Gingival Enlargement Quiz

Gingival Overgrowth

• Gingival overgrowth is the proliferation and intensification of the gingiva.
• It's a common clinical problem, often linked to specific conditions.
• Typically found in areas with teeth, not in edentulous spaces.
• Overgrowth often disappears if a tooth requires extraction in the affected area.
• The overgrowth is chronic and gradually increases in size.
• It's typically painless.
• If surgically removed, it often recurs.
• Spontaneous disappearance usually happens within a few months after discontinuing the related drug.

GDC Learning Outcomes

• The document lists numerous GDC learning outcomes, categorized with numbers in the format '1.1.1' and '1.9.1'.
• Outcomes cover various aspects of the subject matter.

Formative Assessment

• Students are required to complete a mind map titled "The management of the patient presenting with drug-induced gingival overgrowth."
• A gingival overgrowth workbook also needs completion.
• Both assignments are to be submitted to Mrs. Watson.

Aim

• The aim of the lecture is to raise awareness of gingival overgrowth.
• To cover the causes and implications for clinicians.
• To provide ways to help patients with this condition.

Learning Outcomes (Detailed)

• Identify clinical features associated with gingival overgrowth.
• Categorize potential causative factors of gingival overgrowth.
• Select appropriate assessment measures for patients with gingival overgrowth.
• List the classification of gingival overgrowth and areas of the mouth where it may present.
• Evaluate the impact of gingival overgrowth on oral health and patient well-being.
• Recommend potential management for patients with this condition.

Gingival Overgrowth (Detailed)

• Gingival enlargement/overgrowth is the proliferation and intensification of the gingiva.
• It's a common problematic condition typically found in areas with teeth rather than edentulous spaces; overgrowth ceases where teeth are extracted in affected areas.
• The enlargement is chronic and gradually increases in size.
• It's generally painless.
• If surgically removed, it frequently recurs.
• Spontaneous disappearance typically happens a few months after the causative drug is discontinued.

Overgrowth/Enlargement V Hyperplasia

• The terms hyperplasia and hypertrophy have been historically used to describe the condition.
• These terms, however are less precise for gingival enlargement, as they require a histological analysis of a tissue sample.

Cellular Mechanisms

• Fibrosis: Accumulation of collagenous connective tissue.
• Cellular hypertrophy: Increased size of individual cells.
• Cellular hyperplasia: Increased number of individual cells.
• Edema: Abnormal collection of fluid in intercellular spaces.

Classification of Gingival Overgrowth

• The document shows a classification of gingival Overgrowth with a visual representation in a cicle, identifying inflammatory enlargements (chronic and acute), drug-induced enlargement, neoplastic enlargement (gingival tumors), and enlargements associated with systemic diseases and conditions as separate factors.

Gingival Enlargement Classification (Location/Distribution)

• Localized: Limited to gingiva adjacent to a single tooth or group of teeth.
• Generalized: Involves the gingiva throughout the mouth.
• Marginal: Confined to the gingival margins.
• Papillary: Confined to the interdental papilla.
• Discrete: An isolated enlargement, for example, an abscess.
• Diffuse: Involving gingival margins, attached gingivae, and interdental papillae.

Scoring Guide for Gingival Enlargement

• A scoring guide is available for gingival enlargement, which can be used in patient records.
• Enables documentation of progression or reduction of this condition.
• Scoring values range from 0 (no enlargement) to 3 (enlargement covering more than ⅓ of the tooth).

Drug-Induced Gingival Overgrowth (DIGO)

• DIGO refers to abnormal gingival growth due to an adverse drug reaction.
• It's a side effect of systemic drug administration.
• It can be exacerbated by patients with a genetic predisposition, presence of plaque, or gingival inflammation.

Drug Groups Associated with DIGO

• Anticonvulsants (e.g., Phenytoin, Sodium Valproate, Phenobarbitone).
• Immunosuppressants (e.g., Ciclosporin, Tacrolimus, Sirolimus).
• Calcium Channel Blockers (e.g., Amlodipine, Felodipine, Nicardipine Hydrochloride).

Anticonvulsants (Detailed)

• Anticonvulsant drugs, like Phenytoin, are used in epilepsy treatment.
• DIGO was identified within a year of the first anti-epileptic drug being use.
• Up to 50% of patients taking anti-convulsants may develop gingival overgrowth.
• Younger patients tend to show greater susceptibility.
• Symptoms are usually noticeable within 2–3 months and peak in 12–18 months.

Anticonvulsants - Drugs/Medical Conditions

• This section lists specific anticonvulsant drugs and associated medical conditions.

Immunosuppressants (Detailed)

• Immunosuppressants, commonly used in transplant patients and auto-immune conditions, can cause gingival overgrowth.
• Example drugs include Ciclosporin, Tacrolimus, and Sirolimus.
• Ciclosporin is most commonly associated with DIGO.
• 53% of patients on ciclosporin for renal transplants experienced gingival overgrowth.
• Gingiva may appear more vascularized relative to anticonvulsant use.

Calcium Channel Blockers (Detailed)

• Calcium channel blockers are used in the management of various conditions, including hypertension and angina.
• Gingival overgrowth often occurs related to the use of these medications
• The gingival overgrowth frequently appears in greater prominence on the labial surface.
• Overgrowth is usually hyperemic, soft, and with a higher bleeding tendency.
• Increased incidence of gingival overgrowth often occurs when this class of medication is taken in combination with other drugs such as Ciclosporin and Amlodipine/Nifedipine.

Calcium Channel Blockers - Drugs/Medical Conditions

• This section lists specific calcium channel blocker drugs and associated medical conditions.

Complications Due To DIGO

• Questions regarding complications are highlighted for further discussion.

Exacerbating Factors

• Factors that worsen the condition are discussed.

Further Reading

• Includes links to various online resources that provide additional information about the study topic.