Podcast
Questions and Answers
What is a common characteristic of gingival overgrowth induced by Ciclosporin?
What is a common characteristic of gingival overgrowth induced by Ciclosporin?
Which two medications when taken together significantly increase the risk of gingival overgrowth?
Which two medications when taken together significantly increase the risk of gingival overgrowth?
Where is gingival overgrowth due to Calcium Channel Blockers most prominently located?
Where is gingival overgrowth due to Calcium Channel Blockers most prominently located?
Which medical conditions can be treated with Amlodipine?
Which medical conditions can be treated with Amlodipine?
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What type of morphology is associated with gingival overgrowth induced by Calcium Channel Blockers?
What type of morphology is associated with gingival overgrowth induced by Calcium Channel Blockers?
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What is gingival overgrowth primarily characterized by?
What is gingival overgrowth primarily characterized by?
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Which area is more likely to show gingival overgrowth?
Which area is more likely to show gingival overgrowth?
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What is a potential outcome after discontinuation of the drug causing gingival overgrowth?
What is a potential outcome after discontinuation of the drug causing gingival overgrowth?
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What differentiates gingival overgrowth from hyperplasia?
What differentiates gingival overgrowth from hyperplasia?
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What should be done if gingival overgrowth is surgically removed?
What should be done if gingival overgrowth is surgically removed?
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Which of the following is NOT a recommended assessment measure for patients with gingival overgrowth?
Which of the following is NOT a recommended assessment measure for patients with gingival overgrowth?
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Which of the following factors could be a major cause of gingival overgrowth?
Which of the following factors could be a major cause of gingival overgrowth?
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What impact does gingival overgrowth have on the oral cavity's health?
What impact does gingival overgrowth have on the oral cavity's health?
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What does hyperplasia specifically require for a precise description?
What does hyperplasia specifically require for a precise description?
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Which term refers to an increase in the size of individual cells?
Which term refers to an increase in the size of individual cells?
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What characterizes localized gingival enlargement?
What characterizes localized gingival enlargement?
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What type of edema is considered an abnormal collection of fluid in the intercellular spaces?
What type of edema is considered an abnormal collection of fluid in the intercellular spaces?
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What is a characteristic of generalized gingival enlargement?
What is a characteristic of generalized gingival enlargement?
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Which of the following classifications would NOT be considered a type of gingival enlargement?
Which of the following classifications would NOT be considered a type of gingival enlargement?
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Fibrosis is best described as which of the following?
Fibrosis is best described as which of the following?
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The term used for drug-induced enlargement is best categorized under which classification?
The term used for drug-induced enlargement is best categorized under which classification?
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Which of the following is NOT a classification of gingival enlargement?
Which of the following is NOT a classification of gingival enlargement?
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What might cause false enlargement of gingiva?
What might cause false enlargement of gingiva?
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What type of gingival enlargement is isolated and characterized by an abscess?
What type of gingival enlargement is isolated and characterized by an abscess?
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Which scoring guide for gingival enlargement records a progression or reduction of the condition?
Which scoring guide for gingival enlargement records a progression or reduction of the condition?
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Which statement is true about drug-induced gingival overgrowth (DIGO)?
Which statement is true about drug-induced gingival overgrowth (DIGO)?
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What is the defining characteristic of diffuse gingival enlargement?
What is the defining characteristic of diffuse gingival enlargement?
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Which of the following conditions is NOT categorized as true enlargement?
Which of the following conditions is NOT categorized as true enlargement?
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What might exacerbate drug-induced gingival overgrowth?
What might exacerbate drug-induced gingival overgrowth?
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Which form of gingival enlargement covers more than ¾ of the tooth?
Which form of gingival enlargement covers more than ¾ of the tooth?
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Chronic inflammatory enlargements can also be classified as which of the following?
Chronic inflammatory enlargements can also be classified as which of the following?
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What type of enlargement primarily affects systemic health conditions?
