Key points in brief
- Gum overgrowth caused by medication is an enlargement of the gums that develops after months or years of taking certain medicines. The inflammation is treated first, and a procedure is considered if excess gum remains after a few months.
- In some people, treating the gums alone clearly reduces the overgrowth, and sometimes makes it disappear completely, even without changing the medicine.
- The medicines most often involved are some medicines for high blood pressure, such as amlodipine, some epilepsy medicines, and ciclosporin, which is used after organ transplants, among other things. Dental plaque, which keeps gum inflammation going, makes overgrowth more likely.
- Keep taking your medicine as your doctor prescribed, because only the doctor who manages your treatment can change the medicine or its dose. Bring a list of your medicines to the dental appointment, with the date you started each one.
- If your gums are growing quickly, bleed on their own, look bluish or have ulcers, or if you have a fever, weakness or bruises, see a doctor the same day. Such symptoms are sometimes a sign of a blood disorder.
Consult your case with an expert and get your treatment plan
Which medicines cause gum overgrowth
Gum overgrowth occurs most often with three groups of medicines. The first is calcium channel blockers, used for high blood pressure, including amlodipine, nifedipine, felodipine, verapamil and diltiazem. The second is ciclosporin (also spelled cyclosporine), a medicine that lowers immunity and is given, among other uses, after an organ transplant. The third is some epilepsy medicines, of which phenytoin is the best known. Doctors call this drug-induced gingival overgrowth, gingiva being the medical word for the gum.
Overgrowth develops in only some of the people who take these medicines, and marked overgrowth is rarer still. After a transplant, overgrowth is more common with ciclosporin than with tacrolimus, another medicine that lowers immunity.
What gum overgrowth caused by medication looks like
Overgrowth appears after a few months of taking the medicine, and sometimes only after a year or two. In itself it usually does not hurt, so it is easy to overlook.
In a mild form, the papillae, the triangular parts of the gum between the teeth, become thicker and more rounded. In a moderate form, the edge of the gum next to the teeth also enlarges, and in a severe form so does the gum further from the edge, which can cover part of the teeth. The tissue that has grown is usually firmer and paler than gum swollen by inflammation.
If the gum already covered a large part of your teeth before you started any of these medicines, it may be a gummy smile.
What to write down before your appointment
Before the appointment, write down:
- the names and doses of all the medicines you take, including those prescribed by different doctors;
- the date you started each medicine and the date of the last change in dose;
- since when you have noticed that your gums are larger, and whether they have kept growing since then;
- whether your gums bleed when you brush, or hurt;
- your other medical conditions, such as diabetes, and the contact details of the doctor who prescribed the medicine.
Dates written side by side show whether the change in your gums may be linked to a medicine.
How gum overgrowth caused by medication is treated
Gum overgrowth caused by medication is treated in three stages. First the dentist treats the gum inflammation, and at the same time the doctor who prescribed the medicine assesses whether it can be switched. The last stage, if excess gum remains, is a procedure. Part of what looks like gums swollen from medication is swelling caused by inflammation, which usually goes down after gum treatment. Part is firmer tissue that has grown. This shrinks more slowly or stays. Only once the inflammation has settled can the dentist see how much overgrowth really needs to be removed.
| Stage | When | What happens |
|---|---|---|
| 1. Oral hygiene and treating the inflammation | from the first visit (the biggest improvement can come in the first 3 months) | instruction in cleaning, removal of tartar and plaque above and below the gum, checking the effect |
| 2. Talking to the prescribing doctor | at the same time as stage 1 | the dentist describes the changes, and the prescribing doctor assesses whether switching the medicine is possible and safe |
| 3. Surgical correction | after a few months, if excess gum remains | cutting away the excess gum and reshaping it |
Stage 1: oral hygiene and treating the inflammation
Every patient with overgrowth caused by medication needs this stage. The hygienist or dentist shows you how to clean your teeth and the spaces between them, and then removes tartar and plaque above and below the gum. Where the pockets, the gaps between the tooth and the gum, are deeper, the dentist also cleans the root surfaces below the gum. This procedure is sometimes called curettage. Closed and open curettage differ in whether the dentist lifts the gum back during it. In people who have had a transplant or who have a blood disorder, cleaning below the gum is planned with the doctor who manages their treatment.
