If you’ve got receding gums, you’re far from alone. About half of adults under age 65 do – and 88% of seniors – usually a result of things like clenching or grinding, smoking, oral piercings, or just brushing or flossing too aggressively.

But while gum recession is common, far fewer people are aware of its opposite: overgrowth of the gums, or gingival hyperplasia. (“Gingiva” is the anatomical name of the gums. “Hyper” means excess, and “plasia” means growth.)

A new case report in the Journal for Nurse Practitioners illustrates one way it can show up. The case involved an obese 52-year old man with high blood pressure, prediabetes, and left ventricular hypertrophy. For 7 years, he’d been taking numerous drugs for his conditions, including amlodipine, a calcium channel blocker used to treat hypertension and coronary artery disease.

Calcium channel blockers are one type of drug that’s known to contribute to gingival hyperplasia. (The others are phenytoin, an antiseizure drug, and cyclosporine, an immunosuppressant.)

After a few years of taking the medication, the patient noticed his teeth shifting but was unable to get help for it at the time. This is what his teeth and gums eventually came to look like:

gingival hyperplasia

We wish this story had a happy ending. It doesn’t. The patient was told to stop taking the amlodipine right away. He was given new guidance for blood pressure control and asked to return in a couple weeks. His financial and employment situation kept that from happening, and it was a year before he had any follow-up.

He continues to struggle with loose and disorganized teeth, causing pain, difficulty eating, and psychological injury. He is working with his new health care providers to achieve control of his blood pressure. He is also planning to have all of his teeth extracted within the coming months.

Importantly, pharmaceutical drugs aren’t the only possible trigger for hyperplasia. Genetics can play a role, as well. For instance, there’s a rare condition called hereditary gingival fibromatosis, in which the excess tissue can cover not just the teeth but the roof of the mouth, as well. In this case from several years ago, the teeth were completely covered.

Hardly all cases are as severe as these, however.

Hormonal imbalances, such as those during puberty and pregnancy, are another factor that can lead to overgrown gums. Certain health problems can do so, too, including leukemia, Crohn’s, HIV, and diabetes. So can vitamin C deficiency.

As ever, it’s important to pinpoint the cause and address that, as well as the overgrowth itself. For the latter, oral surgery may be called for in severe cases, while milder cases may benefit from improved oral hygiene, nutrition, or other minimally invasive measures.

Good long term results are most apt to come when we take a more holistic, biologic, big picture view.

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