His Gums Had Grown Over the Teeth Until You Could Barely See Them

Quick answer: Some medications cause the gums to overgrow. How severe it becomes depends heavily on plaque control — the drug creates the tendency, and plaque drives the extent. That means much of it is preventable and a good deal of it is reversible.

The call

He had stopped smiling in photographs about four years earlier, which his sister mentioned and he did not.

Eliyahu, 34, from RBS Daled, had epilepsy managed with phenytoin since his teens. His gums had been enlarging gradually for years, and at some point the change had crossed from noticeable to disfiguring.

He had been told it was a side effect and that nothing could be done. Half of that was true.

What we found

Generalised gingival enlargement, worst at the front of both arches. The gum between the teeth had proliferated into firm, pale, lobulated masses that covered roughly two-thirds of the crowns of the lower incisors.

The tissue was firm and fibrous rather than soft and red — characteristic of drug-induced overgrowth rather than ordinary inflammation, though there was inflammation on top of it.

Heavy plaque and calculus, unavoidably: the enlarged tissue had created deep false pockets he could not clean into, and cleaning had become impossible, which made the overgrowth worse. A self-reinforcing loop.

Pseudopockets of 8 to 10mm. On the x-rays, bone levels were surprisingly reasonable — much of the pocket depth was overgrown tissue, not lost bone. That distinction mattered greatly for the prognosis.

He had difficulty eating, difficulty speaking clearly, and had not eaten in company for years.

The mechanism. Three drug classes are classically implicated: certain anticonvulsants, calcium channel blockers used for blood pressure, and ciclosporin used after transplantation. They appear to affect gingival fibroblast activity and collagen turnover, producing tissue overgrowth.

The part that matters most and is almost never explained: the drug creates susceptibility, and plaque determines severity. Patients on these medications with excellent plaque control often develop little or no overgrowth. Patients with poor control develop a great deal. Nobody had told him that his cleaning affected the outcome, so he had regarded the whole thing as inevitable.

What we did

Wrote to his neurologist first, describing the severity and asking whether an alternative anticonvulsant might be considered. Newer agents are not associated with overgrowth in the same way.

The reply was that his epilepsy was well controlled on his current medication after a difficult history of finding something that worked, and that a change carried real risk of losing seizure control. That was the right answer, and it settled the plan: we work around the drug.

That conversation is worth having even when the answer is no. Sometimes it is yes.

An intensive hygiene phase first, for three months. Not surgery — this comes first for a specific reason: a proportion of the enlargement is inflammatory and resolves with plaque control alone, and operating before that leaves you removing tissue that would have shrunk.

Four sessions of thorough debridement under local anaesthetic. Interdental brushes sized for the spaces. Chlorhexidine for the first fortnight. Detailed technique coaching, twice.

At three months, the enlargement had reduced by roughly a quarter and the tissue was firmer and less inflamed. Not enough, and a meaningful start.

Gingivectomy for what remained. The excess tissue was surgically removed and recontoured to a normal architecture, done in two sessions, upper and lower, under local anaesthetic.

Then maintenance every three months, indefinitely, which is the entire determinant of whether it recurs. Drug-induced overgrowth recurs reliably where plaque control lapses and considerably less where it does not.

The outcome

Normal gum contours. Teeth fully visible. He eats and speaks without difficulty.

Four years on, with three-monthly maintenance and daily interdental cleaning, there has been mild recurrence in two areas and nothing requiring further surgery.

He remains on the same medication, with the same epilepsy control, which was never negotiable.

What to do if this happens to you

1. Ask whether any of your medications cause gum overgrowth. Anticonvulsants, calcium channel blockers and ciclosporin are the main ones.
2. Understand that your cleaning affects the severity. This is the part most people are never told.
3. Never stop or change medication on dental advice. Seizure or blood pressure control comes first.
4. Expect a hygiene phase before surgery. Some of the enlargement resolves without an operation.
5. Commit to three-monthly maintenance. It is what prevents recurrence.
6. Ask about interdental brushes sized individually. Floss does not manage this.

Gums enlarging on long-term medication? Ramat Beit Shemesh Urgent Dental Care treats this without changing your prescription. 055-985-8845 · WhatsApp https://wa.me/972559858845 · Harav Kook 28/1, Beit Shemesh

This is a composite clinical story. It reflects a presentation we see regularly in Beit Shemesh and Ramat Beit Shemesh; the name and details are illustrative and are not those of a real patient.