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# Gingival overgrowth: drugs, leukaemia and other causes

- Oral pathology

Gums that grow over the teeth are often caused by medicines such as phenytoin, ciclosporin or calcium channel blockers, and are worse with plaque.

Updated Nov 12, 2026

## Key points

- Phenytoin, ciclosporin and calcium channel blockers cause gum overgrowth.
- Plaque makes it worse; changing the drug can reverse it.
- Spongy, bleeding gums with systemic signs: check for leukaemia.

## What it is

Gingival overgrowth (enlargement or hyperplasia) is an increase in gum tissue that can cover the teeth, cause bleeding and make cleaning difficult. Three drug groups cause most cases: anticonvulsants (phenytoin above all), the immunosuppressant ciclosporin, and calcium channel blockers (nifedipine, amlodipine and others). It begins in the papillae, mainly at the front, within months of starting the drug, and plaque makes it worse. Other causes include leukaemic infiltration (acute myeloid leukaemia, especially monocytic types), pregnancy, mouth breathing, hereditary gingival fibromatosis and granulomatous diseases.

## How to recognise it

- Drugs: phenytoin, ciclosporin, calcium channel blockers (most often nifedipine).
- Firm, pink, lobulated overgrowth, starting in the interdental papillae.
- Good plaque control reduces severity; changing the drug often leads to regression.
- Leukaemic gingival infiltration is spongy, bleeds and comes with fatigue, fever or bruising.
- Tacrolimus causes less overgrowth than ciclosporin; other anticonvulsants cause less than phenytoin.

## Differential and risks

- Rapid gum swelling in a person not taking a culprit drug needs a blood count to exclude leukaemia.
- Overgrowth can hide caries and periodontitis and affect speech and eating.
- Surgery (gingivectomy) helps, but overgrowth recurs if the drug and plaque remain.

## Next step / Initial management

- Review the drug list; with the prescriber, consider an alternative drug if overgrowth is significant.
- Rapid or spongy, bleeding gum swelling, or systemic symptoms: full blood count and blood film the same day; refer urgently if abnormal.
- Refer to the dentist for intensive hygiene and, if needed, surgical reduction.

## Test yourself

Think of the answer, then tap the question to see it.

## Which three drug groups classically cause gingival overgrowth?

Anticonvulsants such as phenytoin, ciclosporin, and calcium channel blockers such as nifedipine.

## Which leukaemia most often infiltrates the gums?

Acute myeloid leukaemia, especially the monocytic subtypes.

## What reduces drug-induced gingival overgrowth besides changing the drug?

Strict plaque control and professional cleaning; surgery for severe cases.

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## Connections

## Related 3

- [Drugs that harm the mouth](https://durgical.com/en/dentistry/drugs-that-harm-the-mouth/)
- [Gingivitis: bleeding gums](https://durgical.com/en/dentistry/gingivitis-bleeding-gums/)
- [Blood disorders in the mouth: leukaemia, anaemia and bleeding](https://durgical.com/en/dentistry/blood-disorders-in-the-mouth-leukaemia-anaemia-and-bleeding/)

## Related conditions 2

- [Acute leukaemia (AML and ALL)](https://durgical.com/en/conditions/acute-leukaemia/)
- [Epilepsy and seizures](https://durgical.com/en/conditions/epilepsy-and-seizures/)

## In Pharmacology 5

- [Phenytoin](https://durgical.com/en/pharmacology/phenytoin/)
- [Nifedipine](https://durgical.com/en/pharmacology/nifedipine/)
- [Amlodipine](https://durgical.com/en/pharmacology/amlodipine/)
- [Ciclosporin](https://durgical.com/en/pharmacology/ciclosporin/)
- [Calcium channel blockers](https://durgical.com/en/pharmacology/classes/calcium-channel-blockers/)

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Educational content; it does not replace assessment by a dentist or doctor and is not a clinical instruction. For facial or neck swelling with difficulty swallowing or breathing, a knocked-out tooth or bleeding that will not stop, go to an emergency department at once.

Sources: [Drug-Induced Gingival Overgrowth](https://www.ncbi.nlm.nih.gov/books/NBK538518/) (StatPearls Publishing (NCBI Bookshelf), 2022); [Phenytoin](https://medlineplus.gov/druginfo/meds/a682022.html) (MedlinePlus, US National Library of Medicine, 2023).

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Representative model, for educational purposes only.

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License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/dentistry/gingival-overgrowth-drugs-leukaemia-and-other-causes/