In practice, this is basic periodontal treatment, that is, treatment of the gums and the tissues that hold the teeth in place. In some people, this stage alone clearly reduces the overgrowth, and sometimes makes it disappear completely, even when the medicine stays the same.
Stage 2: talking to the prescribing doctor
Alongside stage 1, the dentist may ask the prescribing doctor whether the medicine can be switched. The dentist describes the changes in your gums and what has already been done, but the decision rests solely with the doctor who prescribed the medicine. This description can take the form of a short note from the dentist, which you show the prescribing doctor at your next appointment.
A switch only makes sense if the new medicine controls the condition you are being treated for equally well. For example, instead of ciclosporin the doctor may consider tacrolimus, and instead of amlodipine or a similar medicine, a different medicine for high blood pressure. Not every medicine can be safely switched. If it cannot, treatment relies on keeping the inflammation under control and, if needed, on a procedure.
For some people who have had a transplant and take ciclosporin, a short course of the antibiotic azithromycin may also be considered. The overgrowth sometimes shrinks after it, but the effect is sometimes temporary. Such a course is prescribed by a doctor, never started by the patient on their own.
Do not stop the medicine or lower its dose on your own, even if your gums bother you a great deal. Stopping it on your own can put at risk the treatment of the condition the medicine was prescribed for.
Stage 3: surgical correction
If the inflammation is already under control but large, firm overgrowth remains that makes cleaning your teeth and eating difficult, or changes the look of your smile, the dentist may suggest surgical correction. Its simplest form is a gingivectomy, which means cutting away the excess gum and shaping it to look close to natural. In people with long-term illnesses, for example after a transplant, the timing of the procedure and the preparation for it are agreed together with the doctor who manages their treatment.
Why gum overgrowth affects only some people
Studies most often link overgrowth with dental plaque, which keeps gum inflammation going. Overgrowth is more common in people who remove plaque less well, and enlarged gums create nooks where plaque builds up even more easily. The simplest sign of inflammation is bleeding gums when you brush. With amlodipine and similar medicines, overgrowth may also be more common in people who do not clean between their teeth every day and in people with type 2 diabetes.
Studies have not clearly confirmed that the overgrowth is greater the higher the dose or the longer the medicine is taken. With ciclosporin, it more often affects younger people. When ciclosporin is combined with amlodipine or a similar medicine for high blood pressure, the overgrowth is usually, though not always, greater.
It is not fully known why one person develops overgrowth and another on the same medicine does not. So it is not possible to predict with certainty who will develop it, but the risk can be reduced. If the gums are in poor condition before a person starts the medicine, the overgrowth may later be more severe. Regular preventive care may reduce the risk of overgrowth, although it does not prevent it in everyone. That is why it is a good idea to have your gums treated before starting such a medicine, for example before a transplant.
How a dentist checks whether the overgrowth is caused by a medicine
Gum overgrowth caused by medication is recognised from its timing in relation to the medicine, from the appearance of the gums and by ruling out other causes. So the dentist starts by talking with you about your medicines. Then the dentist looks at the gums, checks whether they bleed and assesses how much plaque remains on the teeth. The hygienist may stain the plaque with a special liquid to show the places you usually miss when brushing.
The next step is measuring the pockets with a thin probe. With overgrowth, a pocket can be deep even when the bone is where it should be, because it is the gum that has grown and now covers more of the tooth. An X-ray shows the level of the bone.
Medicines are not the only reason gums enlarge. Gum inflammation in someone wearing braces or during pregnancy can look similar, and less often so can an inherited gum condition or a blood disorder. If the enlargement is not linked in time to any medicine, or does not shrink despite thorough cleaning of the teeth, the dentist looks for another cause and sometimes takes a small sample of gum for testing.
When enlarged gums can be a sign of a blood disorder
Gum enlargement in leukaemia and other blood disorders needs particular attention. Such gums may be bluish or dark red and bleed easily, even without brushing. They may have ulcers and be painful, and the enlargement grows quickly. It may come with a fever, weakness or bruises on the skin. With such symptoms, the dentist does not start routine gum treatment but refers you urgently to a doctor. If you notice these symptoms, see a doctor the same day.