What type of enlargement primarily affects systemic health conditions?
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Which of the following is not a characteristic of gingival enlargement?
Which of the following is not a characteristic of gingival enlargement?
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What proportion of patients on anti-convulsant medications may present with DIGO?
What proportion of patients on anti-convulsant medications may present with DIGO?
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Which of the following drugs is commonly associated with DIGO in immunosuppressant treatment?
Which of the following drugs is commonly associated with DIGO in immunosuppressant treatment?
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Which group of drugs is primarily used for the treatment of epileptic patients?
Which group of drugs is primarily used for the treatment of epileptic patients?
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How long does it typically take for DIGO to become clinically noticeable after starting anti-convulsant medication?
How long does it typically take for DIGO to become clinically noticeable after starting anti-convulsant medication?
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Which immunosuppressant is noted to cause less severe DIGO compared to Ciclosporin?
Which immunosuppressant is noted to cause less severe DIGO compared to Ciclosporin?
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What is the maximum severity timeframe for DIGO after the initiation of anti-convulsant treatment?
What is the maximum severity timeframe for DIGO after the initiation of anti-convulsant treatment?
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Which of these conditions is commonly treated with anti-convulsants?
Which of these conditions is commonly treated with anti-convulsants?
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What type of enlargement does DIGO typically lead to in patients on anti-convulsants?
What type of enlargement does DIGO typically lead to in patients on anti-convulsants?
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Which of the following is NOT a drug that may cause DIGO?
Which of the following is NOT a drug that may cause DIGO?
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Which statement is true about the incidence of DIGO in patients on Ciclosporin?
Which statement is true about the incidence of DIGO in patients on Ciclosporin?
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Study Notes
Gingival Overgrowth
- Gingival overgrowth is the proliferation and intensification of the gingiva.
- It is a common clinical problem, typically linked to specific conditions.
- The overgrowth is chronic and gradually increases in size.
- It is typically pain-free and, if surgically removed, it tends to reoccur.
- Spontaneous disappearance usually happens within a few months of the drug discontinuation.
- Overgrowths commonly appear in areas containing teeth, not in edentulous areas and often regress when a tooth needs removal.
GDC Learning Outcomes
- A list of learning outcomes (1.1.1 to 1.7.3, 1.9.1, 1.10.2–1.10.5, 3.1, 3.2, 5.2, 6.1, 6.2, 6.3) are presented.
Formative Assessment
- Students are required to complete a mind map titled "The management of the patient presenting with drug-induced gingival overgrowth."
- A second task requires completing a workbook on gingival overgrowth.
- Both tasks need to be returned to the instructor.
Aim
- The lecture aims to raise awareness of gingival overgrowth, its causes, and implications for clinicians.
- The lecture will explain how to help patients with this condition.
Learning Outcomes (Further)
- Identify clinical features linked with gingival overgrowth.
- Categorise potential causes of gingival overgrowth.
- Choose appropriate assessment measures for patients with gingival overgrowth.
- List the classification of gingival overgrowth and specify locations in the mouth.
- Evaluate the impact of gingival overgrowth on oral cavity health and patient well-being.
- Recommend management strategies for patients with gingival overgrowth.
Gingival Overgrowth Details
- Gingival enlargement is the proliferation and intensification of the gingiva.
- This is commonly linked to specific conditions.
- Typically happens around teeth, not in edentulous areas and may disappear if a tooth needs removal.
- It's typically chronic and gradually increases in size. The overgrowth is pain-free; however, it may reoccur if surgically removed..
- Spontaneous disappearance is typical within months of discontinuing the drug/treatment.
Overgrowth/Enlargement vs. Hyperplasia
- Hyperplasia and hypertrophy have been used to describe gingival enlargement.
- These terms are not precise for describing gingival enlargement, requiring histological analysis of a tissue sample.
Types of Enlargement
- Fibrosis: Accumulation of collagenous connective tissue.
