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Cause and Effect Relationships for Gum Overgrowth
Gummy Smile, as a descriptive phrase or term is a common reference to the appearance or actual existence of too much gum tissue, as it relates to a person's overall smile or as a proportion to
the amount of tooth surface (enamel) that is showing.
Baby teeth, in a youngster, is probably an image that we are all familiar with. Nothing unusual about that since it is considered to be developmental stage we all go through.
It is not uncommon for patients to have adult teeth fully developed but with a quantity of gum tissue that mimicks the tooth-gum proportioning of children.
Another common visual reference many of us may have is the appearance (includes the actual occurence of) too much gum tissue while wearing orthodontic braces and brackets. The accumulation of metallic or ceramic colored hardware may cover part of the tooth enamel and create the impression that too much gum tissue exists.
For some ortho patients, proper oral health maintenance can be difficult... which can lead to an almost imperceptible accumulation of bacteria which can initiate an overgrowth of gum tissue that migrates onto the enamel surfaces (hyperplasia). Oral health solutions and water irrigation apparatus (e.g. WaterPik) can help minimize this event.
Drug Induced Hyperplasia
There are several drugs and medication classes that can cause overgrowth of the gingiva for many patients. Dilantin and blood pressure meds are the most common. Read more detailed information on hyperplasia and prescribed medication regimens.
Representative Photos
The pictures below reflect different types of hyperplasia and gummy smile conditions and suggested treatment options.
An example of a fairly common treatment need for adults. The amount of gum tissue exceeds what would be considered normal for an adult. The tissue excess creates the appearance of smaller teeth and is often equated with a "juvenile smile."
The typical treatment is a gum lift or crown lengthening procedure. A tssue lasers is the instrument of choice which enables an accomplished dentist to simultaneously remove unwanted gum tissue AND small quantities of underlying bone, to assure that papillary tissue forms properly.
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Small Teeth Appearance - Juvenile Smile
Mitchell Pohl, DDS, Boca Raton FL |
This extreme case of gum tissue overgrowth was actually precipitated by medication effects of high blood pressure medications. Once started however, the difficulty of maintaining good oral hygiene becomes difficult and causes a cascading effect of increasing bacteria and infection, the usual precursors to various flavors of gum disease and periodontitis. Notice how the puffy tissue caused some perceived tooth movements.
Extensive periodontal lasser treatments and periodic removal of bacteria reversed the process, leaving a residual of minor tissue and bone loss. |
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Drug Induced Gum Growth - Hyperplasia
Edward Brant, DDS, MS, Long Island, NY |
Mild hyperplasia as it is depicted here is not uncommon. Considered to be a developmental or genetically based condition, the patient otherwise had excellent oral health status. This type of "gingival cosmetic" produces a juvenille appearance of dentition.
Removal of the excess tissue with careful sculpting that preserves the papilla and harmonizes well with the overall arch can be achieved with manual instruments or a specialized dental laser (instrument of choice). In cases where the CEJ (Cemento Enamel Junction) requires slight modification to assure proper physical proportions between the tooth and enamel surface, laser instruments tend to provide a more satisfactory result that is natural in appearance.
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Developmental Hyperplasia
Edward Brant, DDS, MS, Long Island, NY |
Orthodontic braces, for some patients, can cause overgrowth of gum tissue due to the accumulation of difficult to remove bacteria and inadequate gum stimulation that can result from wearing braces. To prevent this occurence, many orthodontists will recommend for certain patients the use of a water irrigation device to help facilitate a more complete removal of bacteria and debris. Gum tissue modifications are fairly straight forward. In most cases, once the bracketing hardware is removed and the soft tissues are modified, recurrence of the overgrowth is minimal, if any at all.
Tissue removal and resculpting of the gingival arches was achieved, for this teenaged patient, with a dental laser.
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Post Orthodontic Gum Growth
Edward Brant, DDS, MS, Long Island, NY |
Orthodontic gingival hyperplasia, but for a male. The dynamics of this type of hyperplasia are practically identical to the case pictured above. A combination of difficult and perhaps somewhat "lacking" diligence in practicing good oral health habits. Wishful thinking, hope and benign neglect do not replace the real activities of keeping things clean and free of debris. Patients who anticipate problems or are already facing "gum tissue events" such as those pictured here are strongly recommended to use specialized rinses and irrigation instruments to possibly reverse or prevent the hyperplasia event.
Tissue changes otherwise will require the help of a gum tissue dentist or periodontist. In severe cases where overgrowth is abundant, the bracketing hardware can be removed temporarily to facilitate a straight forward modification of gingival tissues. The potential for relapse is strong however for those patients who don't become proactive in daily oral hygiene habits.
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Gummy Orthodontics
Edward Brant, DDS, MS, Long Island, NY |
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