How to reduce the risk of the overgrowth coming back
Gum overgrowth caused by medication can come back, including after a procedure, especially when the medicine is still being taken and plaque and inflammation are not under control. That is why regular check-up visits are planned after treatment. When the overgrowth comes back easily, visits are sometimes needed every 3 months. The risk of it coming back rises when a patient stops attending these visits.
At home, the most important thing is cleaning between the teeth and along the edge of the gum every day, because that is where plaque stays longest. A mouthwash can only add to brushing. If you want to use one, check which mouthwashes for gingivitis have a proven effect.
What to do if you notice your gums getting bigger
Do not interrupt the treatment of the condition you take the medicine for. If you have no symptoms of a blood disorder, have a dentist look at your gums within a few weeks, without waiting for your routine check-up, and bring a list of your medicines with the dates you started them. Gum inflammation is treated first. The prescribing doctor will decide on any switch of medicine, and after a few months of treatment a periodontist, a dentist who specialises in the gums, may suggest a procedure. In people with long-term illnesses, the procedure is planned together with the doctor who manages their treatment.
Frequently asked questions
Will my gums go back to normal after the medicine is changed?
After the medicine is switched, the overgrowth usually shrinks, sometimes within a few weeks. Only the prescribing doctor can decide whether a switch is safe, because they know your condition and the other possible medicines. The overgrowth does not always disappear completely, however, for example when the gum has already become fibrous, that is, hardened. Treating the gum inflammation is needed whether or not the medicine is changed.
What does removing overgrown gum involve?
A gingivectomy is usually done under local anaesthetic. The periodontist removes the excess gum with a scalpel or a laser. After laser treatment there may be less pain in the first days, but studies do not settle which method gives a longer-lasting result. The procedure is usually done only once the inflammation is under control.
How should I clean my teeth when my gums are enlarged?
Brush your teeth with a soft toothbrush, including along the edge of the gum. Clean between your teeth every day with interdental brushes chosen for you by the hygienist. Where the papillae are thick, a single-tuft brush may help. Bleeding in the first days of this kind of cleaning usually eases as the inflammation subsides. If it has not eased after a week or two, show it to your dentist. If your gums bleed on their own, without brushing, see a doctor the same day.
How long before I can see how much overgrowth is left after the inflammation is treated?
The result is usually assessed a few months after the teeth have been cleaned and oral hygiene has improved. The biggest improvement can come in the first 3 months, but the gum may keep shrinking for six months, and sometimes longer. That is why the dentist does not plan a procedure too early: part of the enlargement that looks permanent disappears along with the inflammation.
How does the gum heal after the overgrowth is removed?
For the first few days, the wound is usually protected by a surgical dressing, and you do not brush the teeth in that area. Pain is worst in the first 24 hours and eases towards the end of the week. The wound closes gradually, usually within 2 to 4 weeks, and sometimes takes longer in people on medicines that lower immunity. If the pain gets worse, the bleeding does not stop or you have a fever, call the dental practice the same day.
Read more:
- Periodontist in Warsaw Wola
- Bleeding gums when brushing — when is it normal and when is it a sign of disease?
- Closed vs open curettage — a comparison of methods for treating advanced periodontitis
- Mouthwash for gingivitis — what does the evidence say really works?
- Periodontitis: Symptoms, causes and modern treatment methods. How to treat periodontal disease
Content and liability disclaimer
This article is informational and educational in nature and does not constitute medical advice, a diagnosis or a therapeutic recommendation — it does not replace a consultation with a specialist. If you are experiencing symptoms, have doubts or are facing a decision about treatment, consult a dentist. The methods described and the data cited are general in nature. The results of scientific studies relate to populations, not to an individual patient. The course and outcome of therapy depend on the individual clinical situation and may vary between patients. No information contained in this article constitutes a guarantee of result. The content has been prepared with due care, based on publicly available medical knowledge and the scientific publications indicated in the Sources section. We do not advise taking or refraining from any health-related action solely on the basis of the content of this article, without prior consultation with a doctor.
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