- Cellular hypertrophy: Increase in the size of individual cells.
- Cellular hyperplasia: Increase in the number of individual cells.
- Oedema: Collection of abnormal amounts of fluid in the intercellular spaces.
Classification of Gingival Overgrowth
- This describes the categories of gingival overgrowth.
- It discusses inflammatory enlargements, drug-induced enlargements, neoplastic enlargements (gingival tumors), enlargements linked to systemic diseases and conditions.
Gingival Overgrowth Classification (Location)
- Localized: Limited to the gingiva adjacent to one or a 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 (e.g., an abscess).
- Diffuse: Involves the gingival margins, attached gingivae, and interdental papillae.
Scoring Guide for Gingival Enlargement
- A scoring guide for gingival enlargement exists, which could be included in contemporaneous records.
- The guide can monitor progression or reduction of the condition.
- The scoring system lists 0 (no enlargement), 1 (enlargement confined to the interdental papilla), 2 (enlargement involving the papilla and gingival margins), and 3 (enlargement covering more than 50% of a tooth).
Drug-Induced Gingival Overgrowth (DIGO)
- DIGO is an abnormal gingival growth due to adverse drug reactions.
- It can be a side effect of systemic drugs.
- Genetic predisposition, plaque or gingival inflammation can exacerbate DIGO.
Drug Groups Associated With DIGO
- Anticonvulsants (e.g., phenytoin, sodium valproate, phenobarbital, gabapentin).
- Immunosuppressants (e.g., ciclosporin, tacrolimus, sirolimus).
- Calcium channel blockers (e.g., amlodipine, felodipine).
Anticonvulsants
- Used to treat epilepsy.
- First anti-epileptic drug introduced in 1938.
- DIGO has been reported within a year.
- Up to 50% of epileptic patients on these drugs might experience DIGO.
- DIGO effects are usually noticeable within 2-3 months and reach their peak at approximately 12-18 months post initial drug administration.
Anticonvulsants (Specific Drugs)
- A list of specific anticonvulsant drugs is provided (phenytoin, ethosuximide, etc.).
- There's also a list of related medical conditions associated with anticonvulsant use (e.g., Down's Syndrome, Parkinson's Disease).
Immunosuppressants (Specific Drugs)
- A list of immunosuppressants is listed (Ciclosporin, Tacrolimus and Sirolimus)
- The incidence of gingival enlargement is highest with ciclosporin (almost 53%) in patients receiving renal transplants.
- Tacrolimus sometimes replaces ciclosporin for transplant recipients, causing slightly less severe gingival enlargement (DIGO).
- Ciclosporin-induced DIGO is more seen on the labial surface, and is hyperemic (reddened), soft, and has high bleeding tendencies.
- Combination drug therapy (ciclosporin + Amlodipine/Nifedipine) often leads higher severities of gingival enlargement.
Calcium Channel Blockers
- Used to treat hypertension, angina, peripheral vascular disease, and coronary artery spasms.
- Calcium channel blockers can lead to gingival overgrowth, predominantly in the papillary region.
- Overgrowth may appear as nodules/lobulations extending to the attached and marginal gingivae.
- This should be routinely checked during medical history intake.
Calcium Channel Blockers (Specific Drugs)
- A list of specific calcium channel blocker drugs is provided (amlodipine, felodipine, etc.).
- These are correlated with certain health problems including hypertension, gastro-oesophageal reflux disease, arrhythmias and peripheral vascular disease.
Other Relevant Topics:
- Complications due to DIGO, and possible exacerbating factors are mentioned for discussion and consideration.
Further Reading
- A list of relevant web pages, for extra research and study.
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Description
This quiz examines the condition of gingival overgrowth, its common clinical problems, and management strategies. It includes learning outcomes and assessment tasks related to drug-induced gingival overgrowth. Understand the implications of this condition and how to manage patients effectively.
