Gum hypertrophy
Related Subjects:
|Macroglossia
|Microstomia
|Glossitis
|Medical Teeth
|Gum hypertrophy
|Angular Stomatitis - Cheilitis
|Oral Aphthous Ulcers
|Oral Leukoplakia
🦷 Gum hypertrophy (gingival hyperplasia) may occur with chronic anticonvulsants (esp. phenytoin) and in pregnancy.
⚠️ Always consider haematological malignancy if gum hypertrophy is new, progressive, or associated with systemic features.
📖 About
- Common exam topic linking pharmacology, oral medicine, and haematology.
- Seen with long-term anticonvulsants and immunosuppressants, but also with systemic disease.
- Can impair dental hygiene, speech, and quality of life.
🧪 Aetiology
- 🪥 Poor oral hygiene: Plaque-induced gingivitis can cause gum overgrowth.
- 💊 Medications:
- Phenytoin (anticonvulsant – classic association).
- Ciclosporin (immunosuppressant, transplant patients).
- Nifedipine (calcium channel blocker, hypertension).
- 🤰 Hormonal: Pregnancy and oral contraceptives may cause gum hypertrophy.
- 🍊 Vitamin deficiency: Scurvy (vitamin C deficiency) → bleeding, swollen gums.
- 🩸 Haematological: AML and other leukaemias may present with gingival hypertrophy + bleeding.
🧠 Clinical Presentation
- Swollen, inflamed gums ± bleeding when brushing or eating.
- Discomfort, aesthetic concerns, halitosis.
- Severe cases: difficulty with speech and mastication.
🔍 Investigations
- 🧪 FBC: Look for anaemia, thrombocytopenia, or blast cells if leukaemia suspected.
- 📋 Medication history: Always ask about phenytoin, ciclosporin, nifedipine.
- 🦷 Dental review: Assess plaque burden, denture fit, periodontal status.
💊 Management
- 💊 Medication review: Discuss alternatives with prescriber if drug-induced.
- 🪥 Optimise oral hygiene: Regular brushing, flossing, and dental cleaning (scaling/root planing).
- 🦷 Dental/surgical intervention: Gingivectomy if overgrowth is severe and functionally limiting.
- 🍊 Nutritional support: Vitamin C supplementation if scurvy suspected.
- ⚠️ Red flag: If unexplained gum hypertrophy + systemic symptoms (weight loss, fever, night sweats) → urgent haematology referral.
🌍 Teaching Pearl
- 💡 Phenytoin, Ciclosporin, Nifedipine = the “big three” drug causes. Easy marks in exams.
- 💡 AML → gum hypertrophy + bruising + fatigue = classic OSCE red flag.
