorable regardless of the causative disorder. If the gingival bleeding is based on administration of medication, there is a rapid prospect of relief.As soon as the treatment plan is restructured, the causative medication for gingival hyperplasia can be discontinued. Immediately thereafter, the symptoms regress until freedom from symptoms is achieved. In these patients, the underlying disease continues to be treated with alternative agents. If the disease persists or long-term therapy is necessary, surgery is performed. In this procedure, the growths of the gums are removed by a surgeon. It is a routine procedure that takes place with the help of local anesthesia. Although complications may occur, they are relatively minor and occur only in exceptional cases. If the operation is successful, the patient is free of symptoms after the surgical procedure. Despite the favorable prognosis, the symptoms may recur at any time during the patient’s life. The prospect of recovery remains favorable even if gingival overgrowth recurs. If gingival hyperplasia triggers emotional problems because of the visual abnormalities, the risk of psychological irregularity must be considered in the overall prognosis.
Prevention
To prevent the development of gingival proliferation, dentists recommend regular thorough cleaning of the teeth. In this way, at least the extent of gingival hyperplasia can be contained. If medications are taken that are suspected of triggering gingival proliferation, the gums must be consistently monitored. The same is true during pregnancy.
Follow-up care
In most cases, follow-up care for gingival hyperplasia proves to be relatively difficult. The patient is primarily dependent on medical treatment to prevent further complications. However, gingival hyperplasia can be treated relatively well, so that a reduced life expectancy is not to be expected. In most cases, the course of the disease is positive. The earlier the symptoms are detected, the better the further course of this disease. Gingival hyperplasia is usually treated by surgical intervention in the oral cavity. After such an operation, patients should rest and take care of their body. Above all, the oral cavity should be spared and not stressed. In most cases, it is also not possible to take solid food after the procedure, so the body should get used to solid food over time. In some cases, gingival hyperplasia also requires a follow-up visit to detect and then treat any new growths. In this case, a new intervention is necessary. Affected individuals should pay attention to gum cleaning and, in general, proper oral hygiene to prevent gingival hyperplasia.
What you can do yourself
If the gingival growths are due to malnutrition as a result of a reduction diet, the most effective form of self-help is to take supplements. Often, gum growths are then the result of a vitamin C deficiency, which can most easily be compensated for by taking ascorbic acid in powder form. Corresponding preparations are available over the counter in pharmacies and drugstores. If gingival hyperplasia is triggered by taking medications such as nifedipine or valproate, the attending physician should be consulted. It is important to clarify whether medications are available with which the undesirable side effect does not occur. However, the most common reason for gingival hyperplasia is inadequate oral hygiene. In this case, affected persons should clean their teeth thoroughly with a soft brush and toothpaste after every meal. At least twice a day, brushing must be done for at least three minutes. In between meals, the teeth can be cleaned more sparingly, but all food debris should always be removed thoroughly. The tongue should not be forgotten, as bacterial plaque can form on it very quickly. It is also important to use dental floss. In the case of gingival hyperplasia, an antibacterial mouthwash can also be helpful. In protracted cases, regular professional cleaning of the teeth and gums by a dental hygienist is also indicated.
