Are your child’s gums looking swollen or puffy? Is there an area of gum tissue that seems inflamed? Do your child’s gums appear to be growing over, and covering up, your child’s teeth? If you answered yes to any of these questions, your child might have gingival enlargement. Read on to find out more about the nature of gingival enlargement, what could be causing it, and what can be done about it.

What Is Gingival Enlargement?

Gingival enlargement refers to swelling or overgrowth of a person’s gums. Note that this is a fairly general term. A child with gingival enlargement could present with anything from a small, swollen bump in the gum tissue near one tooth to gum tissue that has enlarged to the point of covering up most of the child’s teeth and disfiguring his or her face. Furthermore, depending on the cause of enlargement, the enlarged gum tissue could be red and bleed easily or it could be firm, pink and fibrous. 

What Is the Difference Between Gingival Enlargement, Gingival Hyperplasia, and Gingival Hypertrophy?

Although the terms gingival enlargement, gingival hyperplasia, and gingival hypertrophy are sometimes used interchangeably, gingival hyperplasia and gingival hypertrophy are actually two subcategories of gingival enlargement. Gingival hyperplasia refers to an increase in the number of gum tissue cells a person has, whereas gingival hypertrophy refers to an increase in the size of individual gum tissue cells.

What Causes Gingival Enlargement in Children?

There are four general categories of gingival enlargement in children1: (1) drug-induced gingival enlargement, (2) inflammation-related gingival enlargement, (3) enlargement associated with systemic diseases, and (4) genetic gingival enlargement.

  1. Drug-Induced Gingival Enlargement. When a child has widespread gingival enlargement (i.e., the child’s gums are growing over all of his or her teeth), it is often a side effect of a medication the child is taking. Some of the most common culprits include
    • Cyclosporine, an immunosuppressant often used to prevent organ rejection after a transplant;
    • Nifedipine and other calcium channel blockers, which are commonly used to treat high blood pressure and heart conditions; and 
    • Phenytoin, an anticonvulsant used for epilepsy. Approximately 50% of patients who use phenytoin long-term develop gingival enlargement, with the enlargement typically becoming noticeable within two to three months of when the child starts the medication. 
  2. Inflammatory Gingival Enlargement. Gingival enlargement can occur as an inflammatory response to an irritant. A few examples of irritants include the following:
    • Plaque and Tartar Build-Up. When kids do not brush their teeth or floss thoroughly enough, they can get plaque and tartar buildup. The bacteria in plaque and tartar can irritate the child’s gums and lead to redness and swelling.
    • Braces. Some children experience gingival enlargement when they get braces. The reasons for this are not fully understood. One possibility is that braces can make it harder for children to clean their teeth thoroughly, and the resulting plaque and tartar buildup leads to gum inflammation as described above. Some scientists have also theorized that the nickel content of many orthodontic appliances may lead to gum overgrowth, although more research is needed in this area.
    • Other Foreign Bodies. If a foreign object, such as a popcorn hull, becomes lodged in a child’s gums, the gum tissue surrounding the object can become inflamed.
    • Mouth Breathing. Some children who breathe through their mouths experience redness and swelling in the gum tissue surrounding the child’s front teeth. The exact reason for this is unknown, but it is believed that this type of enlargement results from the gum tissue in the front of the mouth drying out when the child’s mouth is open.
  3. Gingival Enlargement Associated with Systemic Diseases. Certain systemic diseases can lead to gingival enlargement in children. To provide a few examples:
  • Children with leukemia – especially children with acute monocytic leukemia – may experience gingival enlargement. 
  • Some children with Crohn’s disease develop gingival enlargement. In fact, in rare cases, gingival enlargement is the first sign of this disease.
  • Children with diabetes may experience gum inflammation.
  • Gingival enlargement can be a symptom of granulomatosis with polyangiitis, a rare autoimmune disease in which the child’s immune system mistakenly attacks the blood vessels.
  1. Genetic Gingival Enlargement. In rare cases, gingival enlargement can be genetic. This condition, often referred to as hereditary gingival fibromatosis, can occur on its own or as part of a syndrome, such as Cowden syndrome. Hereditary gingival fibromatosis can be localized (affecting the gum tissue in only one area) or generalized (affecting the gum tissue around all the teeth), and it often appears when a child’s permanent teeth begin coming in.

