![]() With this type of CO 2 laser, sutures and/or surgical dressing are often not needed. Conventional instrumentation-such as blades, knives, and high-speed burs-can often lead to bleeding after surgical removal when the tissue is inflamed. Unlike other lasers, the Solea laser has the capabilities of removing both soft and hard tissue, precise cutting accuracy due to control of both laser beam power and size, and the ability to cauterize inflamed tissue (figures 4c and 4d). 3Īnother laser that has been used to treat gingival enlargement and gummy smiles is a 9.3 micron CO 2 laser (Solea from Convergent Dental figure 2a). Dental lasers such as diodes, 10.6 micron CO 2, erbium YAG, erbium chromium YAG, and Nd:YAG lasers have also been implemented to remove excess soft tissue. Conventional surgical treatment includes the use of surgical blades, knives, and high-speed burs to remove the excess gingival tissue. If these methods are ineffective, surgical treatment is warranted. Azithromycin has been used in some cases of drug-induced gingival overgrowth, as this antibiotic can slow down fibroblast division and lead to a reduction in excess gum tissue. The first line of treatment is most often noninvasive and includes the discontinuation of any offending medication, controlling the systemic disease with medical care, institution of good home oral care, and nonsurgical mechanical debridement (dental cleaning). ![]() Other more serious causes of gingival enlargement include leukemias, malignant neoplasms/carcinomas, as well as many forms of granulomatous diseases.Benign neoplasms such as giant cell granuloma, papillomas, and fibromas.Vitamin deficiencies (mostly vitamin C and vitamin Bs).Diseases requiring hormone replacement therapy.Hormonal changes associated with pregnancy or puberty.Systemic causes of gingival enlargement may result in localized gum tissue overgrowth or a generalized response in which all the teeth are affected. What are the systemic causes of gingival enlargement? ![]() If these methods do not result in the resolution of gingival enlargement, surgical treatment may be necessary (figures 4c and 4d). Bacteria caused by poor oral hygiene can exacerbate the drug’s effect, therefore nonsurgical mechanical debridement and good home care should be emphasized. Treatment may not be needed, and spontaneous resolution may occur if the drug causing the problem is discontinued or another drug is substituted. 10% or fewer of the cases are typically attributed to amphetamines.10% to 20% of the cases are typically attributed to calcium channel blockers, with nifedipine being the most notable problem (figures 4a and 4b).30% of the cases are typically attributed to cyclosporine.50% of the cases are typically attributed to phenytoin (figure 3).Amphetamines (cocaine, Ritalin, methamphetamine)Ĭonsider this when evaluating the incidence of drug-induced gingival enlargement:.Antihypertensives (calcium channel blockers such as nifedipine, amlodipine, and verapamil).Anticonvulsants (phenytoin, phenobarbital, lamotrigine, vigabatrin, ethosuximide, topiramate, and primidone).1 The following classes of drugs have been associated with gum overgrowth: Medication-induced (drug-induced) gingival enlargement can be caused by certain classes of drugs people may be taking. Medications that cause gingival enlargement In some instances, surgical removal of excess gingival tissue may be needed (figure 2a).įurther reading: Considerations when using veneers to fabricate a perfect smile Typical first-line treatment includes instituting good oral hygiene and dental cleanings (nonsurgical mechanical debridement). In addition to bacterial infiltration of the gums due to poor oral hygiene, orthodontic appliances have been associated with gingival enlargement since braces can act as food traps (figure 2). Gum disease (gingivitis and periodontitis) can result in gum tissue swelling, redness, gum overgrowth, and bleeding (figure 1). One reason people develop gummy smiles is inflammatory-induced gingival enlargement, typically caused by biofilm (bacteria) and the host response. How does oral bacteria cause gingival enlargement? This article will briefly discuss examples of gingival enlargement and its associated causes, as well as present surgical treatment that can assist in correcting certain types of gingival enlargement. Treatment can be in the form of natural healing, once the etiology is removed, by instituting proper dental hygiene, and through nonsurgical treatment and/or surgical treatment. The gummy smile is caused by gingival enlargement and can be induced by three main causes: (1) inflammation, (2) medication, and (3) systemic disease.
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