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Questions and Answers
What is the primary aim of the lecture on gingival overgrowth?
What is the primary aim of the lecture on gingival overgrowth?
Where does gingival overgrowth typically occur?
Where does gingival overgrowth typically occur?
What is a characteristic feature of gingival overgrowth?
What is a characteristic feature of gingival overgrowth?
What happens to gingival overgrowth after discontinuation of the causative drug?
What happens to gingival overgrowth after discontinuation of the causative drug?
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Which of the following is a management approach for patients with gingival overgrowth?
Which of the following is a management approach for patients with gingival overgrowth?
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What is a potential consequence of untreated gingival overgrowth?
What is a potential consequence of untreated gingival overgrowth?
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Which aspect is crucial for managing patients with gingival overgrowth?
Which aspect is crucial for managing patients with gingival overgrowth?
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What is the difference between overgrowth and hyperplasia in gingival conditions?
What is the difference between overgrowth and hyperplasia in gingival conditions?
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What is the term used to describe gingival enlargement that is restricted to the interdental papillae?
What is the term used to describe gingival enlargement that is restricted to the interdental papillae?
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Which score indicates that gingival enlargement covers more than three-quarters of the tooth?
Which score indicates that gingival enlargement covers more than three-quarters of the tooth?
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What does the acronym DIGO stand for in relation to gingival condition?
What does the acronym DIGO stand for in relation to gingival condition?
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What factor exacerbates Drug Induced Gingival Overgrowth in patients?
What factor exacerbates Drug Induced Gingival Overgrowth in patients?
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Which of the following is NOT a characteristic of the gingival enlargement classification?
Which of the following is NOT a characteristic of the gingival enlargement classification?
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In what context does Drug Induced Gingival Overgrowth manifest?
In what context does Drug Induced Gingival Overgrowth manifest?
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Which of the following types of enlargement involves the gingival margins, attached gingivae, and interdental papillae?
Which of the following types of enlargement involves the gingival margins, attached gingivae, and interdental papillae?
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The scoring guide for gingival enlargement allows for monitoring of what aspect of the condition?
The scoring guide for gingival enlargement allows for monitoring of what aspect of the condition?
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What is the main distinction between hyperplasia and hypertrophy in terms of cellular changes?
What is the main distinction between hyperplasia and hypertrophy in terms of cellular changes?
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Which of the following describes fibrotic changes in gingival tissue?
Which of the following describes fibrotic changes in gingival tissue?
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What defines oedema in the context of gingival enlargement?
What defines oedema in the context of gingival enlargement?
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How can gingival enlargement be classified based on location?
How can gingival enlargement be classified based on location?
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Which type of gingival enlargement is characterized by involvement of the gingiva throughout the mouth?
Which type of gingival enlargement is characterized by involvement of the gingiva throughout the mouth?
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Which of the following accurately describes false enlargement in the gingiva?
Which of the following accurately describes false enlargement in the gingiva?
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What is the relationship between systemic diseases and gingival enlargement?
What is the relationship between systemic diseases and gingival enlargement?
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What histological analysis is required to accurately classify gingival enlargement?
What histological analysis is required to accurately classify gingival enlargement?
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Which drug group is primarily associated with drug-induced gingival overgrowth (DIGO)?
Which drug group is primarily associated with drug-induced gingival overgrowth (DIGO)?
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What proportion of patients taking anti-convulsants may experience DIGO?
What proportion of patients taking anti-convulsants may experience DIGO?
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Which of the following is NOT considered an anti-convulsant medication?
Which of the following is NOT considered an anti-convulsant medication?
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What is the common occurrence timeframe for DIGO to become clinically noticeable after starting anti-convulsant medication?
What is the common occurrence timeframe for DIGO to become clinically noticeable after starting anti-convulsant medication?
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Which immunosuppressant is noted for having the most common association with DIGO?
Which immunosuppressant is noted for having the most common association with DIGO?
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Which statement regarding Tacrolimus is accurate?
Which statement regarding Tacrolimus is accurate?
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Which clinical features characterize gingival overgrowth caused by anti-convulsants?
Which clinical features characterize gingival overgrowth caused by anti-convulsants?
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When does DIGO typically reach its maximum severity in patients taking anti-convulsants?
When does DIGO typically reach its maximum severity in patients taking anti-convulsants?
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What is a common consequence of using ciclosporin?
What is a common consequence of using ciclosporin?
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Which calcium channel blocker is noted for potentially leading to drug-induced gingival overgrowth?
Which calcium channel blocker is noted for potentially leading to drug-induced gingival overgrowth?
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What is a characteristic of gingival overgrowth due to calcium channel blockers?
What is a characteristic of gingival overgrowth due to calcium channel blockers?
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Which of the following medical conditions is NOT typically treated with ciclosporin?
Which of the following medical conditions is NOT typically treated with ciclosporin?
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Which of the following statements is true regarding the use of calcium channel blockers?
Which of the following statements is true regarding the use of calcium channel blockers?
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Why are immunosuppressants like ciclosporin prescribed?
Why are immunosuppressants like ciclosporin prescribed?
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Which of the following calcium channel blockers is used to manage coronary artery spasm?
