Gingival (Gum) hyperplasia or hypertrophy
“Gingival enlargement” is the preferred umbrella term since the distinction between hyperplasia (↑ cell number) and hypertrophy (↑ cell size) is often blurred. Biopsy can differentiate histologically, but is rarely needed in day-to-day clinical practice. Enlargement may be localised (focal) or diffuse and often reflects systemic or drug-related processes.
⚠️ Causes (Mnemonic = IMHO)
- I – Infections & Deficiencies 🦠🍊
- Vincent’s angina (necrotising gingivitis)
- Scurvy (Vitamin C deficiency)
- M – Medications 💊
- Anticonvulsants: Sodium Valproate (and classically Phenytoin)
- Calcium channel blockers: Nifedipine, Amlodipine
- Immunosuppressants: Ciclosporin
- H – Haematological Disorders 🩸
- Acute Myeloid Leukaemia (AML, esp. M5 subtype) → gingival infiltration
- O – Oestrogen / Hormonal changes ♀️
- Pregnancy gingivitis
- Oral contraceptive pill–related changes
🧾 Clinical Presentation
- Swollen, enlarged gums ± bleeding on brushing.
- Overgrowth may interfere with oral hygiene, speech, or eating.
- Look for systemic clues: pallor, bruising, fever, weight loss → consider AML.
- Review drug history (epilepsy, hypertension, transplant patients).
🔍 Management
- Medication Review: Liaise with GP/specialist about alternative therapy if culprit drugs suspected (e.g. switch from nifedipine → another antihypertensive).
- Dental Measures:
- Strict oral hygiene education (brushing, flossing, chlorhexidine mouthwash).
- Professional scaling & polishing → reduces bacterial plaque stimulus.
- Severe/refractory cases → gingivectomy (surgical removal of overgrown tissue).
- Treat Underlying Disease:
- Vitamin C supplementation for scurvy.
- AML → urgent haematology referral (gingival enlargement may regress after chemotherapy).
🚩 Red Flags (Exam Tip!)
- Rapidly enlarging, painful, or ulcerated gums.
- Associated systemic symptoms (fatigue, fevers, night sweats, weight loss).
- Gingival swelling + cytopenias on FBC → think leukaemia.
✨ Teaching Pearl
Most gingival enlargement is drug-related or due to poor oral hygiene.
Always ask: Could this be AML? - especially if associated with systemic symptoms.
