The gingival and associated soft tissue surrounding teeth may be enlarged in response to various interactions between the host and the environment. In rare cases, benign and malignant neoplasm’s may also cause enlargement of the gingiva and associated tissues. According to location and distribution it can be localized or generalized. It can also be marginal,  papillary or discrete.

Causes of Gingival Enlargement

• It can be acute i.e. persisting for short period of time or since long time called as chronic 
• Enlargement associated with systemic diseases such as pregnancy, puberty, vitamin deficiency or other diseases like plasma cell gingivitis etc 
• Leukemia can cause infiltration of cells in gingival tissue and lead to overgrowth
• Neoplastic gingival enlargement can be either due to Benign lesions or malignant tumors 
• False gingival enlargement is also possible. False enlargement refers to the apparent increase in the size of gingiva due to increase in size of underlying osseous structures during teeth eruption 
• Gingival enlargement may also be seen in individuals with mouth breathing habit. Usually seen in maxillary anterior region. Gingiva appears red and edematous with a diffuse surface and the exposed area appears shiny. The altered gingiva can be clearly demarcated from the adjacent unexposed gingiva 

• Gingival and periodontal abscess can also be a reason 
• Drug induced gingival overgrowth are quite common too. Anticonvulsants drugs which tends to show gingival overgrowth as their side effect includes; chronic use of valproic acid, carbamizapine or phenobarbitone in adult patients. 
• Immunosuppressants, calcium channel blockers also cause gingival enlargement.  
• Pregnancy (Granuloma) Tumor/Lobular Capillary Hemangioma/Angiogranuloma - This is a hyperactive inflammatory response due to bacterial plaque mediated by systemic condition, it usually occurs during the 1st and 3rd trimester of pregnancy. Usually seen in the upper anterior teeth. The granuloma appears dusky red or magenta in color (Raspberry like appearance) with numerous deep red, pinpoint markings and a smooth, glistening surface 
• Gingival enlargement may be seen in males and females during puberty, in area of plaque accumulation. It undergoes spontaneous reduction after puberty, if plaque and calculus are removed 
• Gingival overgrowth is marginal, appears bluish red in color, tender, grossly swollen and boggy in case of Vitamin C deficiency 
• Neoplastic gingival enlargement comprises a small percentage of gingival enlargements. They comprise only 8% of all oral tumors occuring on gingiva. 

Management of Gingival Enlargement

Visit to a dentist, discuss the past medical history, medications being taken; it will help in determining the cause for gingival enlargement and appropriate intervention. Intervention can range from change of medicines, non-surgical periodontal therapy and surgical periodontal therapy when indicated.

Take Home Message 

Noticing the changes in our oral cavity/ in our patient’s oral cavity (by a dentist) is the first step towards limiting the changes in the gingiva / gums i.e. gingival enlargement. Proper knowledge about the cause and management is vital. Whenever required consulting general physician for management of gingival overgrowth shouldn't be hesitated by a dentist.  

Article by: Dr. Siri P. B.