Which of the following calcium channel blockers is used to manage coronary artery spasm?
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In patients taking Amlodipine, where does drug-induced gingival overgrowth typically appear?
In patients taking Amlodipine, where does drug-induced gingival overgrowth typically appear?
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Study Notes
Gingival Overgrowth
- Gingival overgrowth is the proliferation and intensification of the gingiva.
- It's a common clinical problem, often linked to specific medical conditions.
- Typically, overgrowth occurs in areas with teeth, not in edentulous spaces.
- The overgrowth is chronic and slowly increases in size.
- It's typically pain-free.
- Following surgical removal, it often recurs.
- Spontaneous disappearance is possible within months after discontinuation of the causative drug.
GDC Learning Outcomes
- The presentation includes a list of GDC learning outcomes, coded alphabetically (e.g. 1.1, 1.1.1, 1.1.2 etc).
- Outcomes are related to gingival overgrowth.
- No further details on specific outcomes are available.
Formative Assessment
- Students must complete a mind map titled "The management of the patient presenting with drug-induced gingival overgrowth."
- They must also complete a separate gingival overgrowth work assignment.
- The completed assignments should be returned to Mrs. Watson
Aim
- The goal of today's lecture is to raise awareness about gingival overgrowth.
- The lecture will cover the causes and implications of this condition for clinicians.
- It will also address how clinicians can assist patients with this issue.
Learning Outcomes
- Identify the clinical features of gingival overgrowth.
- Categorize the potential causes of gingival overgrowth.
- Select appropriate assessment methods for patients with gingival overgrowth.
- Detail the classification of gingival overgrowth and associated locations.
- Evaluate the impact of gingival overgrowth on the oral cavity and well-being of patients.
- Recommend potential management strategies for patients with gingival overgrowth.
Overgrowth/Enlargement V Hyperplasia
- The terms hyperplasia and hypertrophy used in the past for gingival issues are imprecise.
- Precise descriptions require histological (tissue) sample analysis.
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: Abnormal accumulation of fluid in intercellular spaces.
Classification of Gingival Overgrowth
- The classification categorizes different types of gingival overgrowth.
- Includes inflammatory, drug-induced, and neoplastic types.
- Mentions chronic and acute conditions.
Location/Distribution of Gingival Enlargement
- Gingival enlargement can be categorized by location or distribution in the mouth.
- Localized: Limited to the gingiva adjacent to a tooth or group of teeth.
- Generalized: Involves the gingiva throughout the mouth.
- Marginal: Confined to the gingival margins.
- Papillary: Confined to the interdental papillae.
- Discrete: An isolated enlargement, such as an abscess.
- Diffuse: Involves gingival margins, attached gingiva, and interdental papillae.
Scoring Guide for Gingival Enlargement
- There exists a scoring guide for gingival enlargement.
- This guide can be used for recording progression or reduction of the condition in patient notes.
- The guide displays a pyramid with 0 (no enlargement), 1 (enlargement confined to interdental papilla), 2 (enlargement involving papilla and gingival margins), and 3 (enlargement covering more than ¾ of a tooth).
Drug Induced Gingival Overgrowth (DIGO)
- DIGO is an abnormal gingival growth due to adverse drug reactions from systemic drugs.
- It's exacerbated by genetic predispositions, plaque, and/or gingival inflammation in patients.
Drug Groups Associated with DIGO
- Anticonvulsants, Immunosuppressants, and Calcium Channel Blockers.
Anticonvulsants and DIGO
- Anticonvulsants are used in epilepsy treatment.
- One year after their introduction, DIGO was documented.
- A high percentage (up to 50%) of patients using anticonvulsants can exhibit DIGO.
- DIGO symptoms manifest usually between 2-3 months after initiation and peak in severity around 12-18 months.
- Specific anticonvulsant drugs associated with DIGO are Phenytoin, Ethosuximide, Sodium Valproate, Phenobarbitone, Primidone, Carbamazepine, and others.
Immunosuppressants and DIGO
- Immunosuppressants are used for preventing transplant rejection and treating autoimmune diseases.
- The gingival tissue appears inflamed and vasculature seems more visible.
- Ciclosporin, Tacrolimus, and Sirolimus cause DIGO.
- One study's results show that up to 53% of patients exhibit gingival overgrowth from ciclosporin.
Calcium Channel Blockers and DIGO
- Calcium channel blockers treat blood pressure, angina and cardiac issues.
- DIGO from Calcium Channel Blockers often is concentrated on the labial surface and is hyperemic, soft, with a higher bleeding tendency
- This gingival overgrowth is typically more notable in the papillary region, extending to attached and marginal gingiva.
- The overgrowth is commonly encountered when reviewing medical issues in patients using these drugs.
- Relevant drug examples involve amlodipine, nifedipine, and verapamil.
Complications of DIGO
- The presentation highlights a need for investigation into potential complications of DIGO.
- No details on the potential complications are provided.
Exacerbating Factors for DIGO
- Exacerbating factors that may worsen gingival overgrowth are mentioned (but the factors presented are not explained further).
Further Reading
- A list of links to potential further information about this topic is provided.
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