Gingivectomy

What a gingivectomy is

A gingivectomy trims away gum tissue that has grown too large, so that the edge of the gum sits close to where it normally would, around the neck of the tooth.

When gum overgrows, its edge creeps up the crown of the tooth. The gap between gum and tooth becomes deeper, even though the tooth has not lost any of its attachment or bone. Dentists call this a false pocket. Plaque collects in it and a toothbrush cannot reach it well. Removing the extra gum makes the pocket shallower and the teeth easier to keep clean.

The same operation is sometimes used to even out an uneven gum line. This page is about overgrowth and gum health.

Why gum overgrows

Overgrown gum is also called gingival enlargement, gingival overgrowth or gingival hyperplasia. It has several causes, and more than one often acts at once:

• plaque left along the gum line, which inflames the gum and makes it swell;
• some medicines, notably the anti-epileptic phenytoin, the immunosuppressant ciclosporin (used after organ transplants and for some autoimmune conditions), and calcium-channel blockers such as nifedipine or amlodipine, used for high blood pressure and some heart conditions;
• hormonal changes, for example in puberty or pregnancy, which make the gum react more strongly to plaque;
• fixed braces, which make cleaning along the gum harder;
• less often, an inherited tendency or another medical condition.

Not everyone who takes these medicines is affected. In those who are, plaque makes the overgrowth worse, so cleaning matters even when a medicine is the main cause.

Overgrown gum can look puffy and make the teeth look shorter. When it is inflamed, it is red and tender and bleeds easily; overgrowth linked to a medicine is often firmer and paler. In marked cases it covers a large part of the crowns. Because plaque is harder to remove, gum disease and decay become more likely.

Dealing with the cause

A gingivectomy removes the extra gum, but not the reason it grew. The cause is therefore looked at before any surgery, and often that is all that is needed:

• Plaque control. Thorough brushing along the gum line and cleaning between the teeth every day, with professional cleaning to remove plaque and tartar. Where overgrowth is mild, the gum often shrinks back with this alone.
• A medicine review. The dentist may contact the doctor who prescribed the medicine to ask whether a different one is possible. Only that doctor can decide, and a change is not always possible.
• Pregnancy. Gum swelling linked to pregnancy usually settles after the birth. Careful cleaning helps in the meantime.
• Braces. Careful cleaning around the brackets and wires.

When a gingivectomy is considered

Surgery is considered when overgrowth remains despite good cleaning and attention to its cause, and:

• the enlarged gum traps plaque and makes the teeth hard to keep clean;
• it covers part of the teeth, or gets in the way of chewing or of teeth coming through;
• false pockets remain deep around the teeth;
• it is uncomfortable, or its appearance troubles the person.

Where gum disease has caused loss of bone around the teeth, other kinds of gum surgery are usually more suitable. When the cause of an overgrowth is unclear, a small sample of gum may be examined in a laboratory before treatment is planned.

How the procedure usually proceeds

1. Assessment. The dentist asks about medicines and general health, examines the gum, measures the pockets around the teeth with a fine probe and may take X-rays.

2. Anaesthetic. Local anaesthetic injections numb the gum and teeth. The person stays awake and usually goes home the same day.

3. Removing the excess gum. The overgrown gum is trimmed away and its edge shaped to follow the teeth. This is usually done with a scalpel. A laser, or electrosurgery, which cuts with a high-frequency electric current through a fine tip, is sometimes used instead; both seal small blood vessels as they cut.

4. Protecting the area. A soft periodontal dressing may be placed over the gum to protect it and make it more comfortable while it heals. It is removed at a review if it has not come away by itself.

5. Checking the tissue. The removed gum may be sent to a laboratory for examination, to make sure that no further treatment is needed.

After the operation

The dentist gives written aftercare advice. It commonly includes:

• leaving the dressing in place and not trying to lift it off;
• not brushing the treated gum while the dressing is on, and using a chlorhexidine mouthwash if one is prescribed;
• brushing the rest of the mouth as usual;
• soft food, chewing away from the treated area at first, and pain relief as the dentist advises;
• avoiding smoking, alcohol and vigorous exercise for a while.

Once the dressing is off, gentle but thorough brushing helps the gum heal and stops plaque building up again. Bleeding that does not stop with firm pressure, swelling that gets worse, or a fever should be reported to the dentist promptly.

Risks and limits

Soreness is common after the operation. Other possible effects include:

• bleeding, swelling or bruising;
• teeth that are sensitive to cold for a while, which a toothpaste for sensitive teeth can help;
• the gum shrinking back further than planned, so that more of the tooth shows;
• less often, infection of the wound.

Overgrown gum can come back, especially when its cause continues: a medicine that cannot be changed, a medical condition, or plaque left along the gum line. Thorough daily cleaning and regular professional care reduce the chance, and the operation is sometimes repeated.

Most gum swelling begins with plaque. The guide to gum disease explains how it develops, and cleaning your teeth shows how to clean along the gum line and between the teeth.