While growths on the gums that are related to oral cancer (such as squamous cell carcinomas) are sometimes included in discussions of gingival enlargement, they are outside the scope of this article.

What Should You Do If Your Child Has Gingival Enlargement?

If your child is experiencing gum swelling or overgrowth, it is important to schedule an exam with your child’s pediatric dentist so that the underlying cause can be identified. 

In some cases, a child’s gum swelling or overgrowth signals an underlying condition that requires treatment. For example, there have been some cases where gingival enlargement was the first sign that a child had a serious systemic disease, such as leukemia or Crohn’s disease. In rare cases, what initially looks like a benign gingival overgrowth could turn out to be a malignant growth, such as oral squamous cell carcinoma. Much more commonly, swollen gums could indicate the presence of a foreign object (such as a popcorn hull) that needs to be removed.

Moreover, gingival enlargement can create issues in and of itself. It can make it harder for children to brush and floss their teeth properly and, depending on the location and severity, can create aesthetic concerns that may affect a child’s self-esteem. In severe cases, gingival enlargement can even interfere with speech, eating, and/or the eruption of the child’s teeth. 

How Do You Treat Gingival Enlargement in Kids?

Treatment for gingival enlargement often involves addressing the underlying cause. For example, if the enlargement appears to be the result of mouth breathing related to a sinus issue, the child may be referred to an ENT (ear/nose/throat doctor). If poor dental hygiene is causing gum inflammation, the appropriate treatment might involve a professional dental cleaning and a discussion with your child’s pediatric dentist about how to improve at-home oral hygiene routines. If one of your child’s medications is the cause, the best course of action might be to speak with the prescribing doctor to see if an alternative medication would be appropriate.

Of course, in some cases, the underlying cause cannot be changed. You cannot change your child’s genetics, for example, or there might not be any suitable substitutes for your child’s gingival-enlargement-causing medication. If this is the case, and the gingival enlargement is interfering with your child’s well-being, a gingivectomy might be recommended. This minor surgery involves removing a portion of the child’s gum tissue, either with a laser or a scalpel. 

In all cases of gingival enlargement, meticulous oral hygiene practices – both at home and with professional cleanings – are advised.

Children’s Dentistry in Hurst, Texas

If your child appears to be experiencing some form of gingival enlargement, schedule a dental check-up at Hurst Pediatric Dentistry today. Our board-certified pediatric dentists are trained to help identify the cause and suggest treatment options for your child. 

Hurst Pediatric Dentistry is located in Hurst, Texas, and serves pediatric patients from Hurst, Euless, Bedford, Colleyville, North Richland Hills, and the surrounding areas.

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This article is intended to provide general information about oral health topics. It should not be used
to diagnose or treat any disease or as a substitute for the advice of a healthcare professional who is
fully aware of and familiar with the specifics of your case. Always seek the advice of your dentist or
other qualified healthcare provider with any questions you may have regarding a medical condition or treatment.

MEDICALLY REVIEWED BY:

Dr. Jin Lin

Doctor Jin Lin, Board Certified Pediatric Dentist

Dr. Jin Lin is a board-certified pediatric dentist with a passion for helping children achieve healthier, more beautiful smiles. He earned his Bachelor of Science degree from Cornell University and his Doctor of Dental Medicine (D.M.D.) degree from the Harvard School of Dental Medicine. After graduating cum laude from dental school, he completed his post-doctoral pediatric dentistry training at Boston Children’s Hospital and the Harvard School of Dental Medicine, where he served as chief resident and worked with children with a wide variety of special medical and dental needs, including children with rare syndromes.