Gingival Hyperplasia: Causes, Epidemiology, In Animals and Treatment

Also seen as a gingival enlargement, it is an abnormal overgrowth of the gingival tissues.

There are several causes of gingival enlargement and can be grouped into four categories: 1) inflammatory gingival enlargement, 2) medication-induced gingival enlargement, 3) hereditary gingival fibromatosis and 4) systemic causes of gingival enlargement.

Inflammatory gingival enlargement

The observed gingival enlargement can be localized or generalized and is an inflammatory response that occurs when the plaque (collection of food debris and bacteria) accumulates in the teeth.

This is the result of the patient not achieving effective oral hygiene. An example is shown on the right. The gums affected by this condition are often tender, soft, red and bleed easily.

Fortunately, this condition is usually solved with effective oral hygiene practices (brushing, flossing) to remove plaque and irritants from the teeth.

Medication-induced gingival enlargement

Patients who take certain medications can develop gingival enlargement. In contrast to the inflammatory gingival enlargement, the gum tissues in these cases are typically firm, non-sensitive, pale pink, and do not bleed easily.

In severe cases, the gum can completely cover the crowns of the teeth, causing periodontal (gum) disease (due to the difficulty to keep the teeth clean), as well as problems of eruption and alignment of the teeth.

Medication-induced gingival enlargement can be partially or completely resolved when the medication is discontinued.

If the medication can not be stopped, surgical removal of excess gum (gingivectomy) may be performed, but the condition is likely to recur.

As this condition is somewhat worsened by the level of plaque buildup on the teeth, effective oral hygiene measures will reduce severity.

Fibromatosis Gingival Hereditaria

This is a rare hereditary condition that usually develops during childhood, although some cases may not be evident until adulthood.

The condition appears as an enlargement of the gingival gingiva of slow growth, generalized or occasionally localized, not sensitive, firm and pale pink.

The example on the right reveals how the teeth can be covered by the exuberant gingival overgrowth. Surgical removal of excess gum is often necessary to prevent impaction and displacement of the teeth. Repeated surgical resections may be required due to the recurrent nature of this condition.

Systemic causes of gingival enlargement or hyperplasia

There are numerous physiological and systemic conditions that can promote localized and / or generalized gingival enlargement, such as pregnancy, hormonal imbalances and leukemia.

The gingival enlargement associated with systemic conditions is usually resolved when the underlying condition is treated or, in the case of pregnancy, the child’s birth.

As with gingival enlargement induced by medication, effective oral hygiene measures will reduce the risk of gingival enlargement.

Questions and answers about gingival enlargement or hyperplasia

P: What medications can cause gingival enlargement?

A: The most commonly implicated medications associated with gingival enlargement are:

  1. Phenytoin: an anticonvulsant medication used to treat various types of seizures and seizures.
  2. Cyclosporine: an immunosuppressant medication used to prevent organ rejection after transplantation. It can also be used in the treatment of a variety of other conditions mediated by immunity such as psoriasis, atopic dermatitis, rheumatoid arthritis and nephrotic syndrome.
  3. Calcium channel blockers: a class of cardiovascular medications used in the treatment of conditions such as hypertension, chest pain, and irregular heartbeat. Commonly prescribed examples include Nifedipine, Amlodipine and Verapamil.

P: What are my chances of developing gingival enlargement if I am taking one of the medications mentioned above?

A: The likelihood of drug-induced gingival enlargement associated with the long-term use of phenytoin is estimated at 50%. For ciclosporin, the prevalence is around 25-30% in adults (higher in children ≈> 70%).

For blockers of calcium channels, the prevalence varies a lot (15-85%) depending on the type of calcium channel blocker; the risk of gingival enlargement seems to be the highest with Nifedipine (6-15%).

P: Is gingival enlargement or hyperplasia associated with the dose of my medication?

A: The dose of the medication seems to be a minor problem than having good oral hygiene (less plaque present in the teeth).

Q: What should I do if I notice that my gums are enlarged?

A: You must schedule an appointment with your dentist for an evaluation. Most cases of gingival enlargement are easily explained after the dentist makes a complete medical history and performs an oral examination.

In rare cases, other tests such as blood studies or a biopsy may be necessary to determine the exact cause of your gingival enlargement.

P: Is the gingival enlargement contagious?

A: No, these conditions are not infectious. He did not catch anyone and can not transmit it.

P: What can I do to reduce the severity of gingival enlargement or hyperplasia?

A: In general, your ability to practice effective oral hygiene measures on a daily basis helps reduce the risk of developing gingival enlargement. Your dental team is available to monitor its effectiveness and help you when necessary.

For example, you may need to undergo more frequent professional cleanings or be instructed on how to improve your brushing technique.

Effective oral hygiene is especially important to control gingival enlargement caused by chronic inflammation and cyclosporin.

For medication-induced gingival enlargement, your doctor may substitute medication to reduce the risk of developing gingival enlargement.

For gingival enlargement associated with a systemic condition, the management of the underlying systemic condition generally results in partial or complete resolution of the gingival enlargement.

Epidemiology of gingival hyperplasia

Gingival enlargement is common.

Gingival hyperplasia in animals.

It is commonly seen in Boxer dogs and other brachycephalic breeds, and in the English Springer Spaniel. It usually starts around middle age and progresses.

Some areas of the gum can be quite large, but they have only a small accessory for the rest of the gum, and can completely cover the teeth. Infection and inflammation of the gum are common with this condition.

Under anesthesia, the enlarged areas of the gum can be trimmed with a scalpel blade or CO2 laser, but it often recurs.

Gingival enlargement is also a possible sequel to gingivitis. As in humans, it can be seen as a side effect of the use of ciclosporin.

Treatment of gingival hyperplasia

The management of the first line of gingival overgrowth is improved oral hygiene, ensuring that the irritative plaque is removed around the neck of the teeth and gums.

Situations in which chronic inflammatory gingival enlargement includes significant fibrotic components that do not respond or contract when exposed to scaling and root planing are treated with the surgical removal of excess tissue, most often by a procedure known as gingivectomy.

In AGIF (Drug Induced Gingival Enlargement) or Gingival Hyperplasia, improved oral hygiene and plaque control remain important to help reduce any inflammatory components that may be contributing to overgrowth.

Reverting and preventing gingival enlargement caused by medications is as easy as stopping taking medications or replacing them with another medication.

However, this is not always an option; in such a situation, an alternative pharmacological therapy may be employed, if possible, to avoid this deleterious side effect.

In the case of immunosuppression, tacrolimus is an available alternative that produces a much less severe gingival proliferation than cyclosporine, but is similar to nephrotoxic.

The dihydropyridine derivative isradipidine may replace Nifedipine in some uses of calcium channel blockade and does not induce a gingival overgrowth.